Diagnostic Threshold For Diabetes Research Articles

Impact of Statin Therapy on Diabetes Incidence: Implications for Primary Prevention

Abstract Purpose of Review The present review aims to summarize current evidence, explore underlying mechanisms, and help guide clinicians regarding statin therapy and diabetes risk in primary prevention. Recent Findings The observational and genetic epidemiology, as well as evidence from randomized controlled trials and meta-analyses, illustrate a modest, dose-dependent increase in risk of diabetes from statin therapy. Summary Risk of new onset diabetes from statins appears to be greatest in those near the diagnostic threshold for diabetes or with diabetes risk factors prior to statin initiation. The risk of incident diabetes is vastly offset by the cardiovascular protection offered from statin therapy and should not deter guideline recommended statin initiation in primary prevention.

Management of Prediabtes (An Increased Risk of Type 2 Diabetes) with Life Style Modifications

Prediabetes, characterized by elevated blood glucose levels that are below the diagnostic threshold for diabetes, poses a significant health challenge worldwide due to its association with an increased risk of developing type 2 diabetes mellitus. This abstract explores the crucial role of lifestyle modifications in the effective management of prediabetes, emphasizing a holistic approach to prevent or delay the progression to overt diabetes. The primary focus of this review is on lifestyle interventions, including dietary changes, regular physical activity, and weight management, as key strategies to address the underlying factors contributing to insulin resistance and impaired glucose metabolism. Evidence from clinical studies underscores the efficacy of these interventions in improving insulin sensitivity, promoting weight loss, and stabilizing blood glucose levels among individuals with prediabetes. Furthermore, the abstract highlights the importance of personalized and sustainable lifestyle modifications, considering individual preferences, cultural influences, and socioeconomic factors. Behavioral interventions, such as motivational coaching and support groups, are discussed as essential components to facilitate long-term adherence to healthy lifestyle practices. In conclusion, this article advocates for a comprehensive and patient-centered approach to managing prediabetes, with a strong emphasis on lifestyle modifications. By empowering individuals with prediabetes to make sustainable changes in their daily habits, there is a promising avenue to curb the progression to type 2 diabetes and improve overall health outcomes.

Abstract 17511: Aortic Stiffness Among Mexican-American Adults With Diabetes and Prediabetes: Evidence of Accelerated Vascular Aging and Increased Cardiac Biomarkers

Introduction: Type 2 diabetes mellitus is associated with increased aortic stiffness, a finding that predicts adverse cardiovascular events. Whether individuals with dysglycemia below the diagnostic threshold for diabetes have increased aortic stiffness has been less studied, particularly in Hispanic adults, a population sharing a disproportionate burden of dysglycemia. Hypothesis: We hypothesized that individuals with prediabetes would: (1) have increased aortic stiffness compared to normal glycemia, and (2) increased aortic stiffness would be associated with biomarkers of myocardial injury. Aims: We aimed to: (1) identify the relationship between aortic stiffness and glycemic status in a Hispanic cohort, and (2) determine the relationship between cardiac biomarkers and aortic stiffness. Methods: We prospectively measured carotid-femoral pulse wave velocity (PWV) and glycemic measures in 728 Mexican American adults in Starr County, Texas. Cardiovascular biomarkers [high-sensitivity troponin T (hs-TnT), galectin-3, and NT-proBNP] were measured in a subset (n=404). Multivariable models (using natural log PWV) were used to adjust for confounders. Results: 45% of participants had diabetes, and 28% had prediabetes. PWV increased across glycemic categories; median PWV (25 th , 75 th ) in diabetes was 11.7 m/sec (9.9, 13.7), prediabetes 9.9 m/sec (8.6, 11.1), and normal glycemia 8.7 m/sec (7.9, 9.9) (adjusted p-value <0.001 and 0.008, respectively). The figure demonstrates PWV stratified by age decade; PWV in prediabetes was similar to PWV in those without diabetes who were a decade younger. Median levels of hs-TnT, galectin-3, and NT-proBNP increased across quartiles of PWV (p trend <0.001 for all). Conclusion: In a cohort of Hispanic adults, increased aortic stiffness develops before the onset of diabetes and seen in those with pre-diabetes. Importantly, increased aortic stiffness is associated with biomarkers of cardiac injury.

