Higher Fasting Plasma Glucose Levels Research Articles

Islet Autoimmunity is Highly Prevalent and Associated With Diminished Beta-Cell Function in Patients With Type 2 Diabetes in the Grade Study

Background: Islet autoimmunity may contribute to beta-cell dysfunction in type 2 diabetes (T2D). Its prevalence and clinical significance have not been rigorously determined. We investigated the prevalence of cellular and humoral islet autoimmunity in T2D and their relation to beta-cell function. Methods: The study was nested in the Glycemia Reduction Approaches in Diabetes – A Comparative Effectiveness (GRADE) study. Participants included 419 T2D patients (age 57·4±10·3 y [mean±SD], body mass index 33·6±6·2 kg/m2, diabetes duration 4·0±3·0 y, HbA1c 7·5±0·5%). We measured humoral (autoantibodies against GAD65, IA2, ZnT8) and cellular (T-cell autoreactivity against islet antigens) autoimmunity, beta-cell function (ratio of incremental area under the curve of C-peptide to that of glucose from 0–120 min of an oral glucose tolerance test [iAUC-CG]), and ratio of C-peptide to glucose from 0–30 min (∆C-peptide(0–30)/∆glucose(0–30)), and glycemic parameters. Findings: Cellular islet autoimmunity was present in 41·3%, humoral islet autoimmunity in 13·5%, and both in 5·3%. iAUC-CG and ∆C-peptide(0–30)/∆glucose(0–30) were lower among T-cell-positives than -negatives using two different adjustments for insulin sensitivity (iAUC-CG: 13·2% [95% CI 0·3, 24·4%] or 11·4% [95% CI 0·4, 21·2%] lower; ∆C-peptide(0–30)/∆glucose(0–30)) 19% [95% CI 3·1, 32·3%] or 17·7% [95% CI 2·6, 30·5%] lower). T-cell-positives had 0·17% higher HbA1c (95% CI 0·07,0·28) and 7·7 mg/dL higher fasting plasma glucose levels (95% CI 0·2,15·3) than T-cell-negatives. Interpretation: Islet autoimmunity is highly prevalent in patients with T2D. T-cell-mediated autoimmunity is associated with diminished beta-cell function and worse glycemic control. Funding Information: This study was funded by the NIH. This ancillary study to the GRADE study was independently funded by grant R01DK104832 (to AB and JPP) from the National Institute of Diabetes and Digestive and Kidney Diseases. The GRADE study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK (U34-DK-088043). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by Becton, Dickinson an Company, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: Nineteen centers obtained local Institutional Review Board approval for the ancillary study and contributed participants.

Relationship of plasma aldosterone levels and carbohydrate metabolism in heart failure with preserved ejection fraction

Aim. To determine the relationship between the blood aldosterone levels and parameters of carbohydrate metabolism in patients with heart failure (HF) with preserved ejection fraction (HFpEF).Material and methods. This cross-sectional study included 158 patients with stable HFpEF. HFpEF was established in the presence of symptoms and/or signs of HF, left ventricular ejection fraction >50%, increased blood NT-proBNP levels, and characteristic structural cardiac changes according to echocardiography. The study did not include patients with primary hyperaldosteronism and those taking mineralocorticoid receptor antagonists within the previous 6 weeks. In all patients, the blood aldosterone and carbohydrate metabolism parameters were assessed. The aldosterone levels were determined by the enzyme immunoassay and the concentration of 40-160 pg/ml was considered the reference values. Diabetes was diagnosed in the following cases: history of diabetes, treatment with antidiabetic drugs, blood glucose level ≥7,0 mmol/L in two samples or glycated hemoglobin (HbA1c) >6,5%. Prediabetes was recorded if the blood glucose level in a patient without diabetes was in the range of ≥5,6 mmol/L and<7,0 mmol/L.Results. In 99 patients (62,7%, group 1), the aldosterone levels were within the normal range, while in the remaining 59 patients (37,3%, group 2), it exceeded the upper limit. Patients with hyperaldosteronemia compared with those with normal aldosterone levels had significantly higher fasting plasma glucose levels (6,60 (6,00-7,90) mmol/L vs 5,80 (5,25-6,80) mmol/L, p<0,001) and HOMA value (5,86±1,12 vs 4,46±1,02, p=0,01). HbA1c levels did not differ significantly between groups. Patients of the 2nd group more often suffered from diabetes (39,0% vs 19,2%, p<0,001) and hyperglycemia in general (89,8% vs 61,6%, p=0,011) compared with patients of the 1st group. Correlation analysis showed a significant relationship between the level of aldosterone and blood glucose (r=0,29), HbA1c (r=0,17) and HOMA (r=0,23) values. After standardization by age, HF class, body mass index, blood pressure, cholesterol and blood potassium levels in multivariate analysis, the presence of hyperaldosteronemia was significantly correlated with diabetes (odds ratio, 1,64, 95% confidence interval, 1,14-3,32, p=0,013) and hyperglycemia (odds ratio, 2,84, 95% confidence interval, 1,94-14,2, p=0,008). Conclusion. The development of secondary hyperaldosteronism in patients with HFpEF is associated with a significant increase in the risk of hyperglycemia and diabetes.

