Abnormal Glucose Tolerance Research Articles

Effect of low-dose aspirin on mid-luteal phase uterine Artery blood flow in women with unexplained recurrent pregnancy loss

Objectives: As a possible therapy for recurrent pregnancy loss, this study sought to ascertain if low-dose aspirin was effective in increasing uterine artery blood flow. Study Design: This investigation was structured as a single-arm clinical trial Patients and Methods: All participants were aged 39 years or younger and had no prior or current indications of abnormal glucose tolerance, thyroid dysfunction, hyperprolactinemia, or Antiphospholipid antibody syndrome. Bilateral assessments of the Systolic/Diastolic (S/D) ratio, Resistive Index (RI), and Pulsatility Index (PI) were conducted in the chosen patients in the mid-luteal phase, before to and following a minimum of two weeks of low-dose aspirin administration. Results: The results of this investigation showed significant variation in the S/D and PI prior to and following aspirin administration. There was no discernible shift in RI. The analysis revealed a statistically significant reduction in uterine artery PI after aspirin administration (1.92±0.29) compared to the pre-treatment value (2.22±0.27), with a p-value of 0.0001. Remarkably, the pulsatility indices of the left and right uterine arteries did not significantly differ from one another. Conclusion: For women who have a history of miscarriages, low-dose aspirin can be recommended as an adjuvant therapy as it effectively improves uterine artery blood flow in these patients. However, more well-designed research is required to ascertain whether improved pregnancy outcomes are correlated with improved uterine perfusion. The current study supported the aspirin guideline for women with a history of recurrent miscarriages by showing that aspirin treatment resulted in a reduction in uterine artery PI.

Usefulness of urine dipstick test in the management of adverse events associated with immune checkpoint inhibitors.

The usefulness of urine dipstick tests (UDTs) in patients with diabetes has been reported. The aim of the present study was to investigate the utility of self-performed UDTs and patient diaries in the management of impaired glucose tolerance, one of the adverse events of immune checkpoint inhibitors (ICIs). Patients receiving ICIs underwent self-checks with UDTs twice a week for up to 6months. Pharmacists checked the results at every patient visit, and by phone every 3months. The primary endpoint was to prospectively assess whether symptoms recorded in patient diaries and UDTs could reduce unscheduled hospital admissions due to impaired glucose tolerance. The secondary endpoint was the correlation between the symptoms in the patient diaries and UDT results. A total of 112 patients were enrolled in the study. Out of the 3197 planned self-UDTs, 3128 (97.8%) were performed. Forty-four patients (39.3%) were admitted to the hospital, two (1.8%) of whom were admitted due to abnormal glucose tolerance, with one having a positive UDT. There were 46 unscheduled outpatient visits (41.1%), of which five (4.5%) were due to abnormal glucose tolerance symptoms and four were due to a positive UDT. The correlation between descriptions of fatigue or dry mouth in the patient diaries and positive glucose UDTs was 52.4% in sensitivity and 62.4% in specificity. Self-monitoring of symptoms and self-performing of UDTs could not reduce the emergency hospitalization rate. However, this approach could be effective in the objective monitoring of patient status, especially regarding glucose intolerance occurrences.

