Association Of Fasting Plasma Glucose Research Articles

Association of Fasting Plasma Glucose and Serum Lipids in Type 2 Diabetics.

Dyslipidemia is a significant morbidity associated with diabetes and cardiovascular disorders. The present study was undertaken to assess the lipid profile of type 2 diabetic and age-gender matched healthy subjects and its association, if any, with fasting plasma glucose. Clinically diagnosed diabetic subjects were recruited for the study. The fasting plasma glucose and lipid profiles were analyzed for 99 diabetic and 101 healthy volunteers. The blood samples were analyzed for fasting plasma glucose, total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol and very low density lipoprotein-cholesterol. Correlation analysis of lipid profile with fasting plasma glucose and calculation of risk ratio was done. The levels of high density lipoprotein-cholesterol and low density lipoprotein-cholesterol were found to be significantly low in diabetics and subjects with lower low density lipoprotein-cholesterol were on statins. Inspite of lower lipid values, the risk ratio for diabetics was significantly higher. The correlation analysis indicated significant difference in relationship between fasting plasma glucose, lipid parameters and risk ratios in the two groups. Diabetics with lower high density lipoprotein-cholesterol and higher total cholesterol present with a higher risk ratio pointing to need of non-statin high density lipoprotein-raising medications decreasing their predisposition to cardiovascular disorders. The study highlights the altered pattern of correlation of lipid profile with fasting plasma glucose in diabetics and their increased risk of cardiovascular disorders. The dyslipidemia in the form of triglyceridemia and significantly low high density lipoprotein-cholesterol in diabetics point towards the need of non-statin high density lipoprotein-raising medications.

Correlation of Fasting and Post Prandial Plasma Glucose with Hemoglobin Glycation

Association of fasting plasma glucose (FPG) and post prandial plasma glucose (PPG) on hemoglobin glycation is still controversial. In this study we aimed to assess the influence of FPG and PPG on hemoglobin glycation in newly diagnosed never treated diabetic (NDNT-DM) subjects and treated diabetic (T-DM) subjects. One hundred and seventy seven diabetic subjects were included in this study. Plasma glucose concentrations were measured by hexokinase end point technique and glycated hemoglobin (HbA1c) levels were measured by modified cationexchange high performance liquid chromatography (HPLC). Univariate and multivariate linear regression models were applied to assess the relative contribution of FPG and PPG on HbA1c. Univariate linear regression analysis showed significant positive association of FPG and PPG with HbA1c in both groups. Multivariate regression model showed that ? (beta) value of HbA1c was 0.5528 (p<0.0001) for FPG and 0.3047 (p<0.01) for PPG in the NDNT-DM whereas 0.5509 (p<0.0001) for FPG and 0.1874 (p>0.05) for PPG in treated diabetic subjects. After adjustment for age and sex, beta remains statistically significant for FPG and PPG where beta value for FPG was higher for FPG than for PPG in both NDNT-TM group and T-DM groups. This study revealed that FPG has a stronger association on hemoglobin glycation as compared to PPG in diabetes mellitus. Anwer Khan Modern Medical College Journal Vol. 4, No. 2: July 2013, Pages 28-30 DOI: http://dx.doi.org/10.3329/akmmcj.v4i2.16939

Association of fasting plasma glucose with the prevalence and severity of angiographic coronary artery disease in population with no history of diabetes

A total of 906 subjects with no history of diabetes who had undergone coronary angiography were included in this study and categorized into four groups according to the level of fasting plasma glucose (FPG):≤5.5 mmoL/L,5.6-6.0 mmol/L,6.1-6.9 mmoL/L,and ≥ 7.0 mmol/L.Significant coronary artery disease (CAD) was defined as ≥ 50％ reduction of lumen diameter at least in one major coronary artery.The severity of coronary atherosclerosis was defined by the Gensini score.The clinical data,laboratory indexes,and coronary angiography results were compared among various groups.The risk factors for the prevalence and severity of angiographic CAD were analyzed.The results showed that the prevalence of angiographic CAD,the number of diseased vessels,and the Gensini score were increasing with increasing FPG levels among four groups (P＜0.05 or P＜0.01).The FPG level was significantly correlated with angiographic CAD (P =0.004) and the Gensini score (P =0.010),suggesting that FPG was an independent risk factor for the prevalence and severity of angiographic CAD. Key words: Fasting plasma glucose; Coronary artery disease; Coronary angiography

