Fasting Glucose Measurements Research Articles

Analysis of self-monitoring of blood glucose metrics in gestational diabetes mellitus and their association with infants born large for gestational age: A historical observational cohort study of 879 pregnancies.

Self-monitoring of blood glucose (SMBG) is the standard of care for women with gestational diabetes mellitus (GDM). This study aimed to review SMBG profiles in women with GDM and to examine how glucose metrics derived from SMBG relate to fetal overgrowth and infants born large for gestational age (LGA, >90th percentile). This was a single-center, historical, observational cohort study of 879 GDM pregnancies in Sweden. The diagnosis of GDM was based on a universal 75 g oral glucose tolerance test at gestational week 28 or 12 in high-risk women. The glucose metrics derived from the SMBG profiles were calculated. Treatment targets for glucose were <5.3 mmol/L fasting, and ≤7.8 mmol/L 1-h postprandial. The median (interquartile range) number of glucose measurements in the analysis for each woman was 318 (216-471), including 53 (38-79) fasting glucose measurements. Associations between glucose metrics and LGA were analyzed using binary logistic regression analysis adjusted for maternal age, body mass index, smoking, nulliparity, and European/non-European origin. Receiver operating characteristic (ROC) curves were used to evaluate glucose levels for LGA prediction. Differences in means were tested using analysis of variance. The proportion of LGA infants was 14.6%. Higher mean glucose levels and smaller proportion of readings in target (glucose 3.5-7.8 mmol/L) were significantly associated with LGA (odds ratio [95% confidence interval]: 3.06 [2.05-4.57] and 0.94 [0.92-0.96], respectively). The strongest association was found with mean fasting glucose (3.84 [2.55-5.77]). The ability of mean fasting glucose and overall mean glucose to predict LGA infants in the ROC curves was fair, with areas under the curve of 0.738 and 0.697, respectively (p < 0.001). The corresponding discriminating thresholds were 5.3 and 6.1 mmol/L, respectively. Mean glucose levels increased and readings in target decreased with increasing body mass index category and at each step of adding pharmacological treatment, from diet alone to metformin and insulin (p < 0.001). Higher mean glucose levels and a smaller proportion of readings within the target range were associated with an increased risk of LGA. Suboptimal glucose control is associated with obesity and the need for pharmacological treatment.

Observable, but Not Unobservable Health Numbers are Associated With Self-Reported Health: NHANES 2017-2020

Objective: Present study explored the influence of self-reported health on diff between observable and unobservable health factors. Method: Data obtained through the 2017-2020 pre-pandemic dataset of the National Health and Nutrition Examination Survey (NHANES). A series of analyses of covariance were conducted with self-reported health as the independent variable, and measures of blood pressure, waist-to-hip ratio, fasting glucose and total cholesterol as dependent variables. Family income served as a covariate. Results: Results revealed significant differences in self-reported health and blood pressure, waist-to-hip ratio, and fasting glucose. Individuals who rated their health excellent or very good tended to have better health numbers than those who rated their health as fair or poor. No statistically significant difference was found with self-reported health and cholesterol. Conclusion: It is possible that health numbers that can be observed (or assessed) at home, without a health care professional, may be more aligned with how individuals perceive their own health. Health care professionals may want to further help patients recognize their own health status. The use of wearable technologies may provide added health information resulting in more accurate perception of health. A more accurate perception of a patient’s own health may aid health care professionals in further improving patient care.