6674 Non-Progressive Diabetes Leading to Neurologic Diagnosis

Abstract Disclosure: F.L. Thelmo: None. M. Murugesh: None. B. Simon: None. Introduction: The autoantibody GAD (anti-glutamic acid decarboxylase) is highly associated with Type 1 diabetes (T1DM) and Latent Autoimmune Diabetes in Adulthood (LADA). If GAD is detected before the onset of overt diabetes, typically 80% of patients with abnormal glucose tolerance progress to insulin deficiency and the need for insulin treatment after 5 years.[1] Stiff Person Syndrome (SPS) is also associated with GAD antibodies, but in SPS, the GAD antibodies are believed to be different epitopes that target GABA production in neuromuscular pathways. We present a case of presumed LADA that did not progress for 30 years, with progressive neurologic symptoms leading to a diagnosis of SPS in later adulthood.Case: A 52-year-old female presented for evaluation of T1DM and worsening neuropathies. She had a long history of prediabetes, with mildly elevated glucose values noted on labs since her early twenties. There was no family history of T1DM or autoimmune conditions. Six years ago, she sought endocrine evaluation. HgbA1c values were 6.1 to 6.6%. Intermittent use of continuous glucose monitoring (CGM) revealed post-prandial hyperglycemia up to 180mg/dL, occasionally (but rarely) exceeding 200mg/dL. She recalls being told that she had positive antibodies (unclear which ones tested) and given a diagnosis of T1DM. She declined insulin and maintained glycemic control with carbohydrate restriction and exercise; there were no episodes of diabetic ketoacidosis. She then developed neurologic symptoms: fullness, tightness and bloating in the abdomen (diagnosed with gastroparesis on scanning) and after a COVID 19 booster in 2021, muscle spasms in the legs and back with worsening abdominal tightness. At the time of her current presentation, A1C was 6.4%, glycated albumin was 14.4% (prediabetes range 13.6 - 15.5%) and CGM time in range was 99%. A non-fasting C-peptide was 3.6 ng/mL (1.1- 4.4ng/mL) with glucose of 119 mg/dL. Repeat antibody testing revealed undetectable IA-2 and ZnT8 antibodies, but GAD was grossly elevated at 1,015.3 U/mL. Given the unusually high GAD titer, SPS was suspected, and this diagnosis was confirmed on referral to neurology. The patient was advised to liberalize diet and will be monitored with HgbA1c and serial C-peptide levels to assess progression in the future. Discussion: While high GAD antibody levels are associated with progression to insulin dependence in adults with LADA, in SPS the GAD titers tend to be even higher2. The presence of only one auto-antibody for T1DM (and not multiple), long-standing non-progressive hyperglycemia, and normal C-peptide pointed away from autoimmune diabetes being the etiology for mild glucose intolerance in this patient. If neurologic symptoms are present, high GAD should prompt the evaluation for other syndromes associated with GAD antibody epitopes such as SPS. Presentation: 6/2/2024

5041 Lifecourse Changes in Insulin Demand-adequacy Association and Utility of a Novel Index for Predicting Abnormal Glucose Tolerance

5041 Lifecourse Changes in Insulin Demand-adequacy Association and Utility of a Novel Index for Predicting Abnormal Glucose Tolerance

Safety and tolerability of a low glycemic load dietary intervention in adults with cystic fibrosis: a pilot study.

To achieve and maintain adequate weight, people with cystic fibrosis (CF) May often consume energy-dense, nutrient-poor foods high in added sugars and refined carbohydrates; however, little is known about the glycemic and metabolic effects of dietary composition in this patient population. The objective of this pilot study was to investigate the safety and tolerability of a low glycemic load (LGL) diet in adults with CF and abnormal glucose tolerance (AGT). Ten adults with CF and AGT completed this prospective, open-label pilot study. Mean age was 27.0 ± 2.1 years, 64% were female, and all had pancreatic insufficiency. Each participant followed his/her typical diet for 2 weeks, then transitioned to a LGL diet via meal delivery service for 8 weeks. The primary outcome was change in weight from baseline to study completion, with safety established if no significant decline was noted. Other key safety outcomes included change in hypoglycemia measured by patient report and continuous glucose monitoring (CGM). Exploratory outcomes included changes in other CGM measures, body composition by dual energy X-ray absorptiometry (DXA), and patient reported outcomes. There were no significant changes in weight or in subjectively-reported or objectively-measured hypoglycemia. Favorable non-significant changes were noted in CGM measures of hyperglycemia and glycemic variability, DXA measures of fat mass, and gastrointestinal symptom surveys. A LGL dietary intervention was safe and well tolerated in adults with CF and AGT. These results lay the groundwork for future trials investigating the impact of low-glycemic dietary interventions on metabolic outcomes in the CF population.

Arterial Spin Labeling (ASL) MRI in Evaluating Pancreatic Blood Perfusion in Subjects With Different Glucose Tolerances.