Evaluation for Fasting and 2-hour Glucose and HbA1c for Diagnosing Diabetes Based on Prevalence of Retinopathy in a Chinese Population

BackgroundThe glycemic thresholds for diabetes diagnosis have long been at the forefront of discussion. However, no information about glycemic cutoff points has been made available for the Chinese population. The aim of the present study was to examine the association of fasting plasma glucose (FPG), 2-h plasma glucose (2-h PG) and HbA1c levels with diabetic retinopathy (DR) and determine the associated cutoff levels in a Chinese population.Methodology and Principal FindingsIn a cross-sectional population-based sample of 2551 Chinese (representing a population of 1,660,500 in a Beijing district) between 18–79 years of age, the three glycemic measures were measured in a 75 g oral glucose tolerance test, and DR was assessed by two 45° color digital retinal images. The prevalence of DR increased in the ninth decile of each variable, corresponding to an FPG of ≥7.2 mmol/l, a 2-h PG of ≥10.7 mmol/l, and HbA1c of ≥6.4%, according to the Joinpoint regression method. After excluding individuals receiving antihyperglycemic medication, the prevalence significantly increased at an FPG of ≥6.8 mmol/l, a 2-h PG of ≥12.0 mmol/l, and HbA1c of ≥6.7%. The area under the ROC curve for all three measures showed no significant differences for detecting DR. After excluding individuals receiving antihyperglycemic medication, the three measures also showed no significant differences.Conclusions and SignificanceA significant increase in retinopathy prevalence occurs among individuals with FPG ≥7.2 mmol/l, 2-h PG ≥10.5 mmol/and HbA1c ≥6.4%; and measuring FPG or HbA1c are equally reliable methods as measuring 2-h PG for the diagnosis of diabetes in the Chinese population.

Does Insulin Resistance Drive the Association between Hyperglycemia and Cardiovascular Risk?

BackgroundSeveral studies have shown associations between hyperglycemia and risk of cardiovascular disease (CVD) and mortality, yet glucose-lowering treatment does little to mitigate this risk. We examined whether associations between hyperglycemia and CVD risk were explained by underlying insulin resistance.MethodsIn 60 middle-aged individuals without diabetes we studied the associations of fasting plasma glucose, 2-hour post oral glucose tolerance test plasma glucose, insulin sensitivity as well as body fat percentage with CVD risk. Insulin sensitivity was measured as the glucose infusion rate during a euglycemic hyperinsulinemic clamp, body fat percentage was measured by dual X-ray absorptiometry, and CVD risk was estimated using the Framingham risk score. Associations of fasting plasma glucose, 2-hour plasma glucose, insulin sensitivity and body fat percentage with the Framingham risk score were assessed in linear regression models.ResultsBoth fasting and 2-hour plasma glucose levels were associated with higher Framingham risk score (fasting glucose: r2 = 0.21; 2-hour glucose: r2 = 0.24; P<0.001 for both), and insulin sensitivity with lower Framingham risk score (r2 = 0.36; P<0.001). However, adjustment for insulin sensitivity and 2-hour glucose made the effect of fasting glucose non-significant (P = 0.060). Likewise, when adjusting for insulin sensitivity and fasting glucose, the association between 2-hour glucose and Framingham risk score disappeared (P = 0.143). In contrast, insulin sensitivity was still associated with Framingham risk score after adjusting for glucose levels (P<0.001). Body fat was not associated with Framingham risk score when taking insulin sensitivity into account (P = 0.550).ConclusionThe association between plasma glucose levels and CVD risk is mainly explained by insulin resistance, which raises the question of whether glucose lowering per se without changes in the processes that underlie hyperglycemia should be the sole clinical paradigm in the treatment of type 2 diabetes or its prevention.

