Glucose Tolerance Test Research Articles

The Influence of X Chromosome Parent-of-Origin on Glycemia in Individuals with Turner syndrome

Introduction: The cause of increased diabetes mellitus (DM) risk in individuals with Turner syndrome (TS) is poorly understood. Parent-of-origin effects related to whether the maternal or paternal X chromosome (Xchr) remains intact have been found for several TS phenotypes, including hypercholesterolemia. Therefore, Xchr parent-of-origin may impact DM risk in TS. The aim of this study was to determine whether Xchr parent-of-origin affects glycemia, as measured by oral glucose tolerance test (OGTT), in TS. Methods: A total of 81 individuals with 45,X karyotype from the TS: Genotype Phenotype study had Xchr parent-of-origin assessment and completed a 3-hour OGTT. Parallel-slopes multiple linear regression modeling was used to test whether Xchr parent-of-origin, age, and/or body mass index (BMI) significantly predicted incremental area under the glucose curve (iAUC). A second analysis included 62 additional individuals with 45,X mosaicism. Results: All three factors predicted iAUC glucose in the 81 individuals with 45,X karyotype (age: B = 0.36, p = 0.0004; BMI: B = 0.33, p = 0.001; Xchr parent-of-origin: B = 0.21; p = 0.01). The overall model remained statistically significant when including individuals with 45,X mosaicism, but Xchr parent-of-origin was no longer significant. Conclusions: Maternal Xchr monosomy predicts higher glucose concentration than paternal Xchr monosomy in response to oral glucose in 45,X individuals. This effect is obscured when including individuals who are mosaic, potentially due to the presence of both parent Xchrs in the non-45,X cell line.

Is glucose‐induced hypersecretion of glicentin after the revision surgery using Roux‐en‐Y gastric bypass related to improved glycemic control due to insulin hypersecretion in a type 2 diabetes patient without diabetes remission after laparoscopic sleeve gastrectomy?

ABSTRACTWe report case details of a morbidly obese patient with type 2 diabetes mellitus (T2DM) who became a failure of diabetes remission after laparoscopic sleeve gastrectomy (LSG). He had a marked improvement of hyperglycemia after the revision surgery using Roux‐en‐Y gastric bypass (RYGB), where passage failure of a solid food intake at the gastric angle portion disappeared after the revision surgery. Interestingly, he showed improvements of insulin and a marked glicentin secretions with minor changes in glucagon related peptide 1 (GLP‐1) and glucose‐dependent insulinotropic polypeptide (GIP) secretions in the oral glucose tolerance test OGTT after the RYGB surgery compared with post‐LSG. Although a marked increase in glucose‐induced glicentin secretion after RYGB surgery with increased insulin secretion, further studies are needed to confirm if the increased glicentin secretion after RYGB surgery is linked to stimulation of insulin secretion.

Determining how the gestational changes, including low hemoglobin influence the hba1c and estimated average glucose relationship

ABSTRACT Background: Gestational Diabetes Mellitus (GDM) affects up to 14% of pregnancies globally, with accurate glycemic control critical for preventing adverse outcomes. While HbA1c is a standard marker for long-term glucose control, its reliability in pregnant women with anemia is debated. This study explores the association between anemia and glycemic indicators (Glycosylated hemoglobin HbA1c, Random plasma glucose (rPG), and Estimated average glucose (eAG) in pregnant women with GDM. Additionally, it examined the correlation between average glucose levels or eAG, measured by random plasma glucose rPG, and HbA1C. Methods: A prospective case-control study was carried out over eight months at the Departments of Chemical Pathology and Obstetrics and Gynecology, Dow University of Health Sciences (DUHS). Pregnant women in their second trimester after being diagnosed for GDM through oral glucose tolerance test were classified into anemic (hemoglobin < 10.5 g/dL) and non-anemic groups. Blood samples were collected and analyzed for HbA1c, hemoglobin, and random plasma glucose levels. Data were processed using SPSS (version-26) different variables compared by using independent t-test and correlation analyses at a significance level of p < 0.05. Results: Mean values for eAG, HbA1C, and rPG were 174.22 ± 24.489 mg/dl, 8.342 ± 1.6152%, and 166.21 ± 21.478 mg/dl, respectively. Anemia was associated with significantly higher HbA1C (p < 0.001), eAG (p < 0.001), and rPG (p = 0.004). A strong positive correlation was observed between eAG and rPG (r = 0.958, p < 0.01), while eAG showed a moderate correlation with HbA1C (r = 0.501, p < 0.01). In contrast, the correlation between HbA1C and rPG was weaker (r = 0.331, p < 0.01). Conclusion: eAG proved to be a good indicator for assessing glycemic control in pregnant non-anemic women with GDM. Anemia significantly affected glycemic metrics, leading to higher HbA1C and glucose levels.

