Glucose Categories Research Articles

RELATIONSHIP BETWEEN BENIGN PROSTATIC HYPERPLASIA AND METABOLIC SYNDROME

Introduction: Factors that may increase the risk of Benign Prostatic Hyperplasia (BPH), and one theory suggests a possible connection between metabolic syndrome and the development of BPH. This study aims to investigate the potential relationship between metabolic syndrome and the development of BPH. Methods: This study analyzed medical records from Saiful Anwar Hospital in Malang from 2015 to 2020, using a case-control research design. It applied Chi-Square and Logistic Regression methods for data analysis. Results: The study, based on data from 90 patients, found that the highest number of BPH cases (75.56%) occurred in those with hypertension. Factors like body mass index and blood pressure were significantly associated with BPH (p-values = 0.046; OR = 2.473). Logistic regression confirmed the impact of fasting blood glucose, blood pressure, and body mass index categories on BPH. Conclusion: This research illustrates that there is an association between type 2 diabetes, hypertension, and obesity with the occurrence of BPH. However, there is no statistically significant relationship between the components of metabolic syndrome and the occurrence of BPH.

Technology advances in diabetes pregnancy: right technology, right person, right time.

This review outlines some of the extraordinary recent advances in diabetes technology, which are transforming the management of type 1 diabetes before, during and after pregnancy. It highlights recent improvements associated with use of continuous glucose monitoring (CGM) but acknowledges that neither CGM nor insulin pump therapy are adequate for achieving the pregnancy glucose targets. Furthermore, even hybrid closed-loop (HCL) systems that are clinically effective outside of pregnancy may not confer additional benefits throughout pregnancy. To date, there is only one HCL system, the CamAPS FX, with a strong evidence base for use during pregnancy, suggesting that the pregnancy benefits are HCL system specific. This is in stark contrast to HCL system use outside of pregnancy, where benefits are HCL category specific. The CamAPS FX HCL system has a rapidly adaptive algorithm and lower glucose targets with benefits across all maternal glucose categories, meaning that it is applicable for all women with type 1 diabetes, before and during pregnancy. For women of reproductive years living with type 2 diabetes, the relative merits of using non-insulin pharmacotherapies vs diabetes technology (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors) are unknown. Despite the urgent unmet need and potential benefits, studies of pharmacotherapy and technology use are extremely limited in pregnant women with type 2 diabetes.

Glycemic status, insulin resistance, and mortality from lung cancer among individuals with and without diabetes

BackgroundThe effects of glycemic status and insulin resistance on lung cancer remain unclear. We investigated the associations between both glycemic status and insulin resistance, and lung cancer mortality, in a young and middle-aged population with and without diabetes.MethodsThis cohort study involved individuals who participated in routine health examinations. Lung cancer mortality was identified using national death records. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% CIs for lung cancer mortality risk.ResultsAmong 666,888 individuals (mean age 39.9 ± 10.9 years) followed for 8.3 years (interquartile range, 4.6–12.7), 602 lung cancer deaths occurred. Among individuals without diabetes, the multivariable-adjusted HRs (95% CI) for lung cancer mortality comparing hemoglobin A1c categories (5.7–5.9, 6.0–6.4, and ≥ 6.5% or 39–41, 42–46, and ≥ 48 mmol/mol, respectively) with the reference (< 5.7% or < 39 mmol/mol) were 1.39 (1.13–1.71), 1.72 (1.33–2.20), and 2.22 (1.56–3.17), respectively. Lung cancer mortality was associated with fasting blood glucose categories in a dose–response manner (P for trend = 0.001) and with previously diagnosed diabetes. Insulin resistance (HOMA-IR ≥ 2.5) in individuals without diabetes was also associated with lung cancer mortality (multivariable-adjusted HR, 1.41; 95% CI, 1.13–1.75). These associations remained after adjusting for changing status in glucose, hemoglobin A1c, insulin resistance, smoking status, and other confounders during follow-up as time-varying covariates.ConclusionsGlycemic status within both diabetes and prediabetes ranges and insulin resistance were independently associated with an increased risk of lung cancer mortality.