The pancreas plays a central role in type 2 diabetes mellitus (T2DM), and its blood flow is usually associated with insulin release demand. To noninvasively assess pancreatic blood flow (PBF) changes and modulation in people with different glucose tolerance following a glucose challenge using ASL MRI. Prospective. Fourteen prediabetes, 22 T2DM, and 40 normal. Pseudo-continuous ASL with a turbo gradient spin echo sequence at 3.0 T. All normal and subjects (diagnosed by oral glucose tolerance test) underwent ASL after fasting for at least 6 hours. The normal and prediabetes groups additionally had ASL scans at 5, 10, 15, 20, and 25 minutes following oral glucose (50 mL, 5%). PBF maps were generated from the ASL data and measured at body and tail. The ability of baseline PBF (BL-PBF) of body, tail (BL-PBFtail), and their average to determine abnormal glucose tolerance and stage was assessed. ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, paired sample t-test, intra-class correlation coefficient, repeated measures ANOVA, correlation analysis, receiver operating characteristic analysis, and logistic regression analysis. A P value <0.05 was considered significant. There were significant differences in BL-PBF among the three groups. The prediabetes group exhibited significantly lower PBF than the normal group at all time points; Both groups showed similar changing trends in PBF (peaking at the 15th minute and subsequently declining). The BL-PBFtail had the highest diagnostic performance when evaluating abnormal glucose tolerance or stage (area under the curves = 0.800, 0.584, respectively) and was an independent risk factor for glucose tolerance status. ASL can noninvasively assess changes in PBF among individuals with varying glucose tolerance and in response to glucose challenge, which could be linked to insulin release demand and might help characterize changes in pancreatic endocrine function. 2 TECHNICAL EFFICACY: Stage 1.

Analysis of Risk Factors Associated with Gestational Diabetes Mellitus: A Retrospective Case-Control Study.

Gestational diabetes mellitus (GDM) is a complication of abnormal glucose tolerance during pregnancy, with incidence is on the rise. There are inconsistent results on the risks of GDM and it has not been reported in our region. The purpose of this study is to explore the risk factors of GDM. A total of 383 pregnant women were analyzed, including 67 (17.5%) pregnant women with GDM and 316 (82.5%) with normal glucose tolerance (NGT). The relationship of personal history, family history and reproductive history of pregnant women, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), inflammatory markers in blood cell analysis at the first prenatal examination, and fetal ultrasound indices and the risk of GDM were analyzed. The fetal biparietal diameter, head circumference, and femur length were negatively correlated with HCG level, but not inflammatory markers. The proportion of pregnant women aged ≥30 years old, body mass index (BMI) in early pregnancy≥24.0 kg/m2, history of polycystic ovary syndrome (PCOS), cesarean section, adverse pregnancy, and oral contraceptive use, and pregnant women who conceived through assisted reproduction in GDM group were higher than those in NGT group. Logistic regression analysis showed that age of pregnant woman ≥30 years old (≥30 vs <30 years old, odds ratio (OR): 2.142, 95% confidence interval (CI): 1.183-3.878, p=0.012), BMI≥24.0 kg/m2 (≥24.0 kg/m2 vs 18.5-23.9 kg/m2, OR: 1.887, 95% CI: 1.041-3.420, p=0.036), history of adverse pregnancy (yes vs no, OR: 1.969, 95% CI: 1.022-3.794, p=0.043), and history of oral contraceptive use (yes vs no, OR: 2.868, 95% CI: 1.046-7.863, p=0.041) were associated with GDM. Age of pregnant woman ≥30 years old, BMI≥24.0 kg/m2, history of adverse pregnancy and oral contraceptive use were independent risk factors for GDM.

Effect of dietary myo-inositol supplementation on the insulin resistance and the prevention of gestational diabetes mellitus: an open-label, randomized controlled trial.

