High Normal Blood Glucose Research Articles

Третий этап кардиореабилитации после перенесенного острого коронарного синдрома: распространенность сахарного диабета и его факторов риска

Aim: to determine risk factors for type 2 diabetes (T2D) in patients with the prior acute coronary syndrome (ACS) in the 3rd phase of cardiac rehabilitation. Patients and Methods: retrospective analysis of medical records of 200 patients (151 men, 75.5%) was performed. The mean age was 61.7±9.6 years. All patients attended a 12-month cardiac rehab program that included adequate pharmacotherapy (atorvastatin monotherapy or atorvastatin plus ezetimibe), physical and psychological rehabilitation, therapeutic feeding, and preventive group consultations (health schools). Both quantitative (fasting blood glucose, weight, body mass index, waist circumference, hip circumference, a body shape index) and qualitative (overweight, obesity, other risk factors for T2D, diabetes, de novo diabetes) parameters were studied. Results: in patients with prior ACS, a high prevalence of conventional and additional risk factors for T2D (≥ 6 risk factors were revealed in 90% of patients) was reported in the 3rd phase of cardiac rehab. After completing the cardiac rehab program, the prevalence of T2D in patients with prior ACS was 24% thereby demonstrating a significant increase (p < 0.05). Additionally, a significant increase in the proportion of patients with high normal blood glucose (5.0–6.0 mmol/l) was reported. Unfavorable de novo abnormalities of carbohydrate metabolism (pre-diabetes, T2D plus pre-diabetes) were commonly revealed in patients with high normal blood glucose. Cardiac rehab program provided weight control in patients with T2D risk. A significant increase in waist circumference, a body shape index, the waist-to-height ratio was reported thus demonstrating redistribution of fat mass and an increase in visceral fat. These signs may indicate an unfavorable trend of increased insulin resistance. Conclusions: searching for risk factors of unfavorable metabolic abnormalities identified and means to optimize management of these patients (including medical treatment) based on the assessment of metabolic benefits and drawbacks is required. KEYWORDS: acute coronary syndrome, cardiac rehabilitation, type 2 diabetes, pre-diabetes, insulin resistance, risk factors, statins. FOR CITATION: Druk I.V., Korennova O.Yu., Savchenko M.V. et al. Third phase of cardiac rehabilitation after acute coronary syndrome: prevalence of diabetes and its risk factors. Russian Medical Inquiry. 2021;5(4):176–184 (in Russ.). DOI: 10.32364/2587-6821-2021- 5-4-176-184.

Pre-impaired fasting glucose state is a risk factor for endothelial dysfunction: Flow-mediated Dilation Japan (FMD-J) study

IntroductionDiabetes mellitus is associated with endothelial dysfunction. However, there is little information on the relationships of fasting blood glucose (FBG), including high normal blood glucose and impaired fasting glucose (IFG)...

Pre-Impaired Fasting Glucose State Is a Risk Factor for Endothelial Dysfunction: Flow-Mediated Dilation Japan (FMD-J) Study

