High Risk Of Diabetes Research Articles

Air pollution, road traffic noise and lack of greenness and risk of type 2 diabetes: A multi-exposure prospective study covering Denmark

ObjectiveAir pollution, road traffic noise and lack of greenness coexist in urban environments and have all been associated with type 2 diabetes. We aimed to investigate how these co-exposures were associated with type 2 diabetes in a multi-exposure perspective. MethodsWe estimated 5-year residential mean exposure to fine particles (PM2.5), ultrafine particles (UFP), elemental carbon (EC), nitrogen dioxide (NO2) and road traffic noise at the most (LdenMax) and least (LdenMin) exposed facade for all persons aged > 50 years living in Denmark in 2005 to 2017. For each air pollutant, we estimated total concentrations and traffic contributions. Based on land use maps, we estimated proportion of green and non-green space within 150 and 1000 m of all residences. In total, 1.9 million persons were included and 128,358 developed type 2 diabetes during follow-up. We performed analyses using Cox proportional hazards models, with adjustment for individual and neighborhood-level sociodemographic co-variates. ResultsIn single-pollutant models, all air pollutants, noise and lack of green space were associated with higher risk of diabetes. In two-, three- and four-pollutant analyses of the air pollutants, only UFP and NO2 remained associated with higher diabetes risk in all models. LdenMax, LdenMin and the two proxies of green space remained associated with diabetes in two-pollutant models of, respectively, noise and green space. In a multi-pollutant analysis, we found hazard ratios (95 % confidence intervals) per interquartile range of 1.021 (1.005; 1.038) for UFP, 1.012 (0.996; 1.028) for NO2, 1.022 (1.012; 1.033) for LdenMin, 1.013 (1.004; 1.022) for LdenMax, and 1.038 (1.031; 1.044) and 1.018 (1.010; 1.025) for lack of green space within, respectively, 150 m and 1000 m, and a cumulative risk index of 1.131 (1.113; 1.149). ConclusionsAir pollution, road traffic noise and lack of green space were independently associated with higher risk of type 2 diabetes.

Air Pollution, Oxidative Stress, and the Risk of Development of Type 1 Diabetes.

Despite multiple studies focusing on environmental factors conducive to the development of type 1 diabetes mellitus (T1DM), knowledge about the involvement of long-term exposure to air pollution seems insufficient. The main focus of epidemiological studies is placed on the relationship between exposure to various concentrations of particulate matter (PM): PM1, PM2.5, PM10, and sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (O3), versus the risk of T1DM development. Although the specific molecular mechanism(s) behind the link between increased air pollution exposure and a higher risk of diabetes and metabolic dysfunction is yet unknown, available data indicate air pollution-induced inflammation and oxidative stress as a significant pathway. The purpose of this paper is to assess recent research examining the association between inhalation exposure to PM and associated metals and the increasing rates of T1DM worldwide. The development of modern and more adequate methods for air quality monitoring is also introduced. A particular emphasis on microsensors, mobile and autonomous measuring platforms, satellites, and innovative approaches of IoT, 5G connections, and Block chain technologies are also presented. Reputable databases, including PubMed, Scopus, and Web of Science, were used to search for relevant literature. Eligibility criteria involved recent publication years, particularly publications within the last five years (except for papers presenting a certain novelty or mechanism for the first time). Population, toxicological and epidemiological studies that focused particularly on fine and ultra-fine PM and associated ambient metals, were preferred, as well as full-text publications.

Weight loss strategies, weight change, and type 2 diabetes in US health professionals: A cohort study.

