High-normal Fasting Plasma Glucose Research Articles

Age-Related Sex Differences in Glucose Tolerance by 75 g Oral Glucose Tolerance Test in Japanese.

To elucidate the age-related sex difference in glucose tolerance, we conducted 75 g oral glucose tolerance tests in 1156 participants. Participants were divided into four groups, namely, young (22-29) males, young females, middle-aged (>50) males, and middle-aged females. According to the Japanese Clinical Practice Guideline for Diabetes 2019, the prevalence of normal glucose tolerance (NGT) was significantly lower in middle-aged than in young participants. The prevalence of high-normal fasting plasma glucose (FPG) was higher, and NGT was lower in young males (high-normal FPG 15.2%, NGT 82.0%) than young females (high-FPG 3.9%, NGT 94.3%). Combined glucose intolerance (CGI) was higher and NGT was lower in middle-aged males (CGI 10.2%, NGT 25.2%) than in middle-aged females (CGI 3.3%, NGT 39.8%). FPG and body mass index (BMI) were the lowest and Homeostatic model assessment beta cell function (HOMA-β) was the highest in young females, followed by young males, middle-aged females, and middle-aged males. Multiple linear regression analysis revealed that BMI weakly correlated with HOMA-β and Matsuda index in all subjects except young females. The superior glucose tolerance in females was apparent in young, but attenuated in middle-aged females. The differences are due to the higher insulin secretion potential and lower BMI in young females.

LBODP051 Relation Of The Quadrumvirate ― Hepatic Steatosis, High Normal Fasting Glucose, And Attenuated Whole Body-insulin Sensitivity And Glucose-stimulated Acute Insulin Secretion ― To Incident Prediabetes, The Beginning Of Type 2 Diabetes

Abstract Type 2 diabetes begins as conversion of normal glucose metabolism (NGM) to prediabetes, and 5-10% per year of people with prediabetes progress to diabetes. Therefore, understanding evolution of prediabetes is mandatory to know how type 2 diabetes starts. However, the process of conversion of NGM to prediabetes, which may be ethnicity-specific, has poorly been investigated. We analyzed 599 Japanese adults with NGM (fasting plasma glucose (FPG) <100 mg·dL-1 and 2-h PG at 75 g oral glucose tolerance (OGTT) <140 mg·dL-1) (male 62%, the mean age, body mass index (BMI), fasting IRI/FPG and 2-h IRI/PG, 52 years, 23.1 kg·m-2, 4.1 μU·mL-1/92 mg·dL-1 and 24.5 μU·mL-1/104 mg·dL-1, respectively). They received follow-up OGTTs at a mean of 3.7 years later (2,061 person-years observation). Prediabetes developed in 179 (impaired fasting glucose 102, impaired glucose tolerance 39, and impaired fasting glucose/impaired glucose tolerance 28). By the screening univariate analysis, Fatty Liver Index (FLI), FPG, ISIMATSUDA (index of basal and post-glucose whole body insulin sensitivity (Si) and Stumvoll's first phase (Stumvoll-1, an index of glucose-stimulated acute (∼10 min) insulin secretion (Isec) were robust risk factors for incident prediabetes. In contrast, indices of basal Si such as HOMA-IR, and basal, 30 min, or later phase index of Isec such as HOMAbeta and insulinogenic index, respectively, were not significant risk for prediabetes. In multivariate Cox model adjusted for age and sex, HR (95%CI) per 1 IQR increase were FLI 1.303 (1. 063-1.586), P <0. 01; FPG 1.400 (1. 076-1.840), P <0. 01; ISIMATSUDA 0.841 (0.712-0.963), P = 0. 03; Stumvoll-1 0.764 (0.622-0.935) P <0. 01. Note that FLI and FPG are risk factors and ISIMATSUDA and Stumvoll-1 are protective factors. Notably, FLI was a risk even after adjustment for BMI. The best cutoff values differentiating prediabetes Progressors from Nonprogressors obtained by the ROC curve using entire range of each risk factor was ≥12.4 for FLI, ≥95 mg·dL-1 for FPG, ≤11.99 for ISIMATSUDA and ≤486.3 for Stumvoll-1, and incidence of prediabetes was progressively high as 10/127 (6%), 34/153 (22%), 56/189 (30%), 53/106 (50%) and 16/24 (67%) among the participants with no, one, two, three and four unfavorable discriminating values for progression, respectively. AUC of ROC curve (AUROC) for the combination of the quadrumvirate was as large as 0.729 (0.661-0.788) with high precision as sensitivity 73.4% and specificity 63.8%. In conclusion, at the beginning of type 2 diabetes in the Japanese population who are non-obese and insulin-sensitive as shown, hepatic steatosis, the high normal FPG, attenuation of whole-body insulin sensitivity, lowered acute phase glucose-induced insulin release (the quadrumvirate) are synergistically and independently, with comparable strength each other, related to the development of prediabetes. Presentation: No date and time listed