Continuous Glucose Monitoring for the Diagnosis of Post-Transplantation Diabetes Mellitus and Impaired Glucose Tolerance From Years One to Five After Kidney Transplantation—A Prospective Pilot Study

Post-transplantation diabetes mellitus (PTDM) and prediabetes are associated with increased cardiovascular morbidity and mortality in kidney transplant recipients (KTR), when diagnosed by an oral glucose tolerance test (oGTT). Hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) display low concordance with the oGTT in the early phase posttransplant. For this prospective cross-sectional pilot study, 41 KTR from years one to five after transplantation without known preexisting PTDM (defined by HbA1c ≥ 6.5% (NGSP) or 48 mmol/mol (IFCC) at last visit or glucose-lowering therapy) were recruited at the Charité Transplant Outpatient Clinic. For each study participant HbA1c, FPG and an oGTT were followed by CGM. 38 of the 41 patients recruited had sufficient CGM-recordings (≥10 days). PTDM and impaired glucose tolerance (IGT), as defined by the gold standard oral glucose tolerance test (oGTT)-derived 2-h plasma glucose (2hPG), were diagnosed in one (3%) and twelve (32%) patients, respectively. HbA1c exhibited good test characteristics regarding IGT (ROC-AUC: 0.87); sensitivity/specificity of HbA1c-threshold 5.7% (NGSP) or 39 mmol/mol (IFCC) were 1.0/0.64, respectively. Best performing CGM-readouts mean sensor glucose and percent of time >140 mg/dL (%TAR (140 mg/dL)) displayed acceptable diagnostic performance (ROC-AUC: 0.78 for both). Thus, HbA1c can aid in timely diagnosis of IGT in the stable phase after kidney transplantation.

Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy.

Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile distributions in women with normal (non-IR and non-GDM) and suboptimal glycemic status (IR and/or GDM). CGM measurements were taken for 3-10days at 18-24weeks' gestation, followed by fasting serum insulin and oral glucose tolerance testing at 24-28weeks' gestation. IR and GDM were determined by the updated Homeostasis Model Assessment of IR score of ≥ 1.22 and 2013 World Health Organization criteria, respectively. Risks of IR and GDM were estimated using modified Poisson models, and hourly interstitial glucose centiles determined using Generalized Additive Models for Location, Scale and Shape. This prospective cohort study involved 167 pregnant women in Singapore, with a mean age of 31.7years, body mass index of 22.9kg/m2, and gestation of 20.3weeks. 25% of women exhibited IR and 18% developed GDM. After confounders adjustment, women with suboptimal glycemic control, indicated by higher mean daily glucose (risk ratio 1.42; 95% confidence interval 1.16, 1.73), glucose management indicator (1.08; 1.03, 1.12), and J-index (1.04; 1.02, 1.06), as well as those with greater glycemic variability, indicated by higher standard deviation (1.69; 1.37, 2.09), coefficient of variation (1.03; 1.00, 1.06), and mean amplitude of glycemic excursions (1.4; 1.14, 1.35) derived from CGM in early gestation were associated with higher risks of developing IR in later gestation. These associations were similarly observed for the development of GDM. Centile curves showed that, compared to those with normal glycemic status, women with suboptimal glycemic status had higher glucose levels, with greater fluctuations throughout 24h. In pregnant women who subsequently developed IR and GDM, interstitial glucose levels assessed by CGM were elevated and varied greatly. This supports the potential use of CGM to screen for glycemic changes early in pregnancy.

Skinny fat model of metabolic syndrome induced by a high-salt/sucrose diet in young male rats.