BackgroundWeight loss is crucial for disease prevention among individuals with overweight or obesity. This study aimed to examine associations of weight loss strategies (WLSs) with weight change and type 2 diabetes (T2D) risk among US health professionals.Methods and findingsThis study included 93,110 participants (24 to 60 years old; 11.6% male) from the Nurses’ Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS) cohorts who were free of T2D, cardiovascular disease, and cancer at baseline (1988 for NHS/HPFS and 1989 for NHSII) for analyses of weight change and 104,180 (24 to 78 years old; 14.2% male) for T2D risk assessment. WLSs used to achieve an intentional weight loss of 4.5+ kg were collected in 1992 (NHS/HPFS)/1993 (NHSII) and grouped into 7 mutually exclusive categories, including low-calorie diet, exercise, low-calorie diet and exercise, fasting, commercial weight loss program (CWLP), diet pills, and FCP (selected at least 2 methods from fasting, CWLP, and pill). The reference group was participants who did not attempt to lose weight. Generalized estimating equations and Cox regression were applied to estimate up to 10-year weight change trajectory and incident T2D risk through 2016 (NHS/HPFS)/2017 (NHSII), respectively.The associations of WLSs with weight change and T2D risk were differential by baseline body weight (Pinteraction < 0.01). Among individuals with obesity, all WLSs tended to associate with less weight gain [ranging from −4.2% (95% confidence interval (CI), −5.1% to −3.2%; P < 0.001) for exercise to −0.3% (−1.2% to 0.7%; P > 0.99) for FCP] and a lower T2D risk [hazard ratios (HRs) ranging from 0.79 (0.66 to 0.95; P = 0.04) for exercise to 0.87 (0.66 to 1.13; P = 0.30) for pill]. Such a pattern was less clear among overweight individuals: the difference of weight change varied from −2.5% (−3.0% to −2.1%; P < 0.001) for exercise to 2.0% (1.3% to 2.7%; P < 0.001) for FCP, and HRs of T2D varied from 0.91 (0.77 to 1.07; P = 0.29) for exercise to 1.42 (1.11 to 1.81; P = 0.02) for pill. The pattern was further inverted among lean individuals in that weight change ranged from −0.4% (−0.6% to −0.1%; P = 0.02) for exercise to 3.7% (3.1% to 4.3%; P < 0.001) for FCP, and the HRs of T2D ranged from 1.09 (0.91 to 1.30; P = 0.33) for exercise to 1.54 (1.13 to 2.10; P = 0.008) for pill. Approximately 15.6% to 46.8% of the association between WLSs and the T2D risk was attributed to weight changes. This study was limited by a single assessment of WLSs, heterogeneity within each WLS, and potential misclassification of the timing of weight loss and weight regain.ConclusionsThe current study showed that individuals with obesity who attempted to lose weight, regardless of the WLSs used, tended to gain less body weight and have a lower diabetes risk. In contrast, lean individuals who intentionally lost weight tended to gain more weight and have a higher diabetes risk. These data support the notion that intentional weight loss may not be beneficial for lean individuals and the use of WLSs for achieving weight loss shall be guided by medical indications only.

Detection of Leptin Using Electrocatalyst Mediated Impedimetric Sensing.

Obesity is a complex disorder associated with immense health consequences including high risk of cardiovascular diseases, diabetes, and cancer. Abnormality in the thyroid gland, genetics, less physical activity, uptake of excessive diet, and leptin resistance are critical factors in the development of obesity. To determine the treatment strategy, understanding the pathophysiology of obesity is crucial. For instances, leptin resistance mediated obesity defined by the presence of excessive leptin hormone (Lep) in the systemic circulation is very common in diet induced obesity. Therefore, our hypothesis is that quantitative measurement of Lep from blood can help to identify individuals with Lep resistant mediated obesity and thereby guide toward a proper treatment strategy. In this work, we aim to utilize an electrochemical immunosensing platform for diagnosis of obesity by measuring the Lep content in systemic circulation. A porous carbon confined FeNi bimetallic system was synthesized with three different ratios of Fe and Ni ions using high temperature pyrolysis technique. The suitability of the sensor for detecting Lep was studied using both CV and EIS techniques. The limit of detection (LOD) for GCE was recorded as 157.4 fg/mL with a wide linear concentration range of 500 fg/mL to 80 ng/mL, while for SPCE the LOD was 184.9 fg/mL with a linear range of 500 fg/mL to 50 ng/mL. Finally, the feasibility and applicability of the sensor for Lep detection was tested with serum collected from high fat diet induced obese rats. The selectivity, sensitivity, storage, and experimental stability and reproducibility tests showed potential for this biosensor platform as a point-of-care Lep detection device.

The 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) score and diabetes risk in the Diabetes Prevention Program Outcomes Study (DPPOS)

BackgroundThe 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 3rd expert report highlights up-to-date Cancer Prevention Recommendations that may reduce burdens of many chronic diseases, including diabetes. This study examined if following a lifestyle that aligns with the recommendations – assessed via the 2018 WCRF/AICR Score – was associated with lower risk of type 2 diabetes in high-risk adults participating in the Diabetes Prevention Program Outcomes Study (DPPOS).MethodsThe Diabetes Prevention Program (DPP) randomized adults at high risk for diabetes to receive a lifestyle intervention (ILS), metformin (MET) or a placebo (PLB) (mean: 3.2 years), with additional follow-up in DPPOS for 11 years (mean: 15 years total). 2018 WCRF/AICR Scores included seven components: body weight, physical activity, plant-based foods, fast foods, red and processed meat, sugar-sweetened beverages, and alcohol; the optional breastfeeding component was excluded. Scores ranged 0-7 points (with greater scores indicating greater alignment with the recommendations) and were estimated at years 0, 1, 5, 6, 9, and 15 (N=3,147). Fasting glucose and HbA1c were measured every six months and oral glucose tolerance tests were performed annually. Adjusted Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were used to examine the association of both Score changes from years 0-1 and time-dependent Score changes on diabetes risk through DPP and year 15.ResultsScores improved within all groups over 15 years (p<0.001); ILS Scores improved more than MET or PLB Scores after 1 year (p<0.001). For every 1-unit improvement from years 0-1, there was a 31% and 15% lower diabetes risk in ILS (95% CI: 0.56-0.84) and PLB (95% CI: 0.72-0.97) through DPP, and no significant association in MET. Associations were greatest among American Indian participants, followed by non-Hispanic White and Hispanic participants. Score changes from years 0-1 and time-dependent Score changes in ILS and PLB remained associated with lower risk through year 15.ConclusionsScore improvements were associated with long-term, lower diabetes risk among high-risk adults randomized to ILS and PLB, but not MET. Future research should explore impact of the Score on cancer risk.Trial registrationDiabetes Prevention Program: NCT00004992; Diabetes Prevention Program Outcomes Study: NCT00038727