Hepatic Steatosis and High-Normal Fasting Glucose as Risk Factors for Incident Prediabetes.

ContextThe role of hepatic steatosis (HS) in the initial stages of developing type 2 diabetes remains unclear.ObjectiveWe aimed to clarify the impact of HS indexed by Fatty Liver Index (FLI) and high-normal fasting plasma glucose (FPG) as risk factors for incident prediabetes in a nonobese cohort.MethodsData from 1125 participants with ADA-defined normal glucose metabolism (median age 52 years; BMI 23.1 kg/m2) were used for retrospective analysis. In the entire population, correlation between normal FPG and FLI was evaluated by multiple regression adjusted for age and sex. Follow-up data from 599 participants in whom 75-g OGTT was repeated 3.7 years later showed that 169 developed prediabetes. This was analyzed by the multivariate Cox proportional hazards model.ResultsIn the entire population, FLI was positively correlated with FPG (P < 0.01): mean FLI increased from 15.8 at FPG 4.2 mmol/L to 31.6 at FPG 5.5 mmol/L. Analysis of the 599 participants (2061 person-years) by Cox model, adjusted for sex, age, family history of diabetes, ISIMATSUDA, and Stumvoll-1, clarified an increased risk of prediabetes with high-normal FPG and FLI. Risk was increased 2.2 times with FLI ≥ 16.5 vs FLI < 16.5, P < 0.001, and increased 2.1 times in participants with FPG ≥ 5.3 mmol/L, P < 0.001. Cutoff values (unadjusted) were obtained by ROC at the point of the largest Youden’s index using the entire range of the variables.ConclusionEven among nonobese individuals, HS indexed by FLI and a high-normal FPG (≥ 5.3 mmol/L) are risk factors for prediabetes, independently from insulin.

Hypertension and cardiometabolic comorbidity in patients with different levels of blood glucose in the non-diabetic range

Objective. To study the prevalence of hypertension (HTN), concomitant and associated cardiovascular, metabolic diseases and disorders in people with different levels of blood glucose in the non-diabetic range.Design and methods. A content analysis of 1503 outpatient maps was carried out with the assessment of age, body weight, body mass index (BMI), fasting plasma glucose (FPG), total cholesterol, low density lipoprotein cholesterol (LDL)), overweight/obesity, HTN, atherosclerotic diseases. The changes in carbohydrate metabolism were classified as following: highnormal FPG (5,6-6,0 mmol/l; n = 141; group 1), normoglycemia (FPG up to 5,5 mmol/l; n = 1227; group 2), previously diagnosed prediabetes (n = 54; group 3) and diabetes mellitus (n = 81).Results. Group 1 was characterized by higher body mass, BMI, FPG, total cholesterol, higher prevalence of dyslipidemia, atherosclerotic diseases, overweight/obesity, HTN (p &lt; 0,001) compared with group 2. The presence of a “highnormal level of FPG” is associated with an increased risk of dyslipidemia (relative risk: RR 1,579; 95 % confidence interval (CI): 1,348-1,803), atherosclerotic diseases (RR2,095; 95 % CI 1,371-3,832), obesity (RR 1,766; 95 % CI 1,568-1,934), AH (RR 1,697; 95 % CI 1,45-1,93). Groups 1 and 3 did not differ by the general characteristics. HTN patients in group 1 compared with group 2 more often had dyslipidemia (p = 0,034) and overweight/obesity (p = 0,014). In patients with HTN, the presence of “highnormal FPG” is associated with an increased risk of dyslipidemia (RR 1,221; 95 % CI 1,005-1,429), overweight/obesity (RR 1,189; 95 % CI 1,0291,319). HTN patients in groups 1 and 3 did not differ in the frequency of dyslipidemia, atherosclerotic diseases, overweight/obesity.Conclusions. “Highnormal level of FPG” is associated with an increased risk of dyslipidemia, atherosclerotic diseases, HTN, obesity; among HTN patients—with an increased risk of dyslipidemia, overweight/ obesity. Patients with “highnormal FPG” and patients with prediabetes show similar cardiometabolic status.