7788 Importance of Neuronal STAT3, but Not ERK2 or mTOR, for Pubertal Timing and Reproductive Activity in Mice

Abstract Disclosure: R.A. Lord: None. M.A. Inglis: None. G.M. Anderson: None. The adipose-derived hormone leptin is important for regulating reproduction. The canonical JAK2/STAT3 pathway is the best-characterised leptin receptor signalling pathway. Neural STAT3 deletion is known to cause obesity; however, its reproductive influence is less understood. This experiment investigated whether STAT3 knockout from brain neurons or AgRP neurons, a neuronal population necessary for normal pubertal timing and reproduction, would unveil the necessity of STAT3 in reproductive function. We also tested the role of ERK2 and mTOR, two alternative leptin signalling molecules.Transgenic mice with a neuronal knockout were created via the Cre-loxP system. CamKinaseIIα-Cre mice were crossed with STAT3, mTOR or ERK2 floxed mice. AgRP-Cre mice were crossed with STAT3 floxed mice for STAT3 knockout in AgRP neurons. All groups were compared to Cre-negative littermate controls (n=6-12/group). Puberty onset was assessed post-weaning by examining genitalia development. Reproductive cyclicity and organ weights were measured in adults. Metabolic effects were evaluated through body weight, abdominal fat and fasting glucose measurements. Brain tissue analysis evaluated cellular responses to leptin for STAT3, ERK2, and mTOR. Data presented as mean ± SEM.Mice with ERK2 KO or mTOR KO showed no reproductive or metabolic deficits compared to controls. In marked contrast, neuronal STAT3 KO mice showed significantly increased body weight by 5 weeks of age and a 6-fold increase in abdominal adiposity as adults (both p&amp;lt;0.001 using two-way ANOVA and Student’s t-test respectively) compared to controls. Males had a significant 5-day delay in age at preputial separation (KO: 32.1±2.09 d; Control: 26.8±0.45 d, p&amp;lt;0.01, Student’s t-test) while females had a significant 7-day delay in vaginal opening (KO: 33.0±1.85 d, Control: 26.6±0.37 d, p&amp;lt;0.05, Student’s t-test), a 9-day delay in first estrus (KO: 37.8±1.89 d; Control: 29.4±0.65 d, p&amp;lt;0.01, Student’s t-test) and pronounced acyclicity. Neuronal STAT3 KO mice also had a &amp;gt;2-fold elevation in fasting glucose levels (p&amp;lt;0.001, Student’s t-test) and regressed reproductive organs. Female mice with STAT3 knockout in AgRP neurons showed significantly increased body weight (by 3 weeks [p&amp;lt;0.001], two-way ANOVA) and a significant 3-day delay in first estrus (KO: 31.1±0.71 d, Control: 28.6±0.45 d, p&amp;lt;0.01, Student’s t-test). These data show that neuronal STAT3 is critical for correctly timed puberty and subsequent fertility in male and female mice, whereas mTOR and ERK2 are not essential. These results have prompted a re-evaluation of previous conclusions about the role of STAT3 from experiments using LepR-Cre mice. Additionally, AgRP neuronal requirements for STAT3 exactly recapitulate AgRP requirements for leptin receptors. A better grasp of leptin signalling pathways will improve our understanding of how infertility arises due to metabolic disease. Presentation: 6/3/2024

A-073 Is there a relationship of FIB 4 with weight and insulin resistance in subjects without type 2 diabetes and with normal transaminases?

Abstract Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common hepatic disease, affecting 20-30% of the world's population, and is more frequent in subjects with cardiometabolic diseases. The Fibrosis-4 Index (FIB-4) is a non-invasive scoring system that helps estimate the risk of hepatic fibrosis in MASLD. It is based on age, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and platelets (PLT). MASLD is associated with high risk of insulin resistance (IR) and type 2 diabetes (DM2), and subjects with overweight or obesity are more likely to have both. In such cases the association of FIB-4 with IR and weight are evident. It is questioned whether, even in subjects without DM2 and with normal transaminases, FIB-4 could be associated with the body mass index (BMI) and the homeostasis model assessment of insulin resistance index HOMA-IR, which is the index usually used to assess IR. The objective of this study was to evaluate how FIB-4 would behave in subjects without DM2 and with normal transaminases and whether there was a correlation between FIB-4 with HOMA-IR and BMI in these subjects. Methods Authors studied the distribution of FIB-4 results and correlation of HOMA-IR and BMI with FIB-4 using the database of a clinical laboratory. We included patients aged 20-65 years, both gender, who measured fasting glucose and insulin, in the same visit, and transaminases and platelets within up to one year before or later. Were excluded hospitalized subjects, those using medications to treat DM2, dyslipidemia, subjects with blood glucose over 200 mg/dL, and AST and/or ALT above the reference range for gender and age. The methods and reference intervals were: transaminases: UVKinetic, AST &amp;lt; 40 U/L for men and &amp;lt; 32 U/L for women, ALT &amp;lt; 41 for men and &amp;lt; 33 for women; PLT: automated method, 150000-450000/µL. Glucose: hexokinase, 70 - 99 mg/dL; Insulin: electrochemiluminescence, 2-12 mcU/mL. HOMA-IR index was calculated using the equation: glucose (mg/dL) x insulin (mcIU/mL) / 405 and FIB-4 using the equation: age (years) × TGO (U/L) / [(platelets (µL) ÷1000) x √TGP (U/L))]. Shapiro Wilk test was performed to assess whether the analytes had normal distribution. To evaluate the correlation with HOMA-IR, Spearman's non-parametric correlation test was used. Results After applying the exclusion criteria and subtracting outliers 270,135 records were selected, 75% female, with 39,9 ± 10.1 years. As the parameters did not present Gaussian distribution, the results are shown in median and 25th and 75th percentiles: AST=18.9 (16-22); ALT=17.2 (13-23.3); PLT=266000 (229000-308000); glucose = 89.3 (84.2-95); insulin = 8.17 (5.52-12.8); HOMA-IR=1.81 (1.19-2.75); IMC=26.53 (23.80-29.91); FIB-4 = 0.65 (0.5 - 0.86). A weak and surprisingly negative correlation between HOMA-IR and BMI with FIB-4 was found. (HOMA-IR: r=- 0.2, p&amp;lt;0.001; BMI: r=- 0.1, p&amp;lt;0.01). Conclusions Our study showed that in a population with normal transaminases, FIB-4 had results compatible with low risk of fibrosis in subjects without DM2 even in cases with high HOMA-IR or BMI. The negative correlation was surprising and perhaps indicates that FIB-4 may not be a good predictor of liver fibrosis for this population profile.

