Diagnosis Of Impaired Fasting Glucose Research Articles

Association between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants

Abstract Introduction Different studies results show that higher iron intake and increased iron stores in the body are significantly associated with a higher risk of diabetes mellitus (DM), a risk factor for cardiovascular diseases. Iron metabolism in the body is associated with the production of free oxygen radicals, which, combined with the stressful effect of glycation end products in pre-diabetes, increases the risk of diabetes and cardiovascular events. The purpose of the study was to assess the relationship between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants. Methods Study group consisted of 1889 individuals (1185 women and 704 men, aged 35-70 years, from urban and rural area), who were participants of the Polish arm of the Prospective Urban Rural Epidemiology (PURE) study. The study was approved by the Ethics Committee. The data were collected between 2007-2009, in the first stage of the PURE Poland study. Diabetes was diagnosed when fasting glucose level was ≥ 126 mg/dl or there was a declaration about DM occurrence in the medical interview. Diagnosis of impaired fasting glucose (IFG) was made when fasting glucose level was between 100-125 mg/dl with no statement about DM in the interview. Analysis were conducted for DM+IFG in three models: 1. crude data, 2. adjusted for energy intake, 3. adjusted for energy intake, age, body mass index and smoking. Food Frequency Questionnaire (FFQ) was used to assess food intake. FFQ was developed and validated for this population within the PURE study. Iron intake with diet was calculated based on the data from FFQ. For further analysis the study group was divided into tertiles based on the daily iron intake with diet, separately for men and women. Results The prevalence of DM+IFG in each tertile (T) of iron intake with diet was: 27.6% (T1), 37.0% (T2) and 38.7% (T3) among women, and 30.3% (T1), 40.9% (T2) and 37.9% (T3) among men. Taking into account crude data the OR (95% CI) for DM+IFG among women was 1.54 (1.14-2.08) in T2 and 1.66 (1.23-2.24) in T3 when comparing with T1. In model 2 the OR (95% CI) for DM+IFG among women was 1.63 (1.16-2.28) in T2 and 1.88 (1.21-2.94) in T3 when comparing with T1. In model 3 in the group of women the OR (95% CI) for DM+IFG was 1.52 (1.07-2.16) and 1.62 (1.02-2.56) when comparing T2 vs T1 and T3 vs T1, respectively. In the group of men in model 1 the OR (95% CI) for DM+IFG prevalence was 1.59 (1.08-2.32) in T2 vs T1 and 1.40 (0.95-2.05, p>0.05) in T3 vs T1. In the group of men in model 2 and 3 the results were not statistically significant, both in T2 vs T1 and T3 vs T1. Taking into account the whole study group the risk of DM+IFG was significantly higher in T2 vs T1 (model 1, 2 and 3) and in T3 vs T1 (model 1 and 2). Conclusions Higher iron intake with diet was associated with a higher risk of diabetes and impaired fasting glucose in the study group, especially among women.

Cumulative exposure to impaired fasting glucose and gastrointestinal cancer risk: A nationwide cohort study.