ADIPOR2 variant is associated with higher fasting glucose level in non-diabetic Chinese Han population

A high but normal fasting plasma glucose level in adults is a marker for insulin resistance and future development of type 2 diabetes mellitus. We aimed to investigate whether ADIPOR2 variants are associated with increased fasting plasma glucose (FPG) in non-diabetic Chinese Han subjects who had normal FPG levels. This study included 2038 subjects among the non-diabetic Chinese Han population. The ADIPOR2 polymorphisms were genotyped by the TaqMan method. For the analysis, participants were divided into low-normal FPG group (FPG FPG ≥ 4.88 mmol/L). We identified five single nucleotide polymorphisms (SNPs) of ADIPOR2 gene: rs10773989, rs2370055, rs9300298, rs10773983, and rs13611594. There was no significant difference in FPG levels between different genotypes of rs10773989, rs2370055, rs9300298, and rs13611594. Our data showed a significant association of rs10773983 with higher FPG levels, fasting insulin levels, and homeostatic model assessment of insulin resistance (HOMA-IR) in A-allele carriers (p = 0.006, p < 0.001, and p < 0.001, respectively). The subjects in high FPG group had higher median fasting insulin level (9.25 vs 8.16 μIU/mL, p = 0.003) and higher HOMA-IR (2.21 vs 1.58, p < 0.001) than those in normal FPG group. Subjects with the A-allele of rs10773983 compared to subjects with G-allele had 1.222-fold higher risk for high-normal FPG (OR = 1.222, 95%CI = 1.010–1.478, p = 0.039). Our findings suggest that ADIPOR2 rs10773983 polymorphism may be associated with an increased risk of high-normal FPG among non-diabetic Chinese Han subjects who have normal FPG levels.

Risk of Future Diabetes in Japanese People with High-normal Fasting Plasma Glucose Levels: A 4-Year Follow-up Study.

Objective There is no definite consensus regarding the treatment and guidance for individuals with high-normal fasting plasma glucose levels (FPG;100-109 mg/dL). The present study aimed to determine the risk factors for future diabetes in Japanese people with high-normal FPG. Methods Retrospective cohort studies were conducted from 2008 to 2012, including 15,097 individuals who underwent medical examinations. First, the participants were divided into normal FPG (n=13,065) and high-normal FPG (n=2,032) groups to compare the diabetes incidence. Second, the high FPG group was divided into diabetes onset (n=133) and non-diabetes onset (n=1,899) groups to compare the baseline values. Third, to determine the risk factors for future diabetes in the high-normal FPG group, multivariate analyses were conducted. Results The cumulative incidence during the mean follow-up of 4 years was 94/13,065 (0.72%) and 133/2,032 (6.55%) in the normal FPG and high-normal FPG groups, respectively. Within the high-normal FPG group, the baseline body mass index, waist circumference, triglycerides, FPG, alanine aminotransferase (ALT), and gamma-glutamyl transferase were significantly higher and high-density lipoprotein cholesterol (HDL-C) was significantly lower in the diabetes onset group than in the non-diabetes onset group. Obesity, abdominal obesity, hypertriglyceridemia, low HDL-C, and high ALT were significant risk factors for diabetes according to a multivariate analysis. Conclusion The high-normal FPG group had a higher risk of diabetes than the normal FPG group, particularly when accompanied with obesity, abdominal obesity, hypertriglyceridemia, low HDL-C, and high ALT. Thus, this high risk group should receive appropriate guidance for lifestyle changes to avoid developing diabetes at an early stage.

Therapeutic Use of Metformin in Prediabetes and Diabetes Prevention.