Background: Diabetes mellitus is associated with endothelial dysfunction. However, there is little information on the relationships of fasting blood glucose (FBG) including high normal blood glucose and impaired fasting glucose (IFG) with endothelial function. The purpose of this study was to evaluate the relationship between FBG level and flow-mediated vasodilation (FMD) in detail using a large sample size. Methods: This study was a cross-sectional study. We measured FMD in 7265 subjects at 31 general hospitals. The subjects were divided into four groups based on FBG levels: <5·55 mmol/L, 5·55-6·05 mmol/L, 6·11-6·94 mmol/L, and ≥6·99 mmol/L or known diabetes. The subjects were also divided into six groups based on FBG levels: <5·00 mmol/L, 5·00-5·22 mmol/L, 5·27-5·50 mmol/L, 5·55-6·05 mmol/L, 6·11-6·94 mmol/L, and ≥6·99 mmol/L or known diabetes. Findings: FMD decreased in relation to increase in FBG level. There was a significant difference in FMD between the FBG of <5·55 mmol/L group and the other three groups (6·7±3·1% vs. 5·9±2·8%, 5·7±3·1%, and 5·1±2·6%; p<0·0001, respectively). After adjustment for confounding factors, the odds of having the lowest quartile of FMD was significantly higher in the FBG of 5·27-5·50 mmol/L, 5·55-6·05 mmol/L, 6·11-6·94 mmol/L, and ≥6·99 mmol/L or known diabetes groups than in the FBG of <5·00 mmol/L group. Interpretation: These findings suggest that FBG of 5·55-6·05 mmol/L and FBG of 6·11-6·94 mmol/L are similarly associated with endothelial dysfunction and that a pre-IFG state (FBG of 5·27-5·50 mmol/L) is also a risk for endothelial dysfunction compared with FBG of <5·00 mmol/L. Funding Statement: Grant-in-Aid for Scientific Research from the Ministry of Education, Science and Culture of Japan (18590815 and 21590898 to Y.Higashi) and a Grant-in-Aid of Japanese Arteriosclerosis Prevention Fund (to Y.Higashi). Declaration of Interests: All authors have no conflicts of interests to report. Ethics Approval Statement: The Ethics Committee of Hiroshima University approved the study protocol. Written informed consent for participation in this study was obtained from all participants.

Abstract P080: Glucose Homeostasis, Diabetes, and Orthostatic Hypotension in a Community-based Population: The ARIC Study

Background: Although orthostatic hypotension (OH) screening is recommended for adults with diabetes, the extent to which blood glucose (BG) levels are associated with OH has not been characterized. Hypothesis: Higher BG levels are associated with having OH, while low levels of BG are not associated with OH. Methods: We examined the cross-sectional association of OH with BG and diabetes status in middle-aged (range 44 to 66 yrs) ARIC participants (1987-1989). OH was defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) within 2 min of standing, when transitioning from the supine to standing position. Using logistic regression, we examined the association of the following 5 categories of BG without diabetes or diabetes and OH: (1) low-normal BG (fasting BG &lt;80 or non-fasting BG &lt;100 mg/dL), (2) high-normal BG (fasting BG of 80-99 or non-fasting BG of 100-139 mg/dL), (3) pre-diabetes (fasting BG of 100-125 or non-fasting BG of 140-199 mg/dL), (4) undiagnosed diabetes (fasting BG ≥126 or non-fasting BG ≥200 mg/dL), or (5) diabetes (self-reported diagnosis or current medication use). We also modeled BG as a continuous variable by diabetes status, using restricted cubic splines to characterize the association between BG level and OH. Results: In 12,636 participants (mean age 54.6 ± 5.7 yrs, 55% women, 26% black), 4.3% had OH at baseline. The mean BG was 108 ± 38 mg/dL; 7% had diabetes (self-reported diagnosis or diabetes medications). After adjustment, adults with low BG (group 1) or diabetes (group 5) were both more likely to have OH compared to the normal BG group (group 2) with ORs of 2.15 (95% CI: 1.26, 3.65) and 2.20 (95% CI: 1.65, 2.92), respectively. Continuous characterization of the relationship between BG and OH was U-shaped for participants with or without diabetes ( Figure, panels A&amp;B ). Conclusions: Low BG in adults without diabetes, diabetes, and high BG in adults with diabetes were associated with OH. This suggests a more prominent role for BG homeostasis in blood pressure stabilization with standing.