LONG-TERM EFFECTS OF BLOOD PRESSURE 130-139/80-89 MMHG ON ALL-CAUSE AND CARDIOVASCULAR MORTALITY AMONG CHINESE ADULTS WITH DIFFERENT GLUCOSE METABOLISM

Objective: This study aimed to investigate the risks of all-cause and cardiovascular mortality associated with blood pressure (BP) levels of 130–139/80–89 mmHg in Chinese adults with different glucose metabolism, during a long-term follow-up of over 20 years. Design and method: A prospective population-based cohort of 2,132 adults in Shanghai was established in 2002 and followed for 21 years. The association between BP categories and mortality was assessed, and the risk was further analyzed using multiple Cox regression analysis by combining BP and blood glucose categories. Results: The final analysis included 2,004 participants, with 397 all-cause and 166 cardiovascular mortality. The incidence of all-cause and cardiovascular mortality per 1,000 person-years for different BP categories were as follows: BP &lt;130/80 mmHg (4.5 and 1.3), 130-139/80-89 mmHg (7.7 and 2.9), and &gt;=140/90 mmHg or treated groups (19.9 and 8.7), respectively. After adjusting for age, sex, and other factors, BP &gt;=140/90 mmHg was significantly associated with a higher risk of mortality across different blood glucose categories. However, using BP&lt;130/80 mmHg and normoglycemia as the reference, a BP of 130–139/80–89 mmHg was significantly associated with higher risks of all-cause (hazard ratio 3.26 [95% confidence interval 1.46-7.29], P&lt;0.01) and cardiovascular mortality (9.53 [1.92-4.74], P&lt;0.01) in diabetes, but not in those with normoglycemia or prediabetes. Conclusions: BP of 130–139/80–89 mmHg may lead to a significantly higher risk of all-cause and cardiovascular mortality in Chinese adults with diabetes, but not in those with normoglycemia or prediabetes. This suggests that the targeted BP for people with diabetes should be &lt;130–139/80–89 mmHg.

Universal screening for early detection of chronic autoimmune, metabolic and cardiovascular diseases in the general population using capillary blood (UNISCREEN): low-risk interventional, single-centre, pilot study protocol

IntroductionChronic autoimmune (type 1 diabetes and coeliac disease) and metabolic/cardiovascular (type 2 diabetes, dyslipidaemia, hypertension) diseases are highly prevalent across all age ranges representing a major public health burden. Universal...

Long-term effects of blood pressure 130–139/80–89 mmHg on all-cause and cardiovascular mortality among Chinese adults with different glucose metabolism

BackgroundThis study aimed to investigate the risks of all-cause and cardiovascular mortality associated with blood pressure (BP) levels of 130–139/80–89 mmHg in Chinese adults with different glucose metabolism, during a long-term follow-up of over 20 years.MethodsA prospective population-based cohort of 2,132 adults in Shanghai was established in 2002 and followed for 21 years. The association between BP categories and mortality was assessed, and the risk was further analyzed using multiple Cox regression analysis by combining BP and blood glucose categories.ResultsThe final analysis included 2,004 participants, with 397 all-cause and 166 cardiovascular mortality. The incidence of all-cause and cardiovascular mortality per 1,000 person-years for different BP categories were as follows: BP < 130/80 mmHg (4.5 and 1.3), 130–139/80–89 mmHg (7.7 and 2.9), and ≥ 140/90 mmHg or treated groups (19.9 and 8.7), respectively. After adjusting for age, sex, and other factors, BP ≥ 140/90 mmHg was significantly associated with a higher risk of mortality across different blood glucose categories. However, using BP < 130/80 mmHg and normoglycemia as the reference, a BP of 130–139/80–89 mmHg was significantly associated with higher risks of all-cause (hazard ratio 3.30 [95% confidence interval 1.48–7.38], P < 0.01) and cardiovascular mortality (9.60 [1.93–47.7], P < 0.01) in diabetes, but not in those with normoglycemia or prediabetes.ConclusionsBP of 130–139/80–89 mmHg may lead to a significantly higher risk of all-cause and cardiovascular mortality in Chinese adults with diabetes, but not in those with normoglycemia or prediabetes. This suggests that the targeted BP for people with diabetes should be < 130–139/80–89 mmHg.