People with elevated, non-diabetic, levels of blood glucose are at risk of progressing to clinical type 2 diabetes and are commonly termed ‘prediabetic’. The term prediabetes usually refers to high–normal fasting plasma glucose (impaired fasting glucose) and/or plasma glucose 2 h following a 75 g oral glucose tolerance test (impaired glucose tolerance). Current US guidelines consider high–normal HbA1c to also represent a prediabetic state. Individuals with prediabetic levels of dysglycaemia are already at elevated risk of damage to the microvasculature and macrovasculature, resembling the long-term complications of diabetes. Halting or reversing the progressive decline in insulin sensitivity and β-cell function holds the key to achieving prevention of type 2 diabetes in at-risk subjects. Lifestyle interventions aimed at inducing weight loss, pharmacologic treatments (metformin, thiazolidinediones, acarbose, basal insulin and drugs for weight loss) and bariatric surgery have all been shown to reduce the risk of progression to type 2 diabetes in prediabetic subjects. However, lifestyle interventions are difficult for patients to maintain and the weight loss achieved tends to be regained over time. Metformin enhances the action of insulin in liver and skeletal muscle, and its efficacy for delaying or preventing the onset of diabetes has been proven in large, well-designed, randomised trials, such as the Diabetes Prevention Program and other studies. Decades of clinical use have demonstrated that metformin is generally well-tolerated and safe. We have reviewed in detail the evidence base supporting the therapeutic use of metformin for diabetes prevention.

Cardiometabolic Phenotype in Children with Obesity

To investigate the anthropometric and metabolic correlates of different patterns of left ventricular (LV) geometry in a cohort of outpatient children with high prevalence of obesity. Anthropometric measures, lipid profile, blood pressure (BP), fasting plasma glucose (FPG), and echocardiographic variables were evaluated in 281 white children (6-16 years), of whom 105 were obese and 105 were morbidly obese. Patterns of LV geometry were defined as follows: normal geometry, eccentric LV hypertrophy (LVH), concentric LV remodeling, and concentric LVH. One hundred forty-eight children exhibited normal LV geometry, 53 eccentric LVH, 36 concentric LV remodeling, and 44 concentric LVH. The 4 groups differed in body mass index, waist circumference, waist-to-height ratio, triglycerides/high-density lipoprotein cholesterol ratio (Tg/HDL-C), and BP (P < .05-.0001). A statistically significant impairment of diastolic function (expressed as greater E/E', P < .002) was observed across patterns of LV geometry. Among anthropometric measures, waist-to-height ratio showed better performance in relation to LVH, with an optimal cut-point of 0.58, compared with body mass index and waist circumference. Children with concentric LVH exhibited the worst metabolic risk profile, with greater prevalence of visceral obesity, high Tg/HDL-C, high BP, and high-normal FPG, than children with normal LV geometry. In children with high levels of obesity, an unfavorable "cardiometabolic phenotype" can be identified, which includes concentric LVH, visceral obesity, high BP, high Tg/HDL-C, and high-normal FPG.

A slightly high-normal glucose level is associated with increased arterial stiffness in Japanese community-dwelling persons with pre-diabetes

Impaired fasting glucose (IFG) in diabetes is a risk factor for arterial stiffness and cardiovascular disease (CVD), but the impact of a slightly high-normal glucose level remains controversial. We investigated whether slightly high-normal fasting plasma glucose (FPG) was independently associated with arterial stiffness in non-diabetic community-dwelling persons. We recruited 114 men aged 69 ± 9 years (range 40-89) and 208 women aged 68 ± 7 years (range 36-84) during their annual health examination in a single community. Arterial stiffness was evaluated by the mean of the right and left brachial-ankle pulse wave velocity (ba-PWV). Age-adjusted ba-PWV increased significantly from the lowest to the highest FPG group (p < 0.001). Multiple linear regression analyses for ba-PWV revealed that FPG levels (β=0.154, p < 0.001) were independently and significantly associated with ba-PWV. The multivariate-adjusted ba-PWV value of the high-normal glucose group (Group 3: 95-100 mg/dL) was significantly higher than that of the lowest normal glucose group (Group 1: 52-89 mg/dL) (p=0.021), and the ba-PWV value in the IFG group (Group 4: 101-125 mg/dL) was significantly higher than those of the normal glucose groups (Group 1: <90 mg/dL; Group 2: 90-94 mg/dL) (p<0.001 and p=0.009, respectively). Slightly high-normal glucose levels were associated with arterial stiffness in Japanese community-dwelling persons.