Childhood and puberty can affect metabolism, leading to tissue injury and malfunction later in life. The consumption of high-processed foods rich in salt and sugar is increasing in middle- and high-income countries, especially among young people. It is necessary to evaluate the effects of high salt and sugar levels in the youth on most injured organs during metabolic challenges. We aimed to investigate whether high salt/sucrose intake affects whole-body development and leads to end-organ injury. Weaned Male Wistar rats were divided into two groups: a control group fed a standard diet (CO) and tap water, and an experimental group (SS) fed a standard diet and a beverage containing 1.8% NaCl and 20% sucrose instead of tap water. The animals were treated for 60 days, starting after weaning at 21 days of age, after which the animals were subjected to glucose and insulin tolerance tests, urine collection, and heart rate monitoring, and euthanized for sample collection at 81 days of age. SS showed reduced body weight gain and increased food intake of sodium/sucrose solution. Interestingly, high salt/sucrose intake led to increased body adiposity, liver lipid inclusion, heart rate, and renal dysfunction. SS exhibits increased levels of peroxisome proliferator-activated receptor alpha to counterbalance the hypertrophy of brown adipose tissue. Our findings reveal that the SS rat model exhibits non-obvious obesity with end-organ damage and preserved brown adipose tissue function. This model closely parallels human conditions with normal BMI but elevated visceral adiposity, providing a relevant tool for studying atypical metabolic disorders.

Attenuation of high-fat diet-induced weight gain by apolipoprotein A4.

Apolipoprotein A4 (APOA4) is synthesized by the small intestine in response to dietary lipids. Chronic exposure to a high-fat diet (HFD) desensitizes lipid-induced APOA4 production and attenuates brown adipose tissue (BAT) thermogenesis. We hypothesized that exogenous APOA4 could increase BAT thermogenesis and energy expenditure in HFD-fed mice, resulting in decreased obesity and improved glucose tolerance. BAT and inguinal white adipose tissue (IWAT) thermogenesis, body composition, energy intake and expenditure, and locomotor activity were measured using an infrared camera, immunoblots, quantitative magnetic resonance imaging, and a comprehensive lab animal monitoring system. An intraperitoneal glucose tolerance test and hepatic lipid accumulation and steatosis were assayed. Mice receiving continuous infusion of APOA4 for the last 4 weeks of 10 weeks of HFD feeding gained no additional body weight and had reduced fat mass but enhanced BAT and IWAT thermogenesis and energy expenditure, despite unaltered food intake and locomotor activity. Additionally, APOA4 infusion elevated fatty acid β oxidation; decreased lipogenesis, lipid accumulation, and steatosis in liver; and improved glucose tolerance. Maintenance of plasma APOA4 via exogenous APOA4 protein parallels elevation of BAT and IWAT thermogenesis, hepatic fatty acid β oxidation, and overall energy expenditure, with subsequent prevention of additional weight gain in HFD-fed obese mice.

Abstract 4134475: Effects of E-cigarette Vaping on Endothelial Function in Diet-Induced Obese Mice

Introduction: Although electronic cigarettes (e-cigs) have been known to increase the risk of vascular complications, little is known about whether e-cig represents an independent risk factor for the development and worsening of obesity and its associated vascular diseases. We hypothesize that a high-fat diet (HFD) enhances e-cig-induced vascular complications. Methods: Male and female eight-week-old C57Bl/6J mice were fed normal chow (NC) or HFD for 15 weeks before being exposed to e-cigs (PG/VG only [PGVG] or PG/VG + 24 mg/ml nicotine [Nic]) or fresh air (FA) for 12 weeks (n=6-8). At the end of the experiments, glucose level and thoracic aortic responses to phenylephrine (PE), acetylcholine (ACh), and sodium nitroprusside (SNP) were assessed via the glucose tolerance test (GTT) and wire myography, respectively. Total RNA from male aortas was extracted and RNA-seq was utilized to identify the transcriptomic changes in our diet-induced obesity mouse model subjected to e-cig vapors (n=4). Results: Compared to NC with FA, HFD alone caused glucose intolerance as shown by the GTT, which was improved only by exposure to nicotine-containing e-cigs (HFD+Nic). Similar improvement in glucose intolerance were found in the NC group with e-cigs (PGVG or Nic). In addition, both NC and HFD-fed male mice exhibited endothelial dysfunction characterized by a decrease in the ACh-dependent (endothelium) relaxation of PE-induced contractions. Importantly, nicotine-containing e-cig exposure (Nic) dramatically reduced the sensitivity of the aorta in the HFD group (HFD+Nic) to both ACh and SNP, while it only affected the sensitivity and maximum relaxation to ACh in the male NC group (NC+Nic). There were no significant differences in the vasoreactivity of female mice exposed to e-cig or HFD. Finally, RNA-seq results suggested that e-cig-treated male mice had altered expression of genes related to endothelial and smooth muscle function and metabolism, particularly fatty acid metabolism, which was also significant with the addition of HFD. Conclusion: Collectively, our results suggest that acute e-cig exposure results in significant vascular dysfunction in male mice, which is worsened in HFD mice. The identification of genes dysregulated in mice exposed to e-cigs provides novel insights into vascular biology and could have a significant impact on our understanding of vascular complications associated with e-cig usage and provide insights into its contributions to obesity and diabetes.