Arsenic exposure and measures of glucose tolerance in Bangladeshi adults: A cross-sectional study.

Arsenic has been associated with diabetes and impaired glucose tolerance in many studies, although some reports have shown null findings. We conducted a cross-sectional study among 300 adults in Bangladesh. Participants were randomly selected from a roster of 1800 people who previously participated in studies of arsenic and skin lesions. We measured fasting glucose and insulin levels. We assessed drinking water arsenic concentration using graphite furnace atomic absorption spectrophotometry (GF-AAS) and toenail arsenic concentration using inductively coupled mass spectrometry (ICP-MS). We ran covariant-adjusted, linear regression and spline models to examine associations of arsenic concentrations with the homeostatic model assessment of insulin resistance (HOMA-IR), a marker of insulin resistance, and HOMA of beta-cell function (HOMA-β), a marker of beta-cell function. Among 285 participants with complete data, the median (IQR) arsenic concentration was 4.0 (6.9) μg/g in toenails and 39.0 (188.5) μg/L in drinking water. Arsenic concentrations were not associated with insulin resistance or beta-cell function. HOMA-IR was 0.67% lower and HOMA-β was 0.28% lower per µg/g increment in toenail arsenic, but these effect estimates were small, and confidence intervals crossed the null value. Although arsenic exposure has been associated with diabetes, we found no evidence of an adverse effect on insulin resistance or beta-cell function.

The 5:2 Diet Affects Markers of Insulin Secretion and Sensitivity in Subjects with and without Type 2 Diabetes-A Non-Randomized Controlled Trial.

This non-randomized controlled trial aimed to compare the effect of the 5:2 diet on insulin levels as a primary outcome and markers of insulin secretion (connecting peptide (C-peptide) and insulin-like growth factor binding protein-1 (IGFBP-1)) and sensitivity (Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)), as well as body composition as secondary outcomes in overweight/obese individuals with and without type 2 diabetes (T2D). Ninety-seven participants (62% women), 35 with T2D and 62 BMI- and waist-matched controls without T2D, followed the 5:2 diet (two days per week of fasting) for six months with a 12-month follow-up. At six months, there was no loss to follow-up in the T2D group, whereas four controls discontinued this study. Overall, 82% attended the 12-month follow-up. After the intervention, insulin levels decreased in the control group and glucose decreased in the T2D group, while C-peptide, HOMA-IR, waist circumference, BMI, trunk, and total fat% decreased in both groups. Furthermore, low IGFBP-1, indicating hyperinsulinemia, improved in the T2D group. The changes in fasting glucose and waist measurement were significantly more improved in the T2D group than in the controls. Persistent positive effects were observed at the 12-month follow-up. The 5:2 diet for six months was feasible and efficient to reduce markers of insulin secretion and resistance and therefore holds promise as management of overweight/obesity in subjects with and without T2D.

Relationship between triglyceride-glucose index and endometriosis: a cross-sectional analysis

BackgroundThe link between insulin resistance and endometriosis is not well established. The triglyceride-glucose (TyG) index serves as a straightforward and economical indicator of insulin resistance. This study examines the link between the TyG index and the prevalence of endometriosis in a U.S. cohort.MethodsThis cross-sectional study analyzed data from the NHANES conducted between 1999 and 2006. Reproductive health was assessed through questionnaires, and the TyG index was derived from fasting triglyceride and glucose measurements. Weighted logistic regression models were used to analyze the relationship between the TyG index and endometriosis. Restricted cubic spline (RCS) curves explored the linear relationship, while stratified and sensitivity analyses assessed potential interactions and the robustness of the findings.ResultsThe study included 2,346 women, with 176 diagnosed with endometriosis and 2,170 without. Women with endometriosis exhibited an elevated TyG index compared to those without the condition. The weighted logistic regression analysis revealed that the TyG index is an independent risk factor for endometriosis (OR = 1.58, 95% CI 1.17–2.14, p = 0.004). RCS analysis indicated a significant positive linear association between the TyG index and endometriosis, with a turning point at 8.51. Subgroup analysis indicated a stronger association in certain populations. The post-propensity score matching analysis confirmed the robustness of these findings.ConclusionIn the U.S. population, a higher TyG index is positively and linearly associated with endometriosis prevalence. Effective management of blood glucose and lipid levels may reduce the prevalence of endometriosis.