Dried Blood Spot Test for Glycated Hemoglobin Measurement in Pediatric Diabetes Care

BackgroundThe dried blood spot (DBS) card is a novel collection method for measuring glycated hemoglobin (A1C) in individuals with diabetes mellitus. The potential benefits of DBS specimens compared with traditional phlebotomy include a reduction in required total blood volume, reduced procedural pain, and an ability for self-initiated collection. DBS cards for A1C measurement have been validated in the adult population, but there is a paucity of pediatric data. MethodsThe aim of this study was to validate the use of A1C measurement by DBS cards in comparison to venous A1C and to identify potential barriers to implementing this novel approach. Venous and DBS card A1C samples were collected simultaneously from 62 patients at their local laboratory and transported to the central provincial lab for analysis. Correlation analyses compared venous and DBS A1C with data rescaling performed to account for the DBS–venous interassay difference. ResultsMean venous A1C was 7.49% and DBS A1C was 7.26%, with an interassay difference of 0.23%. Data showed a strong, positive correlation between A1C collection methods (r=0.86, p<0.001); this was further strengthened at lower A1C values (A1C <7.5%, r=0.87, p<0.0001). A stronger relationship emerged when the data were rescaled to account for the DBS–venous interassay difference (r=0.8935, p<0.0001). ConclusionsGiven the potential feasibility, practicality, accessibility, cost-effectiveness, and performance characteristics of the DBS A1C, especially at lower A1C values hovering around the diagnostic threshold for diabetes, this study provides supporting evidence for consideration of the use of DBS A1C testing in pediatric diabetes care.

Neuropathy in prediabetes.

Diabetic neuropathies are the most frequent complications of diabetes, contributing to high morbidity, excess mortality, reduced quality of life, and increased healthcare costs. Prediabetes is characterised by glucose levels within an intermediate range above normoglycaemia yet below the diagnostic threshold for diabetes. In 2021, 10.6% and 6.2% of adults worldwide were estimated to have impaired glucose tolerance and impaired fasting glucose, respectively, the majority of whom are unaware of having prediabetes. Evidence has accumulated suggesting that prediabetes is a predictor of cardiovascular disease (CVD) and increased mortality. The past 2decades have witnessed an extensive debate, particularly among diabetologists and neurologists, as to whether prediabetes is associated with peripheral neuropathy. In this review, we elaborate on the current evidence, particularly from population-based studies supporting an increased risk of distal sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN) in people with prediabetes. Moreover, we discuss whether lifestyle interventions showing efficacy in preventing or delaying the transition from prediabetes to diabetes in persons with prediabetes may also exert favourable effects on the development and progression of DSPN and CAN. This review should help in raising the awareness of and translating the current knowledge on neuropathies in people with prediabetes into clinical practice and public health. The current recommendation that adults who are overweight or obese should be screened for prediabetes and referred to or offered preventive interventions should ultimately culminate in preventing not only CVD but also prediabetic neuropathy.

The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Prevent Diabetes in People With Prediabetes.

Individuals with an elevated fasting glucose level, elevated glucose level after glucose challenge, or elevated hemoglobin A1c level below the diagnostic threshold for diabetes (collectively termed prediabetes) are at increased risk for type 2 diabetes. More than one-third of U.S. adults have prediabetes but fewer than one in five are aware of the diagnosis. Rigorous scientific research has demonstrated the efficacy of both intensive lifestyle interventions and metformin in delaying or preventing progression from prediabetes to type 2 diabetes. The National Clinical Care Commission (NCCC) was a federal advisory committee charged with evaluating and making recommendations to improve federal programs related to the prevention of diabetes and its complications. In this article, we describe the recommendations of an NCCC subcommittee that focused primarily on prevention of type 2 diabetes in people with prediabetes. These recommendations aim to improve current federal diabetes prevention activities by 1) increasing awareness of and diagnosis of prediabetes on a population basis; 2) increasing the availability of, referral to, and insurance coverage for the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program; 3) facilitating Food and Drug Administration review and approval of metformin for diabetes prevention; and 4) supporting research to enhance the effectiveness of diabetes prevention. Cognizant of the burden of type 1 diabetes, the recommendations also highlight the importance of research to advance our understanding of the etiology of and opportunities for prevention of type 1 diabetes.

Prediabetes Defined by First Measured HbA1c Predicts Higher Cardiovascular Risk Compared With HbA1c in the Diabetes Range: A Cohort Study of Nationwide Registries.