Abstract 16295: Glucose Homeostasis and Frequency of Pre-Heart Failure in Hispanics/Latinos: Insights From the Echocardiographic Study of Latinos (ECHO SOL)

BACKGROUND: Diabetes Mellitus (DM) is an independent risk factor for heart failure (HF), yet research on the association of glucose homeostasis with pre-HF is limited. We assessed glucose homeostasis longitudinally in relation to prevalent and incident pre-HF in the Echocardiographic Study of Latinos, Echo-SOL. Methods: Serial echocardiograms from 1595 adults (mean age 56.4 years), 61% female, from Echo SOL were analyzed on average 4.3 years apart. Prevalent pre-HF was defined as the presence of one of the following parameters: LVEF &lt;50%, global longitudinal strain &gt; -15%, diastolic dysfunction ≥ grade 1, left ventricular mass index &gt;115 in men/&gt;95 in women, relative wall thickness &gt;0.42. Glucose homeostasis was assessed at baseline (2008-2011) by fasting plasma glucose (FGP), oral glucose tolerance test (OGTT), and hemoglobin A1C (A1C) and categorized as normal glucose tolerance [NGT]: FPG&lt;100 mg/dL, OGTT &lt;140 mg/dL, and A1C &lt;5.7%; prediabetes [PDM]: FPG 100-125 mg/dL, OGTT 140-199 mg/dL, or A1C 5.7-6.4%. Among those with prevalent DM, controlled DM [CDM] was defined as A1C &lt;7%, and uncontrolled DM [UDM] as A1C &gt;7%. Incident pre-HF was assessed at visit 2 (2014-2017) among those free of pre-HF at visit 1. Complex survey design is accounted for in all analyses. Results: Over time there was increased frequency of UDM with decreased frequency of NGT (Figure) . Prevalent pre-HF (72.5% overall) gradually increased as glucose homeostasis worsened: 50.5% NGT, 69.2% PDM, 78.3% CDM, 86% UDM, p value &lt;0.05. Incident pre-HF (56.2% overall) occurred more frequently among baseline dysregulated glucose categories: 65.5% PDM, 71.3% UDM, p value &lt;0.05. CONCLUSION: Pre-HF rates, in both the non-DM and DM groups, increase with worsening and uncontrolled glucose homeostasis. Early detection of antecedent PDM stages and uncontrolled diabetes may offer opportunities to prevent clinical HF.

Adipose tissue dysfunction serum markers are associated with high density lipoprotein size and glycation in the early stages of type 2 diabetes

BackgroundHigh-density lipoproteins (HDLs) have antiatherogenic properties related to their chemical structure. Adipose tissue (AT) influences HDL reverse cholesterol transport and plasma HDL cholesterol levels. However, whether AT dysfunction affects HDL subpopulations and their glycation in early type 2 diabetes (T2D) is still unknown.ObjectiveTo investigate the association of inflammation and AT dysfunction serum markers with the size and glycation of HDLs in normoglycemic, prediabetes, and T2D subjects.MethodsWe assessed HDL particle size and advanced glycation end-product (AGE) content in HDLs isolated from normoglycemic (n = 17), prediabetes (n = 17), and recently T2D-diagnosed (n = 18) subjects. Insulin, adiponectin, and plasminogen activator inhibitor 1 (PAI-1) were determined using the Bio-Rad Multiplex Platform, and free fatty acids (FFAs) and high sensitivity C-reactive protein (hs-CRP) were determined by standard procedures. The AT insulin resistance (ATIR) index and ATIR/adiponectin and adiponectin/leptin ratios were calculated.ResultsHDL was progressively smaller (nm) and enriched with AGE (mg-BSA-AGE/mg protein) according to the glucose categories: 8.49 and 7.5 in normoglycemic subjects, 8.44 and 12.4 in prediabetic subjects, and 8.32 and 14.3 in T2D subjects (P = 0.033 and P = 0.009 for size and AGE, respectively). In multivariable regression analysis, the ATIR/adiponectin ratio was inversely associated with HDL size (β = -0.257, P = 0.046), and the ATIR ratio was directly associated with HDL glycation (β = 0.387, P = 0.036). In contrast, adiponectin and the adiponectin/leptin ratio were not associated with alterations in HDL particles. Furthermore, HDL size was associated with resistin (β = -0.348, P = 0.007) and PAI-1 (β = -0.324, P = 0.004). HDL and AGE were related to insulin concentrations (β = 0.458, P = 0.015). Analyses were adjusted for age, sex, body mass index, triglycerides, and HDL-cholesterol.ConclusionHDL size was significantly associated with the ATIR/adiponectin ratio and inflammation, whereas glycation was more strongly related to the ATIR index. These findings have important implications for the management and prevention of cardiovascular disease in T2D patients.