Myo-inositol (MI) is an insulin-sensitizing dietary supplement, enhancing the transfer of glucose into the cell. Gestational diabetes mellitus (GDM) is characterized by abnormal glucose tolerance, which is associated with elevated insulin resistance. The present study aimed to assess the effect of MI supplementation during pregnancy on the incidence of GDM. We performed a single-center, open-label, randomized controlled trial. A cohort of 200 pregnant women at 11-13+6 weeks of gestation were randomly assigned in two groups: MI group (n = 100) and control group (n = 100). The MI group received MI and folic acid (4000 mg MI and 400 mcg folic acid daily), while the control group received folic acid alone (400 mcg folic acid daily) until 26-28 weeks of gestation, when the 75 g Oral Glucose Tolerance Test (OGTT) was performed for the diagnosis of GDM. Clinical and metabolic outcomes were assessed. The incidence of GDM was significantly higher in the MI group (14.9%) compared to the control group (28.5%) (P = 0.024). Women treated with MI had significantly lower OGTT glucose values, than those not treated with MI (P < 0.001). The insulin resistance as assessed by HOMA-IR was significantly lower in the MI group versus control (P = 0.045). Furthermore, MI group had significantly higher insulin sensitivity as measured by the Matsuda Index, compared to the control group (P = 0.037). MI supplementation seems to be an effective option to improve the glycemic control of pregnant women and prevent the onset of GDM. ISRCTN registry: ISRCTN16142533. Registered 09 March 2017.

Abnormal Glucose Tolerance Among Children with Cystic Fibrosis

Abstract Background Cystic fibrosis (CF) is a severe, autosomal recessive disease of high prevalence caused by mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene which is located on the long arm of chromosome 7. Objective to screen for glucose tolerance abnormalities among children with cystic fibrosis. Patients and Methods This was a cross-sectional study conducted on 25 cystic fibrosis patients in the age group from 1 – 15 years in the Pediatric pulmonology clinic, from the first of July 2020 to the end of January 2022. The patients were classified according to their glucose tolerance results into CF patients with normal glucose tolerance and CF patients with abnormal glucose tolerance. Results Our analysis also showed that the most important factor associated with abnormal glucose tolerance test was found to be higher age and glycosylated hemoglobin. The previous findings highlight the need for routine screening of CF patients to exclude CFRD or any abnormality in glucose tolerance in these patients. Conclusion The current study demonstrated that abnormal glucose tolerance is not uncommon among the studied CF patients. Our results concluded that abnormal glucose tolerance was significantly associated with older age and higher glycosylated hemoglobin.

Central Obesity is Associated with Increased Left Ventricular Maximal Wall Thickness and Intrathoracic Adipose Tissue Measured with Cardiac Magnetic Resonance.

Central obesity (CO), characterized by an increased waist circumference increases the risk of cardiovascular disease (CVD) and morbidity, yet the underlying mechanisms are not fully understood. CO is often associated with general obesity, hypertension, and abnormal glucose tolerance, confounding the independent contribution of CO to CVD. We investigated the relationship of CO (without associated disorders) with left ventricular (LV) characteristics and intrathoracic adipose tissue (IAT) by cardiac magnetic resonance. LV characteristics, epicardial (EAT), and mediastinal adipose tissue (MAT) were measured from 29 normoglycemic, normotensive males with CO but without general obesity (waist circumference >100 cm, body mass index (BMI) <30 kg/m2) and 18 non-obese male controls. LV maximal wall thickness (LVMWT) and IAT but not LV mass or volumes were increased in CO subjects compared to controls (LVMWT, 12.3±1.2 vs. 10.7±1.5 mm, p < 0.001; EAT, 5.5±3.0 vs. 2.2±2.0 cm2, p = 0.001; MAT, 31.0±12.8 vs. 15.4±10.7 cm2, p < 0.001). The LVMWT was ≥12 mm in 69% of subjects with CO and 22% of controls (p = 0.002). In CO suspects, EAT correlated inversely with LV end-diastolic volume index (r = -0.403, p = 0.037) and LV stroke volume (SV) (r = -0.425, p = 0.027). MAT correlated inversely with SV (r = -0.427, p=0.026) and positively with LVMWT (r = 0.399, p = 0.035). Among CO subjects, the waist-to-hip ratio (WHR) was an independent predictor of LVMWT (B = 22.4, β = 0.617, p < 0.001). The optimal cut-off with Youden's index for LV hypertrophy was identified at WHR 0.98 (sensitivity 85%, specificity 89%). CO independent of BMI is associated with LV hypertrophy and intrathoracic adipose tissue contributing to cardiovascular burden.