Association between systemic immunity-inflammation index and glucose regulation in non-diabetic population: A population-based study from the NHANES (2005-2016).

To investigated the link between the systemic immunity-inflammation index (SII), a new inflammatory biomarker, and the risk of abnormal glucose regulation in non-diabetic population. Using data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES), we conducted a cross-sectional study on non-diabetic adults with data on SII and glucose regulation markers. We analyzed the relationship between SII and indicators of glucose regulation, including fasting plasma glucose, fasting insulin, hemoglobin A1c, oral glucose tolerance test (OGTT), and states of abnormal glucose regulation like impaired glucose tolerance (IGT), insulin resistance, and prediabetes. Adjusting for confounders, higher SII levels were significantly associated with a higher OGTT and a greater likelihood of IGT (OR = 2.673, 95% CI: 1.845, 3.873). In subgroup analysis, participants without hyperlipidemia in the highest SII quartile had a 240% higher odds of IGT compared to those in the lowest quartile (OR = 3.407, 95%CI: 1.995, 5.820), an association not observed in those with hyperlipidemia (p for interaction < 0.05). SII emerges as a useful biomarker for identifying IGT in non-diabetic individuals, specifically in those without hyperlipidemia.

Proteomic Insights Into Gingival Crevicular Extracellular Vesicles in Periodontitis and Gestational Diabetes: An Exploratory Study.

To characterize the gingival crevicular fluid (GCF) and plasma extracellular vesicles (EVs) and explore their proteomic cargo in healthy pregnant women compared to those with gestational diabetes mellitus (GDM) and periodontitis. One-hundred and four pregnant women were recruited at 24-30 gestation weeks. GDM was diagnosed by an oral glucose tolerance test. GCF and plasma samples were obtained to isolate EVs and characterized by nanoparticle tracking, immunoassays, electron microscopy and mass spectrometry. Of the recruits,17.3% women were healthy, 50% had periodontitis and 32.7% had both GDM and periodontitis. Probing depth, clinical attachment loss and bleeding on probing were more severe in GDM and periodontitis pregnancies (p < 0.0001). Additionally, this group showed an increase concentration of total, small and large GCF-EVs (p = 0.0015, p = 0.0011 and p = 0.0008, respectively), with decreased expression of CD9, CD81 and CD81/CD63 ratio (p = 0.0461, p = 0.0164 and p = 0.0005, respectively). No differences were observed in plasmatic EVs concentration or markers expression. Proteomic analysis of GCF-EVs showed peptides of both host and bacterial origin. Gene ontology analysis revealed that proteins of GCF-EVs participate in immune inflammatory responses, glucose metabolism and insulin response mechanisms. GCF-EVs were increased in both GDM and periodontitis, and their proteomic cargo suggest their involvement in immune inflammatory response, glucose metabolism and insulin pathways during pregnancy.

Abstract 4116298: Once Weekly Utreglutide (GL0034), a Glucagon-like Peptide-1 Receptor Agonist, at 4 × 450 µg Doses Reduces Blood Pressure, Lipids, and Body Weight in Post-menopausal Females: A Phase I Study