Type 2 Diabetes: Also a “Clock Matter”?

We investigated whether chronotype is associated with glycemic control, antidiabetic treatment, and risk of developing complications in patients with type 2 diabetes (T2DM). The diabetologists filled out an online questionnaire on the Google Form platform to collect the following parameters of subjects with T2DM: body mass index (BMI), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), diabetes history, antidiabetic treatment, diabetic complications, and chronotype categories. We enrolled 106 subjects with T2DM (M/F: 58/48; age: 63.3 ± 10.4 years; BMI: 28.8 ± 4.9 kg/m2). Thirty-five point eight% of the subjects showed a morning chronotype (MC), 47.2% an intermediate chronotype (IC), and 17% an evening chronotype (EC). EC subjects reported significantly higher HbA1c (p < 0.001) and FPG (p = 0.004) values, and higher prevalence of cardiovascular complications (CVC) (p = 0.028) and of subjects taking basal (p < 0.001) and rapid insulin (p = 0.01) compared to MC subjects. EC subjects reported significantly higher HbA1c (p < 0.001) and FPG (p = 0.015) than IC subjects. An inverse association was found between chronotype score, HbA1c (r = -0.459; p < 0.001), and FPG (r = -0.269; p = 0.05), remaining significant also after adjustment for BMI, age, and disease duration. EC is associated with higher prevalence of CVC and poorer glycemic control independently of BMI and disease duration in subjects with T2DM.

Three-year change in glycemic state and the future risk of incident hypertension among Iranian adults: Tehran Lipid and Glucose Study.

The impact of 3-year change in glycemic state on the risk of hypertension among Tehranian adults aged ≥20 years was assessed. The study population included 1679 men and 2348 women who were non-diabetic normotensive at enrollment. The following categories were defined both at baseline visit and three years later (second visit): normoglycemia [normal fasting glucose (NFG) and normal glucose tolerance (NGT)] and prediabetes [impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)]. Changes in the categories, i.e., regression to normoglycemia, remaining in previous status, and progression to diabetes were assessed. Changes in fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) categories were also considered separately. We used theCox models adjusted for traditional hypertension risk factors to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During a median follow-up of 9.4 years, 485 men and 589 women developed hypertension. Among men, considering both FPG and 2hPG, compared to individuals remaining normoglycemic, changing from prediabetes to normoglycemia had a HR of 1.30 (95% CI: 0.98-1.71; P-value: 0.064). Defining changes by 2hPG showed that compared to remaining NGT, incident IGT (progression from NGT to IGT) had a significant association with increased risk of hypertension development by a HR of 1.61 (1.13-2.30). Among women, on the other hand, change in glycemic state generally didn't show a significant association with incident hypertension. To sum up, change in glycemic state hadn't a significant association with hypertension development among women; however, compared to remaining NGT,menwith incident IGT had a significant higher risk.

Poor Eating Behaviors Related to the Progression of Prediabetes in a Japanese Population: An Open Cohort Study.

This study aimed to examine lifestyle factors associated with the change in glucose categories among individuals without diabetes. We analyzed cohort data of medical check-ups at baseline between April 2008 and December 2012. The primary and secondary outcomes were the change in glucose categories from normoglycemia (glycated hemoglobin (HbA1c) < 5.7% and fasting plasma glucose (FPG) < 5.6 mmol/L) to prediabetes (HbA1c 5.7–6.4% or FPG 5.6–6.9 mmol/L) and from prediabetes to normoglycemia. During a mean follow-up of 2.4 years, 7083 of 57,018 individuals with normoglycemia developed prediabetes, whereas 4629 of 9926 individuals with prediabetes returned to normoglycemia. Factors associated with progression to prediabetes were baseline BMI (hazard ratio [95% confidence interval]: 1.08 [1.07–1.09]), change in BMI during follow-up (1.05 [1.03–1.07]), late dinner/snacking (1.16 [1.10–1.22]), skipping breakfast (1.12 [1.06–1.18]), and heavy alcohol consumption (1.33 [1.24–1.42]). Factors associated with return to normoglycemia from prediabetes were baseline BMI (0.94 [0.93–0.95]) and change in BMI during follow-up (0.95 [0.93–0.97]). In conclusion, poor eating behaviors, such as skipping breakfast, late dinner/snacking, and heavy alcohol consumption, were associated with the progression from normoglycemia to prediabetes.

