Fasting Plasma Glucose Values Research Articles

Short-term outcome of metabolic surgery versus intensive medical therapy among obese type 2 diabetics: a quasi-experimental study

Objective: To compare the short-term outcomes of metabolic surgery and intensive medical therapy in the management of diabetes mellitus among obese persons with type 2 diabetes mellitus. Methods: The quasi-experimental study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from March 2018 to February 2019, and comprised obese type 2 diabetes mellitus patients of either gender aged 20-65 years. Those undergoing metabolic and bariatric surgery were assigned group A, while those undergoing intensive medical therapy formed control group B. All patients were followed up for 6 months to monitor their metabolic profile, including body mass index, glycosylated haemoglobin and fasting plasma glucose. Data was analysed using SPSS 20. Results: Of the 72 patients, 36(50%) were in group A; 23(63.9%) females and 13(36.1%) males with mean age 41.2 years (SD± 10.2). The remaining 36(50%) patients were in group B; 22(61.1%) males and 14(38.9%) females with mean age 42.5 years (SD ± 10.6) (p>0.05). At 6 months, mean body mass index, glycosylated haemoglobin and fasting plasma glucose values were significantly lower in group A compared to group B (p<0.001). There were 33(91.7%) patients in group A with remission of diabetes compared to 1(2.8%) patient in group B (p<0.001). Conclusion: Bariatric surgery was found to produce a good early outcome in the management of diabetes in the obese population, leading to remission post-surgery. Key Words: Bariatric surgery, Metabolic surgery, Obese T2DM, Diabetes remission, Diabetes.

Association between the early or late onset of gestational diabetes mellitus with neonatal adverse outcomes: a retrospective cohort study

BackgroundThe literature has been evolving to standardize gestational diabetes mellitus (GDM) diagnosis and terminology. The significance of timing in diagnosing hyperglycemia during pregnancy is underlined by evidence that women diagnosed at 24 weeks of gestation or earlier are at a higher risk of developing postpartum prediabetes, but its association with adverse outcomes for the newborn is controversial. We aimed to investigate the association between early-onset GDM and adverse outcomes in newborns and neonates, comparing it with the late-onset GDM model.MethodsIt was a retrospective cohort study conducted at the Perinatal Diabetes Research Center in Assis/SP, affiliated with the Botucatu Medical School-UNESP in Brazil. The group composition was as follows: early-onset participants had fasting glucose levels ≥ 92 mg/dL and < 126 mg/dL before 20 weeks of gestation, while late-onset participants had a negative first-trimester screening and a positive 75g-OGTT at 24–28 weeks. For early-onset GDM, a fasting glucose level of ≥ 92 mg/dL is a recognized threshold associated with an increased risk of adverse pregnancy outcomes, while < 126 mg/dL ensures the exclusion of overt diabetes. The criteria for late-onset GDM, involving a negative initial screening and a positive OGTT at 24–28 weeks, align with the standard diagnostic timeframe when insulin resistance typically peaks due to placental hormone secretion. The maternal baseline characteristics included pre-pregnancy body mass index (BMI; kg/m2) and pregnancy weight gain (kg), calculated as the difference between the final pregnancy weight (36 gestational weeks or more) and pre-pregnancy maternal weight, classified according to the pre-pregnancy BMI. Additionally, the perinatal outcomes evaluated in this study included gestational age (GA) at birth, birth weight (BW) categorized according to GA as adequate, large, or small and Apgar scores at the first and 5th minutes.ResultsEight hundred eighty pregnant women were selected, of whom 203 (23.07%) presented GDM and were eligible from December 2016 to December 2021. Based on the timing onset of GDM, 89 (43.8%) were in the early-onset group, and 114 (56.2%) were in the late-onset group. The fasting plasma glucose values in the first trimester were higher in the early-onset group. The 75-g OGTT values were higher in the late-onset group. The final BMI was higher in the early-onset group. Univariate linear regression was performed to determine the relationship between late-onset and maternal and neonatal outcomes; however, no significant relation was detected.ConclusionPregnant women with early-onset GDM showed a higher BMI during pregnancy, but there was no difference between early and late-onset GDM concerning neonatal adverse outcomes.

Is Nutritional Status Associated with Quantitative Insulin Sensitivity Check Index in the First Trimester of Gestation?