Measuring the global, regional, and national burden of type 2 diabetes and the attributable risk factors in all 194 countries.

No detailed quantitative global, regional, or national estimates of the disability-adjusted life years (DALYs) of type 2 diabetes mellitus (T2DM) are available. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to estimate the global, regional, and national incidence rates and DALYs of T2DM, as well as the associated risk factors, in all 194 countries and territories by age, sex, and sociodemographic status during the period from 2007 to 2017. Globally, the age-standardized incidence and DALY rates increased by 3.23% and 5.07% during 2007 to 2017, respectively. The age-standardized incidence and DALY rates in 2017 and the corresponding percentage changes during 2007 to 2017 were highest in the low-middle sociodemographic index (SDI) quintile. Regionally, the highest 2017 age-standardized incidence and DALY rates were observed in Oceania, whereas the largest percentage increases in both rates during 2007 to 2017 were observed in Southeast Asia. Nationally, Iran, the United Kingdom, and Indonesia reported the largest percentage increases in the age-standardized incidence rates, whereas Georgia, Czech Republic, and Iran showed the largest percentage increases in the age-standardized DALY rates. Globally, the largest percentage increases in risk-attributable DALYs were associated with a high body mass index, low physical activity level, high fasting plasma glucose level, and high sugar-sweetened beverage and red meat consumption. The global T2DM age-standardized incidence and DALY rates increased globally between 2007 and 2017, especially in the low-middle SDI quintile, Southeast Asia.

Status and disparities of diabetes among urban and rural residents aged 40 years and older: insight from a population-based study in northeast China, 2017–2019

ObjectivesTo evaluate the up-to-date epidemiology of diabetes in northeast China.MethodsThe cross-sectional study was conducted between September 2017 and March 2019 using a multistage, stratified and cluster random sampling method. 18...

Serum Klotho Levels Contribute to the Prevention of Disease Progression.

BackgroundAssessing the progression of a disorder from its pre-clinical state is important in the prevention of various diseases. In the present study, we evaluated the role of serum levels of αKlotho (αKl) in the progression of several pre-clinical disorders.MethodsThis cohort study included 80 males who underwent their annual health checkup during the entry period between April 2005 and March 2008. Physical and biochemical parameters were obtained from all subjects. The associations of baseline serum levels of soluble αKl (sαKl) with the progression of the disorders were assessed in the study.ResultsBaseline serum levels of sαKl were significantly lower in subjects developing a high fasting plasma glucose (FPG) level than in subjects not developing a high FPG level. Logistic multivariable analysis showed that baseline serum levels of sαKl and FPG levels significantly associated with a high FPG level progression. It is suggested that low sαKl levels are associated with the progression of hyperglycemia. Evaluation of serum levels of sαKl in subjects with multiple disorders revealed that those with more pre-clinical disorders progression tended to show lower sαKl levels.ConclusionA decrease in serum levels of sαKl could be associated with the progression of pre-clinical disorders.

Disease Burden and Attributable Risk Factors of Alzheimer's Disease and Dementia in China from 1990 to 2019.