High-normal Glucose Levels in Non-diabetic and Pre-diabetic Men Are Associated with Decreased Testosterone Levels

BackgroundTestosterone levels are decreased in diabetic patients and recent studies have suggested that high-normal fasting glucose is a risk factor for cardiovascular disease. To further elucidate the relationship between plasma glucose and testosterone, we investigated the association between fasting plasma glucose (FPG) and endogenous sex hormones (serum total testosterone, sex hormone binding globulin, estradiol, and the ratio of testosterone to estradiol) in non-diabetic and pre-diabetic men.MethodsThis study included 388 men (age ≥ 40 years) who visited the health promotion center of a university hospital from May 2007 to August 2008. The subjects were divided into quartiles based on their FPG levels and correlation and multiple linear regression analyses were performed. Q1 (65 mg/dL ≤ FPG < 88 mg/dL), Q2 (88 mg/dL ≤ FPG < 94 mg/dL), Q3 (94 mg/dL ≤ FPG < 100 mg/dL) and Q4 (100 mg/dL ≤ FPG < 126 mg/dL).ResultsFPG was independently, inversely associated with total testosterone in the non-diabetic population after adjusting for age, body mass index, smoking, and alcohol consumption (β = -0.082, P < 0.01). Among the quartiles, subjects in the high-normal FPG groups (Q2, Q3, and Q4 with FPG ≥ 88 mg/dL) had significantly decreased testosterone levels when compared with subjects in the normal FPG group (Q1 with FPG < 88 mg/dL, P < 0.005). Sex hormone binding globulin, estradiol and the ratio of testosterone to estradiol were not correlated with FPG.ConclusionOur study indicates that high-normal fasting glucose levels are associated with decreased testosterone levels in non-diabetic and pre-diabetic men.

Fasting Plasma Glucose and Clustering of Cardiometabolic Risk Factors in Normoglycemic Outpatient Children and Adolescents

OBJECTIVETo evaluate whether fasting plasma glucose (FPG) within a normoglycemic range is associated with cardiometabolic risk factors (CMRF) among children and adolescents in an outpatient setting.RESEARCH DESIGN AND METHODSSubjects (780; age 6–16 years) with FPG <100 mg/dL were divided into tertiles of FPG.RESULTSBMI, waist circumference, homeostasis model assessment-insulin resistance, systolic blood pressure, and white blood cell (WBC) count (P < 0.0001) increased across tertiles of FPG. Subjects with high-normal FPG (89–99 mg/dL) showed a higher risk of insulin resistance, hypertension, and high WBC count compared with subjects with low-normal FPG, independent of BMI z score.CONCLUSIONSIn outpatient children and adolescents, higher FPG within the normal range is associated with several CMRF, independent of obesity. Thus the simple measurement of FPG may help identify subjects who warrant some monitoring in relation to cardiovascular risk.

High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation

A high but normal fasting plasma glucose level in adults is a risk factor for future development of type 2 diabetes mellitus and cardiovascular disease. We investigated whether normal fasting plasma glucose levels (<5.60 mmol/l) are associated with decreases in insulin sensitivity and beta cell function, as well as an adverse cardiovascular profile in obese youth. We performed a cross-sectional analysis in a multiethnic sample of 1,020 obese youth (614 girls and 406 boys; mean age 12.9 years [CI 95% 12.7-13.1], BMI z score 2.34 [CI 95% 2.31-2.38]) with normal fasting plasma glucose. All participants had a standard OGTT, with calculation of indices of insulin sensitivity and beta cell function. For the analysis, prepubertal and pubertal participants were stratified into quartiles of normal fasting plasma glucose. We observed a significant increase in fasting insulin and AUC 2 h glucose across quartiles. Pronounced changes were observed in insulin sensitivity and secretion, particularly in the pubertal group. Moreover, the odds of presenting with impaired glucose tolerance increased by 4.5% with each 0.06 mmol/l increase in fasting plasma glucose. No significant differences in cardiovascular indices were seen across quartiles. These data suggest that in obese youth, independent of age, BMI z score, sex, family history and ethnicity, insulin sensitivity and secretion decline when moving from low to high normal fasting plasma glucose. The simple measure of fasting plasma glucose could assist clinicians in identifying children for targeted diabetes screening and subsequent lifestyle management.