The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study.

Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown. We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/mL) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/mL) between adult PWH with and without DM. Poisson regression was used to examine the rate of incident viremia based on the diagnosis of DM among PWH. DM was defined as two consecutive fasting glucose measurements ≥126 mg/dL, use of anti-diabetic medications, pre-existing DM diagnosis, or a confirmed HbA1c >6.5%. 1,061 women (112 with DM, 949 without DM) and 633 men (41 with DM, and 592 without DM) were included in the analysis. The relative rate (RR) of incident HIV viremia for women with HIV and DM was lower when compared to women without DM (0.85 [95% CI: 0.72-0.99]; p = 0.04). The RR of incident viremia for women with uncontrolled DM (HbA1c>7.5%) was higher when compared to women with controlled DM (HbA1c <7.5%) (1.46 [95%CI: 1.03-2.07]; p = 0.03). In contrast, the RR of incident viremia for men with HIV and DM was not statistically different compared to men without DM (1.2 [95%CI: 0.96- 1.50]; p = 0.12). The results were stratified by adherence levels (100%, 95-99%, and less than 95% based on self-report). Women with DM who are highly adherent to ART (100% self-reported adherence) have a lower risk of viremia compared to women with HIV without DM. However, women with poorly controlled DM were at higher risk of HIV viremia than women with controlled DM. Further research is necessary to understand the impact of sex, DM, and ART adherence on HIV viremia.

Clinical Features, Investigative Profile and Association with Metabolic Syndrome in Facial Acanthosis Nigricans: A Case–Control Study in Indian Patients

Objectives: The present study was undertaken to study the clinical profile and laboratory abnormalities in patients with facial acanthosis nigricans (FANs). The significance of FAN as a marker of insulin resistance (IR), metabolic syndrome (MS) and its components was determined by comparing with controls without FAN. Materials and Methods: Fifty clinically diagnosed cases of FAN of all ages and both sexes were enrolled. Age- and sex-matched obese patients without FAN were included as controls. Waist circumference, blood pressure and body mass index were measured. Venous samples were taken from all patients and controls for measuring fasting glucose level, fasting insulin levels and fasting lipid profile. Statistical analysis was done using the Chi-square test and unpaired t-test. Results: The prevalence of hypertension, dysglycaemia, hyperlipidaemia, elevated Homeostatic Model Assessment for IR (HOMA-IR) and MS was significantly higher in cases of FAN than controls (P &lt; 0.05). The mean levels of fasting blood sugar, HOMA-IR, hypertension, high-density lipoprotein and serum triglycerides were significantly higher in patients of FAN than controls (P &lt; 0.05). The odds ratio for FAN cases developing MS was determined to be 5.31. Conclusion: FAN may be considered as a significant clinical marker of IR with increased risk for MS and its component when compared to controls. All patients with FAN should be considered for a thorough biochemical workup to rule out MS. In all detected cases, it is prudent to initiate prompt remedial measures including lifestyle changes and pharmacotherapy to prevent long-term morbidity and mortality.

Abstract 3025: Association Of Systemic Insulin Sensitivity With Walking Distance In Peripheral Artery Disease

Background: Skeletal muscle in patients with peripheral artery disease (PAD) is subjected to chronic ischemia and is known to be insulin resistant. The association of insulin resistance with walking distance in unclear. Research Question: Does systemic insulin sensitivity (assessed by Homeostatic Model Assessment of Insulin Resistance [HOMA-IR] and Adipose tissue insulin resistance index [Adipo-IR]) associate with 6-minute walk test distance (6MWT)? Aims: To understand the role insulin resistance plays in ambulatory impairment in PAD. Methods: Patients with PAD (defined as ABI &lt;0.85) and age-matched controls (ABI 1.00-1.40) were recruited and underwent measurements of fasting glucose, free fatty acids (FFA), and insulin followed by 6-minute walk testing. HOMA-IR was calculated as (glucose [mg/dL] x insulin [uU/mL])/405 and Adipo-IR was calculated as FFA (mmol/L) x insulin (uU/mL). Comparisons between controls and those with PAD were done with Mann-Whitney U tests. Linear regression modeling was used to assess the association of insulin sensitivity with 6MWT. Results: Seventy subjects (median [IQR] age 67.5 [61.0, 73.0] years, 45 (64.3%) males) were recruited, including 20 controls and 50 with PAD. Insulin levels were significantly high in those with PAD (9.6 vs 12.1 uU/mL, p=0.05) while FFA (0.37 vs 0.34 mmol/L, p=0.04) levels were lower. Glucose levels were similar (77.9 vs 79.5 mg/dL, p=0.53). HOMA-IR was significantly higher in PAD (2.4 vs 2.0, p=0.03) while Adipo-IR was similar (3.9 vs 3.7, p=2.42). Insulin level, HOMA-IR, and Adipo-IR were significantly associated with 6MWT distance in univariate analysis, but no association was seen after adjusting for ABI, which strongly associated with walking distance. Conclusion: Patients with PAD exhibit systemic insulin resistance, although ABI was more strongly associated with 6MWT distance than the degree of insulin sensitivity.