Impaired fasting glucose (IFG) is associated with the risk of various cancers, but the cumulative effect of IFG on gastrointestinal cancer risk remains unclear. This study evaluated the association between the cumulative exposure to IFG and gastrointestinal cancer risk. The authors extracted data from the Korean National Health Insurance Service and health examination data sets. Among individuals ≥40 years old who were free of diabetes or cancer, 1,430,054 who underwent national health examinations over 4 consecutive years from 2009 to 2012 were selected and followed up until gastrointestinal cancer diagnosis, death, or December 31, 2019. The IFG exposure score (range, 0-4) was based on the number of IFG diagnoses over 4years. The median follow-up duration was 6.4years. Consistent normoglycemia for 4years was found in 44.3% of the population, whereas 5.0% had persistent IFG and 50.7% had intermittent IFG. Compared to the group with an IFG exposure score of 0, groups with IFG exposure scores of 1, 2, 3, and 4 had a 5%, 8%, 9%, and 12% increased risk of gastrointestinal cancer, respectively (score 1: adjusted hazard ratio [aHR], 1.05; 95% confidence interval [CI], 1.01-1.08; score 2: aHR, 1.08; 95% CI, 1.04-1.12; score 3: aHR, 1.09; 95% CI, 1.05-1.14; score 4: aHR, 1.12; 95% CI, 1.06-1.19). Persistent IFG exposure was also associated with higher risks of individual cancer types (colorectum, stomach, pancreas, biliary tract, and esophagus). Cumulative exposure to IFG is associated with an increased risk of developing gastrointestinal cancer, in a dose-dependent manner. Hyperglycemia, including both diabetes and prediabetes, has been associated with an increased risk of various cancers. However, the cumulative effect of impaired fasting glucose on the risk of developing gastrointestinal cancer remains unclear. A frequent diagnosis of impaired fasting glucose was dose-dependently associated with a higher risk of developing overall gastrointestinal cancer. Furthermore, risks of individual cancer types increased with persistent impaired fasting glucose. Early detection of hyperglycemia and strict glycemic control can lower the risk of gastrointestinal cancer by reducing hyperglycemic burden. Additionally, for some individuals, lifestyle changes such as managing metabolic syndrome or abstaining from alcohol may also be helpful.

Aberrations in carbohydrate metabolism in patients with diagnosed acromegaly - observational study.

Acromegaly is characterized by excessive secretion of growth hormone (GH). The incidence rate of acromegaly is 40 to 70 persons per one million people. Carbohydrate disorders often accompany the above pathology. The aim of this study was to examine the influence of high levels of somatotropin on aberrations in glycaemia in patients with acromegaly, and then a 5-year observation. The study group consisted of 86 patients (48 females and 38 males) with acromegaly diagnosed on the basis of clinical features, elevated insulin-like growth factor 1 (IGF-1) levels, and/or no inhibition of GH ≤ 1 ug/L secretion during 2 hours after an oral glucose load. In the study group type 2 diabetes mellitus (T2DM) was diagnosed in 21 patients (24.4%). There were also 14 cases (16.3%) of the diagnosis of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) combined. The mean age of participants with concomitant T2DM was 52.1 years, while the mean age of those without carbohydrate metabolism disturbances was 46.1 years. During a 5-year observation, we noticed an increase level of glycated haemoglobin (HbA1c) and new cases of pre-diabetes and T2DM. In patients with acromegaly the incidence rate of T2DM is 3-4 times higher than in the rest of the population, and it increases with age, especially after the patient reaches 55 years old.

Long-Term Follow-up of β-Transfusion-Dependent Thalassemia (TDT) Normoglycemic Patients with Reduced Insulin Secretion to Oral Glucose Tolerance Test (OGTT): A Pilot Study.

ObjectiveTo study the endocrine pancreas’ function in transfusion-dependent β-thalassemia (β-TDT) patients with a normal glucose tolerance test (NGT) and hypoinsulinemia. In addition, the prospective long–term follow-up using an annual oral glucose tolerance test (OGTT) to detect any abnormality of glucose metabolism.Patients and methodsSeven β-TDT patients (mean age 22.4 ± 4.2 years) with NGT and inadequate insulin response (hypoinsulinemia) to OGTT were referred for a second opinion to an Italian Centre.ResultsThe first-phase insulin response (FPIR), expressed as the sum of 1 and 3 minutes insulin, to intravenous glucose tolerance test (IVGTT), was between the 1st and 3rd percentile in two patients and between the 3rd and 10th percentile in five. The results were not associated with β-cell autoimmunity. After 43 ± 26 months (range 11 – 80 months) of follow-up, two patients developed impaired glucose tolerance (IGT), three both IGT and impaired fasting glucose (IFG) and two overt diabetes mellitus (DM). Interestingly, the patients who developed DM had, at baseline, the lowest value of the insulinogenic index (IGI: 0.08 and 0.25), defined as the ratio of the increment of plasma insulin to plasma glucose during the first 30 minutes after OGTT. Moreover, a significant correlation was found between the IGI at baseline and at follow-up in the patients who developed IGT with or without IFG (R= 0.927; P: 0.023). A significant reduction of Matsuda insulin sensitivity index (ISIM) and Insulin Secretion-Sensitivity Index-2 (ISSI-2) was documented in the study cohort at the diagnosis of IFG, IGT, and DM. There was a significant inverse correlation between ISSI-2 and area under the curve plasma glucose (AUC-PG).ConclusionsThese data demonstrated, for the first time, progressive deterioration in glucose homeostasis in β-TDT subjects with NGT and hypoinsulinemia and that the ISSI-2 index may be a valuable parameter to identify patients at high risk for developing glucose dysregulation.