All-cause Mortality of High-normal Random Blood Glucose using Basic Demographics

Abstract Background: The prevalence of diabetes has reached epidemic proportions both in the United States and worldwide. A recent World Health Organization (WHO) report has estimated the prevalence has quadrupled in just three decades and is directly responsible for the deaths of 1.5 million people worldwide. More than 80% of these deaths occur in low and middle income countries. The forecasted urban population in developing nations is expected to double by the year 2030, compared to the year 2000. Methods: We utilized a limited teaching dataset from the Framingham Heart Study to examine the relationship between blood glucose levels and mortality using a Multivariate Cox proportional hazards model, adjusting for age, gender, body mass index and blood pressure. We divided glucose according to four categories, with normal reflecting conventional “intensive” control, high-normal reflecting a higher glucose level and moderate and severe elevations for further comparison of relative mortality. Results: 3,270 subjects were followed for 20 years, of which 316 fell into a high normal blood glucose category and 2,885 subjects had a normal blood glucose. The relative risk of death in the high normal random blood glucose (RBG) group was 1.22 times that of those with a random normal blood glucose (95% CI: 1.021.45; pvalue = 0.030). Discussion: A high normal random glucose level with limited covariates may prognosticate a greater risk of allcause morbidity and mortality compared to low normal glucose levels. These findings may help to provide estimates of risk in low and middle-income countries, where there is limited access to healthcare and basic lab testing such as HgbA1c.

Efficacy of a church-based lifestyle intervention programme to control high normal blood pressure and/or high normal blood glucose in church members: a randomized controlled trial in Pretoria, South Africa.

BackgroundIn persons 15 years and above in South Africa the prevalence of pre-diabetes and diabetes has been estimated at 9.1% and 9.6%, respectively, and the prevalence of systolic prehypertension and hypertension, 38.2% and 24.6%, respectively. Elevated blood glucose and elevated blood pressure are prototype of preventable chronic cardiovascular disease risk factors.Lifestyle interventions have been shown to control high normal blood pressure and/or high normal blood glucose.Methods/DesignThis study proposes to evaluate the efficacy of a community (church)-based lifestyle intervention programme to control high normal blood pressure and/or high normal blood glucose in church members in a randomized controlled trial in Gauteng, South Africa. The objectives are to: (1) measure non-communicable diseases profile, including hypertension and diabetes, health behaviours, weight management and psychological distress of church members; (2) measure the reduction of blood glucose and blood pressure levels after the intervention; (3) prevent the development of impaired glucose tolerance; (4) compare health behaviours, weight management and psychological distress, blood glucose and blood pressure levels between intervention and control groups, and within group during 6, 12, 24 and 36 months during and post intervention. The study will use a group-randomized design, recruiting 300 church members from 12 churches. Churches will be randomly assigned to experimental and control conditions.DiscussionLifestyle interventions may prevent from the development of high blood pressure and/or diabetes. The findings will impact public health and will enable the health ministry to formulate policy related to lifestyle interventions to control blood pressure and glucose.Trial registration numberPACTR201105000297151

Efficacy of a family practice-based lifestyle intervention program to increase physical activity and reduce clinical and physiological markers of vascular health in patients with high normal blood pressure and/or high normal blood glucose (SNAC): study protocol for a randomized controlled trial

BackgroundPrevious interventions to increase physical activity and reduce cardiovascular risk factors have been targeted at individuals with established disease; less attention has been given to intervention among individuals with high risk for disease nor has there been determination of the influence of setting in which the intervention is provided. In particular, family practice represents an ideal setting for the provision and long-term maintenance of lifestyle interventions for patients at risk (ie high-normal blood pressure or impaired glucose tolerance).Methods/designThe Staged Nutrition and Activity Counseling (SNAC) study is a randomized clustered design clinical trial that will investigate the effectiveness and efficacy of a multi-component lifestyle intervention on cardiovascular disease risk factors and vascular function in patients at risk in primary care. Patients will be randomized by practice to either a standard of care lifestyle intervention or a behaviourally-based, matched prescriptive physical activity and diet change program. The primary goal is to increase physical activity and improve dietary intake according to Canada's Guides to Physical Activity Healthy Eating over 24 months. The primary intention to treat analysis will compare behavioral, physiological and metabolic outcomes at 6, 12 and 24 months post-randomization including estimation of incident hypertension and/or diabetes.DiscussionThe design features of our trial, and the practical problems (and solutions) associated with implementing these design features, particularly those that result in potential delay between recruitment, baseline data collection, randomization, intervention, and assessment will be discussed. Results of the SNAC trial will provide scientific rationale for the implementation of this lifestyle intervention in primary care.Trial registrationISRCTN: ISRCTN:42921300