Background: Utreglutide (GL0034), a novel, once weekly glucagon-like peptide-1 receptor agonist (GLP-1RA), previously demonstrated significant reductions in body weight (BW) after a single dose ascending study in individuals with obesity . BW reductions after pharmacological treatment of obesity with GLP-1RA is associated with blood pressure (BP) lowering effects. Aim: This phase I study assessed the safety, tolerability, and cardio-metabolic effects of utreglutide after multiple ascending doses in post-menopausal female volunteers with overweight and obesity. Methods: In this randomized, double-blind, placebo-controlled study 12 post-menopausal female volunteers with overweight/obesity, aged 18 to 65 years old with a body mass index (BMI) ≥26 kg/m 2 were randomized (9:3) to subcutaneous utreglutide fixed doses (4 × 450 µg); or placebo once weekly for four weeks. Safety, tolerability, and key cardio-metabolic parameters were assessed. Biomarker measurements included oral glucose tolerance test (OGTT) insulin and glucose area under the curve (AUC), systolic- and diastolic BP, lipid profile (triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), and non-high-density lipoprotein (non-HDL), creatinine, potassium, BW and leptin. Results: Utreglutide was generally well tolerated and related adverse effects were mainly gastrointestinal with dose-dependent nausea, vomiting and decreased appetite. Reductions in OGTT AUCs of insulin ( p &lt;0.05) and glucose ( p &lt;0.01) were noted on Day 23 after four weeks treatment with Utreglutide. This was accompanied by a decrease ( p &lt;0.001) in mean systolic and diastolic BP on Day 23 from baseline (BL). On Day 23, significant reductions in TC ( p &lt;0.01), LDL ( p &lt;0.05) and non-HDL ( p &lt;0.05) were observed. BW reduction versus BL ( p &lt;0.001) was 2.0 kg and 1.8 kg respectively on Day 29 and End of Study (EoS). Leptin levels significantly reduced from BL on Day 23 ( p&lt; 0.01) and EoS ( p &lt;0.001). No significant changes were observed for TG, creatinine and potassium (Table). Conclusions: Once weekly utreglutide dosing for four weeks at a dose of 450 µg in post-menopausal females with overweight and obesity, demonstrated clinically relevant reductions of systolic and diastolic BP. This was associated with improved performance of OGTT AUC of insulin and glucose, lipids, BW and leptin with an overall good tolerability and with potential to demonstrate cardio-metabolic benefits.

Abstract 4139148: Mechanisms of Maternal Cardiovascular Disease Development in a Novel Mouse Model of Pregnancy-Induced Diabetes

Background: Women with gestational diabetes mellitus (GDM) are more likely to develop cardiovascular disease (CVD) within 3 to 10 years following pregnancy. Endothelial dysfunction is a mechanism implicated in both hyperglycemia and CVDs, and it may constitute the missing link in this interaction. One reason for the lack of progress into the cardiovascular complications of GDM is the need for appropriate preclinical models that mimic human GDM. Also, the exact mechanisms mediating increased future cardiovascular risk in maternal with pregnancy-induced diabetes is unclear. Aim: To determine the mechanisms underlying cardiovascular disease in hormonal model of GDM. Methods: Sixteen week-old C57BL/6J female mice were treated with insulin receptor antagonist (S961) or saline (n=4) from the second trimester of pregnancy until delivery to develop a model of GDM. Glucose tolerance test was determined by glucometer and fasting insulin by colorimetry. Cardiac structure and function were measured by echocardiography (VEVO 3100) and pulse wave velocity was measured by Pulse Wave Doppler. Exercise tolerance test was performed on treadmill. Plasma endothelin-1 and nitrite were measured by ELISA and colorimetric assay. Aortic SIRT-1 was determined by western blot and aortic vascular reactivity was determined by wire myograph. Results: S961-induced GDM mice exhibit hyperglycemia (169.2 ± 3.6 vs. 105.5 ± 10.8mg/dL, P&lt;0.004 ) and hyperinsulinemia (1.9 ± 0.2 vs. 0.8 ± 0.1ng/ml , p&lt;0.01 ) which mimics the condition observed in human GDM. Interestingly, S961-induced GDM mice went on to develop systolic and diastolic dysfunction, vascular stiffness (3.7 ± 0.1 vs. 3.1 ± 0.08m/s, p&lt;0.005 ), exercise intolerance and increased thickness of the cardiac wall at 10 weeks post-delivery. Plasma ET-1 was elevated in our model during pregnancy (28.1 ± 1.7 vs. 5.2 ± 0.2pg/ml, p&lt;0.002 ) and at 10 weeks post-delivery (19.9 ± 2.9 vs. 6.7 ± 0.7pg/ml, p&lt;0.05 ). Circulating NO and aortic expression of sirtuin-1 (SIRT 1), that is involved in endothelial longevity is reduced in GDM mice. Additionally, vascular relaxation to acetylcholine was attenuated in S961-induced GDM mice. Conclusion: We have developed a novel mouse model of GDM similar to that observed in pregnant women by treatment with S961. Moreover, S961 treated mice develop cardiac dysfunction and vascular stiffness at 10 weeks post-delivery. Alterations in ET-1, SIRT 1, and NO levels may be responsible for the development of CVD in this model.