Background: As pregnancy progresses, insulin sensitivity (SI) might slowly decrease to 50% of the average value, which could result in gestational diabetes. As weight gain is associated with reduced SI and vice versa, we evaluated the possible correlation between nutritional status and SI, especially in early pregnancy. Methods: This cross-sectional study was conducted on 138 healthy primiparous women between 6 and 10 weeks of gestation. By using a researcher-made questionnaire, the characteristics of the participants were gathered. A digital scale was used to measure participants’ weights. Nutrient intake was estimated based on the 72-hour dietary recall by Nutritionist 4 software. We used the pregnancy physical activity scale to estimate physical activity. In addition, fasting plasma glucose (FPG) and insulin values were included in the relevant formula to calculate the quantitative index of SI. Results: After adjusting for significant maternal characteristics, the quantitative insulin sensitivity check index (QUICKI) in the first trimester was correlated with participants’ weight and household income. Furthermore, the QUICKI index had a significant inverse relationship with saturated and polyunsaturated fatty acids (PUFAs) intake while total fat intake was positively correlated. Also, consuming vitamin C, glucose, fructose, sugar, and carbohydrates increased the QUICKI index, while vitamin E intake decreased it. Conclusion: The results showed that weight management may prevent gestational diabetes mellitus (GDM) during the first trimester. Moreover, the significant correlation between the above-mentioned nutrients and household income with the QUICKI index can be further examined in future studies.

Effect of Pre- and Postprandial Plasma Glucose Levels on Thyroid Hormones: A Cross-Sectional Study.

Background There is not much data regarding the effect of plasma glucose on thyroid hormones. Currently, there is no consensus regarding the timing of blood sample collection for thyroid hormones. Evaluation of the correlation between plasma glucose and thyroid hormones may enhance pathophysiological understanding of postprandial thyroid stimulating hormone (TSH) decline. Objectives To study the effect of pre-andpostprandial plasma glucose levels on thyroid hormones. Methodology A cross-sectional study was done among participants aged 18 years and above after obtaining informed consent. Venous blood samples for fasting and postprandial plasma glucose, fasting, and postprandial thyroid profile ((FT3), (FT4), and TSH) were collected. The association was studied using the t-test and chi-square test between groups, while correlation using Pearson's correlation coefficient. A p-value of <0.05 was considered statistically significant. Results Among the 197 participants, 126 (64%) were female and 71 (36%) were male. The mean (± S.D.) of age was 43.74 (± 12.62) years. Mean (± S.D.) postprandial TSH (4.31 μU/ml (± 7.79)) and free T3 (285.52 pg/dl (± 32.46)) were less than the fasting values (4.99 μU/ml (± 7.78)) and (295.84 pg/dl (± 32.56)). The mean (± S.D.) of both fasting and postprandial TSH and free T4 were less in the high plasma glucose group compared to the normal plasma glucose group (fasting state p-values 0.005, <0.0001 & postprandial state p-values 0.016, <0.0001). The correlation between fasting plasma glucose and fasting TSH values (Pearson correlation; r=-0.18; p-value 0.232) was observed across all the plasma glucose ranges. Conclusion There is a significant postprandial decline in TSH levels than the fasting TSH, indicating that there is a plasma glucose-mediated reduction in TSH values.

Triglyceride Glucose Index: A Potential Indicator in the Evaluation of Graves Ophthalmopathy.

To determine the relationship between Graves ophthalmopathy (GO) and triglyceride glucose index (TGI) and to evaluate the predictive importance of this index in terms of GO activity. This retrospective study included 20 inactive GO patients, 20 active GO patients, and 20 healthy controls. TGI was calculated using fasting plasma triglyceride and fasting plasma glucose levels and values were compared between the groups. The receiver operating characteristics curve was used to calculate the optimal TGI cutoff value and the sensitivity and specificity of this value between active and inactive GO groups. No significant difference was detected between the groups in terms of age and gender ( p = 0.561 and p = 0.762, respectively). TGI value was 8.49 (8.41, 8.67) in the control group, 8.76 (8.74, 8.87) in the inactive GO group, and 9.06 (8.87, 9.08) in the active GO group ( p < 0.001 for control group vs. inactive GO group; p < 0.001 for control group vs. active GO group; p = 0.001 for inactive GO group vs. active GO group). The optimal receiver operating characteristics cutoff value of TGI between active and inactive GO groups was 8.86 with 85% sensitivity and 75% specificity (area under curve: 0.837, p < 0.001, 95% confidence interval: 0.711-0.964). TGI was higher in both inactive and active GO patients compared with controls. It also appears that TGI may be used as a predictive marker indicating GO activity. This cheap and easily accessible parameter may be beneficial in detecting the disease and monitoring its activity in clinical practice.

The effect of fasting plasma glucose on in-hospital mortality after acute myocardial infarction in patients with and without diabetes: findings from a prospective, nationwide, and multicenter registry.