Is there a residual risk of large-for-gestational-age infant related to gestational diabetes mellitus when it is treated?

ObjectiveThe hyperglycaemia and adverse pregnancy outcomes (HAPO) study, where hyperglycaemia was untreated, showed a continuous association between large-for-gestational-age (LGA) infant and seven increasing categories of fasting plasma glucose (PG), 1-hour and 2-hour PG values after a 75 g oral glucose tolerance test at 24–32 gestational weeks. We evaluated whether the excess risk persisted in the 6th and 7th glucose categories - corresponding to women treated for gestational diabetes mellitus (GDM). Patients and methodsWe included 7,190 women meeting the HAPO criteria, of whom 655 (9.2%) were treated for GDM (dietary education in all; insulin therapy in 150 (20.3%)). We evaluated the adjusted odds ratio (aOR) for each glucose category (reference 1st category) for LGA infant. ResultsThe aOR for LGA linearly increased from the 1st to 5th categories of fasting, 1-hour and 2-hour PG. Specifically, the aORs for the 5th category were 2.20 (95% confidence interval 1.41–3.44), 2.25 (1.11–4.59), and 2.51 (1.63–3.85), respectively. The aORs for the 6th category were globally stable at 2.52 (1.46–4.36), 2.87 (1.48–5.54), and 2.47 (1.46–4.16), respectively. The same was true for the 7th category: 1.41 (0.56–3.55), 2.84 (1.03–7.86), and 3.53 (1.77–7.06), respectively. ConclusionWe confirmed the association between increasing PG category and LGA infant in women without GDM. We did not observe a residual risk of LGA infant in women treated for GDM in our hospital, irrespective of elevated fasting, 1-hour, or 2-hour PG diagnosis. The risk of LGA infant was globally similar to that in women with high normal glucose values.

Development of a clinical risk score to predict death in patients with COVID-19.

ObjectiveTo build a clinical risk score to aid risk stratification among hospitalised COVID‐19 patients.MethodsThe score was built using data of 417 consecutive COVID‐19 in patients from Kuwait. Risk factors for COVID‐19 mortality were identified by multivariate logistic regressions and assigned weighted points proportional to their beta coefficient values. A final score was obtained for each patient and tested against death to calculate an Receiver‐operating characteristic curve. Youden's index was used to determine the cut‐off value for death prediction risk. The score was internally validated using another COVID‐19 Kuwaiti‐patient cohort of 923 patients. External validation was carried out using 178 patients from the Italian CoViDiab cohort.ResultsDeceased COVID‐19 patients more likely showed glucose levels of 7.0–11.1 mmol/L (34.4%, p < 0.0001) or >11.1 mmol/L (44.3%, p < 0.0001), and comorbidities such as diabetes and hypertension compared to those who survived (39.3% vs. 20.4% [p = 0.0027] and 45.9% vs. 26.6% [p = 0.0036], respectively). The risk factors for in‐hospital mortality in the final model were gender, nationality, asthma, and glucose categories (<5.0, 5.5–6.9, 7.0–11.1, or 11.1 > mmol/L). A score of ≥5.5 points predicted death with 75% sensitivity and 86.3% specificity (area under the curve (AUC) 0.901). Internal validation resulted in an AUC of 0.826, and external validation showed an AUC of 0.687.ConclusionThis clinical risk score was built with easy‐to‐collect data and had good probability of predicting in‐hospital death among COVID‐19 patients.

Haemoglobin A1c and serum glucose levels and risk of gastric cancer: a systematic review and meta-analysis

BackgroundThis systematic review and meta-analysis examined associations between serum levels of haemoglobin A1c (HbA1c) and glucose and the risk of gastric cancer.MethodsMEDLINE, Embase, and Cochrane Library were searched for studies examining associations between serum levels of HbA1c or glucose and the risk of gastric cancer. Inclusion of studies, quality assessment, and data extraction were conducted independently by two authors. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were synthesised using random-effects models. Cochran’s Q test and I2 statistic were used to assess heterogeneity.ResultsAmong 3473 identified studies, 12 were included. Of these, 5 studies examined HbA1c levels and 7 studies examined serum glucose levels. Serum HbA1c levels >6% were associated with an increased risk of gastric cancer (HR 1.36, 95% CI 1.06–1.74). When compared with the lowest glucose categories, the highest glucose categories were associated with a borderline increased risk of gastric cancer (HR 1.11, 95% CI 0.98–1.26). In subgroup analyses, studies that adjusted for Helicobacter pylori infection indicated stronger associations between elevated HbA1c levels and gastric cancer (HR 2.08, 95% CI 1.46–2.98) than those without such adjustment (HR 1.10, 95% CI 0.91–1.32).ConclusionsLong-standing poor glycaemic control may increase the risk of gastric cancer.Registration numberPROSPERO CRD42020157453.