Abstract 4135662: Dietary Inulin Improves Glucose Metabolism and Energy Balance in Obese Mice via Adipocyte Free Fatty Acid Receptor 2 (FFAR2)

Background: Inulin is a non-digestible prebiotic dietary fiber that can promote metabolic health including reduced body weight and improved glucose metabolism via effects on gut microbiota. We hypothesize that inulin prevents obesity-associated cardiometabolic alterations by augmenting the production of short-chain fatty acids (SCFA) from gut microbiota, which activate free fatty acid receptor 2 (FFAR2), a major SCFA receptor, in murine adipose tissue. Methods: 8-week-old male C57BL/6J (wild-type, WT; n=34) and adipocyte FFAR2-knockout (Ad-FFAR2 KO; n=25) mice were fed a high-fat high-sucrose (HFHS) diet for 8 weeks, then randomized into experimental groups to receive either continued HFHS (n=8-13), or HFHS containing inulin (10% w/w chicory root inulin; n=17-21) for a further 5 weeks. Body weight was recorded weekly, food intake, body composition, and indirect calorimetry were assessed before and after the inulin intervention, and intraperitoneal glucose and insulin tolerance tests were performed. Subcutaneous and visceral white adipose tissue (WAT) samples were collected at the study termination. Results: HFHS-fed Ad-FFAR2 KO mice showed higher body weight (7.4%), fat mass, and WAT weight due to increased food intake, with worse glucose tolerance compared to WT mice. In WT mice, inulin significantly reduced body weight gain and body adiposity. These effects were associated with reduced locomotor activity and respiratory quotient (RQ) without effects on energy expenditure and were accompanied by improvements in glucose tolerance. Strikingly, inulin had no effect on body weight or body adiposity in Ad-FFAR2 KO mice but reduced RQ, locomotor activity, and improved glucose tolerance similar to WT mice. Conclusions: Our findings suggest that FFAR2 signaling in adipose tissue is crucial for improving cardiometabolic outcomes in obesity and that gut metabolites responsive to dietary interventions, such as inulin, are potential targets for obesity treatment strategies.

Association between type 2 diabetes and periodontitis: a population-based study in the North Peru

Background Periodontitis, one of the most common forms of periodontal disease, has been linked to several cardiovascular factors including metabolic syndrome and inflammatory processes. This study aimed to determine the association between type 2 diabetes mellitus (T2DM) and periodontitis in a representative sample of individuals in the north of Peru. Materials and methods Secondary data analysis using information of a population-based survey, enrolling subjects aged 35 to 69 years. The outcome was periodontitis, evaluated using a self-reported and validated 8-item questionnaire, whereas the exposure was the presence of T2DM, evaluated using results of oral glucose tolerance test and categorized into two different forms: (a) normoglycemic, prediabetes, and T2DM, and (b) without T2DM, with T2DM and &lt;5 years of diagnosis, and with T2DM and ≥5 years of diagnosis. Poisson regression models were utilized to report prevalence ratios (PR) and 95% confidence intervals (95% CI). Results Data from 1606 individuals were analyzed, with a mean age of 48.2 (SD: 10.6) years, and 50.3% were women. Of these, 272 (16.9%) had prediabetes and 176 (11.0%) had T2DM (17.3% with &lt;5 years of disease). Overall, 97.0% presented at least one symptom compatible with periodontitis, 882 (55.0%) had mild, 643 (40.0%) had moderate, and 5% had severe periodontitis. In multivariable model, those with T2DM had a higher prevalence of periodontitis (PR = 1.99; 95% CI: 1.12 - 3.54). Similarly, those with &lt;5 years of disease had a higher prevalence of periodontitis (PR = 2.48; 95% CI: 1.38 - 4.46). Conclusions Our research confirms the association between T2DM and periodontitis, especially among those with recent diagnosis (&lt;5 years). Symptoms of periodontitis are quite common in our study population. Our results suggest a need to periodically assess oral health in patients with T2DM.