Association of Clinical Factors with the Development of GDM in the Hoosier Mom’s Cohort

Introduction: Gestational diabetes mellitus (GDM) develops during pregnancy, raising the risk of adverse perinatal outcomes. The objective of this study was to investigate potential therapeutic targets for prepregnancy and early pregnancy interventions to decrease the impact of GDM on health during and after pregnancy. Methods: The Hoosier Mom’s Cohort was a prospective pregnancy cohort designed to assess for predictors of GDM. Inclusion criteria were gestational age &lt;20 weeks, a singleton pregnancy, and being at least 18 years old. Individuals with a pregestational diabetes diagnosis, HbA1c at screening of ≥6.5, or abnormal 3-hour oral glucose tolerance test before 20 weeks of gestation were excluded. Study visits with survey completion and biospecimen collection occurred, one at enrollment, and one in the early third trimester. All participants were given a Garmin activity tracker to collect objective physical activity and sleep data. Sociodemographic, medical, behavioral, and psychosocial characteristics were obtained, and obstetric outcomes were abstracted after delivery by certified chart abstractors. The primary outcome was development of GDM. Associations between categorical variables and GDM were made with Chi-square testing, and those between continuous variables and GDM were done with t-test. Results: Of 411 participants recruited into the Hoosier Moms Cohort, complete data was available for 391 (95.1%). Participants had a mean age of 30 years, a BMI of 28, and 17% were of Hispanic ethnicity. Study participants self-identified mostly as White (71%) or Black (16%). 66% of participants were nulliparous. Additionally, 54% reported a family history of diabetes, with 4% of patients also reporting a prior history of GDM. A total of 39 participants (10.0%) developed GDM. Participants who developed GDM had significantly higher BMI at study entry (31.6 ±8.5 vs 27.2 ±6.5, p=0.003), lower probability of being nulliparous (15.38% vs 33.61%, p=0.02), higher baseline HbA1c values (5.24 ±0.3 vs 5.07 ±0.3, p&lt;0.001), higher triglycerides levels (156.85 ±62 vs 134.16 ±54.5, p=0.022), and higher blood glucose values (85.90 ±14.4 vs 79.96 ±17.7, p=0.025) at first study visit. Additionally, 28% of participants who developed GDM had a prior history of GDM, compared to 2% of participants who did not (p&lt;0.0001). Those who developed GDM had higher rates of chronic hypertension (12.82% vs 1.96%, p=0.0034) and higher insomnia scores (9.62 ±5.1 vs 7.80 ±4.7, p=0.028). Conclusion/ Implications: Multiple clinical factors were found to be statistically associated with the development of GDM. These characteristics will be utilized in a comprehensive predictive model using machine learning methodologies to guide clinical decisions early in pregnancy.

Fetal Origin of Abnormal Glucose Tolerance in Adult Offspring Induced by Maternal Bisphenol A Analogs Exposure.

With the widespread use of bisphenol A (BPA) analogs, their health risks have attracted attention. The effects of maternal BPA analogs exposure on glucose homeostasis in adult offspring and the underlying fetal origins require further exploration. Herein, we exposed pregnant mice to two types of BPA analogs─BPB and BPAF; we evaluated glucose homeostasis in adult offspring and maternal-fetal glucose transport by testing intraperitoneal glucose tolerance, determining glucose and glycogen contents, conducting positron emission tomography (PET)/computed tomography (CT), detecting expression of placental nutrient transport factors, and assessing placental barrier status. We observed that adult female offspring maternally exposed to BPB and BPAF exhibited low fasting blood glucose in adulthood, with even abnormal glucose tolerance in the BPAF group. This phenomenon can be traced back to the elevated fetal glucose induced by the increased efficiency of placenta glucose transport in late pregnancy. On the other hand, the expression of genes associated with vascular development and glucose transport was significantly altered in the placenta in the BPAF group, potentially contributing to enhanced fetal glucose. These findings provide preliminary insights into potential mechanisms underlying the disturbance of glucose metabolism in adult female offspring mice induced by maternal exposure to BPA analogs.