Associations of Fasting Blood Glucose With Cholesterol Absorption and Synthesis in Nondiabetic Middle-Aged Men

NIDDM and the metabolic syndrome are characterized by a low serum, HDL cholesterol content and a high triglyceride level, whereas total and LDL cholesterol concentrations are not necessarily elevated. Variable results have been reported on cholesterol absorption, elimination, and synthesis in NIDDM, but no studies are available on subjects within the normal range of blood glucose. From serum samples collected in 1985 from 203 nondiabetic men aged 51-66 years, we examined lipids, cholesterol precursors (reflecting cholesterol synthesis), and plant sterols and cholestanol (reflecting cholesterol absorption) in relation to fasting blood glucose. The findings prompted us (in 1993) to further examine 11 men from the highest and lowest glucose thirds of 203 nondiabetic men by additional dietary, serum, and fecal analyses for absorption, elimination, and synthesis of cholesterol and insulin sensitivity. In 1985, blood glucose was significantly related to LDL apolipoprotein B (P = 0.05) but not to LDL cholesterol (P = 0.19). Significantly higher serum lathosterol and desmosterol-to-cholesterol proportions and lower plant sterol and cholestanol proportions in the highest rather than the lowest glucose thirds suggested that the subjects with high normal blood glucose had decreased absorption and enhanced synthesis of cholesterol. In 1993, men with the lowest glucose versus those with the highest glucose had a lower waist-to-hip ratio, plasma HbA1c, fasting and postload insulin and glucose values, and a higher insulin sensitivity index. In agreement with the 1985 non-cholesterol sterol data, direct analyses of cholesterol metabolism showed further higher cholesterol absorption efficiency (P = 0.03) and serum plant sterol and cholestanol proportions (P < 0.001). Despite a slightly lower dietary cholesterol intake, cholesterol synthesis (P = 0.02) and serum lathosterol (P < 0.01) and desmosterol (P < 0.01) proportions were lowest in men with the lowest glucose third. We conclude that noncholesterol sterols in serum exhibits a long-lasting correlation with blood glucose level in a nondiabetic male population. Low intestinal absorption and high synthesis of cholesterol characterize men with high normal blood glucose. Differences in cholesterol metabolism could be due to underlying insulin effects associated with obesity-like fat distribution and may thus imply novel aspects in the metabolic interrelation between insulin and cholesterol in humans.

Effect of Sorbent-Based Dialytic Therapy with the BioLogic-DT on an Experimental Model of Hepatic Failure

An experimental model of hepatic failure in the dog has been developed in which the liver is devascularized in two stages. Under general anesthesia, a portacaval shunt is created, ligatures placed around the hepatic and gastroduodenal arteries, and the dog recovered. Two days later under general anesthesia, the ligatures are pulled, converting hepatic insufficiency to hepatic failure. Five control animals developed hypotension, severe lactic acidosis, hypoglycemia, and increasing liver enzyme levels during 6 hrs of follow-up. The BioLogic-DT system includes a cellulosic plate dialyzer with a suspension of powdered charcoal and cation exchangers as dialysate. Five animals were treated with the BioLogic-DT for 6 hrs after creation of hepatic failure. These animals were more stable physiologically, developed less lactic acidosis and less enzyme elevation, and maintained high normal blood glucose levels. The results help explain the clinical improvement demonstrated in patients with hepatic failure treated by the BioLogic-DT, and confirm that many of the toxins of hepatic failure are dialyzable and bound by simple sorbents such as charcoal and cation exchangers.