Abstract 4138815: Prognostic Implications of Glycemic Variability Assessed by Continuous Glucose Monitoring-derived Coefficient of Variation among Patients Hospitalized for Acute Heart Failure

Background: Recent findings indicate that high glycemic variability (GV) could increase the risk of adverse outcomes in patients with cardiovascular disease. With the advances in technology, the utility of continuous glucose monitoring (CGM) has grown during recent years, which can provide valuable information that is not captured by HbA1c. We used the glucose coefficient of variation (CV, calculated as the ratio of standard deviation divided by the mean glucose level) of the obtained CGM data to analyze GV. Aims: We aimed to analyze CGM-derived CV as an indicator of GV and to evaluate prognostic implications of CGM-derived CV in patients hospitalized for acute heart failure (HF). Methods: Patients hospitalized for HF who had not been diagnosed diabetes were performed 75g-oral glucose tolerance test (OGTT). CV was evaluated using CGM system for at least 72 consecutive hours after being able to have meals stably during hospitalization. The primary outcome was a composite of cardiovascular death or re-hospitalization for HF. Patients were divided into two groups based on the median value of CV. Results: We prospectively analyzed 130 patients (mean age: 76±10 years, male 56%) admitted for acute HF. Following the 75g-OGTT, only 21% of the entire cohort exhibited normal glucose tolerance. During the median follow up period of 905 days, Kaplan–Meier curve analysis revealed that the cumulative incidence of the primary outcome event was significantly higher in patients with CV above median than in those with CV less than median (51.7% versus 24.4%, Log-rank P=0.01)(Figure). Multivariate Cox proportional analysis demonstrated that the risk of CV per 1% increment for the primary outcome was significant adjusted for history of diabetes, CGM-derived mean glucose level, and HbA1c level (hazard ratio: 1.06, 95% confidence interval 1.03–1.09). Conclusions: CGM-derived CV was associated with long term prognosis of patients hospitalized for HF with or without diabetes.

Innovating Diabetes Care in Pregnancy: Do group care models improve outcomes and equity?

Shared medical appointments (SMAs) for diabetes and group prenatal care (GPC) for pregnant patients, have emerged as innovative care delivery models. They have the potential to transform diabetes care by overcoming many of the time limitations of traditional one-on-one clinical visits. There is compelling evidence that SMAs improve glycemic control for non-pregnant patients with diabetes, GPC reduces Black/White health disparities in preterm birth, and Diabetes Group Prenatal Care increase postpartum glucose tolerance test uptake among patients with gestational diabetes mellitus. GPC models standout as one of few interventions that reduce racial health disparities, which we hypothesize occurs because they inadvertently exert their effect on both the patient and clinician through a 20+ hour meaningful shared experience. This Perspective explores the evidence for SMA and GPC in diabetes and pregnancy, theoretical underpinnings of the models, their potential to promote more equitable care, and future directions from my Perspective, as a high-risk obstetrician and 2019 ADA Pathway Accelerator award recipient.

The Predictive Power of the Mother’s Neck Circumference in the Early Diagnosis of Gestational Diabetes Mellitus

Background: Gestational diabetes mellitus (GDM) is a risk factor for the health of both the mother and fetus, responsible for a significant number of maternal, perinatal, and neonatal complications. Timely diagnosis and effective treatment can reduce the burden of the disease on the health of women and their infants during and after pregnancy. Objectives: The present study aimed to examine the predictive power of the mother’s neck circumference in the early diagnosis of gestational diabetes mellitus. Methods: This prospective cohort study was conducted on 782 pregnant women with a gestational age of 16 weeks who visited health centers in Jiroft between 2020 and 2021. Neck circumference was measured in the 16th week of pregnancy. Gestational diabetes mellitus was diagnosed using an oral glucose tolerance test (OGTT) with 75 grams of glucose at 24-28 weeks of pregnancy. Participants were selected using convenience sampling, and data were collected through interviews with the participants. Results: Among the 782 pregnant women, 179 were diagnosed with GDM, while 603 did not have GDM. The best cut-off point for neck size was determined to be 35.45 cm using the ROC curve. For the neck circumference test, sensitivity was 71.5%, specificity was 60%, positive predictive value was 34.8%, and negative predictive value was 87.7%. Conclusions: The findings indicate that a neck circumference greater than 35.45 cm in early pregnancy (16 weeks) can be considered a new diagnostic test for GDM. Early identification of women at risk should prompt necessary measures to reduce the complications associated with gestational diabetes mellitus.

Female Wistar Kyoto More Immobile rats with genetic stress hyper-reactivity show enhanced contextual fear memory without deficit in extinction of fear.