Fasting plasma glucose correlates with angiographic coronary artery disease prevalence and severity in Chinese patients without known diabetes

Type 2 diabetes mellitus is a risk factor for coronary artery disease (CAD). While there is a clear association of fasting plasma glucose (FPG) with microvascular complications, the risk for CAD conferred by FPG is relatively less clear. Therefore, we investigate the association between different FPG and the prevalence and severity of angiographic CAD in high-risk Chinese patients without known diabetes. Among 1,419 subjects who were to undergo coronary angiography for the confirmation of suspected myocardial ischemia, 906 subjects without known diabetes were included in this study and categorized into four groups according to the level of FPG: group 1, ≤5.5 mmol/l; group 2, 5.6-6.0 mmol/l; group 3, 6.1-6.9 mmol/l; and group 4, ≥7.0 mmol/l. Significant angiographic CAD was defined as ≥50 % lumen diameter reduction in at least one major coronary artery in a given subject. The severity and extent of coronary atherosclerosis were defined as the number of diseased vessels, the proportion of totally occluded vessel and the Gensini score. Associations between FPG and the prevalence and severity of CAD were assessed by logistic and linear stepwise regression analyses. The angiographic CAD prevalence, the number of diseased vessels, the totally occluded vessel, and the Gensini score increased corresponding to increasing FPG levels from ≤5.5 mmol/l to 5.6-6.0 mmol/l to 6.1-6.9 mmol/l to ≥7.0 mmol/l (P < 0.05). The FPG had significant association with angiographic CAD (adjusted OR, 1.53; 95 % CI, 1.19-1.98; P = 0.001) and the Gensini score (standardized regression coefficient = 0.172, P = 0.011). Compared with group 1, group 2, 3 and 4 demonstrated significantly higher CAD prevalence after adjustment (adjusted OR, 1.61 [1.16-2.19]; P = 0.015 for group 2; 1.49 [1.11-2.59]; P = 0.027 for group 3; and 4.19 [2.85-6.16]; P = 0.024 for group 4, respectively). FPG group was also significantly associated with the Gensini score (Standardized coefficients, 0.185; P = 0.007, respectively). FPG was an independent risk factor for the prevalence and severity of significant angiographic CAD in our study population. The severity of angiographic CAD increased along with the increasing FPG levels even in prediabetic state.

Ageing and associations of fasting plasma glucose and 2 h plasma glucose with HbA1C in apparently healthy population. “FIN-D2D” study

ObjectiveIn this FIN-D2D cross-sectional survey the relationship of age with HbA1c and fasting and 2h glucose in the oral glucose tolerance test (OGTT) was explored in apparently randomly selected healthy population. Patients and methodsThe glycaemic parameters were measured in 1344 men and 1482 women (aged 45–74 years), and among them we excluded all subjects with known diabetes, hypertension or dyslipidaemia. The final analyses for HbA1c and the ratios of fasting glucose/HbA1c and 2h glucose/HbA1c included 649 men and 804 women. ResultsMean age was 57 years and BMI 26.1kg/m2 for both genders. HbA1c increased in both genders with age (p<0.001). For a particular fasting glucose level HbA1c level was higher in older age groups (p<0.001 for linearity). By contrast, a particular 2h plasma glucose value in OGTT implied significantly lower HbA1c in the elderly (p<0.001 for linearity). ConclusionIn apparently healthy population, screened with OGTT, in older individuals compared with younger ones a particular HbA1c value implies slightly lower fasting glucose, but relatively higher 2h glucose. These results need to be verified in different populations. The effects of age on relation between HbA1c and plasma glucose should be taken into account in classifying people into different dysglycaemia categories.

Normal fasting plasma glucose and risk of prediabetes and type 2 diabetes: the Isfahan Diabetes Prevention Study.