High-normal fasting glucose levels are associated with increased prevalence of impaired glucose tolerance in obese children

The natural history of impaired glucose tolerance (IGT) and Type 2 diabetes among obese children is not clear. Although the cut-off for impaired fasting glucose (IFG) has recently been changed from 110 (6.1 mmol/l) to 100 mg/dl (5.6 mmol/l), it does not seem a reliable way to find all subjects with impaired glucose homeostasis. The aim of our study was to determine whether high-normal fasting glucose level could predict the occurrence of IGT and metabolic syndrome. Three hundred and twenty-three Italian obese children and adolescents were included in the study (176 females, mean age 11+/-2.9 yr; mean body mass index z-score: 3+/-0.6). Waist circumference, serum glucose, insulin, triglyceride, cholesterol HDL, blood pressure were evaluated and an oral glucose tolerance test (OGTT) was performed. The prevalence of IFG and IGT were respectively 1.5% (5 subjects) and 5% (18 patients); no diabetic patients were found. Metabolic syndrome was diagnosed in 20% of patients. Fasting glycemia values <100 mg/dl (5.6 mmol/l) have been divided in quintiles. Metabolic syndrome prevalence increased across quintiles, although not in a statistically significantly manner, but it could depend on the selected diagnostic criteria as no univocal definition exists for metabolic syndrome in youths. Interestingly high-normal fasting plasma glucose levels constitute an independent risk factor for IGT among obese children and adolescents; therefore, this very easy-to-use parameter may help to identify obese patients at increased risk of diabetes or at least could suggest in which subjects to perform an OGTT.

The potential of metformin for diabetes prevention

Well designed intervention trials, such as the Diabetes Prevention Program (DPP), have demonstrated the potential of lifestyle interventions or pharmacologic treatments for the prevention or delay of type 2 diabetes in subjects with impaired glucose tolerance (IGT). Lifestyle interventions are likely to form the cornerstone of the management of IGT in the future, as they do in the management of type 2 diabetes today. However, it remains to be seen whether the intensive lifestyle interventions employed in trials such as the DPP can be transferred successfully from the highly structured environment of a randomised trial to routine, day-to-day management within the primary care sector. Thus, pharmacologic treatment may provide an important additional option where subjects are unwilling or unable to improve their diet and levels of physical activity. Treatment with metformin significantly reduced the incidence of diabetes in subjects with IGT and high-normal fasting plasma glucose in the DPP. Moreover, metformin was well tolerated, and health economic analyses suggest that metformin treatment is cost-effective in the US and Europe. The DPP investigators found that the protective effect of metformin persisted beyond the end of the study, and estimated that only one quarter of the protection arose from a short-lived pharmacological effect. The results of the DPP identify metformin as an effective option for the prevention of diabetes in subjects with IGT and impaired fasting glucose.

Pancreatic β-cell function in cirrhotic patients with and without overt diabetes. C-peptide response to glucagon and to meal

To study the role of pancreatic β-cell function in glucose intolerance and frank diabetes that sometimes develops in cirrhosis, the C-peptide response to a bolus IV injection of 1 mg of glucagon was measured in nine controls and in two groups of patients with cirrhosis. The first group comprised nine subjects with normal or high-normal fasting plasma glucose and no glycosuria; five of them had impaired glucose tolerance. The second group consisted of eight cirrhotics in whom frank diabetes had developed six to 48 months after the diagnosis of cirrhosis. They were characterized by fasting plasma glucose > 140 mg/dL and permanent glycosuria. No differences in the degree of liver impairment or portal-systemic shunting were observed between the two groups. Plasma glucose response to glucagon was similarly reduced in cirrhotic subjects. Basal C-peptide was high normal in patients with cirrhosis, and significantly increased in nondiabetic subjects. By contrast peak C-peptide levels and total C-peptide responses to glucagon were low normal in cirrhotics and significantly reduced in patients with cirrhosis and diabetes. In 14 patients the C-peptide response to a standard meal was also measured. It was significantly reduced in patients with cirrhosis and diabetes (six cases), as compared to cirrhotic subjects without diabetes. Peak C-peptide after IV glucagon significantly correlated with peak C-peptide after the meal ( r = .927), or total C-peptide response to meal ( r = .871). Impaired insulin secretion may add to insulin resistance in patients with liver cirrhosis, leading to the development of frank diabetes, characterized by fasting hyperglycemia and glycosuria.