The Interactive Effects of Sedentary Time, Physical Activity, and Fat Mass on Insulin Resistance in the Young Population.

Recent evidence in 9-year-old children with overweight/obesity followed up for 7 years until late adolescence concluded that increased physical activity (PA) decreased the risk of high fasting glucose, low insulin sensitivity, and secretion. However, whether this effect persists until young adulthood is unknown. This observational study examined the effects of cumulative sedentary time (ST), light PA (LPA), and moderate-to-vigorous (MVPA) on glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) in 11-year-old children followed up for 13 years until young adulthood. Altogether 792 children from the Avon Longitudinal Study of Parents and Children, UK who had data on at least two measures of accelerometer-based movement behaviour during ages 11, 15, and 24 years follow-up clinic visits with complete fasting glucose, insulin, and HOMA-IR measures at ages 15, 17, and 24 years were included. ST, LPA, and MVPA were measured with an accelerometer. Cumulative ST from ages 11-24 years was associated with increased odds (odds ratio 1.20 [95% CI 1.00-1.44] p=0.047) and cumulative LPA was associated with the decreased odds of hyperinsulinemia (0.80 [0.66-0.96] p=0.017) among participants with overweight/obesity. Cumulative MVPA was inversely associated with insulin but after accounting for the mediating role of fat mass, MVPA effect on lowering insulin decreased by 58% resulting in statistical non-significance. In the temporal path analyses, among participants with overweight/obesity, higher glucose at age 15 years was associated with lower LPA and MVPA at 24 years. Higher LPA at 15 years was associated with lower insulin and HOMA-IR at 24 years and vice-versa. Promoting LPA while decreasing body fat mass and ST may be considered crucial intervention targets to attenuate the risk of hyperinsulinemia and insulin resistance from childhood through young adulthood.

Metabolic Effects of Brown Adipose Tissue Activity Due to Cold Exposure in Humans: A Systematic Review and Meta-Analysis of RCTs and Non-RCTs.

Brown adipose tissue (BAT), specialized in thermoregulation in mammals, has been linked to improved glucose and lipid homeostasis when activated by cold exposure (CE). This systematic review and meta-analysis assessed the metabolic effects of CE-induced BAT activation in healthy humans, examining changes in glucose and lipid metabolism compared to thermoneutrality (TN). A literature search was conducted, identifying relevant human studies, including randomized controlled trials (RCTs) and non-RCTs, based on predefined inclusion criteria. Seven studies (a total of 85 participants) fully met the criteria. Data on plasma glucose, insulin, triglycerides (TGs), and free fatty acids (FFAs) were extracted for meta-analysis. When comparing TN and CE under fasting conditions, there were no significant changes in glucose, insulin, or TG concentrations (all p > 0.36). In contrast, CE significantly increased FFA concentrations (p = 0.002; n = 38). Bias was absent for all parameters, but heterogeneity was observed for insulin (I2 = 74.8%). CE primarily affects FFA concentration, likely reflecting cold-induced BAT activity. This suggests that circulating FFAs, serving as the primary fuel for thermogenesis, could indicate BAT activation. However, understanding the effects of BAT activation on overall metabolism requires a broader approach beyond fasting glucose and lipid concentration measurements.

Triglyceride-Glucose Index as A Crucial Marker for Polycystic Ovary Syndrome Women with Insulin Resistance

BACKGROUND: Insulin resistance (IR) is considered as the main driver of polycystic ovary syndrome (PCOS) pathogenesis. In PCOS condition, IR is frequently related to glucose, anthropometric profile, lipid profile, and hormone profile parameters. However, not all PCOS phenotype show IR. Therefore, this study was conducted to determine the association the parameters mentioned above in PCOS subjects with and without IR.METHODS: Fifty PCOS women with IR and 26 PCOS women without IR were recruited. All subjects underwent physical examination for measurement of weight, waist circumference (WC), and body mass index (BMI). Ferriman Gallwey Score (FGS) was used to evaluate hirsutism. Blood sample was taken from each subject for measurement of fasting glucose, postprandial glucose, fasting insulin, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglyceride (TG), sex hormone binding globulin (SHBG), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), follicle stimulating hormone (FSH), and prolactin. Homeostatic model assessment for IR (HOMA-IR), TG-glucose index (TyGI), and free testosterone index (FTI) were then calculated.RESULTS: From all the parameters examined, only fasting insulin (p&lt;0.001), HOMA-IR (p&lt;0.001), SHBG (p=0.012), TG (p&lt;0.001), and TyGI (p=0.008) that show significant differences between PCOS subjects with and without IR. After multivariate analysis, TyGI was found to have strong association with IR occurrence in PCOS subjects (p=0.005) with an odd ratio of 5.26 (1.65–16.74).CONCLUSION: TyGI appears to have a significant association with the IR occurrence in PCOS subjects. Hence, it can be suggested that TyGI could be an important marker for PCOS women with IR.KEYWORDS: insulin resistance, lipid metabolism, polycystic ovary syndrome, triglyceride-glucose index