Association of NAFLD and Insulin Resistance with Non Metastatic Bladder Cancer Patients: A Cross-Sectional Retrospective Study.

Among risk factors (apart from smoking) likely involved in bladder cancer (BCa), metabolic syndrome (MS), obesity and type 2 diabetes mellitus (T2DM) have been explored with contrasting results. In spite of these studies, there is little data on the association between nonalcoholic fatty liver disease (NAFLD), its main driver, i.e., insulin resistance (IR), and BCa. Implanting a cross-sectional retrospective study we tried to investigate both NAFLD and IR prevalence in a hospital based population of BCa patients. We studied laboratory data from 204 patients with histologically confirmed non metastatic BCa and 50 subjects with no BCa, but with bladder diseases (no Ca BD). We evaluated the presence of NAFLD by the triglycerides/glucose Index (TyG Index), using a cut-off of 0.59 and by the Aspartate Aminotransferase/Alanine Aminotransferase AST/ALT ratio. IR was assessed by the same TyG Index (cut-off 4.68) and the triglycerides/High-Density Lipoprotein HDL ratio (cut-off 2.197). The diagnosis of impaired fasting glucose (IFG), condition of prediabetes, as well as that of T2DM was assessed according to canonical guidelines. The TyG Index predicted NAFLD presence in both groups (p = 0.000), but the BCa group showed a major percentage of NAFLD cases with respect to no Ca BD group (59% versus 40%). A greater proportion of IR (47%) in BCa group than in no Ca BD one (37%) was evidenced by the TyG Index with its median value significantly different (p = 0.0092). This high rate of IR in the BCa group was confirmed by the triglycerides/HDL ratio (p = 0.02). Prediabetes and T2DM were more prevalent in the BCa group than no Ca BD group (p = 0.024). In this study a consistent NAFLD presence was found in BCa patients. This is an important comorbidity factor that deserves further consideration in prospective studies. The higher prevalence of NAFLD, IR, prediabetes and T2DM in the BCa group evidences the need that these disorders should be reckoned as adjunct factors that could impact on this cancerous disease.

Does high-normal 2-hour post load plasma glucose after myocardial infarction in patients with normal glucose tolerance adversely affect prognosis?

Abstract Background Type 2 diabetes mellitus (DM) and pre-DM, newly diagnosed after MI in patients without known DM adversely affects prognosis. 2-hour post-load glucose (2h-PG) predicts post-MI prognosis better than fasting plasma glucose (FPG). Plasma glucose below the conventional threshold for the diagnosis of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), affects post-MI prognosis. Purpose To test whether high-normal post-load plasma glucose in patients with normal glucose tolerance (NGT) would affect post-MI prognosis and whether FPG or 2h-PG increases this risk. Methods Retrospective cohort analysis of 425 MI survivors without known DM and with NGT followed up for (death and non-fatal MI) as MACE. MACE in patients with 2h-PG > median for the whole cohort (Group 2), was compared with those at or below (Group 1). Event free survival in the two groups was estimated from the Kaplan–Meier curves and compared using log-rank test. Cox proportional hazard regression identified predictors of MACE. Continuous net reclassification improvement (NRI>0) and integrated discrimination improvement (IDI) and c-statistics determined the added predictive value of glycaemic matrices. Results Median 2h-PG was 6.3 mmol/l. 219 patients in Group 1 and 206 in Group 2. Group 2 had higher age, prevalence of hypertension, hypercholesterolaemia, ST-segment depression and higher heart rate and GRACE scores. Median follow-up was 40.6 months. MACE was more frequent in Group 2 than Group 1 (OR 2.82, 95% CI 1.55 to 5.16, p<0.001). MACE-free survival was higher in Group 1 (HR 2.43, 95% CI 1.53 to 3.85, p<0.001). Group 2 (HR 2.42, 95% CI 1.44 to 4.04, p<0.001) predicted the MACE-free survival. 2h-PG, but not the FPG independently predicted of MACE (HR 1.73, 95% CI 1.31 to 2.30, p<0.001). Addition of 2h-PG to models containing FPG and other variables improved their predictive performance (NRI>0 0.5062, p<0.001; IDI 0.0376, p=0.003). The c-statistic increased when 2h-PG was added to the GRACE score only model (δAUC 0.037, 95% CI 0.012 to 0.081, p=0.046). Conclusion(s) This study suggests that “high-normal” 2h-PG is an independent predictor of post-MI prognosis. Normoglycaemic patients with 2h-PG ≥6.4 mmol/l, had worse post-MI prognosis compared to those with 2h-PG ≤6.3 mmol/l. The risk of MACE increased with increasing 2h-PG within the normal range. FPG had no effect on prognosis. Funding Acknowledgement Type of funding source: None