Relationship between hyperglycemia, waist circumference, and the course of COVID-19: Mortality risk assessment.

An observational study was conducted in Ukraine to determine the independent mortality risks among adult inpatients with COVID-19. The results of treatment of COVID-19 inpatients (n = 367) are presented, and waist circumference (WC) was measured. Logistic regression analysis was applied to evaluate the effects of factors on the risk of mortality. Odds ratios and 95% CIs for the association were calculated. One hundred and three of 367 subjects had fasting plasma glucose level that met the diabetes mellitus criteria (≥7.0 mmol/L), in 53 patients, diabetes mellitus was previously known. Two hundred and eleven patients did not have diabetes or hyperglycemia. Diabetes mellitus/hyperglycemia odds ratio 2.5 (CI 1.0-6.1), p = 0.045 loses statistical significance after standardization by age, waist circumference or fasting plasma glucose. No effect on gender, body mass index-determined obesity, or hypertension was found. The fasting plasma glucose (>8.5 mmol/L), age (≥61 years), and waist circumference (>105 cm) categories were associated with ORs 6.34 (CI 2.60-15.4); 4.12 (CI 1.37-12.4); 8.93 (CI 3.26-24.5), respectively. The optimal model of mortality risk with AUC 0.86 (CI 0.81-0.91) included the diabetes/heperglycemia and age categories as well as waist circumference as a continued variable. Waist circumference is an independent risk factor for mortality of inpatients with COVID-19.

Changes in β-Cell Function in Offspring of Type-2 Diabetic Patients, as per Fasting and Two-Hour Plasma Glucose Levels.

BackgroundThe changes in β-cell function in high-risk populations who are apparently in the normal glucose tolerant stage are still under investigation for designing earlier prevention strategies. This study analyzes changes in β-cell function and insulin sensitivity across fasting and two-hour glucose categories spanning normal glucose tolerance (NGT) to impaired glucose tolerance (IGT), in offspring of subjects with type-2 diabetes mellitus (T2DM) compared to the controls without a known family history of T2DM.MethodsOffspring of T2DM patients (cases) and individuals without a family history of T2DM (controls) were the subjects for this cross-sectional study. All participants underwent a 75 g oral glucose tolerance test and blood samples were collected for plasma glucose, insulin, C-peptide and proinsulin, at zero, 30, 60, and 120 minutes. ResultsA total of 358 cases (age 23.0 ± 10.8 years, 54% males) and 287 controls (age 28.4 ± 8.10 years, 65% males) were the subjects of this study. Cases and controls were divided into subgroups based on fasting and two-hour glucose categories spanning NGT to IGT. Compared to the reference category of controls (< 80 mg/dL for fasting glucose and < 84 mg/dL for two-hour glucose), cases with IGT had ~60% decline in both β-cell compensation (as measured as disposition index {0-120}) and insulin sensitivity (as measured as whole-body insulin sensitivity index {0-120}); adjusted for age, gender, and body mass index. From lower to higher fasting and two-hour glucose categories, there was a continuous and significant decline in β-cell compensation in both cases and controls. Significant reduction in first-phase insulin secretion, as measured as insulinogenic (0-30) index, was only observed among two-hour glucose categories, not among the fasting glucose categories. In the transition from late NGT cases to IGT cases, there was a significant decline in β-cell compensation, first-phase insulin secretion (more prominent than a decline in overall β-cell secretion) and the changes in whole-body insulin sensitivity were not statistically significant.ConclusionsThe decline in β-cell compensation was continuous and significant in offspring of subjects with type-2 diabetes and controls without a known family history of diabetes from early normal glucose tolerant ranges to impaired glucose tolerant ranges. Compared to the strictest glucose controlled category of controls, approximately 60% decline was observed in β-cell compensation and insulin sensitivity, in impaired glucose tolerant offspring of subjects with type-2 diabetes mellitus.