Chronic kidney disease (CKD) and associated risk in rural South Africa: a population-based cohort study.

Background: In Africa, true prevalence of chronic kidney disease (CKD) is unknown, and associated clinical and genetic risk factors remain understudied. This population-based cohort study aimed toinvestigate CKD prevalence and associated risk factors in rural South Africa. Methods: A total 2021 adults aged 20-79 years were recruited between 2017-2018 from the Agincourt Health and Socio-Demographic Surveillance System in Bushbuckridge, Mpumalanga, South Africa. The following were collected: sociodemographic, anthropometric, and clinical data; venous blood samples for creatinine, hepatitis B serology; DNA extraction; spot urine samples for dipstick testing and urine albumin: creatinine ratio (UACR) measurement. Point-of-care screening determined prevalent HIV infection, diabetes, and hypercholesterolemia. DNA was used to test for apolipoprotein L1 ( APOL1) kidney risk variants. Kidney Disease Improving Global Outcomes (KDIGO) criteria were used to diagnose CKD as low eGFR (<60mL/min/1.73m 2) and /or albuminuria (UACR ≥ 3.0mg/mmol) confirmed with follow up screening after at least three months. eGFR was calculated using the CKD-EPI (creatinine) equation 2009 with no ethnicity adjustment. Multivariable logistic regression was used to model CKD risk. Results: The WHO age-adjusted population prevalence of CKD was 6.7% (95% CI 5.4 - 7.9), mostly from persistent albuminuria. In the fully adjusted model, APOL1 high-risk genotypes (OR 2.1; 95% CI 1.3 - 3.4); HIV infection (OR 1.8; 1.1 - 2.8); hypertension (OR 2.8; 95% CI 1.8 - 4.3), and diabetes (OR 4.1; 95% CI 2.0 - 8.4) were risk factors. There was no association with age, sex, level of education, obesity, hypercholesterolemia, or hepatitis B infection. Sensitivity analyses showed that CKD risk factor associations were driven by persistent albuminuria, and not low eGFR. One third of those with CKD did not have any of these risk factors. Conclusions: In rural South Africa, CKD is prevalent, dominated by persistent albuminuria, and associated with APOL1 high-risk genotypes, hypertension, diabetes, and HIV infection.

Discordance In Fasting And Postprandial Indices Of Glycemic Dysregulation In Individuals With Spinal Cord Injury

Fasting levels of glucose and insulin are routine clinical measures used to diagnose type-2 diabetes. However, individuals with spinal cord injury (SCI) often present with clinically normal fasting glucose but have impaired postprandial responses to a meal challenge. PURPOSE: We aimed to characterize the postprandial glycemic responses and assess the prevalence of glycemic dysregulation using fasting and postprandial indices in individuals with SCI. METHODS: Sixteen men with chronic SCI reported to the laboratory after an overnight fast to undergo either a 2-hour: oral glucose tolerance test (OGTT) using a 75-g (~300 kcal) glucose load (n = 8) or; a mixed meal tolerance test (MMTT, (1037 ± 148 kcal: 45% CHO, 37% fat, 18% PRO) (n = 8). Serial measurements of systemic glucose and insulin concentrations at baseline and in response to the OGTT/MMTT were converted into summary statistics: Insulin Resistance was estimated by the Homeostasis Model Assessment of Insulin Resistance (HOMA2-IR); whole body Insulin Sensitivity Index was estimated using methods described by Matsuda (ISIMatsuda). RESULTS: There were no differences between groups in age (p = 1.0), body mass index (p = 0.87), cardiorespiratory fitness (p = 0.26), fasting glucose (p = 0.53) or insulin (p = 0.19). In the MMTT group, 3 (38%) individuals were identified as prediabetic (fasting plasma glucose (FPG), 7.3 ± 0.9 mmol/L) and 0 individuals had impaired insulin resistance (HOMA2-IR, 1.05 ± 0.6). However, 5 (63%) individuals had impaired postprandial insulin sensitivity (ISIMatsuida, 2.2 ± 0.4). In the OGTT group, 2 (25%) individuals were prediabetic (FPG, 6.2 ± 0.2 mmol/L), 2 (25%) different individuals had impaired insulin resistance (HOMA2-IR, 3.2 ± 0.9), but 7 (88%) individuals had impaired postprandial insulin sensitivity (ISIMatsuida, 2.3 ± 0.9). CONCLUSIONS: In this small study, an OGTT identified more SCI participants with glucose dysregulation than MMTT. Postprandial measures of insulin sensitivity identified a greater proportion of SCI participants with impaired glycemic control and may have preferred utility in identifying individuals at high risk of diabetes. Future studies should compare and contrast the specificity and sensitivity of fasting and postprandial methods in this high-risk population.