To assess the risk of major adverse cardiovascular events (MACE), all-cause mortality, and initiation of medical treatment in subjects with prediabetes according to first-time measured HbA1c. Through registry databases, we identified 326,305 Danish patients with a first HbA1c between 40 and 51 mmol/mol (5.8-6.8%) from 2011 to 2017. After exclusion of patients with prior disease, 84,678 patients were followed 12 months after first HbA1c measurement. Cox regression models were used to estimate hazard ratios (HRs) of MACE and standardized absolute risks. Cumulative incidences were used to analyze initiation of glucose-lowering, antihypertensive, cholesterol-lowering, and antithrombotic medication. The 12-month risk of MACE and all-cause mortality increased gradually with increasing HbA1c until 47 mmol/mol (6.5%). In comparisons of subjects with HbA1c 40-41 mmol/mol (5.8-5.9%), subjects with HbA1c 46-47 mmol/mol (6.4-6.5%) had a 0.79% (95% CI 0.33-1.24) higher standardized absolute risk and an HR of 2.21 (95% CI 1.67-2.92) of MACE. Patients with HbA1c 48-49 mmol/mol (6.5-6.6%) had a 0.09% (95% CI -0.35 to 0.52) lower absolute risk and an HR of 1.33 (95% CI 0.87-2.05) of MACE. Initiation of medication was significantly lower among patients with HbA1c of 46-47 mmol/mol (6.4-6.5%) than among patients with HbA1c of 48-49 mmol/mol (6.5-6.6%). In the Danish population screened for diabetes with HbA1c, the highest risk of MACE and all-cause mortality was found in subjects with HbA1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk factors for subjects with prediabetes.

Consumption of a meal containing refined barley flour bread is associated with a lower postprandial blood glucose concentration after a second meal compared with one containing refined wheat flour bread in healthy Japanese: A randomized control trial.

Foods reducing postprandial hyperglycemia could suppress the postprandial blood glucose response after the next meal (a "second-meal" effect). However, the second-meal effect of refined barley flour bread has not been evaluated. The aim of this study is to determine whether consumption of refined barley flour bread reduces postprandial glucose concentrations after this and the subsequent meal. We enrolled 23 healthy young Japanese adults and conducted a randomized, double-blind, placebo-controlled, crossover study. The participants consumed refined barley flour bread containing 2.5 g β-glucan or refined wheat flour bread in a first meal, then consumed three rice balls as a second meal. Their postprandial blood glucose concentrations were measured 0, 15, 30, 45, 60, 90, and 120 min after both meals. Participants with fasting glucose concentrations above the diagnostic threshold for diabetes were excluded. The blood glucose concentration 30 min after the first meal was significantly lower (P < 0.05) if refined barley flour bread (7.1 ± 1.0 mmol/L) rather than refined wheat flour bread (7.7 ± 1.2 mmol/L) was consumed. Significantly lower glucose concentrations after the second meal measured at 60 (P < 0.05, barley flour bread: 8.7 ± 1.8 mmol/L, wheat flour bread: 9.3 ± 1.7 mmol/L) and 90 min (P < 0.01, barley flour bread: 7.8 ± 1.4 mmol/L, wheat flour bread: 8.8 ± 2.1 mmol/L) were lower in participants who had previously consumed the refined barley flour bread. Consumption of bread made with refined barley flour lowers postprandial blood glucose concentration after this and a subsequent meal compared with the consumption of refined wheat flour bread in healthy young Japanese adults.

Variation of HbA1c affects cognition and white matter microstructure in healthy, young adults.

The metabolic serum marker HbA1c has been associated with both impaired cognitive performance and altered white matter integrity in patients suffering from diabetes mellitus. However, it remains unclear if higher levels of HbA1c might also affect brain structure and function in healthy subjects. With the present study we therefore aimed to investigate the relationship between HbA1c levels and cognitive performance as well as white matter microstructure in healthy, young adults. To address this question, associations between HbA1c and cognitive measures (NIH Cognition Toolbox) as well as DTI-derived imaging measures of white matter microstructure were investigated in a publicly available sample of healthy, young adults as part of the Humane Connectome Project (n = 1206, mean age = 28.8 years, 45.5% male). We found that HbA1c levels (range 4.1-6.3%) were significantly inversely correlated with measures of cognitive performance. Higher HbA1c levels were associated with significant and widespread reductions in fractional anisotropy (FA) controlling for age, sex, body mass index, ethnicity, and education. FA reductions were furthermore found to covary with measures of cognitive performance. The same pattern of results could be observed in analyses restricted to participants with HBA1c levels below 5.7%. The present study demonstrates that low-grade HbA1c variation below diagnostic threshold for diabetes is related to both cognitive performance and white matter integrity in healthy, young adults. These findings highlight the detrimental impact of metabolic risk factors on brain physiology and underscore the importance of intensified preventive measures independent of the currently applied diagnostic HbA1c cutoff scores.