Updated information on the burden of Alzheimer's disease and other forms of dementia are of great importance for evidence-based health care planning. However, such an estimate has been lacking in Chinese populations at both national and provincial levels. To estimate the temporal trends and the attributable burdens of selected risk factors of Alzheimer's disease and other forms of dementia in China. This is an observational description of the Global Burden of Diseases Study 2019 (GBD 2019). Data on incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) of Alzheimer's disease and other forms of dementia were derived from the GBD 2019 study at both national and provincial levels in China. Six indicators were used: incidence, mortality, prevalence, DALYs, YLLs, and YLDs. Absolute numbers in detail by age, sex, region, and age-standardized rates (with 95% uncertainty intervals) were calculated. There were notable increasing trends in the number of deaths (247·9%), incidence (264·8%), prevalence (296·5%), DALYs (228·1%), YLDs (308·7%) and YLLs (201·7%) from 1990 to 2019, respectively. The corresponding age-standardized rates increased by 6·2%, 19·3%, 33·6%, 10·7%, 33·4% and 3·1%. Smoking, high body mass index, high fasting plasma glucose levels, and metabolic risks were the four leading risk factors. Higher burden was observed among females versus males and in the more developed regions. The disease burden in China were increasing substantially. Regional differences of the disease burden are accompanied by discrepancies of economic level and geographical location, as well as different levels of exposure to risk factors. Targeted prevention and control strategies are urgently needed to reduce the disease burden.

Additive Effect of Obesity and Dyslipidemia on Wheezing in Korean Adults: A Nationwide Representative Survey Study.

Besides obesity, there are limited studies regarding the relationship between the individual components of metabolic syndrome and wheezing. It is largely unknown whether the co-existence of other metabolic syndrome components has additive effects on wheezing in the adult population. The association between the individual components of metabolic syndrome and current wheezing was evaluated in adults using data from the Korea National Health and Nutrition Examination Survey from 2008 to 2012. Subjects with metabolic syndrome more frequently had wheezing during the past 12 months (current wheezing) (adjusted odds ratio [aOR] = 1.56; 95% confidence interval [CI] = 1.37–1.77) and wheezing during exercise in the past 12 months (aOR = 1.59; 95% CI = 1.37–1.84). Of the individual metabolic syndrome components, central obesity (aOR = 1.48; 95% CI = 1.31–1.66) and low high-density lipoprotein (HDL) cholesterol (aOR = 1.18; 95% CI = 1.05–1.34) were significantly associated with current wheezing. There were no significant associations between the other components of metabolic syndrome (high triglyceride level, blood pressure, and fasting plasma glucose level) and the presence of current wheezing. In addition, the association was much higher when both central obesity and low HDL cholesterol were present together compared to when either of the conditions was present alone (aOR = 1.67; 95% CI = 1.44–1.94). There is a significant association between metabolic syndrome and current wheezing in Korean adults. Of the components of metabolic syndrome, low HDL cholesterol and central obesity are independently and additively associated with the increased rate of current wheezing.

Metabolic and Nutritional Characteristics in Middle-Aged and Elderly Sarcopenia Patients with Type 2 Diabetes.

Sarcopenia is considered to be a new complication of type 2 diabetes (T2DM) leading to increased risk of adverse outcome. We performed a survey to evaluate glucose metabolism and nutritional status in sarcopenia patients with T2DM. Diabetic participants aged ≥50 years were grouped into a probable sarcopenia group with low muscle strength (n = 405) and a nonsarcopenia group with normal muscle strength (n = 720) according to the revised recommendations from EWGSOP2 (2018). Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, longer diabetes duration, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate and lower bone mineral content, lower fatless upper arm circumference, lower appendicular skeletal muscle mass index (ASMI), and muscle quality in both genders. Multivariable logistic regression analysis showed increased age, male, low BMI, and increased HbA1c, combined with diabetic nephropathy and decreased serum albumin levels, were risk factors associated with low muscle strength in diabetes patients. In conclusion, diabetic patients with sarcopenia had worse glucose metabolism and nutritional status, decreased renal function and reduced muscle quality ,and muscle mass with a greater likelihood of osteoporosis, who need an overall health management to improve outcomes. This clinical trial registration is registered with the Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Assessment of correlation between silent brain damages and clinical characteristics in patients with persistent atrial fibrillation and concomitant arterial hypertension