To evaluate the predictive value of fasting plasma glucose (FPG) for in-hospital mortality in patients with acute myocardial infarction (AMI) with different glucose metabolism status. We selected 5,308 participants with AMI from the prospective, nationwide, multicenter CAMI registry, of which 2,081 were diabetic and 3,227 were nondiabetic. Patients were divided into high FPG and low FPG groups according to the optimal cutoff values of FPG to predict in-hospital mortality for diabetic and nondiabetic cohorts, respectively. The primary endpoint was in-hospital mortality. Overall, 94 diabetic patients (4.5%) and 131 nondiabetic patients (4.1%) died during hospitalization, and the optimal FPG thresholds for predicting in-hospital death of the two cohorts were 13.2 mmol/L and 6.4 mmol/L, respectively. Compared with individuals who had low FPG, those with high FPG were significantly associated with higher in-hospital mortality in diabetic cohort (10.1% vs. 2.8%; odds ratio [OR] = 3.862, 95% confidence interval [CI]: 2.542-5.869) and nondiabetic cohort (7.4% vs. 1.7%; HR = 4.542, 95%CI: 3.041-6.782). After adjusting the potential confounders, this significant association was not changed. Furthermore, FPG as a continuous variable was positively associated with in-hospital mortality in single-variable and multivariable models regardless of diabetic status. Adding FPG to the original model showed a significant improvement in C-statistic and net reclassification in diabetic and nondiabetic cohorts. This large-scale registry indicated that there is a strong positive association between FPG and in-hospital mortality in AMI patients with and without diabetes. FPG might be useful to stratify patients with AMI.

Меtformin-associated maternal and neonatal outcomes in women with gestational diabetes - a retrospective cohort study.

To assess the maternal and neonatal outcomes in women with GDM treated with metformin, medical nutrition therapy (MNT) or insulin. The current retrospective cohort study includes data from 233 women diagnosed with GDM who gave birth between January 2017 and January 2019 at an obstetrics and gynecology hospital in Sofia, Bulgaria. Patients were assigned to three groups, according to the treatment approach - metformin group (n = 70), insulin group (n = 40), and MNT group (n = 123). Values of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) have been evaluated at diagnosis of GDM and the third trimester of pregnancy. A comparative analysis of pregnancy outcomes and short-term neonatal characteristics in the investigated groups has been performed. Women indicated for pharmacological treatment (metformin or insulin) had significantly higher BMI (p < 0.01), FPG (p < 0.001), and HbA1c levels (p < 0.001) at baseline. However, during pregnancy, patients treated with metformin showed a significantly lower BMI (p < 0.01), FPG (p < 0.01), and HbA1c (p < 0.01). Neonates born to metformin-treated mothers had lower birth weight compared to those born to women in the MNT and insulin groups (metformin vs MNT, p < 0.001; metformin vs insulin, p = 0.03). The lowest incidence of newborns with macrosomia and neonatal hypoglycemia has been observed in the metformin cohort. Not a single newborn with an Apgar score under 7 has been identified in the metformin group. According to the current analysis, women with GDM treated with metformin demonstrated better maternal and neonatal outcomes. No short-term complications in newborns have been associated with metformin use during pregnancy.

Prognostic Value of Hyperglycemia and Insulin Resistance Among Patients with Confirmed COVID-19 Infections at Admission to the Alexandria Fever Hospital, Egypt.

Background: The interaction between COVID-19 infection, hyperglycemia, and insulin resistance (IR) may lead to poor outcome. Methods: This prospective study included 100 adult participants without diabetes attending Alexandria Fever Hospital with confirmed COVID-19 infections. They were classified into four groups according to disease severity using World Health Organization (WHO) criteria. Demographic and clinical parameters were collected. Laboratory investigations were obtained. Another follow-up fasting plasma glucose (FPG) value was measured after 3 months in cured patients. Results: Admission FPG, follow-up FPG, lipid profile, markers of IR, and inflammation were significantly higher in severe and critical cases than in mild and moderate cases with increasing values with increased severity. Furthermore, these parameters were significantly higher in died cases compared with cured cases. Admission FPG, TyG index, and homeostatic model assessment (HOMA)-IR showed significant positive correlations with follow-up FPG. Admission FPG was the only independent mortality predictor in multivariate analysis (P = 0.027) with 1.7-folds increased mortality risk with each 10 mg/dL increments. Values exceeding 117 mg/dL, 2.2, and 6.33 for admission FPG, HOMA-IR, and Fasting Insulin Resistance Index, respectively, were able to predict mortality in the studied sample. Conclusions: These results will help in identifying patients at high risk of severe infection and death at admission and take early actions to improve outcome.

Indications for the Postpartum Oral Glucose Tolerance Test—Data From the GestDiab Registry.