Oral Glucose Tolerance Test as a Risk Marker for Developing Post-Transplant Diabetes Mellitus

IntroductionThe incidence of post-transplant diabetes mellitus (PTDM) can reach 30% during the first 6 months after kidney transplantation (KT), increasing the risk of graft failure and mortality. There is no well-established biomarker for predicting PTDM occurrence. This study evaluated the association between the abnormal 2-hour oral glucose tolerance test (OGTT) and the PTDM incidence. MethodsA retrospective single-center study, including adult kidney transplant recipients from deceased donors, was performed between March 2021 and June 2022. Exclusion criteria: age <18 years; pretransplant diabetes mellitus (DM); death with a functioning graft; loss of follow-up and/or graft failure before 6 months post-transplant. The results of pretransplant OGTT, fasting (FPG), and afternoon plasma glucose levels at hospitalization and FPG in the first, second, and third months post-transplant were evaluated. For analysis, patients were grouped according to the PTDM diagnosis: PTDM and non-PTDM. ResultsFrom 164 KT performed in the period, 50 (30%) were included, most male (n = 34, 68%), with a mean age of 48.3 ± 12.5 years. Nine patients (18%) developed PTDM, 44% between 3 and 6 months. General characteristics and immunosuppressive therapy were similar between the groups. The mean FPG in the pretransplant OGTT was significantly higher in the PTDM group compared with the non-PTDM group (85.7 ± 7.9 vs 79.1 ± 8.2, P = .03). The number of patients classified as impaired glucose tolerance (IGT) on the pre-transplant OGTT was significantly higher in the PTDM group. ConclusionIGT in the pretransplant OGTT was associated with PTDM cases in kidney transplant recipients without a previous diagnosis of DM.

Beyond Stages: Predicting Individual Time Dependent Risk for Type 1 Diabetes.

Essentially all individuals with multiple autoantibodies will develop clinical type 1 diabetes. Multiple AABs and normal glucose tolerance define Stage 1 diabetes; abnormal glucose tolerance defines Stage 2. However, the rate of progression within these stages is heterogeneous, necessitating personalized risk calculators to improve clinical implementation. We developed 3 models using TrialNet's Pathway to Prevention data to accommodate the reality that not all risk variables are clinically available. The Small model included AAB status, fasting glucose, HbA1c and age, while the Medium and Large models added predictors of disease progression measured via oral glucose tolerance testing. All models markedly improved granularity regarding personalized risk missing from current categories of stages of T1D. Model derived risk calculations are consistent with the expected reduction of risk with increasing age and increase in risk with higher glucose and lower insulin secretion, illustrating the suitability of the models. Adding glucose and insulin secretion data altered model predicted probabilities within Stages. In those with high 2-hour glucose, a high C-peptide markedly decreased predicted risk; lower C-peptide obviated the age-dependent risk of 2-hour glucose alone, providing a more nuanced estimate of rate of disease progression within Stage 2. While essentially all those with multiple AABs will develop type 1 diabetes, the rate of progression is heterogeneous and not explained by any individual single risk variable. The model-based probabilities developed here provide an adaptable personalized risk calculator to better inform decisions about how and when to monitor disease progression in clinical practice.

Glucose levels measured with continuous glucose monitoring in uncomplicated pregnancies

IntroductionTo characterize glucose levels during uncomplicated pregnancies, defined as pregnancy with a hemoglobin A1c <5.7% (<39 mmol/mol) in early pregnancy, and without a large-for-gestational-age birth, hypertensive disorders of pregnancy, or...

Trajectory of gestational weight gain in patients with gestational diabetes mellitus

Introduction: Weight gain in pregnancy is a significant modifiable factor that impacts immediate and future health of the mother and her fetus Hence, worldwide guidelines are developed about weight gain in pregnancy. In a recent study patients with abnormal glucose tolerance test and diagnosed with gestational diabetes had less deviation from expected gestational weight gain. Purpose: The aim of our study is to look at the trajectory of gestational weight gain for women diagnosed with gestational diabetes followed at the King Faisal Specialist Hospital and Research Centre (KFSH&amp;RC) Methods: Our study population included 215 pregnant women with singleton pregnancy diagnosed with diabetes mellitus who attended the obstetrics outpatient clinic and family health clinics from first antenatal visit until delivery. Results: From among the 215 women in the study cohort, the total number of weight gain was 143. The number of patients who lost weight was 48, and the number of patients who remained stable were 24. Overall, the amount of weight gain for women in this study was comparable to the expected. Conclusion: In our study we found the patients diagnosed with gestational diabetes mellitus have a wide range of changes in their weight gain trajectory from previously expected parameters in the healthy population, which might be explained by other factors like adherence to diet, exercise and medications designed control the metabolism.