SAGE SCORE THAT PREDICTS HIGH PWV APPLIED TO LATIN AMERICAN HYPERTENSIVE PATIENTS EVALUATED WITH OSCIILOMETRIC DEVICES

Objective: Objective: Pulse wave velocity (PWV) analysis represents an important tool to identify subclinical hypertension-mediated organ damage and, carotid-femoral PWV is the gold standard method for measuring large artery stiffness. SAGE is a validated clinical score and it uses four clinical parameters (office SBP, Age, Fasting Glucose and eGFR categories) to identify hypertensive patients with high likelihood of nigh PWW and thus high risk of a major risk of cardiovascular events. We have applied this score to Latin American hypertensive patients evaluated with oscilometric devices. Design and method: Methods: A retrospective analysis of patients submitted to central blood pressure measurement using the validated oscilometric Mobil-O-Graphâ. We have then selected those with hypertension and with all the SAGE parameters available. The score was divided into 18 categories (0 to 17) and, to each of them, a PWV greater 10m/sec analysis of sensitivity, specificity, positive and negative predictive value was done. A ROC curve using Youden index was constructed to define better score to identify these patients with high risk for elevated PWV Results: Results: A total of 1266 patients were selected and 837 have reached predefined criteria of SAGE parameters. Mean age was 58 ± 15 years and 49,3% were male. Diabetes was found in 17% of the sample, smoking 18% and 582 (70%) patients were using anti-hypertensive drugs. Mean office blood pressure was 129 ± 18,2 mmHg for systolic and 82 ± 13,1 mmHg for diastolic. PWV median was 8,3 m/sec ± 2,1 m/sec. According to ROC curves a cut-off &gt;7 was the best one to identify high risk of PWV greater 10 m/sec (sensibility 67,19% CI 95%: 60,1–73,8, specificity 93,95% CI 95%: 91,8–95,7). With this cut-off point 1 in each 5 hypertensive patients would be referred to PWV measurement. This value is close to one that the Original SAGE score identified (&gt;8). Conclusions: Conclusion: SAGE score that identifies patients with high PWV is operational when applied to hypertensive Latin American population with oscilometric device measurement. Yielded cut-off values are similar to those in the original cohort that was validated with carotid-femoral PWV measurements in a European population.

Estimated Treatment Effects of Tight Glycaemic Targets in Mild Gestational Diabetes Mellitus: A Multiple Cut-Off Regression Discontinuity Study Design.

Background: We investigated the treatment effects of tight glycaemic targets in a population universally screened according to the International Association of Diabetes and Pregnant Study Groups (IADPSG)/World Health Organisation (WHO) gestational diabetes mellitus (GDM) guidelines. As yet there, have been no randomized control trials evaluating the effectiveness of treatment of mild GDM diagnosed under the IADPSG/WHO diagnostic thresholds. We hypothesize that tight glycaemic control in pregnant women diagnosed with GDM will result in similar clinical outcomes to women just below the diagnostic thresholds. Methods: A multiple cut-off regression discontinuity study design in a retrospective observational cohort undergoing oral glucose tolerance tests (OGTT) (n = 1178). Treatment targets for women with GDM were: fasting capillary blood glucose (CBG) of ≤5.0 mmol/L and the 2-h post-prandial CBG of ≤6.7 mmol/L. Regression discontinuity study designs estimate treatment effects by comparing outcomes between a treated group to a counterfactual group just below the diagnostic thresholds with the assumption that covariates are similar. The counterfactual group was selected based on a composite score based on OGTT plasma glucose categories. Results: Women treated for GDM had lower rates of newborns large for gestational age (LGA), 4.6% versus those just below diagnostic thresholds 12.6%, relative risk 0.37 (95% CI, 0.16–0.85); and reduced caesarean section rates, 32.2% versus 43.0%, relative risk 0.75 (95% CI, 0.56–1.01). This was at the expense of increases in induced deliveries, 61.8% versus 39.3%, relative risk 1.57 (95% CI, 1.18–1.9); notations of neonatal hypoglycaemia, 15.8% versus 5.9%, relative risk 2.66 (95% CI, 1.23–5.73); and high insulin usage 61.1%. The subgroup analysis suggested that treatment of women with GDM with BMI ≥30 kg/m2 drove the reduction in caesarean section rates: 32.9% versus 55.9%, relative risk 0.59 (95%CI, 0.4–0.87). Linear regression interaction term effects between non-GDM and treated GDM were significant for LGA newborns (p = 0.001) and caesarean sections (p = 0.015). Conclusions: Tight glycaemic targets reduced rates of LGA newborns and caesarean sections compared to a counterfactual group just below the diagnostic thresholds albeit at the expense of increased rates of neonatal hypoglycaemia, induced deliveries, and high insulin usage.