Gestational diabetes mellitus (GDM) affects more than 50 000 pregnant women in Germany every year. In postpartum diabetes screening, a 75 g oral glucose tolerance test (OGT) is recommended. This is time-consuming and can have side effects, and only 40% of mothers take it. The determination of pre-test probabilities might obviate the need for OGT except in women who are at particular risk. We analyzed 5444 cases of GDM from the GestDiab registry over the period 2015-2019. The pretest probabilities of a postpartum diagnosis of diabetes mellitus (DM) or prediabetes were calculated on the basis of clinical variables including postpartum venous fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c). In 0.77% of mothers with a history of GDM in whom DM was not detected by FPG or HbA1c, postpartum DM was diagnosed on the basis of the 2-hour value in the OGT. Individual estimation of the pre-test probability of a diagnosis by OGT of postpartum DM or prediabetes was possible with the aid of the FPG and HbA1c values and clinical predictors including insulin treatment during pregnancy, obesity, GDM diagnosed before 24 weeks of gestation, age over 35, and a 1-hour value in the diagnostic OGT during pregnancy of 180 mg/dL (10.0 mmol/L) or above. The pretest probability of postpartum DM in the study group ranged from 0.11% to 4.17%, and that of postpartum prediabetes from 6.4% to 16.3%. The probability of a diagnosis of postpartum diabetes by OGT after GDM can be estimated in postpartum screening on the basis of various parameters. This enables risk-adapted counseling of the affected women along with a long-term strategy for diabetes prevention and follow-up. The findings of our study should be verified by further research.

Predictive Effects of Early Pregnancy Lipid Profile and Fasting Plasma Glucose on the Risk of Gestational Diabetes Mellitus.

Gestational diabetes mellitus's (GDM's) prevalence in Sri Lanka ranges from 5.5% to 11.5%. It is associated with maternal and perinatal complications, emphasizing the need for early screening and intervention. This study aims to determine the predictive effect of early pregnancy lipid profile and fasting plasma glucose for GDM. It is a prospective cohort study of 172 pregnant women attending antenatal clinics at a tertiary hospital in Jaffna, Sri Lanka. Prediction was derived by calculating odds ratios (ORs) and 95% confidence intervals (CIs) in multivariable logistic regression, assessing lipid and glucose effects on GDM risk. The study included 172 participants (mean age: 29.84±5.38). GDM's prevalence was 16.9%, and 57.14% of these mothers were obese. Significant differences in fasting plasma glucose (FPG) values were observed between the first visit and at 24-28 weeks. GDM mothers showed elevated total cholesterol and low-density lipoprotein (LDL) levels. Triglyceride (TG) levels correlated significantly with FPG at the Point of Assessment (POA), identifying a 0.945 mmol/L cutoff with 75% sensitivity and 77.1% specificity. Logistic regression confirmed a significant TG-GDM relationship. There is an association between FPG levels measured in early pregnancy and the likelihood of developing GDM later on. Specifically, when FPG levels in early pregnancy surpass a cutoff value of 3.94 mmol/L, there is an increased risk of GDM, indicated by an OR of 3.81 Conclusion: Early pregnancy FPG and TG levels are potential markers for predicting GDM. FPG shows higher predictive efficacy than TG. Total cholesterol, LDL, andhigh-density lipoprotein (HDL) lack predictive ability.

Single Center Evaluation of Long-Term Results of Glargin U-300 in Insulin Naive Patients In a Real-World Setting

Objective: Insulin therapy stands as one of the most effective and well-established therapeutic options for managing glycemic control in Diabetes Mellitus (DM). Glargine 300 U/mL (Gla-300) represents a new long-acting insulin analog, which has demonstrated a decrease in the risk of hypoglycemia and a reduction in the total number of injections due to prolonged insulin absorption. In this study, we investigated the long-term effects of Gla-300 on Fasting Plasma Glucose (FPG) and HbA1c levels, as well as the incidence of hypoglycemia in insulin-naive patients admitted to the Internal Medicine outpatient clinic, over a period of 0, 3, 6, 12, and 24 months.. Material and Methods: Between January 2018 and June 2022, insulin-naive patients diagnosed with Type 2 Diabetes Mellitus (T2DM) who initiated treatment with Gla-300 and sought care at the Internal Medicine outpatient clinic were subjected to retrospective analysis. Results: The study included 49 insulin-naive patients. A statistically significant decrease was observed in Fasting Plasma Glucose (FPG) (p = 0.03) and HbA1c (p = 0.02) levels during the 24-month follow-up period of Glargine U-300. Additionally, a significant reduction in both FPG (p &lt; 0.01) and HbA1c (p &lt; 0.01) values was achieved at the time of diagnosis and at 3 months. Hypoglycemia was reported in only 1 patient (2%) during our study, indicating a very low hypoglycemia rate. Conclusion: Diabetes mellitus (DM) poses a significant public health challenge, resulting in economic burden and diminished quality of life. Developed to address these challenges, Gla-300 serves as a long-acting basal insulin that effectively reduces the risk of hypoglycemia while offering targeted glycemic control, as evidenced by our study findings. In Turkey, there is a pressing need for multicenter, prospective real-world studies that incorporate parameters such as insulin dosage and weight monitoring.