Research Progress of Metabolic Syndrome and Renal Cancer

Metabolic syndrome (MS) is a condition of metabolic abnormalities in genetically predisposed individuals that are caused by lifestyle habits such as consumption of diet rich in fat and lack of exercise. Few major symptoms include abnormal glucose tolerance, hypertension, abnormal lipid metabolism (including high triglycerides in the blood, low high density lipoprotein cholesterol, etc.), obesity, etc. Although metabolic syndrome has been found to be mainly related to cardiovascular diseases, diabetes, malignancy and other diseases, in recent years, more and more evidence has shown that MS is closely related to the occurrence, development and prognosis of kidney cancer, among which obesity and hypertension have been identified as major risk factors for kidney cancer. This article reviews the research progress on the relationship between MS and its components and the risk, invasiveness, and prognosis of renal carcinoma, so as to provide reference for the prevention, diagnosis, treatment and prognosis of renal cancer.

Association between abnormal oral glucose tolerance test patterns in the second trimester and large for gestational age newborns

Objective: To investigate the impact of abnormal patterns of 75 g oral glucose tolerance test (OGTT) in the second trimester on the risk of large for gestational age (LGA) newborn deliveries. Methods: General clinical data and OGTT results of 66 290 pregnant women who received regular prenatal care and delivered in Guangdong Maternal and Child Health Hospital from December 24, 2016 to July 26, 2022 were collected. According to the results of OGTT, the pregnant women were divided into 8 groups: normal blood glucose group (normal fasting blood glucose, 1-hour and 2-hour after oral glucose, 54 518 cases), gestational diabetes mellitus (GDM) 0 group (only abnormal fasting blood glucose, 1 430 cases), GDM 1 group (only abnormal blood glucose at 1-hour after oral glucose, 2 150 cases), GDM 2 group (only abnormal blood glucose at 2-hour after oral glucose, 3 736 cases), GDM 0+1 group (both fasting blood glucose and 1-hour after oral glucose were abnormal, 371 cases), GDM 0+2 group (both fasting blood glucose and 2-hour after oral glucose were abnormal, 280 cases), GDM 1+2 group (abnormal blood glucose at 1-hour and 2-hour after oral glucose, 2 981 cases) and GDM 0+1+2 group (abnormal fasting blood glucose, 1-hour and 2-hour after oral glucose, 824 cases). Multivariate logistic regression was used to analyze the effects of different abnormal OGTT patterns on LGA. In addition, the blood glucose measurements at the three time points of OGTT were combined and used as continuous variables in the receiver operating characteristic (ROC) curve to evaluate the predictive value of each blood glucose measurement mode for LGA and the area under the curve (AUC) was compared. Results: (1) Multivariate logistic regression analysis showed that the risks of LGA were significantly increased in GDM 0 group (OR=1.76, 95%CI: 1.50-2.08; P<0.001), GDM 0+1 group (OR=2.29, 95%CI: 1.72-3.04; P<0.001), and GDM 0+1+2 group (OR=1.98, 95%CI: 1.61-2.43; P<0.001). (2) ROC curve analysis showed that fasting blood glucose, 1-hour after oral glucose, 2-hour after oral glucose, fasting+1-hour after oral glucose, fasting+2-hour after oral glucose, 1-hour+2-hour after oral glucose, and fasting+1-hour+2-hour after oral glucose had certain predictive value for LGA (all P<0.001). The AUC of fasting blood glucose measurement was higher than that of 2-hour blood glucose measurement in predicting LGA, and the difference was statistically significant (P<0.05). There was no significant difference in the AUC between fasting blood glucose and other blood glucose measurement modes for predicting LGA (all P>0.05). Conclusions: In the abnormal OGTT patterns, pregnant women with abnormal fasting blood glucose, abnormal fasting+1-hour after oral glucose, and abnormal fasting+1-hour+2-hour after oral glucose have an increased risk of LGA. Fasting blood glucose measurement is of great significance for the prediction of LGA, and could be used as an optimal indicator to evaluate the risk of LGA in clinical practice.