Abstract Introduction Silent cerebral microembolic lesions (SML) are known to occur with higher prevalence in persistent AF and could be potential reason of cognitive decline. It seems reasonable to investigate which factors may be related with the SML occurrence in AF pts to implicate it in the future prophylaxis. Purpose To estimate association between brain MRI findings (incidence of silent cerebral microembolism and microbleedings) in patients with persistent atrial fibrillation and their clinical characteristics including concomitant arterial hypertension (AH) and CHA2DS2-VASc score. Methods Pts with persistent AF (n=69) were included in the study. All subjects underwent clinical assessment, thromboembolic and hemorrhagic risk calculation using CHA2DS2-VASc and HAS-BLED score with subsequent cranial MRI examination. The incidence of SML (registered on MRI like small focal hyperintense areas in the brain matter) and microbleedings were assessed. The pts were divided into groups: Gr1 (n=49) – pts with revealed SML, Gr2 (n=20) – without silent brain damages. Clinical characteristics of pts were compared regarding to presence of SML and microbleedings using Mann-Whitney U test. Spearman analysis and ROC- analysis were used for correlation assessment. Results The total incidence of SML was 71% (n=49). Isolated microbleedings were found in 13% (n=9) pts., 59.4% (n=41) pts were anticoagulant naïve. The most part of investigated pts (82.6%, n=57) had well controlled AH: 42 pts (85.7%) in Gr1 and 15 (75%) in Gr2, p=0.1. Persons with SML were significantly older compared to the pts without SML – 59.6±7.1 years vs 52.1±8.9 (p=0.005), had lower EF – 54.4±9.4% vs 58.5±6.8% (p=0,04), higher CHA2DS2-VASc score – 2 [1; 3] vs 1 [0; 1.5] and higher HAS-BLED score – 0 [0; 3] vs 1 [0; 2] (p=0.02). Notably, higher fasting plasma glucose level was registered in Gr1 in comparison with Gr2 – 6.34±2.4 mmol/l vs 5.4±0.5 mmol/l (p=0.008). Significant correlations were calculated between SML and CHA2DS2-VASc score (AUC – 0.875, CI: 0.773–0.977, p=0.006), SML and degree of AH (AUC – 0.658, CI: 0.512–0.803, p=0.039), SML and age (AUC – 0.757, CI: 0.62–0.895, p=0.001). The age cut-off value for revealing SML on brain MRI in pts with persistent AF was determined: 45.5 years (AUC – 0.757, Sensitivity – 97.9%, Specificity – 71.4%, p=0.001). Individuals with microbleedings had only significantly higher CHA2DS2-VASc score – 3 [1; 4] vs 1 [0; 4] (p=0.002) with weak positive correlation (r=0.32, n=69, p=0.009). Conclusion The correlation between brain SML and CHA2DS2-VASc score confirms the ability of that score to predict not only clinically apparent thromboembolic events but also silent microembolism in persistent AF. Brain SML in pts with persistent AF are associated with higher CHA2DS2-VASc score, higher fasting plasma glucose, degree of arterial hypertension. Notably that pts revealing SML on brain MRI were younger compared to the age using in CHA2DS2-VASc score. Funding Acknowledgement Type of funding source: None

“Non- Alcoholic Fatty Liver Disease and Its Relationship with Metabolic Syndrome Among the Adult Patients Attending in Rajshahi Medical College Hospital, Rajshahi, Bangladesh”