Assessing impaired fasting blood glucose criteria for high-risk dysglycaemic populations: an experience from a European population state.

Discrepancies exist between international bodies for the diagnosis of impaired fasting glucose (IFG). The aim of this study was to establish the IFG characteristics and evaluate the best diagnostic IFG criteria in a high risk dysglycaemic population. An IFG population (n = 451) was identified from a national representative cross-sectional survey using a fasting blood glucose (FBG) ranging from 5.60 to 6.99mmol/L. These participants were invited for a follow-up oral glucose tolerance test (OGTT). Both FBG results (health survey & OGTT) were evaluated in relation to different diagnostic IFG criteria (>5.6mmol/L vs. >6.1mmol/L) while comparing to the final OGTT glycemic diagnosis. Out of the total survey population (n = 1861), 24.34% was diagnosed with IFG. Approximately 50% of the IFG's (n = 227) attended for the OGTT. The majority of the IFG population were male with an overweight-obese status. If the FBG cut-off point of 6.1mmol/L was followed, more than a quarter of the population attending the OGTT would have had a missed dysglycaemic status. High-risk dysglycaemic and body mass populations may establish a more accurate dysglycaemia diagnosis and outcome when following an FBG cut-off point of >5.60mmol/L for IFG.

Evaluation of the use of HbA1c in the Diagnosis of Impaired Fasting Glucose

Diabetes mellitus is a progressive catastrophic medical condition, associated with serious acute and chronic complications. Despite the significant improvement in the diagnostic techniques, it is estimated that up to 50% of diabetic patients are unaware of their disease, especially those with type 2 diabetes mellitus. The impaired fasting glucose, defined as fasting blood glucose 70-100 mg/dl, has been recognized as a major risk factor for the development of type 2 diabetes mellitus.Aim of the study: To investigate the use of HbA1c as an alternative to fasting blood glucose (FBG) in the diagnosis of impaired fasting glucose. Materials and methods: The study involved apparently healthy individuals, attended a private medical laboratory for routine medical checking. Two aspects were followed, dividing participants into 4 groups, group 1 with normal FBG, group 2 with FBS 100-125 mg/dl, group 3 with HbA1c < 5.7%, and group 4 with HbA1c of 5.7%-6.4 %. Group 1 and 2 were investigated for FBS, while group 3 and 4 were investigated for HbA1c.Results: A total number of 312 subjects were included in the current study, with a variable number of individuals in each group. The results of HbA1c were statistically compared with the results of FBG. The sensitivity of HbA1c in the diagnosis of impaired fasting glucose was 80%, and the specificity was 66.4% only while the positive and negative predictive values were 81.4% and 64.6% respectively.Conclusion: HbA1c should be used with caution in the diagnosis of impaired fasting glucose.

The Effect of Colonoscopy on the Diagnosis of Impaired Fasting Glucose in Health Examination Subjects

The Effect of Colonoscopy on the Diagnosis of Impaired Fasting Glucose in Health Examination Subjects

Letter: GDF15 Is a Novel Biomarker for Impaired Fasting Glucose (Diabetes Metab J 2014;38:472-9).