Abstract P289: In Africans With Abnormal Glucose Tolerance the Triglyceride-Glucose Index is a Feasible, Effective Way to Distinguish Between Beta-Cell Failure and Insulin Resistance

Background: With the prevalence of abnormal glucose tolerance (Abnl-GT) soaring in sub-Saharan Africa, there is a growing appreciation that the major etiology of Abnl-GT in Africans may be beta-cell failure rather than insulin resistance (IR). As optimal therapy depends on etiology, distinguishing between beta-cell failure and IR is critical. However, identifying IR with formulas such as the Matsuda Sensitivity Index which requires insulin to be assayed in plasma, is expensive and rarely available in medical clinics in most African countries. Therefore, our goal was to use data from the Matsuda Index as the diagnostic standard, and determine how well the widely available, low-cost Triglyceride-Glucose Index (TyG) performs in distinguishing between beta-cell failure and IR in Africans with Abnl-GT. Methods: OGTTs and fasting triglyceride (TG) levels were obtained in 589 African immigrants living in the Washington DC area (Male: 64%, Age: 39±11, (mean±SD) range 20 -69y; BMI 27.9±4.5 kg/m 2 range 19.5-41.9). Glucose tolerance status was determined by ADA criteria for the OGTT. IR was defined as the lowest quartile of the population distribution of the Matsuda Index (≤2.89). As a primary etiology, beta-cell failure was defined as Abnl-GT in the absence of IR. Insulin secretion was calculated using the insulinogenic index. The formula for TyG was: ln(fasting glucose &amp; fasting TG)/2. IR by TyG was defined by the highest quartile of its distribution across the cohort(≥3.38). Results: Abnl-GT occurred in 39% (228/589) of the enrollees. Among participants with Abnl-GT, the prevalence of beta-cell failure and IR were: 59% (134/228) vs. 41% (94/228), P &lt;0.001, respectively. Compared to Africans with Abnl-GT and IR, Africans with Abnl-GT and beta-cell failure had less IR &amp; lower insulin secretion (both P&lt;0.001). Overall, with data from the Matsuda Index as the diagnostic standard, TyG correctly identified the etiology of Abnl-GT in 90% (205/228) of the participants with Abnl-GT, specifically 93% (125/134) with beta-cell failure and 85% (80/94) of participants with IR. Conclusions: As the TyG correctly identified the etiology of Abnl-GT in 90% of Africans, it may be a feasible, economically viable alternative to the Matsuda Index in determining whether Africans with Abnl-GT have beta-cell failure or IR. With correct information about Abnl-GT etiology, therapy for can be optimized.

Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes.

The prevalence of gestational diabetes mellitus (GDM) has been steadily increasing over the past years. It is a major risk factor for glucose intolerance and type 2 DM (T2DM). The American Diabetes Association recommends that women whose pregnancy was complicated by GDM be screened for persistent glucose abnormalities at six to 12 weeks postpartum with either a fasting plasma glucose test alone or with a fasting 75-g, two-hour oral glucose tolerance test. This study aimed to identify the main predictive factors of glucose tolerance disorders in early postpartum women with a recent history of GDM. In this retrospective descriptive study, we identified 400 women who met the eligibility criteria for the study. The mean age was 34.54 ± 5.51 years. A total of 70% had a family history of DM, 16% had a personal history of GDM, and 23% had fetal macrosomia in previous pregnancies. The overall incidence of postpartum carbohydrate tolerance disorders was 36.4%, including 12% prediabetes and 24.4% DM. The prevalence of prediabetes and T2DM after delivery was higher with older maternal age, multigravidity, a higher BMI, a history of GDM, and fetal macrosomia in previous pregnancies. Furthermore, the persistence of this impaired glucose tolerance in postpartum was associated with a higher term of diagnosis, a higher glycated hemoglobin (HbA1c) percentage (the discriminant cutoff value with the best sensitivity/specificity ratio was 5.25%), the use of insulin therapy, cesarean section delivery, and fetal macrosomia. After adjusting for confounders, only prior GDM, a higher HbA1c level, macrosomia, and gestational term were found to significantly affect postpartum glucose tolerance. Although postpartum screening for T2DM is recommended for all women with GDM, a significant number of patients fail it. A better knowledge of predictive factors for this outcome is therefore needed for a more effective and targeted medical intervention.