Background: Metabolic syndrome describes the co-occurrence of central adiposity, hyperglycemia, hypertension, lipid abnormalities and other metabolic changes that increase risk of cardiovascular, cerebrovascular, renal diseases. This multi-system condition has adverse effects on many organs, the liver being one of them. Nonalcoholic fatty liver disease appears to be the hepatic manifestation of metabolic syndrome, and is increasingly recognized as a major contributor to the burden of chronic liver disease world-wide. Metabolic syndrome and non-alcoholic fatty liver disease appear to have a common pathogenesis, arising from insulin resistance, central adiposity and chronic low grade inflammation. Objective: The aim of the study is to find out the occurrence of NAFLD and metabolic syndrome among the patient attending in RMCH. Materials and Methods: This is a cross sectional descriptive study which was conducted in the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. 250 patients age above 20 years nonalcoholic both male and female were included for the study. All patients were interviewed by structured questionnaire. Statistical analysis was carried out by using the Statistical Package for the Social Sciences (SPSS) software version 23.0 for windows (SPSS Inc, Chicago, Illinois, USA). Continuous data are expressed as the mean ± standard deviation (SD) and categorical variables are expressed as percentages. Pearson correlation coefficient test and unpaired t-test were used for this study. For all statistical tests, p-value is less than 0.05 was considered as statistically significant. Results: Among 250 respondents a total of 67(26.8%) cases were diagnosed as metabolic syndrome and out of the 67 metabolic syndrome patients 23(34.33%) were male and 44(65.67%) were female. Out of the 23 male metabolic syndrome patients 9(39.13%) were diagnosed as NAFLD and out of the 44 female metabolic syndrome patients 16(36.36%) were diagnosed as NAFLD. Among the 250 respondents 53 (21.2%) cases ultarsonographically diagnosed as NAFLD and showed 41(77.36%), 11(20.75%) and 1(1.89%) of cases had grade I, II, and III fatty liver respectively. Out of the 53 NAFLD patient’s 25 patients were presented with metabolic syndrome and 28 patients were without metabolic syndrome. Patients of NAFLD with metabolic syndrome presented with high fasting plasma glucose level in 19(67.80%) cases, hypertensive in 17(68%) cases, high triglyceride in 17((68%) cases, low HDL in 16(64%) cases, waist circumference high in 18(72%) cases. The difference was significant for fasting plasma glucose, blood pressure, triglycerides, high-density lipoprotein and waist circumference (p<0.05) between metabolic syndrome and non-metabolic syndrome patients. Conclusion: From the study, it can be concluded that the proportion of NAFLD significantly higher in metabolic syndrome patients compare to non-metabolic syndrome patients and metabolic syndrome is higher in female compare to male. So early diagnosis of metabolic syndrome suspected cases and ultrasonographic detection of NAFLD would help not only modifying the disease course but also delaying its complication.

Fasting plasma glucose level and the risk of open angle glaucoma: Nationwide population-based cohort study in Korea.

BackgroundThe level of fasting plasma glucose (FPG) is positively associated with intraocular pressure. Diabetes causes early structural changes of retina, especially on ganglion cell layer. In this regard, the FPG level itself may also show an independent association with open angle glaucoma (OAG) development in general population. Herein, we investigate the association of the FPG level with the incidence of OAG.MethodsUsing nationally representative data from the Korean National Health Insurance System, 374,376 subjects ≥40 years of age without OAG who underwent health examinations from 2009 to 2013 were enrolled and followed to the end of 2014. Incident cases of OAG using the International Classification of Diseases 10 codes and medication information were analyzed based on the levels of FPG.ResultsSubjects with the highest FPG level (≥160 mg/dL), compared with the lowest level (<80 mg/dL), showed a higher hazard ratio (HR) [2.189; 95% confidence interval (CI): 1.779–2.695; P for trend < 0.001] for OAG after adjustments for age and sex. This result persisted after further adjustments for the presence of type 2 diabetes, current smoking, drinking, and exercise habits, diastolic blood pressure, body mass index (BMI), and total cholesterol level (HR: 1.588; 95% CI: 1.268–1.989; P for trend < 0.001). The positive association between the FPG level and the incidence of OAG was distinct in subjects 40–64 years of age, those with a BMI <25 kg/m2, and those without hypertension (HR 2.022; 95% CI: 1.494–2.736; P for trend <0.001: HR 1.817; 95% CI: 1.372–2.407; P for trend < 0.001: HR 1.706; 95% CI: 1.180–2.467; P for trend <0.001, respectively).ConclusionsThis nationwide population-based cohort study showed that the fasting glucose was associated with an increased risk of OAG. These findings suggest that subjects with high FPG levels require special attention when screening for glaucoma.

Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria

ObjectivesTo identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance.DesignProspective cohort study.SettingGondar town public health facilities in Northwest...