Growth differentiation factor-15 (GDF15) is widely distributed in mammalian tissues and has been shown to play multiple roles in inflammation, cancer, and cardiovascular diseases [1,2]. It has protective roles in tissue injury or inflammation [1,3,4]; acute tissue injury induces GDF15 level increased compensatively [5,6]. In addition, the fact that overexpression of GDF15 results in improved insulin sensitivity [7,8] and resistance to both genetic and dietary-induced obesity [8], whereas genetic deletion of GDF15 increases glucose level in diabetic rat model [9] supports its favorable effect on metabolic diseases. Despite its beneficial role in experimental studies, subjects with chronic diseases such as cancer, cardiovascular diseases, and metabolic disorders showed paradoxically elevated level of GDF15 [1]. GDF15 level was also increased in subjects with diabetes or prediabetes [10,11]; however, its level in other chronic diseases (e.g., cardiovascular disease) is glucose-independent [12,13]. Cardiovascular disease has been consistently reported to be associated with elevated GDF15 level [6,12,14], and GDF15 is an independent risk factor of cardiovascular disease even after adjusting for glucose level [12,13]. Hong et al. [11] showed that GDF15 levels were elevated in impaired fasting glucose (IFG) and diabetic groups compared with normal glucose tolerance (NGT) group and suggested GDF15 as a novel diagnostic marker for IFG. Considering the increasing epidemiology of IFG or impaired glucose tolerance (IGT) and their impact on cardiovascular disease risk, clinically easier screening tools for the detection of IFG or IGT might be important. However, several things should be considered to address whether GDF15 is a useful diagnostic marker for IFG. First, the main determinant of GDF15 should be investigated. Hong et al. [11] showed the significant correlates of GDF15 levels in monovariate analysis. I wonder what the independent determinants of GDF15 level are in multivariate model including glucose, homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profile. Even in the Xenical in the Prevention of Diabetes in Obese Subjects (XENDOS) trial which showed high GDF15 level is a risk factor for the progression of glucose intolerance, GDF15 concentration was higher only in individuals with IGT but not in those with IFG compared with those with NGT [10]. IGT state has been reported to show higher peripheral insulin resistance [15] and higher cardiovascular risk as compared with IFG [16]. The results of XENDOS trial [10] and the phenotype of transgenic mouse model [7,8] implied that GDF15 concentration might reflect insulin resistance rather than glucose level itself. HOMA-IR is a very useful marker for insulin resistance; however, it is not a diagnostic marker of IFG or IGT. Second, measurement of hemoglobin A1c (HbA1c) along with glucose level is a better validated tool than measuring GDF15 for the diagnosis of prediabetes. What is the strength of GDF15 in the diagnosis of IFG compared with HbA1c? The area under the receiver operating characteristic curve of GDF15 for detection of IFG was less than 0.7 in Hong's study [11], which implied GDF15 is not a useful diagnostic marker for IFG [17].

Success of 2013-2020 World Health Organization action plan to control non-communicable diseases would require pollutants control.

To control diabetes epidemic and NCDs, WHO has been promoting its action plans since 2000, but diabetes epidemic is continuing. New action plan for 2013-2020 aim to reduce shared risk factors of NCDs, such as tobacco use, unhealthy (i.e., high fat) diet, physical inactivity and harmful use of alcohol and is strengthening the risk reduction measures, such as taxing on tobacco, alcohol and sugary beverages, banning advertisements of unhealthy foods. However it might fail because it did not consider the contribution of environmental pollution on the pathogenesis of diabetes and NCDs.