Incident Proteinuria by HIV Serostatus Among Men With Pre--Diabetes Mellitus: The Multicenter AIDS Cohort Study.

Pre-diabetes mellitus (DM) is associated with proteinuria, a risk factor for chronic kidney disease. While people with human immunodeficiency virus (HIV; PWH) have a higher risk of proteinuria than people without HIV (PWOH), it is unknown whether incident proteinuria differs by HIV serostatus among prediabetic persons. The urine protein-to-creatinine ratio was measured at semiannual visits among men in the Multicenter AIDS Cohort Study since April 2006. Men with pre-DM on or after April 2006 and no prevalent proteinuria or use of antidiabetic medications were included. Pre-DM was defined as a fasting glucose level of 100-125 mg/dL confirmed within a year by a repeated fasting glucose or hemoglobin A1c measurement of 5.7%-6.4%. Incident proteinuria was defined as a urine protein-to-creatinine ratio (UPCR) >200 mg/g, confirmed within a year. We used Poisson regression models to determine whether incident proteinuria in participants with pre-DM differed by HIV serostatus and, among PWH, whether HIV-specific factors were related to incident proteinuria. Between 2006 and 2019, among 1276 men with pre-DM, proteinuria developed in 128 of 613 PWH (21%) and 50 of 663 PWOH (8%) over a median 10-year follow-up. After multivariable adjustment, the incidence of proteinuria in PWH with pre-DM was 3.3 times (95% confidence interval, 2.3-4.8 times) greater than in PWOH (P < .01). Among PWH, current CD4 cell count <50/µL (P < .01) and current use of protease inhibitors (P = .03) were associated with incident proteinuria, while lamivudine and integrase inhibitor use were associated with a lower risk. Among men with pre-DM, the risk of incident proteinuria was 3 times higher in PWH. Strategies to preserve renal function are needed in this population.

Effect of Testosterone on Progression From Prediabetes to Diabetes in Men With Hypogonadism

The effect of testosterone replacement therapy (TRT) in men with hypogonadism on the risk of progression from prediabetes to diabetes or of inducing glycemic remission in those with diabetes is unknown. To evaluate the efficacy of TRT in preventing progression from prediabetes to diabetes in men with hypogonadism who had prediabetes and in inducing glycemic remission in those with diabetes. This nested substudy, an intention-to-treat analysis, within a placebo-controlled randomized clinical trial (Testosterone Replacement Therapy for Assessment of Long-Term Vascular Events and Efficacy Response in Hypogonadal Men [TRAVERSE]) was conducted at 316 trial sites in the US. Participants included men aged 45 to 80 years with hypogonadism and prediabetes or diabetes who were enrolled in TRAVERSE between May 23, 2018, and February 1, 2022. Participants were randomized 1:1 to receive 1.62% testosterone gel or placebo gel until study completion. The primary end point was the risk of progression from prediabetes to diabetes, analyzed using repeated-measures log-binomial regression. The secondary end point was the risk of glycemic remission (hemoglobin A1c level <6.5% [to convert to proportion of total hemoglobin, multiply by 0.01] or 2 fasting glucose measurements <126 mg/dL [to convert to mmol/L, multiply by 0.0555] without diabetes medication) in men who had diabetes. Of 5204 randomized participants, 1175 with prediabetes (mean [SD] age, 63.8 [8.1] years) and 3880 with diabetes (mean [SD] age, 63.2 [7.8] years) were included in this study. Mean (SD) hemoglobin A1c level in men with prediabetes was 5.8% (0.4%). Risk of progression to diabetes did not differ significantly between testosterone and placebo groups: 4 of 598 (0.7%) vs 8 of 562 (1.4%) at 6 months, 45 of 575 (7.8%) vs 57 of 533 (10.7%) at 12 months, 50 of 494 (10.1%) vs 67 of 460 (14.6%) at 24 months, 46 of 359 (12.8%) vs 52 of 330 (15.8%) at 36 months, and 22 of 164 (13.4%) vs 19 of 121 (15.7%) at 48 months (omnibus test P = .49). The proportions of participants with diabetes who experienced glycemic remission and the changes in glucose and hemoglobin A1c levels were similar in testosterone- and placebo-treated men with prediabetes or diabetes. In men with hypogonadism and prediabetes, the incidence of progression from prediabetes to diabetes did not differ significantly between testosterone- and placebo-treated men. Testosterone replacement therapy did not improve glycemic control in men with hypogonadism and prediabetes or diabetes. These findings suggest that TRT alone should not be used as a therapeutic intervention to prevent or treat diabetes in men with hypogonadism. ClinicalTrials.gov Identifier: NCT03518034.