To determine the association of fasting plasma glucose (FPG) level within normal range and the risk of prediabetes and type 2 diabetes in an Iranian population. A total of 806 first-degree relatives (FDRs) of patients with type 2 diabetes who had FPG levels less than 5.6 mmol/l (100 mg/dl) in 2003 to 2005, and who did not have diabetes or impaired fasting glucose (IFG), were followed through 2010 for the occurrence of prediabetes or type 2 diabetes. At baseline and through follow-ups, participants underwent a standard 75 g 2-hour oral glucose tolerance test (OGTT). The incidence of type 2 diabetes, impaired glucose tolerance (IGT), and IFG was 9.6 (95% confidence interval (CI): 6.8-12.4), 28.7 (23.8-33.6), and 33.0 (27.7-38.2) per 1,000 person-years based on 4,489 person-years of follow-up, respectively. FPG was associated with the incidence of diabetes, IGT, and IFG. The multivariate-adjusted hazard ratios (95% CI) for diabetes, IGT, and IFG were 1.36 (1.01-1.84), 1.45 (1.10-1.91) and 1.31 (1.00-1.71), for the highest quintile of FPG compared with the lowest quintile, respectively. An increase in FPG in the normal range is associated with an increase in the incidence of IGT, IFG, and type 2 diabetes. These results prove FPG in the normal range to be useful in identifying apparently healthy FDRs of patients with type 2 diabetes at risk of developing prediabetes and diabetes.

Association of fasting plasma glucose with ankle–brachial index and ankle–brachial pulse wave velocity in hypertensive Chinese adults

Association of fasting plasma glucose with ankle–brachial index and ankle–brachial pulse wave velocity in hypertensive Chinese adults

Diagnostic thresholds for diabetes: The association of retinopathy and albuminuria with glycaemia

Aim We examined the association of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) and HbA1c with retinopathy and microalbuminuria using both deciles of glycaemia and change point models, to validate current diagnostic criteria for diabetes and to identify therapeutic thresholds for glycaemic control. Methods The Australian Diabetes Obesity and Lifestyle study (AusDiab), conducted in 1999–2000, included adults aged ≥25 years from 42 randomly selected areas of Australia. Retinopathy and albuminuria were assessed in participants identified as having diabetes (based on self report and oral glucose tolerance test), impaired fasting glucose, impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2182 participants with retinal photographs and 2389 with urinary albumin/creatinine results. Results The prevalence of retinopathy in the first 8 deciles of FPG and HbA1c and the first 9 deciles of 2hPG were 7.2, 6.6, and 6.3%, respectively and showed no variation with increasing glucose or HbA1c. Above these levels, the prevalence rose markedly to 18.6% in the top 2 deciles of FPG, 21.3% in the top 2 deciles of HbA1c and 10.9% in the top decile of 2hPG. The thresholds for increasing prevalence of retinopathy were 7.1 mmol/l for FPG, 6.1% for HbA1c and 13.1 mmol/l for 2hPG. The prevalence of microalbuminuria rose gradually across deciles of each glycaemic measure. Thresholds were less clear than for retinopathy, but were seen at a FPG of 7.2 mmol/l and HbA1c of 6.1%, with no evidence of a threshold effect for 2hPG. Conclusions The prevalence of retinopathy rose dramatically in the highest deciles of each glycaemic measure, while for microalbuminuria the increase of prevalence was more gradual. The FPG values corresponded well with the WHO diagnostic cut-point for diabetes, however the 2hPG value did not. HbA1c thresholds were similar for both retinopathy and microalbuminuria and compared well to values shown in other studies. These results support current targets for FPG and HbA1c in preventing microvascular complications.

Reply to comment on: Godsland IF, Jeffs JA, Johnston DG (2004) Loss of beta cell function as fasting glucose increases in the non-diabetic range. Diabetologia 47:1157–1166