English

OBJECTIVE: This study was conducted to find out the prevalence of 'impaired fasting glucose' and correlate it with other variables like age, sex, weight, body mass index, waist circumference, waist-hip ratio and family history of diabetes.METHODS: The present study has been carried out on 600 Punjabi patients attending the OPD and indoor of Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar having age more than 20 years. A diagnosis of impaired fasting glucose (IFG) was made as per the American Diabetes Association (ADA) guidelines. Data was analyzed using unpaired't' test and Pearson's Chi-square test.RESULTS: The prevalence of impaired fasting glucose in the studied population was found to be 22% (male 21.4% and female 22.6%). It was observed that impaired fasting glycaemia was significantly correlated with advancing age, family history of diabetes and various anthropometric variables.CONCLUSIONS: This study shows that the prevalence of impaired fasting glucose is very high in Punjabi population. The traditional risk factors like body weight, body mass index along with waist-hip ratio, and family history of diabetes havea positive correlation with IFG and play a significant role in the prediction of impaired glycaemia and diabetes in Punjabi population.

Divergence between HbA1c and fasting glucose through childhood: implications for diagnosis of impaired fasting glucose (Early Bird 52).

An HbA1c threshold of ≥ 6.5% has recently been adopted for the diagnosis of diabetes in adults, and of ≥ 5.7% to identify adults at risk. Little,however, is known of HbA1c's behaviour or diagnostic value in youth. Our aim was to describe the course of HbA1c during childhood, and its association with fasting glucose. HbA1c and glucose were measured every year in a cohort of 326 healthy children (162 boys) from 5 to 15 years. Mixed effects modelling was used to establish the determinants of HbA1c and its development over time. ROC analysis was used to determine the diagnostic value of HbA1c in the 55 individuals who showed impaired fasting glucose(IFG – glucose ≥ 5.6 mmol/L). Glucose rose progressively from 4.3 mmol/L at 5 years to 5.1 mmol/Lat 15 years, and although there were positive associations between HbA1c and glucose, from 10 to 13 years, HbA1c fell while glucose continued to rise. IFG developed in 55 children, but HbA1c exceeded 5.7% in only 16 of them. The maximum area under the ROC curve was 0.71 at the age of 14 (p<0.001), and the sensitivity and specificity were optimal at 50 and 80% respectively,corresponding to HbA1c of 5.4%. Although HbA1c retains a positive association with glucose throughout childhood, it is weak, and their trends diverge from 10 years,suggesting that factors other than glycaemia systematically influence the variance of HbA1c in youth. These findings therefore limit the interpretation of HbA1c for the diagnosis of IFG during childhood.

Relation Between C-Reactive Protein and Impaired Fasting Glucose in Obese Subjects

Chronic systemic inflammation, characterized by elevated levels of the acute phase proteins, such as C-reactive protein (CRP), plays an important role in the pathogenesis of glucose metabolic disturbances and diabetes. The aim of this study was to determine if the elevated levels of CRP are associated with impaired fasting glucose (IFG) in obese subjects. Healthy obese men and nonpregnant obese women were enrolled in a case-control study. Individuals with new diagnosis of IFG were considered as cases and compared with a control group without IFG. Elevated CRP was defined by high-sensitivity C-reactive protein (hsCRP) levels between 3.0 and 10.0mg/L and new diagnosis of IFG by the presence of fasting plasma glucose levels of 100 to 126mg/dL. A total of 74 subjects were allocated into the case group and compared with 74 subjects in the control group. Elevated hsCRP was identified in 61 (41.2%) and 34 (23.0%) individuals in the case and control groups, respectively (p < 0.001). The adjusted odds ratio used to assess the association between elevated hsCRP levels and IFG was 3.36; 95% confidence interval was 1.66-6.79. In conclusion, the elevated hsCRP levels are associated with IFG in obese subjects.

Diagnosing preoperative hyperglycemia in non-diabetic patients: a challenge and an opportunity