Association of triglyceride‑glucose index in branch retinal vein occlusion

BackgroundTo investigate the association between the triglyceride-glucose (TyG) index and newly diagnosed branch retinal vein occlusion (BRVO) in patients.MethodsThe study included 57 individuals with BRVO and a control group comprising 50 healthy volunteers matched for age and gender. Detailed eye examinations were conducted, and various blood biochemistry and hematological parameters were recorded. The TyG index was calculated using fasting plasma glucose and triglyceride values. ResultsThe mean age was 61.4 ± 9.6 years for the BRVO group and 60.6 ± 10.3 years for the control group. The TyG values were significantly higher in the BRVO group when compared to the control group (8.84 ± 0.41 vs. 8.52 ± 0.29, p < 0.001). Multivariate analysis revealed that the TyG index independently predicted BRVO (odds ratio = 2.58, 95% confidence interval = 1.69–3.93; p < 0.001). In receiver operating characteristics analysis, the TyG index had an area under the curve of 0.749, and a TyG index higher than 8.52 predicted BRVO with 83% sensitivity and 70% specificity.ConclusionsThis study establishes a significant association between an elevated TyG index and BRVO. Consequently, the TyG index could serve as a valuable predictive tool for identifying individuals at risk for BRVO.

METABOLICALLY ASSOCIATED FATTY LIVER DISEASE IN PATIENTS WITH VERY HIGH CARDIOVASCULAR RISK: PREVALENCE, CLINICAL SIGNIFICANCE, GENDER DIFFERENCES

Introduction. Recently, metabolically associated fatty liver disease (MAFLD) had been proposed as a new term. Due to increasing prevalence, significant morbidity and hepatic and cardiovascular mortality, the association of MAFLD with cardiovascular diseases is gaining considerable relevance and needs further study. The aim of our study was to determine the proportion of MAFLD among patients with a very high cardiovascular risk, and to elucidate clinical features and gender differences in this cohort. Materials and methods. All patients underwent a comprehensive examination to assess both cardiovascular risk and MAFLD. Hepatic steatosis was diagnosed after liver ultrasonography. Participants who met MAFLD criteria were included into the group 1 (n=77; 32 women, 45 men), other patients were assigned to the group 2 (n=39; 19 women, 20 men). Results. Among patients with very high cardiovascular risk, proportion of MAFLD was 66.7 %. Although mild alanine aminotransferase elevation was much more common among patients with MAFLD (16 women (50.0 %) vs. 2 women (10.5 %) in group 2, P = 0.006; 21 men (46.7 %) vs. 2 men in group 2 (10.0 %), P = 0.005), none of the participants met the criteria for steatohepatitis. Despite, the presence of metabolic disorders in the vast majority of participants, proportion of obesity, metabolic dyslipidaemia, prediabetes and type 2 diabetes were significantly higher in patients with MAFLD. Besides, patients with MAFLD usually met 4 or 5 metabolic syndrome criteria, had higher median values of lipid accumulation product (LAP) and HOMA-IR index, but lower median values of Matsuda index. Significant direct correlations were found between MAFLD and LAP, logarithmic index (TG/HDL-C), and HOMA-IR; negative correlations were observed between MAFLD and insulin sensitivity indices. Women with MAFLD had significantly higher median values of glycated haemoglobin, post-load glucose, fasting insulin levels; there was direct correlation between MAFLD and non-HDL-C. Among women with MAFLD, a history of menopause before 45 years of age had 15 persons (46.9 %) vs. one person (5.3 %) in group 2 (P &lt; 0.002); the median age when ASCVD was diagnosed was 58.5 [53.0; 64.0] years vs. 68.0 [63.0; 69.0] years in group 2 (P = 0.002); cardiac valve calcinosis was detected in 31 women (96.6 %) vs. 9 women (47.4 %) in group 2 (P = 0.0001); the left ventricular myocardial mass (LVM) index was 77.5 [62.1; 86.9] g/m2.7 vs. 64.0 [50.6; 74.0] g/m2.7 in women without MAFLD, 67.0 [55.1; 74.0] g/m2.7 in men with MAFLD, and 63.9 [50.0; 73.5] g/m2.7 in men without MAFLD (Kruskal–Wallis ANOVA P &lt;0.0001; median test P=0.002). The prevalence of smoking and alcohol intake was significantly more common among men (gender differences P &lt;0.0001 and P=0.0001 in group 1; P = 0.0004 and P=0.0023 in group 2 for smoking and alcohol intake, respectively). Men with MAFLD had significantly higher median values of fasting plasma glucose, fasting and post-load insulin levels than men without MAFLD; there was a significant direct correlation between MAFLD and serum TG level. In addition, 11 men with MAFLD (24.4 %) had hypertriglyceridemia &gt;2.3 mmol/l that was not observed among men without MAFLD (P=0.013). The proportion of men with fasting and post-load hyperinsulinemia was much higher in group 1 than in group 2 (28 persons (62.2%) vs. 3 persons (15.0 %), P=0.0005 and 26 persons (57.8%) vs. 2 persons (10.0 %), P = 0.0003, respectively). Conclusions: among patients with a very high cardiovascular risk, the prevalence of MAFLD was significantly higher than in the general population. Concomitant MAFLD was associated with more severe metabolic disorders (i.e., obesity, metabolic dyslipidaemia, hyperglycaemia, insulin resistance), which usually combined. The LAP index is a simple available tool that may be used in routine clinical practice to determine the need for MAFLD screening. Women with MAFLD frequently had early menopause, cardiac valve calcification, and much higher median value of LVM index; direct correlation was observed between MAFLD and non-HDL-C. Men with MAFLD more often had fasting and/or post-load hyperinsulinemia and moderate hypertriglyceridemia.