Hyperglycemia is a strong predictor of poor prognosis in COVID-19

AimsThe objective of this study is to explore the association between documented diabetes, fasting plasma glucose (FPG), and the clinical outcomes of Coronavirus disease 2019 (COVID-19). MethodsThis retrospective study included 255 patients with COVID-19. Of these, 214 were admitted to isolation wards and 41were admitted to intensive care units (ICUs). Demographic, clinical, treatment, and laboratory data were collected and compared between ICU and non-ICU patients. Multivariable logistic regression models were used to explore the risk factors associated with poor clinical outcomes (ICU admission or death). ResultsThere were significant changes in several clinical parameters in ICU patients (leukopenia, lymphopenia, elevated D-dimer, as well as higher levels of FPG, cardiac troponin, serum ferritin, IL-6, and high-sensitivity C-reactive protein)compared with non-ICU patients. The prevalence of known diabetes was substantially higher in ICU than non-ICU patients (31.7% vs. 17.8%, P = 0.0408). Multivariable regression analysis showed that a history of diabetes [odds ratio (OR), 0.099; 95% confidence interval (CI), 0.016–0.627; P = 0.014], high FPG at admission (OR, 1.587; 95% CI, 1.299–1.939, P < 0.001), high IL-6 (OR, 1.01; 95% CI, 1.002–1.018, P = 0.013), and D-dimer higher than 1 mg/L at admission (OR, 4.341; 95% CI, 1.139–16.547, P = 0.032) were independent predictors of poor outcomes. Cox proportional hazards analysis showed that compared with FPG < 7 mmol/L, FPG levels of 7.0–11.1 mmol/L and ≥ 11.1 mmol/L were associated with an increased hazard ratio (HR) for poor outcome (HR, 5.538 [95% CI, 2.269–13.51] and HR, 11.55 [95% CI, 4.45–29.99], respectively). ConclusionHyperglycemia and a history of diabetes on admission predicted poor clinical outcomes in COVID-19.

Influence of Fasting Glucose Levels on Achieving Glycemic Target in Individuals with Type 2 Diabetes: a Post Hoc Analysis

FPG GOAL was a 24-week, open-label, treat-to-target randomized controlled trial which demonstrated that the optimal self-monitored fasting blood glucose (SM-FBG) target for most Chinese individuals with type2 diabetes (T2D) using insulin glargine 100IU/mL was 3.9-6.1mmol/L. Individuals who achieved lower fasting plasma glucose (FPG) levels might achieve the target HbA1c of < 7% without increasing the risk of hypoglycemia. For this post hoc analysis, individuals were redivided into three groups based on their actual laboratory FPG levels at 24weeks: level1, ≤ 5.6mmol/L; level2, > 5.6 to ≤ 6.1mmol/L; and level3, > 6.1 to ≤ 7.0mmol/L. At week24, 863 individuals with diabetes had available FPG data and 179, 122, and 179 individuals achieved FPG levels1, 2, and 3, respectively. The proportion of individuals with HbA1c < 7% or HbA1c < 7% without hypoglycemia (≤ 3.9 or ≤ 3.0mmol/L) was significantly higher in FPG levels1 (p < 0.01) and 2 (p < 0.05) than in level3. The least squares mean changes from baseline in HbA1c (- 1.77% and - 1.66% vs - 1.34%; both p < 0.001) and 2-h postprandial glucose (- 3.88mmol/L and - 3.98mmol/L vs - 3.22mmol/L; both p < 0.05) were also significantly higher in FPG levels1 and 2 compared with level3. Linear regression analysis showed a moderate relationship between FPG and HbA1c levels at 24weeks (r = 0.449). Chinese individuals with T2D who achieved lower FPG levels with insulin glargine 100IU/mL were more likely to achieve the recommended target HbA1c of < 7% compared with those with higher FPG levels. ClinicalTrials.gov identifier NCT02545842.