To the Editor, We read with interest the article by Abdelmalak et al. published recently in the Journal. Using retrospective registry data, the authors report the prevalence of undiagnosed diabetes in a large cohort of patients undergoing non-cardiac surgery. We commend the authors for their work on such a sizeable study population but would like to comment on three issues raised in the manuscript. First, the authors based the diagnosis of impaired fasting glucose (IFG) and diabetes mellitus (DM) on their patients’ most recent plasma glucose value prior to surgery; however, it remains unclear if the study patients were fasting at the time of blood glucose measurements and, if they were, for how long. The American Diabetes Association (ADA) criterion for the diagnosis of DM using fasting plasma glucose requires a fasting period of at least eight hours. Hence, not knowing the duration of fasting makes it difficult to differentiate between elevated, impaired, and normal fasting glucose. Second, the ADA stipulates that any method used to diagnose IFG or DM should be repeated at a later date to rule out laboratory error. Although this step was acknowledged by the authors, we would like to emphasize that a variable length of fasting as well as stress-induced changes in glycemia likely account for some of the abnormal plasma glucose levels found in this study. Measurement of hemoglobin A1c in future studies may further clarify the diagnosis. It is well documented that a large portion of adults with type 2 diabetes are unaware of their condition. This article does not state the actual manner in which each patient’s diabetic status was determined. It is not uncommon for patients with confirmed diabetic blood glucose levels not to consider themselves diabetic when being interviewed. It is therefore likely that a database registry underestimates the prevalence of DM, and this may account for a portion of the 10% DM reported in this study. We performed a prospective study in almost 500 patients (fasting [ eight hours) before surgery and showed that 26% of previously undiagnosed patients demonstrated blood glucose levels in the IFG or DM range. Similar to Abdelmalak et al.’s findings, male sex and older age were associated with a higher risk of hyperglycemia. Our study population, however, had a lower mean body mass index. We agree with the authors that pre-surgical identification of IFG and DM may be useful for predicting and influencing postoperative outcomes. We understand the inherent limitations of retrospective data analyses but caution against the premature labelling of patients as prediabetic and diabetic.

Caloric Restriction and L‐Carnitine Administration Improves Insulin Sensitivity in Patients With Impaired Glucose Metabolism

Reduced circulating and tissue carnitine levels, possibly leading to impaired mitochondrial function, have been postulated to be involved in the pathogenesis of insulin resistance. However, whether L-carnitine administration may improve insulin sensitivity in patients with impaired fasting glucose (IFG) or type 2 diabetes mellitus (DM-2) is still controversial. The aim of the study was to explore the role of L-carnitine supplementation in influencing insulin sensitivity. A randomized controlled study involving adult outpatients was designed. Adult patients referred to the outpatient clinic and within 10 days of the diagnosis of IFG or DM-2 were consecutively enrolled. Exclusion criteria were concomitant antidiabetic therapy and modifications of lifestyle during the previous 4 weeks. Patients were randomly assigned to receive a hypocaloric diet for 10 days (group C; n = 8) or the same dietetic regimen in addition to oral L-carnitine (2 g twice daily) supplementation (group LC; n = 8). Oral glucose tolerance test (OGTT), fasting plasma insulin levels, and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed at the beginning and end of the study. Data were statistically analyzed using the Student t test for paired and unpaired data. OGTT at 2 hours improved in both groups. Only in the L-carnitine-supplemented group did plasma insulin levels and HOMA-IR significantly decrease when compared to baseline values. Considering the role of caloric restriction in increasing the intestinal uptake of carnitine, the results suggest that oral L-carnitine administration, when associated with a hypocaloric feeding regimen, improves insulin resistance and may represent an adjunctive treatment for IFG and DM-2.

Increased alanine aminotransferase level and future risk of type 2 diabetes and impaired fasting glucose among the employees in a university hospital in Thailand

Aim The purpose of this study was to determine the association between baseline alanine aminotransferase (ALT) levels, and future risk of impaired fasting glucose and type 2 diabetes among the employees of a university hospital in Bangkok, Thailand. Methods Totally, 2370 and 1619 workers without diabetes and impaired fasting glucose (IFG) at baseline, respectively, who were 35 years or older were followed during 2001–2005. Diagnosis of IFG and type 2 diabetes was based on the fasting plasma glucose levels of 100–125 and greater or equal to 126 mg/dl, respectively. Results Higher baseline ALT levels were associated with future diabetes risk in an obvious dose-response manner (the OR [95% CI] for the groups with baseline ALT of 17–22, 23–38, and greater than 38 mg/dl comparing to the group with baseline ALT of 1–16 mg/dl were 4.75 [1.25–18.10], 6.14 [1.54–24.45], and 7.19 [1.32–39.16], respectively). Magnitude of association were even higher among those with existing IFG at baseline. The association patterns were consistent for both genders. Concerning the IFG risk, while those who developed IFG had significantly higher baseline ALT levels than those who remained normal at the end of follow-up period, further analyses did not show that baseline ALT was significantly associated with future IFG risk. Conclusion Present study provided supporting evidence from a cohort of Asian subjects about the ALT and future type 2 diabetes risk.