Low-grade inflammation and inflammatory mediators in individuals with prediabetes

Background/Aim. Prediabetes is a condition that refers to the state of hyperglycemia not sufficiently high to reach the diagnostic values for type 2 diabetes mellitus (T2DM). This condition often precedes the appearance of T2DM. The association between the development of early glycoregulation disorders and the state of low-grade chronic inflammation is still not sufficiently well understood. The aim of the study was to assess the values of different inflammatory mediators and biomarkers in individuals with prediabetes. Methods. This cross-sectional, observational study included 60 respondents divided into two groups: the prediabetes group (PDG) with 31 patients and the healthy control group (HCG) with 29 respondents. Serum values of seven selected cytokines/biomarkers were compared between the two groups. Examined biomarkers were: interleukin (IL)-1?, IL- 6, IL-8, IL-18, tumor necrosis factor (TNF)-?, E-selectin, and vascular endothelial growth factor (VEGF)-A. In addition, the values of body mass index (BMI), waist circumference (WC), blood pressure (BP), serum triglyceride (TG), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were also compared between the two groups. Results. PDG patients had statistically significantly higher TNF-? values compared to the HCG patients (73 pg/mL vs. 55 pg/mL, p = 0.024). A trend towards higher levels of IL-8 and IL-1? and lower levels of E-selectin, VEGF-A, and IL-18 was registered in PDG patients but without statistical significance. Furthermore, PDG patients had higher values of BMI, WC, systolic BP, serum TG, FPG, and HbA1c when compared to HCG. Conclusion. The results of our study suggest the importance of inflammation and some inflammatory mediators in the pathogenesis of early glycoregulation disorder. We believe that the main goal of future studies should focus on anti-inflammatory therapy in prediabetes.

Diagnostic significance of individual glucose values in oral glucose tolerance test and the associated risk factors for gestational diabetes mellitus in pregnant mothers: A cross-sectional study

Background: The diagnosis of gestational diabetes mellitus (GDM) is mainly based on oral glucose tolerance test (OGTT) in Sri Lankan clinical setting. The present study was to assess the diagnostic significance of individual glucose values in 75g OGTT in a group of pregnant mothers, to modify the test procedure to make it more convenient and cost-effective and to identify the associated risk factors for GDM.Methods: A total of 150 pregnant women within the second trimester and attending the antenatal clinics at Teaching Hospital Mahamodara were recruited for the study. Data collection was carried out via an interviewer-administered questionnaire followed by retrieval of laboratory data on OGTT.Results: Seventeen pregnant women (11.33%) were diagnosed with GDM by OGTT based on the WHO criteria. Diagnosis was based on either fasting or 2-hour glucose values alone or by increased levels in more than one of those parameters. None of them were diagnosed based on the 1-hour glucose value alone. The AUC values were 0.951 (0.884, 1.000), 0.829 (0.715, 0.942) and 0.859 (0.776, 0.943) respectively for fasting, 1-hour and 2-hour glucose concentrations (CI 95%). GDM was associated with uncontrolled sweet consumption (X2=5.86, p=0.015) and no association was observed with reference to maternal age, parity, BMI, positive family history of diabetes, and prior history of GDM or diabetes mellitus.Conclusion: Fasting and 2-hour plasma glucose values have higher diagnostic accuracy over 1-hour glucose values and the findings suggest the performance of fasting and 2-hour samples alone in the standard 75g OGTT procedure for the diagnosis of GDM.

Bariatric surgery induces pancreatic cell transdifferentiation as indicated by single-cell transcriptomics in Zucker diabetic rats.