Utility of in-hospital post-delivery fasting plasma glucose to predict postpartum glucose status in women with hyperglycaemia first detected in pregnancy: A prospective cohort study.

BackgroundWomen with hyperglycaemia first detected in pregnancy (HFDP), including those with gestational diabetes mellitus (GDM), should undergo a glucose evaluation 4–12 weeks after delivery. Globally, suboptimal postpartum return rates limit the opportunity to intervene in women with sustained hyperglycaemia and pragmatic solutions should be sought to bridge this gap.ObjectiveTo assess the utility of postpartum in-hospital glucose evaluation to predict the outcome of the oral glucose tolerance test (OGTT) performed 4–12 weeks after delivery.MethodsThe study was performed prospectively at Tygerberg Hospital, Cape Town, South Africa. Women with HFDP, classified as GDM based on the modified National Institute for Health and Care Excellence criteria, who delivered between November 2018 and June 2019 were included in the study. Fasting plasma glucose (FPG) was performed 24–72 hours after delivery (t1) in the postnatal ward, provided glucose lowering medication was discontinued at delivery. An OGTT 4–12 weeks postpartum (t2) was scheduled for the total cohort. We compared glucose values and glucose categories at t1 and t2 and evaluated antenatal characteristics of women who returned, compared to the group that was lost to follow-up.ResultsIn-hospital post-delivery glucose assessment (t1) was performed in 115 women. Glucose levels were significantly lower at t1 compared to antenatal diagnostic values (t0) and assessment at t2. Of the fourteen women with hyperglycaemia at t2, none had abnormal fasting glucose concentrations at t1. Women with HFDP who fulfilled criteria for overt diabetes at t0, all (24/115) had normal fasting glucose levels at t1 except for IFG in one (1/24). The antenatal characteristics of women with HFDP who returned at t2, were similar to the women who did not return.ConclusionBased on this study, in-hospital fasting glucose 24–72 hours postpartum cannot replace the OGTT 4–12 weeks postpartum. Pragmatic solutions for low postpartum return rates in women with HFDP should be pursued.

Relationship between renal capacity to reabsorb glucose and renal status in patients with diabetes

AimsInterindividual variability in capacity to reabsorb glucose at the proximal renal tubule could contribute to risk of diabetic kidney disease. Our present study investigated, in patients with diabetes, the association between fractional reabsorption of glucose (FRGLU) and degree of renal disease as assessed by urinary albumin excretion (UAE) and estimated glomerular filtration rate (eGFR). MethodsFRGLU [1-(glucose clearance/creatinine clearance)] was assessed in 637 diabetes patients attending our tertiary referral centre, looking for correlations between FRGLU and UAE (normo-, micro-, macro-albuminuria) and Kidney Disease: Improving Global Outcomes (KDIGO) eGFR categories: >90 (G1); 90–60 (G2); 59–30 (G3); and<30–16 (G4) mL/min/1.73 m2. Patients were stratified by admission fasting plasma glucose (FPG) into three groups: low (<6mmol/L); intermediate (6–11mmol/L); and high (>11mmol/L). ResultsMedian (interquartile range, IQR) FRGLU levels were blood glucose-dependent: 99.90% (0.05) for low (n=106); 99.90% (0.41) for intermediate (n=288); and 96.36% (12.57) for high (n=243) blood glucose categories (P<0.0001). Also, FRGLU increased with renal disease severity in patients in the high FPG group: normoalbuminuria, 93.50% (17.74) (n=135); microalbuminuria, 96.56% (5.94) (n=77); macroalbuminuria, 99.12% (5.44) (n=31; P<0.001); eGFR G1, 94.13% (16.24) (n=111); G2, 96.35% (11.94) (n=72); G3 98.88% (7.59) (n=46); and G4, 99.11% (2.20) (n=14; P<0.01). On multiple regression analyses, FRGLU remained significantly and independently associated with UAE and eGFR in patients in the high blood glucose group. ConclusionHigh glucose reabsorption capacity in renal proximal tubules is associated with high UAE and low eGFR in patients with diabetes and blood glucose levels>11mmol/L.