Risk Factors Associated with Diabetic Retinopathy with and without Macular Edema in Recently Diagnosed Patients with Type 2 Diabetes.

To evaluate the risk factors associated with diabetic macular edema (DME) in patients with a recent type 2 diabetes mellitus (T2DM) diagnosis. We conducted a case-control study at a third-level hospital in Mexico City. We enrolled patients ≥18 years old, with T2DM less than five years of diagnosis, without disabling complications, and non-smokers. The control group was patients with diabetic retinopathy and without macular edema (DR-DME). Cases were patients with DR+DME. We measured fasting glucose, creatinine, lipid profile, urinary albumin/creatinine ratio (ACR), and HbA1c. An ophthalmological examination consisted of visual acuity measurement, digital three-field fundus photography with an automatic non-mydriatic camera, slit lamp, and Optical coherence tomography (OCT) examination. 183 and 61 patients with DR-DME and DR+DME, respectively, were included in the analysis. The prevalence of mild DR was higher in the DR-DME group, but the frequencies of moderate and severe retinopathy were higher in the DR+DME group. Patients in the DR-DME group had better vision than those in the DR+DME group. Logistic regression analysis revealed that age (OR, 1.07), HbA1c (OR, 1.19), and Albumin-to-Creatinine Ratio (ACR) > 30 mg/g (OR, 3.37) were associated with an increased possibility of DME compared to DR-DME. Our study provides insights into the association between risk factors and DME. We found a statistically strong association between HbA1c levels, age, and ACR. Patients with poor metabolic control should undergo an extensive medical examination to screen for DME, which may be related to the chronicity of DM and renal damage.

Obesity from Clinical Evaluation to Management Local Perspective

For over two millennia, physicians have been aware of the morbidity and mortality linked to overweight and obesity. Various definitions of obesity, as outlined by the World Health Organization (WHO) and the Centers for Disease Control &amp; Prevention (CDC), utilize the Body Mass Index (BMI) to characterize these conditions. Screening for high-risk patients is crucial for guiding lifestyle changes, treatment decisions, and risk reduction strategies.1,2 The assessment involves clinical and laboratory studies to categorize the type and severity of obesity, forming the foundation for effective management. Globally, the prevalence of obesity in 2015 exhibited a rising trend in females compared to males. Between 1980 and 2015, the prevalence surged from 11.1% to 38.3% for males aged 25 to 29 in low to middle-income countries.3 Pakistan ranks tenth among 188 countries, with half of its population classified as overweight or obese. Alarming projections from the World Obese Federation estimate that 5.4 million Pakistani school-aged children will grapple with obesity by 2030, emphasizing the dual challenges of overnutrition and poor nutrition.4,5 World Health Organization data indicates that 58.1% of Pakistanis are overweight, with 43.9% classified as obese. Asian cutoffs, though not globally recognized, suggest that 72.3% of Pakistanis are overweight, with obesity affecting 58.1% of the population. Research by Danielle H. Bodicoat et al. suggests an obesity threshold of 25 kg/m2 for South Asian individuals, coupled with a very high Waist Circumference (WC).6 A WC ≥ 31 inches (80cm) in Asian females and ≥ 35 inches (90cm) in Asian males is considered abnormal. The primary rationale for managing obesity is to mitigate morbidity, including conditions like diabetes, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, and cancer, ultimately reducing mortality. The initial step in managing obesity involves screening to determine the degree of overweight using BMI and waist circumference measurements. However, studies reveal that only 6% of individuals receive ongoing care for weight management, such as prescriptions for obesity medication or referrals to dieticians.7,8 BMI classifications, primarily based on cardiovascular disease (CVD) risk, may underestimate risks for conditions like diabetes in the Asian population. Beyond BMI, measuring waist circumference is essential for identifying adults at increased risk for morbidity and mortality, especially in the BMI range of 25 to 35 kg/m2.9 In addition to physical examinations, measurements of fasting glucose (or glycated hemoglobin [A1C]), thyroid-stimulating hormone (TSH), liver enzymes, and fasting lipids should be conducted.10 Investigating the causes of obesity involves ruling out a sedentary lifestyle, increased caloric intake, and secondary factors. Medical history should include inquiries about medications that cause weight gain and smoking cessation. Weight loss interventions are recommended for those with a BMI exceeding 25 kg/m2, aiming to prevent, treat, or reverse complications associated with obesity. In conclusion, managing obesity in the Pakistani population requires a comprehensive approach involving clinical and laboratory assessments by physicians. This includes evaluating height, weight, BMI, waist circumference, blood pressure, serum triglycerides, serum HDL, cholesterol, fasting blood sugar/HbA1C, history of sleep apnea, medication history, physical activity, and etiological factors. Moreover, physicians should possess knowledge of dietary goals and medications promoting weight loss and consider bariatric surgery if non-responsive to other interventions.