Bariatric surgery results in rapid recovery of glucose control in subjects with type 2 diabetes mellitus. However, the underlying mechanisms are still largely unknown. The present study aims to clarify how bariatric surgery modifies pancreatic cell subgroup differentiation and transformation in the single-cell RNA level. Male, 8-week-old Zucker diabetic fatty (ZDF) rats with obesity and diabetes phenotypes were randomized into sleeve gastrectomy (Sleeve, n = 9), Roux-en-Y gastric bypass (RYGB, n = 9), and Sham (n = 7) groups. Two weeks after surgery, the pancreas specimen was further analyzed using single-cell RNA-sequencing technique. Two weeks after surgery, compared to the Sham group, the metabolic parameters including fasting plasma glucose, plasma insulin, and oral glucose tolerance test values were dramatically improved after RYGB and Sleeve procedures (p < .05) as predicted. In addition, RYGB and Sleeve groups increased the proportion of pancreatic β cells and reduced the ratio of α cells. Two multiple hormone-expressing cells were identified, the Gcg+/Ppy + and Ins+/Gcg+/Ppy + cells. The pancreatic Ins+/Gcg+/Ppy + cells were defined for the first time, and further investigation indicates similarities with α and β cells, with unique gene expression patterns, which implies that pancreatic cell transdifferentiation occurs following bariatric surgery. For the first time, using the single-cell transcriptome map of ZDF rats, we reported a comprehensive characterization of the heterogeneity and differentiation of pancreatic endocrinal cells after bariatric surgery, which may contribute to the underlying mechanisms. Further studies will be needed to elucidate these results.

Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults.

Racial and ethnic minority groups and individuals with limited educational attainment experience a disproportionate burden of diabetes. Prediabetes represents a high-risk state for developing type 2 diabetes, but most adults with prediabetes are unaware of having the condition. Uncovering whether racial, ethnic, or educational disparities also occur in the prediabetes stage could help inform strategies to support health equity in preventing type 2 diabetes and its complications. We examined the prevalence of prediabetes and prediabetes awareness, with corresponding prevalence ratios according to race, ethnicity, and educational attainment. This study was a pooled cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to March 2020. The final sample comprised 10,262 U.S. adults who self-reported being Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Those with prediabetes were classified as "aware" or "unaware" based on survey responses. We calculated prevalence ratios (PR) to assess the relationship between race, ethnicity, and educational attainment with prediabetes and prediabetes awareness, controlling for sociodemographic, health and healthcare-related, and clinical characteristics. In fully adjusted logistic regression models, Asian, Black, and Hispanic adults had a statistically significant higher risk of prediabetes than White adults (PR:1.26 [1.18,1.35], PR:1.17 [1.08,1.25], and PR:1.10 [1.02,1.19], respectively). Adults completing less than high school and high school had a significantly higher risk of prediabetes compared to those with a college degree (PR:1.14 [1.02,1.26] and PR:1.12 [1.01,1.23], respectively). We also found that Black and Hispanic adults had higher rates of prediabetes awareness in the fully adjusted model than White adults (PR:1.27 [1.07,1.50] and PR:1.33 [1.02,1.72], respectively). The rates of prediabetes awareness were consistently lower among those with less than a high school education relative to individuals who completed college (fully-adjusted model PR:0.66 [0.47,0.92]). Disparities in prediabetes among racial and ethnic minority groups and adults with low educational attainment suggest challenges and opportunities for promoting health equity in high-risk groups and expanding awareness of prediabetes in the United States.

Reductions in liver enzymes are associated with anti-hyperglycaemic and anti-obesity effects of tofogliflozin in people with type 2 diabetes: Post-hoc analyses.

How the pathology of type 2 diabetes (T2D), including hyperglycaemia and obesity, affects liver enzymes has not been clinically demonstrated. Thus, we compared time courses of gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) with those of fasting plasma glucose (FPG) and body weight (BW) during treatment with the SGLT2 inhibitor tofogliflozin for T2D. We post-hocanalysed preexisting data on 1046 people with T2D administered tofogliflozin or placebo for 24 weeks in four tofogliflozin studies. First, time courses of percent changes in variables during the intervention were analysed using a mixed effect model to explore the similarity of the time courses and to evaluate time-treatment interactions. Second, clinical factors related to the percent changes in GGT and ALT were clarified using multivariate analyses. GGT levels and FPG values rapidly and significantly decreased via tofogliflozin as early as week 4, with decreases maintained until week 24. Conversely, BW and ALT decreased progressively until week 24. Time courses of FPG (p = .365, time-treatment interaction) and GGT (p = .510) reductions were parallel between tofogliflozin and placebo from weeks 4 to 24, while BW and ALT reductions (p < .001, respectively) were not. Reductions in GGT at week 24 were associated with reductions in FPG and BW at week 24, whereas ALT reductions were only associated with reductions in BW. Reductions in GGT and ALT were associated with the anti-hyperglycaemic and anti-obesity effects of tofogliflozin, respectively, in people with T2D. Therefore, GGT and ALT may be surrogate markers for hyperglycaemia and obesity in T2D.