HbA1c is significantly associated with arterial stiffness but not with carotid atherosclerosis in a community-based population without type 2 diabetes: The Dong-gu study

ObjectivesWe examined the associations between HbA1c levels and various atherosclerotic vascular parameters among adults without diabetes from the general population. MethodsA total of 6500 community-dwelling adults, who were free of type 2 diabetes and ≥50 years of age, were included. High-resolution B-mode ultrasound was used to evaluate carotid artery structure, including intima-media thickness (IMT), plaque, and luminal diameter. Brachial-ankle pulse wave velocity (baPWV), which is a useful indicator of systemic arterial stiffness, was determined using an automatic waveform analysis device. ResultsNo significant associations were observed between HbA1c, carotid IMT, plaque, or luminal diameter in a fully adjusted model. However, the odds ratio (95% confidence interval) for high baPWV (defined as the highest quartile) increased by 1.43 (1.19–1.71) per 1% HbA1c increase after adjusting for conventional risk factors in a multivariate logistic regression analysis. In addition, HbA1c was independently associated with baPWV in a multivariate linear regression analysis. ConclusionsHigh-normal HbA1c level was independently associated with arterial stiffness, but not with carotid atherosclerotic parameters, in the general population without diabetes. Our results suggest that the functional atherosclerotic process may already be accelerated according to HbA1c level, even at a level below the diagnostic threshold for diabetes.

A rightward shift of the distribution of fasting and post‐load glucose in northern Sweden between 1990 and 2009 and its predictors. Data from the Northern Sweden MONICA study

Most Swedish studies show stable diabetes prevalence despite increasing obesity, but glucose levels may shift upwards below the diagnostic threshold for diabetes. Our aim was to explore trends in glucose distribution in northern Sweden; whether these trends were uniformly distributed throughout the spectrum of glucose concentrations; and to relate trends to traditional risk factors and the obesity-related adipokine leptin. The project consisted of four cross-sectional surveys between 1990 and 2009, with 7069 participants aged 25-64 years. The overall participation rate was 74.4%. Trend analyses of glucose concentrations along the entire distribution and linear regression in relation to survey years and risk markers were used. Fasting and post-load glucose increased in women (both P < 0.001) and post-load glucose in men (P = 0.004). The increase was seen in most deciles of glucose concentrations. The prevalence of impaired glucose tolerance doubled in women to 14.5% and tripled in men to 10.1% (both P = 0.004). The prevalence of impaired fasting glucose rose in women from 4.5 to 7.7% (P < 0.001). The prevalence of diabetes was unchanged-6.4% in 2009. In men, leptin, together with traditional risk factors, explained 7.8 and 10.8% of the variance in fasting (P = 0.008) and post-load (P < 0.001) glucose, respectively. Increasing fasting and post-load glucose concentrations were seen in most deciles of the glucose distribution, indicating a shift in the entire population. Leptin was significantly associated with fasting and post-load glucose in men.

Dysglycemia: A Key Cardiovascular Risk Factor

Although diabetes is a strong independent risk factor for cardiovascular events, this risk is not confined to glucose levels above the diagnostic threshold for diabetes. Rather, there is now a growing consensus that the risk of cardiovascular events rises progressively as the fasting and postprandial glucose levels rise from the clearly normal range right into the diabetes range. Hence, dysglycemia (i.e., any elevated fasting or glucose level) is a progressive, continuous risk factor for cardiovascular events. In this respect it resembles every other well-established and progressive cardiovascular risk factor, such as age, LDL cholesterol, systolic and diastolic blood pressure, degree of smoking, albumin excretion, and body mass index. Whether or not strategies designed to normalize glucose levels in people with either diabetes or lesser degrees of dysglycemia will also reduce cardiovascular risk remains to be established. The results of several large international trials of glucose lowering in dysglycemic individuals should clarify the cardiovascular benefits of such an approach within the next few years.

Clinical Evaluation of a New, Miniaturized Biosensor for Self-monitoring of Blood Glucose

The American Diabetes Association (ADA) has estimated that in 1993 7.8 million people in the United States had type 1 or type 2 diabetes (1) . About 70% of these individuals self-monitor blood glucose, and ∼2 million glucose meters were purchased in 1995–1996 (2) . The ADA’s recent reduction in the diagnostic threshold for diabetes is expected to increase the number of diagnosed patients (3) . Electrochemical meter systems offer some advantages for self-monitoring: compact size, rapid test time, and small sample volume. In this study, the analytical performance of a prototype of the FastTake™ system was evaluated for providing accurate and reproducible blood glucose results. The FastTake system is based on the enzymatic oxidation of glucose (glucose oxidase) using a mediator (ferricyanide) and electrochemical detection. The system produces rapid (15 s) plasma equivalent results from capillary whole blood samples over a wide range of glucose concentrations (200–6000 mg/L). The test strip contains a carbon-based working electrode, silver/silver chloride reference electrode, and dry reagents. This strip has been optimized to reduce temperature and hematocrit sensitivities, using nonconductive, partially silanized silica fillers, selected to balance the hydrophobicity/hydrophilicity of the reaction environment (4) . The silica filler forms a gelatinous layer, which restricts large sample components such as red blood cells from impairing the …