RACE AND SEX DIFFERENCES IN RELATIONS OF DIABETES BIOMARKERS WITH PHYSICAL FUNCTIONING BEFORE DIABETES ONSET

Abstract It remains unclear if declines in physical functioning linked to Type 2 diabetes (T2DM) occur even before T2DM onset. We examined the longitudinal associations of T2DM biomarkers with upper and lower extremity strength among adults without T2DM at baseline. Participants were 1,572 African American (AA) and White adults (M(SD) age at baseline = 47.3 (9.7) years, 55% female, 53% AA) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, assessed on up to 3 time points between 2004-2017. Participants provided blood samples for measurement of fasting glucose and glycosylated hemoglobin (HbA1c), and completed dominant and nondominant handgrip strength assessment, and a chair stands task to assess upper and lower extremity strength, respectively. Linear mixed effects regression models estimating relations of HbA1c on age-related change and adjusting for race, sex, literacy, and poverty status revealed significant four-way interactions of HbA1c, race, sex, and age (B = -.2.59, t(2853) = -2.0 p = 0.04), and to a lesser extent of fasting glucose, race, sex, and age (B = -.07, t(2863) = -1.84 p = 0.06) on change in the chair stands task, but not on handgrip strength (ps &amp;gt; 0.29). Among younger AA and White men, and younger White women, increasing HbA1c was related to worse lower extremity strength. However, among AA women, and older White women, increasing HBA1c was related to better lower extremity strength. Our findings suggest differential relations of worse glucose regulation on physical functioning amongst African American and White men and women.

Cardiac and Metabolic Effects of Bariatric Surgery Among Obese Patients in a Malaysian Tertiary Hospital: A 6-month Prospective Cohort Study.

Obesity is known to be associated with left ventricular diastolic dysfunction due to its effect on blood pressure and glucose tolerance. We aimed to investigate whether weight loss after bariatric surgery might improve diastolic dysfunction through in-depth echocardiographic examination. We recruited twenty-eight patients who were about to undergo bariatric surgery by purposive sampling. They underwent echocardiography at baseline and 6 months after surgery with a focus on diastolic function measurements and global longitudinal strain (GLS). They also had fasting serum lipid and glucose measurements pre- and post-surgery. The mean weight loss after surgery was 24.1 kg. Out of the 28 subjects, fifteen (54%) initially had diastolic dysfunction before surgery. Only two had persistent diastolic dysfunction 6 months after surgery. The mean indexed left atrial volume 6 months post-surgery was 27.1 from 32 ml/m2 prior to surgery. The average E/e' is 11.78 post-surgery from 13.43 pre-surgery. The left ventricular GLS became (-)25.7% after surgery from (-)21.2% prior to surgery. Their post-surgery fasting serum lipid and glucose levels also showed significant improvement. Our study reinforced the existing evidence that bariatric surgery significantly improved echocardiographic parameters of diastolic function and left ventricular global longitudinal strain, along with various metabolic profiles.

Indication of mixed glucose and fatty acid use by inferred brown adipose tissue activity in Samoans.

Despite the growing rates of global obesity and the known positive associations between brown adipose tissue (BAT) and cardiovascular health, little is known about the metabolic effects of BAT activity in Samoans, a population at high risk of obesity and type II diabetes. Here we assessed the potential effects of inferred BAT activity on metabolic health markers in Samoan adults exposed to mild cold. Using point-of-care finger prick technology we measured fasting glucose, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels before and after 30 min of cold exposure among 61 individuals (38 females, 23 males, ages 31-54) from 'Upolu Island, Samoa. Respiratory quotient was measured by indirect calorimetry to determine substrate metabolism at room temperature and cold exposure. Fasting glucose levels decreased significantly (p < .001) after cold exposure while neither total cholesterol (p = .88), HDL (p = .312), nor LDL (p = .089) changed. Respiratory quotient decreased significantly (p = .009) between exposures, suggesting an increased preference for lipid metabolism as a response to cold. The observed effects of inferred BAT activity on biomarkers suggest BAT activity utilizes both glucose and lipid-derived fatty acids as fuel for thermogenesis. Our work provides evidence for the beneficial metabolic effects of BAT and emphasizes the need for the population-specific development of metabolic treatments involving BAT to ensure the successful and equitable minimization of extreme consequences of obesity and metabolic health.