The prevalence of post-traumatic stress disorder (PTSD) is higher in females than males, but pre-clinical models are established almost exclusively in males. This study is aimed to investigate the stress-enhanced fear learning model of PTSD in females. The model mirrors PTSD symptomology in males, whereby prior stress leads to extinction resistant exaggerated contextual fear memory. As stress reactivity is highly relevant to the study and risk for PTSD, females of the stress hyper-reactive Wistar Kyoto More Immobile (WMI) and its nearly isogenic control the Wistar Kyoto Less Immobile (WLI) strains were employed. Prior studies have shown WMI females presenting unchanged or enhanced fear memory in the stress-enhanced fear learning paradigm compared WLIs. The present study confirmed the enhanced fear memory following contextual fear conditioning in WMIs compared to WLI females, but this increased fear memory was neither exaggerated by prior stress nor showed extinction deficit. The novel stressor of a glucose challenge test resulted in subtle strain- and prior stress-induced differences in plasma glucose responses. However, fasting plasma corticosterone levels were lower, and rose slower in response to glucose challenge in WMI females, suggesting a PTSD-like dysfunctional stress response. Hippocampal expressions of genes relevant to both learning and memory and the stress response were decreased in stressed WMIs compared to WLI females, further suggesting a marked dysregulation in stress-related functions like in PTSD. Thus, although WMI females do not show extinction-resistant enhanced fear memory, they do present other characteristics that are relevant to PTSD in women.

Comparison effect of hyperglycaemia induced mixed meal tolerance and oral glucose tolerance test on body oxidative stress

Abstract Objectives The mixed meal tolerance test (MMTT) and oral glucose tolerance test (OGTT) are used in the diagnosis of prediabetes and hypoglycaemia. Data suggest that oxidative stress caused by hyperglycaemia during OGTT may have adverse metabolic effects in prediabetic patients. In this study, we aimed to evaluate oxidant and antioxidant levels in OGTT and MMTT. Methods The study included 72 patients who underwent MMTT and OGTT at one-week intervals. Total Oxidant Status (TOS) and total antioxidant status (TAS) levels were analysed in samples taken from patients at zero, first and second hours of MMTT and OGTT and Oxidative Stress Index (OSI) was calculated, and the data were compared. Results OGTT and MMTT results were compared with each other within the patient group. While significant differences were found between first-hour glucose, TOS and OSI values (p&lt;0.01), no significant differences were observed for zero and second-hour values (p&gt;0.05). There was no significant difference in TAS values (p&gt;0.05). When zero, first, and second-hour results were compared for OGTT and MMTT within the same test, no significant differences were found for the other parameters except for glucose (p&lt;0.01 for both tests). The correlation between glucose and TOS, TAS and OSI values in MMTT and OGTT was not found. Conclusions Our study concludes that the body experiences more oxidative stress in the first hour following an OGTT than the oxidative stress induced by hyperglycaemia in a mixed-meal diet. Further research is needed to determine whether oxidative stress in the first hour triggers dysmetabolic events in the body.

External Validation of the PeRSonal Gestational Diabetes Model for Predicting Adverse Pregnancy Outcomes in Women with Gestational Diabetes: A Retrospective Cohort Study in a Tertiary Hospital in Thailand

Objective: This study aimed to validate the PeRSonal Gestational Diabetes (GDM) model with two-step glucose tolerance diagnostic criteria.Material and Methods: A retrospective cohort study was conducted on participants having delivered with GDM diagnosis in a tertiary hospital; from October 1, 2020, until September 30, 2022. The main outcome was a composite of maternal and perinatal adverse pregnancy complications. Model validation evaluated the predictors and calculated risk by using a two-step glucose tolerance test in the PeRSonal model formula. Model performance was analyzed for discrimination, calibration, and overall performance. Results: This study analyzed 685 from the initial 764 participants with GDM, with 218 (31.8%) developing adverse pregnancy outcomes. The most frequent adverse outcomes were hypertensive disorders in pregnancy 132 (19.3%) and neonatal hypoglycemia 91 (13.3%). This validation achieved an area under the curve (AUC) of 0.70 (95% confidence interval (CI) 0.65 to 0.74), calibration-in-the-large of 0.17, a calibration slope of 1.34, and a Brier score of 0.20, respectively. The cut-off clinical risk probability of 27.5% can predict adverse outcomes with a sensitivity of 67.3%, specificity of 63.8%, a positive predictive value (PPV) of 46.7%, and a negative predictive value (NPV) of 80.5%. Conclusion: The PeRSonal model maintains its predictive effectiveness in two-step glucose tolerance diagnostic criteria.