Hypovitaminosis D Is Associated with Some Metabolic Indices in Gestational Diabetes Mellitus

Background: Gestational diabetes mellitus (GDM), a pregnancy complication, is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Vitamin D deficiency and insufficiency has recently been recognized as a contributing factor to the pathogenesis of GDM, and this link might be associated with hyperglycemia, insulin resistance, and inflammation, which are implicated in GDM. Objectives: This study aims at investigating the relationship between vitamin D, fasting plasma glucose (FPG), insulin, zinc, ferritin, and high-sensitivity C-reactive protein (CRP) in GDM. Method: A case-control study in which 80 women attending the antenatal clinic of University College Hospital (UCH), Ibadan, Nigeria, were recruited; the women were grouped into controls (40 nondiabetic pregnant women) and cases (40 pregnant women with GDM). Blood samples were taken at the second trimester, and metabolites were quantified by standard laboratory methods. Student’s t test and Pearson correlation were used to compare variables and determine the relationship between variables, respectively. Results: Results showed significant (p < 0.05) low levels of serum vitamin D and zinc, and significant (p < 0.05) higher levels of FPG and serum insulin, ferritin, and CRP in the GDM group compared to the control group. In the GDM group, a positive weak relationship was observed between vitamin D and zinc (r = 0.18, p < 0.05), while vitamin D was inversely correlated with FPG, serum insulin, ferritin, and CRP (r = –0.23, –0.21, –0.20, –0.46, respectively, p < 0.05). Conclusion: This study suggests that hypovitaminosis D might be associated with glucose intolerance, insulin insensitivity, and inflammation, which are factors implicated in the development and progression of GDM.

Metformin use in prediabetes: is earlier intervention better?

The aim of this study was to investigate the effectiveness of metformin in diabetes prevention in a prediabetic population across a range of fasting plasma glucose (FPG) levels at baseline. A secondary aim was to assess the effectiveness of metformin in preventing diabetes in those participants where impaired fasting glucose (IFG) was relatively more pronounced as opposed to impaired glucose tolerance (IGT). Participants randomised to metformin and placebo arms in the Diabetes Prevention Program study were stratified into cohorts according to level of FPG at baseline. Cumulative incidence of diabetes for the different cohorts was assessed. Change in FPG, insulin sensitivity, and levels of fasting insulin and proinsulin for the different cohorts were also calculated. The largest reductions in incidence of diabetes and FPG occurred within prediabetic persons with a higher level of FPG at baseline. Metformin was able to stabilise insulin sensitivity in every stratified sub-cohort except one. Sub-cohorts which had higher levels of insulin sensitivity at baseline experienced the largest increases in insulin sensitivity. Metformin reduced the incidence of diabetes by 43% (RR 0.57, CI 0.4-0.9) in those prediabetic persons whose IFG was more pronounced compared to a 26% (RR 0.74 CI 0.7-0.8) when all participants in the study were included. The largest reductions in both incidence of diabetes and FPG occurred in prediabetic persons with a higher level of FPG at baseline. Metformin was able to stabilise insulin sensitivity and was more effective in persons with more pronounced IFG.

Telomere length in different metabolic categories: Clinical associations and modification potential.

Metabolic disorders are known to be associated with accelerated telomere attrition. Their pathophysiological heterogeneity suggests the importance of multiple tests in examining these associations. However, oral glucose tolerance test (OGTT) has rarely been performed in such studies to date. There are few studies aimed at determining leukocyte telomere length (LTL) in different categories of impaired glucose tolerance (IGT), and those that do exist do not take into account the impaired fasting glucose (IFG)/IGT categorization. Therefore, we believe our study, when the OGTT was used, is important to the field. This testing made it possible to determine whether LTLs are associated with glucose levels in different hyperglycemic categories. Our data indicate that relationships between LTLs and IFG/IGT levels are not the same. This distinction can potentially be used in categorization of metabolic disorders and in determining the effectiveness of interventions aimed at treating diabetes and other metabolic abnormalities.