To the Editor: As we stated in our original paper [1], our intention was to define the level of glycaemia at which pancreatic insulin secretion begins to decline. We were careful throughout to emphasise that we were concerned not with causal relationships but with identifying the principal accompaniments of deteriorating fasting plasma glucose (FPG) levels in the sub-diabetic range. We agree with Abdul-Ghani and DeFronzo that the decline in IVGTT first-phase insulin secretion that accompanies the rise in FPG does not necessarily indicate a causal relationship [2]. Nevertheless, in our study, the decline in first-phase pancreatic insulin secretion was by far the most striking feature that accompanied increasing glucose levels. As AbdulGhani and DeFronzo affirm, the important aspect of this decline was that it occurred within ranges of glucose concentrations hitherto considered normal. In drawing attention to glucotoxicity and the sensitivity of pancreatic insulin secretion to rising glucose levels, Abdul-Ghani and DeFronzo raise an important mechanistic possibility. This does, however, pose a potential ‘chicken and egg’ problem, since glucose concentrations would have to rise for there to be deficient pancreatic insulin secretion, but there might have to be deficient insulin secretion for glucose concentrations to rise. Which comes first? One possibility, which they allude to, is that it is not decreasing insulin secretion that sets glucose levels rising but decreasing insulin sensitivity. Our finding that there was little change in insulin sensitivity with increasing FPG appears contrary to the weight of evidence in this respect. Abdul-Ghani and DeFronzo raise the possibility that our IVGTT protocol was not sensitive enough to detect impaired insulin sensitivity [2]. That this is not the case is illustrated by our previous publications, which attest to the ability of our protocol to detect diminished insulin sensitivity in a variety of circumstances and to detect significant associations with metabolic correlates of insulin sensitivity at a strength equivalent to that seen with other protocols and methodologies (see [3–6] for examples). Abdul-Ghani and DeFronzo also question the relevance of conclusions regarding pancreatic insulin secretion based on the non-physiological intravenous route of administration. However, they point out that, consistent with our results [1], in their own studies using the OGTT [7] there was a decline in the OGTT plasma insulin response with increasing FPG at levels >5.6 mmol/l. It is also noteworthy that in the study of Ozaki et al. of 8,923 men and women in Japan, in which OGTT insulin concentrations at 30 and 120 min provided indices of earlyand late-phase insulin secretion, relationships were noted between plasma insulin concentrations and FPG levels in the range 4.4–8.3 mmol/l that were similar to those we distinguished between pancreatic insulin secretion and FPG [8]. With regard to the apparent lack of association between insulin sensitivity and FPG in our study, the critical point to note is that, as stated in the table legend, the data we reported in Table 2 was standardised for age and BMI. As shown in Table 4 of our paper, we did, in fact, identify a significant association between increasing FPG and declining insulin sensitivity, but, in contrast to the various insulin secretion measures, this association ceased to be significant in multiple linear regression analysis when age and BMI were taken into account. The key covariate in this loss of significance appeared to be BMI. Interestingly, the discrepancy between the effect of standardisation for BMI on the associations of FPG with both insulin sensitivity and insulin secretion might provide a clue as to how the cycle of rising FPG concentrations and I. F. Godsland . D. G. Johnston Department of Endocrinology and Metabolic Medicine, Division of Medicine, Faculty of Medicine, Imperial College London, London, UK

Association of fasting plasma glucose with heart rate recovery in healthy adults: a population-based study.

Diabetes is associated with abnormal autonomic function and increased mortality. Abnormal heart rate recovery after exercise, a measure of autonomic dysfunction, is also associated with increased mortality. The objective of this study was to determine the association of fasting plasma glucose with abnormal heart rate recovery and its prognostic importance in healthy adults. We studied 5,190 healthy adults who did not have medically treated diabetes (mean age 45 years, 39% women), were enrolled in the Lipid Research Clinics' Prevalence Study, and underwent exercise testing. Heart rate recovery was defined as the change from peak heart rate to that after 2 min of recovery; an abnormal value was < or = 42 bpm. All-cause mortality was assessed over 12 years. A total of 504 participants (10%) had impaired fasting glucose, and 131 (3%) had untreated diabetes. An abnormal heart rate recovery was found in 1,699 (33%). Compared with participants who had normal fasting plasma glucose, abnormal heart rate recovery was more common among those with impaired fasting glucose (42 vs. 31%; relative risk, 1.34; 95% confidence interval [CI], 1.20--1.50; P < 0.0001) and those with diabetes (50 vs. 31%; relative risk, 1.61; 95% CI, 1.35--1.92; P < 0.0001). Fasting plasma glucose remained an independent predictor of abnormal heart rate recovery even after adjustment for age, sex, and other confounders (P = 0.0003). An abnormal heart rate recovery added to impaired fasting plasma glucose for the prediction of death. Fasting plasma glucose is strongly and independently associated with abnormal heart rate recovery, even at nondiabetic levels.