DWP3-1 The effect of lowering the threshold for diagnosis of impaired fasting glucose

DWP3-1 The effect of lowering the threshold for diagnosis of impaired fasting glucose

The Effect of Lowering the Threshold for Diagnosis of Impaired Fasting Glucose

PurposeThe aim of this study was to evaluate the effect of lowering the fasting plasma glucose (FPG) criteria for impaired fasting glucose (IFG) on the prevalence of IFG and the risk for the development of diabetes associated with IFG in Koreans.Materials and MethodsA total of 7,211 subjects who had normal glucose tolerance (NGT) or IFG were recruited. Subjects were evaluated at baseline and after two years follow up. Clinical data including total cholesterol, FPG and blood pressure were examined.ResultsLowering the criteria for IFG from 6.1 mmol/L (110 mg/dL) to 5.6 mmol/L (100 mg/dL) increased the prevalence of IFG from 6.6% (494 subjects) to 24.4% (1829 subjects). After the 2 years follow up period, 91 subjects (1.3%) developed diabetes. Twenty one (0.3%) subjects developed diabetes among 5,382 NGT subjects and 70 (3.8%) subjects developed diabetes among 1,829 IFG (5.6 - 7.0 mmol/L) subjects. Lowering the IFG threshold from 6.1 mmol/L to 5.6 mmol/L resulted in a 18.4% decrease in specificity and 23.9% increase in sensitivity for predicting diabetes. The baseline FPG for predicting the development of diabetes after 2 years at a point on the receiver operating characteristic curve that was closest to the ideal 100% sensitivity and 100% specificity was 5.7 mmol/L (103 mg/dL).ConclusionLowering the FPG criterion of IFG should have benefits in predicting new onset type 2 diabetes mellitus in Koreans. The economic and health benefits of applying the new IFG criteria should be evaluated in future studies.

Decreased Insulin Secretion and Insulin Sensitivity Are Associated With Liver Function in Subjects With Fasting Glucose Between 100 and 109 mg/dL in Taiwanese Population

In 2003, the American Diabetes Association recommended that the lower limit for the diagnosis of impaired fasting glucose (IFG) should be reduced from 110 to 100 mg/dL in the analysis of the associated risk factors of IFG. It has been proposed that liver dysfunction may contribute to the development of type 2 diabetes. A primary aim was to investigate the relationship between liver enzyme and insulin resistance (IR) in IFG group. The secondary aim was to investigate IR and beta-cell function assessed by homeostasis model assessment (HOMA-IR and HOMA-%B, respectively) in subjects with fasting plasma glucose (FPG) between 100 and 109 mg/dL. We enrolled 284 subjects whose medical history and physical examination required tests to screen for metabolic abnormalities. In addition, we also excluded all factors affecting glucose or insulin metabolism. According to the FPG level, they were divided into the following groups: group A, FPG < 100 mg/dL; group B, FPG = 100 to 109 mg/dL; group C, FPG = 110 to 125 mg/dL. Group B as compared with group A had significant increase of HOMA-IR and decrease of HOMA-%B. Among the whole population, the fasting insulin level, the fasting glucose, HbA1c, HOMA-IR, alanine aminotransferase, gamma-glutamyltranspeptidase, aspartate aminotransferase, and the diastolic blood pressure all increased significantly as the glycemic status progressed, whereas HOMA-%B levels decreased significantly as the glycemic status progressed. The lipid profile, alkaline phosphatase, and systolic blood pressure did not differ significantly among 3 different glycemic classifications. Study results indicate that, first, there was a significant decrease of insulin sensitivity and insulin secretion in subjects with fasting glucose from 100 to 109 mg/dL compared with subjects with normal fasting glucose. Second, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltranspeptidase were associated with IR as the glycemic status progressed in the IFG group.