1530-P: Metabolic Characteristics in Chinese Sarcopenia Patients with Type 2 Diabetes

Objective: To evaluate glucose metabolism characteristics in middle-aged and elderly sarcopenia patients with type 2 diabetes. Methods: Data were collected from a multicenter, cross-sectional survey study. Eligible patients aged 50 years or older with a previous diagnosis of type 2 diabetes were recruited from the endocrinology department of nine different hospitals in Beijing, China. All participants were grouped into a probable sarcopenia group with low muscle strength and a nonsarcopenia group with normal muscle strength according to the recommendations from EWGSOP2 (2018). Body composition, glucose metabolism, laboratory and nutritional index were compared between two groups. Results: A total of 1125 diabetic participants were included, with 405 in probable sarcopenia group and 720 in nonsarcopenia control group. Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate, and lower bone mineral content, basal metabolic rate, fatless upper arm circumference, appendicular skeletal muscle mass index (ASMI) and muscle quality in both men and women. The prevalence of low muscle mass was obviously elevated in probable sarcopenia group in both sexes (men: 11.0% vs. 25.4%, women: 6.8% vs. 19.1%). Multivariable logistic regression analysis showed that aged, male sex, low BMI, increased HbA1c, diabetic nephropathy and decreased serum albumin level were risk factors associated with low muscle strength in diabetes patients. Conclusions: Sarcopenic diabetic patients were older and had lower BMI, worse nutritional status and glucose metabolism, decreased renal function and reduced muscle quality and mass with a greater likelihood of osteoporosis. Clinically, diabetic aged patients should receive an assessment on muscle strength and muscle quality to optimize their treatment program. Disclosure Q. He: None. L. Guo: None.

Incidence of pulmonary tuberculosis in Chinese adults with type 2 diabetes: a retrospective cohort study in Shanghai

To estimate the incidence of pulmonary tuberculosis (PTB) in Chinese diabetes patients and to evaluate the effect of blood glucose on PTB risk, a retrospective cohort study was built based on the diabetes management system in Shanghai and included 240,692 adults aged 35 or above. Incidences of PTB in all diabetes patients and by subgroups were calculated and compared. Multivariable Cox regression models with restricted cubic splines were used to evaluate the association of fasting plasma glucose (FPG) with the risk of PTB. A total of 439 incident PTB cases were identified in the cohort after an average of 3.83 years of follow-up. The overall PTB incidence rate was 51.3/100,000 in diabetes patients, and annual incidence remained higher than that in general population. The PTB incidence rate of diabetes patients was higher in men than in women (86.2 vs. 22.1 per 100,000) and was highest in patients with body mass index (BMI) < 18.5 kg/m2 (215.2/100,000) or FPG ≥ 10 mmol/L (143.2/100,000). Our results suggest that the risk of tuberculosis may be greater at higher levels of FPG in diabetes patients of normal weight. Specific tuberculosis screening strategies for different characteristic diabetes population should be provided to prevent and control tuberculosis in China.

Blood Glucose Levels in Elderly Subjects with Type 2 Diabetes During COVID-19 Outbreak: A Retrospective Study in a Single Center

Aims: Ideal glycemic control is of great importance for diabetic patients during public health emergencies of infectious diseases as long-term hyperglycemic are not only associated with chronic complications but also vital drivers of common and life-threatening infections. The present study was designed to investigate the changes of blood glucose levels in elderly subjects with type 2 diabetes(T2D) during COVID-19 outbreak. Methods:This retrospective study focused on the T2D outpatients at Fujian Provincial Hospital aged 65 years old and above who received baseline test for fasting plasma glucose and/or glycated hemoglobin (HbA1c) between January 1, 2019 and March 8, 2019 and were followed up on fasting plasma glucose and/or HbA1c in the same period in 2020. The baseline and follow-up data were analyzed with the paired-samples T-test. Results: A total of 135 elderly subjects with T2D with baseline and follow-up fasting plasma glucose and 50 elderly subjects with T2D with baseline and follow-up HbA1c were analyzed, respectively. The baseline and follow-up fasting plasma glucose were 7.08±1.80 and 7.48±2.14 mmol/L, respectively (P=0.008). The baseline and follow-up HbA1c were 7.2±1.7% and 7.4±1.8%, respectively (P=0.158). Conclusions: Elderly subjects with T2D had higher fasting plasma glucose levels during COVID-19 outbreak. We should pay more attension to the management of diabetics during public health emergencies. Funding Statement: None. Declaration of Interests: No conflict of interest has been declared by the authors. Ethics Approval Statement: This retrospective study was approved by the Ethics Committee of Fujian Provincial Hospital. Due to the retrospective nature of the study, informed consent was waived. Subjects information was anonymized at the collection and analysis stage.