Sex-specific associations of the difference between 2-hour post-load and fasting plasma glucose with cardiovascular risk in a normoglycemic population

Abstract Background Elevated levels of fasting plasma glucose (FPG) and 2-hour post-load glucose (2hPG) have been established as individual risk factors for cardiovascular disease (CVD), coronary heart disease (CHD), and stroke. However, it is unclear whether the difference between 2hPG and FPG (2hPG-FPG) within normoglycemic influences the cardiovascular risk in women and men. Purpose To investigate the association between 2hPG-FPG and the incidence of CVD, CHD, and stroke among normoglycemic women and men in a large population-based cohort. Methods In this prospective cohort study, a total of 7224 participants with the normoglycemic state (mean age 37±11; women, 57.4%) that had baseline measurements of both FPG and 2hPG values and did not have prior CVD, CHD, or stroke were included and were followed for incidence of outcomes annually until March 2018. The normoglycemic range was defined as FPG&amp;lt; 5.55 and 2 h-PG&amp;lt; 7.77 mmol/L and not taking anti-diabetic medications. CHD was defined as either positive ECG findings and biomarkers, cardiac symptoms accompanied by either positive ECG or biomarker, or angiographic-proven CHD. Stroke was defined based on the WHO criteria. Also, CVD was defined as a composite of CHD and stroke. A Multivariable Cox­-regression model adjusted for age, body mass index, hypertension, hyperlipidemia, FPG, education level, and smoking status was used to assess the association between 2hPG-FPG and incident CVD, CHD, and stroke in women and men. We also used a cumulative incidence curve to illustrate the cumulative sex-specific incidence of CVD, CHD, and stroke during the follow-up time (Figure 1). Results During a median follow-up of 17.9 years (IQR: 13.75-18.46), 487 CVD (174 women), 427 CHD (140 women), and 76 stroke (37 women) events occurred. Among men, 2hPG-FPG was associated with an increased risk of CVD (hazard ratio [HR]:1.11, 95% confidence interval [CI]:1.01-1.22, p=0.03) and CHD (HR:1.11, 95% CI:1.00-1.22, p=0.04 ), but not stroke (HR:1.14, 95% CI:0.88-1.50, p= 0.33). No significant associations among women were found between 2hPG-FPG and the incidence of outcomes, with adjusted HRs of 1.02 (95% CI, 0.88-1.18, p=0.82), 1.00 (0.85-1.17, p=0.99), and 1.10 (0.80-1.52, p=0.54) for incident CVD, CHD, and stroke, respectively (Table 1). Conclusion A greater difference between 2hPG and FPG (2hPG-FPG) within the normoglycemic range was associated with an increased risk for incidence of CVD and CHD in men but not women. Further studies are warranted to explore the potential use of 2hPG-FPG for cardiovascular risk stratification, particularly among those with normal glucose parameters.Association of 2hPG-FPG with CV riskCumulative incidence of CVD, CHD, stroke

Association between blood glucose levels and arterial stiffness marker: comparing the second derivative of photoplethysmogram and cardio-ankle vascular index scores.

This study aimed to compare the association between fasting plasma glucose (FPG) and glycosylated hemoglobin A1c (HbA1c) levels using the second derivative of photoplethysmogram (SDPTG) index and the cardio-ankle vascular index (CAVI). Electronic medical records of 276 participants (160 men, 116 women) who visited the health promotion center of a university hospital were examined. Age, sex, body mass index (BMI), blood pressure, and lipid profile were considered as risk factors for arterial stiffness, together with the FPG, HbA1c, CAVI, and SDPTG indices. Hierarchical regression models were constructed, and all participants were divided into low-normal, high-normal, prediabetic, and diabetic groups to examine the group-based differences in CAVI and SDPTG indices. FPG and HbA1c were independently predictive of increased CAVI, and their predictive powers for CAVI were equivalent (β = 0.214 and 0.200, respectively). Risk factors, including age, BMI, and male sex, were also predictive of CAVI (β= 0.593-0.630, -0.256 - -0.280, and 0.142-0.178, respectively). None of the FPG and HbA1c values were predictive of the SDPTG indices. The CAVI was higher in the diabetes group than in the other three groups according to HbA1c level, while the d/a index of the SDPTG decreased in the prediabetes group and increased in the diabetes group. CAVI may not be substituted for SDPTG indices when evaluating arterial stiffness based on the glucose level. Moreover, the progression rate of arterial stiffness may differ between the diabetic and nondiabetic stages.