POLA MAKAN DAN AKTIVITAS FISIK SAAT WORK FROM HOME (WFH) SEBAGAI DESKRIPTOR RISIKO DIABETES MELLITUS PADA MASA PANDEMI COVID-19

The pandemic era made people abide by recommendations to decline the risk of exposure and transmissions of coronavirus, which one was by work from home (WFH). WFH conducted all daily activities at home, increasing the pattern and quantities of eating without being accompanied by appropriate physical activities or exercise. Thus, it might escalate the risk of DM in people who experience WFH. Changes in eating habits can lead to calorie accumulation in the body. Sedentary habits aggravate this condition in people. As a consequence of this condition, the risk of DM increased. This study aimed to describe eating and activity habits while WFH and risk to DM. This study used an analytic survey with the cross-sectional approach to 60 respondents, which was taken purposively. Data was collected by using a questionnaire about Diabetes Risk from American Diabetes Association (ADA). Most of the respondents have less than 40 years old (71.7%), are female (66.67%), have high school education (53.33%), as private employees (83.33%), and exercise for 30 minutes a week (38.3%). The majority of respondents experienced a different diet (78.3%), gained weight (85%), increased eating quantities (88.3%), and appetites enhancement (91.7%). The risk of diabetes screening result showed that 21.67% have a high risk of diabetes. Even though most respondents have a low risk of diabetes, increasing their diet might escalate the risk. So, it is recommended that the community maintain physical activities for at least 30-60 minutes with mild to moderate aerobic and rearrange the diet as body requirements.

Circulating ceramides and sphingomyelins and the risk of incident cardiovascular disease among people with diabetes: the strong heart study

BackgroundPlasma ceramides and sphingomyelins have been independently linked to diabetes risk, glucose and insulin levels, and the risk of several cardiovascular (CVD) outcomes. However, whether individual ceramide and sphingomyelin species contribute to CVD risk among people with type 2 diabetes is uncertain. Our goal was to evaluate associations of 4 ceramide and 4 sphingomyelin species with incident CVD in a longitudinal population-based study among American Indians with diabetes.MethodsThis analysis included participants with prevalent type 2 diabetes from two cohorts: a prospective cohort of 597 participants in the Strong Heart Family Study (116 incident CVD cases; mean age: 49 years; average length of follow-up: 14 years), and a nested case–control sample of 267 participants in the Strong Heart Study (78 cases of CVD and 189 controls; mean age: 61 years; average time until incident CVD in cases: 3.8 years). The average onset of diabetes was 7 years prior to sphingolipid measurement. Sphingolipid species were measured using liquid chromatography and mass spectrometry. Cox regression and logistic regression were used to assess associations of sphingolipid species with incident CVD; results were combined across cohorts using inverse-variance weighted meta-analysis.ResultsThere were 194 cases of incident CVD in the two cohorts. In meta-analysis of the 2 cohort results, higher plasma levels of Cer-16 (ceramide with acylated palmitic acid) were associated with higher CVD risk (HR per two-fold higher Cer-16: 1.85; 95% CI 1.05–3.25), and higher plasma levels of sphingomyelin species with a very long chain saturated fatty acid were associated with lower CVD risk (HR per two-fold higher SM-22: 0.48; 95% CI 0.26–0.87), although none of the associations met our pre-specified threshold for statistical significance of p = 0.006.ConclusionsWhile replication of the findings from the SHS in other populations is warranted, our findings add to a growing body of research suggesting that ceramides, in particular Cer-16, not only are associated with higher diabetes risk, but may also be associated with higher CVD risk after diabetes onset. We also find support for the hypothesis that sphingomyelins with a very long chain saturated fatty acid are associated with lower CVD risk among adults with type 2 diabetes.

Impact of Prediabetes on Cardiac Function Among Primary Care Patients.

Background: Prediabetes is a novel risk factor recently associated with changes in the left ventricle. Our aim is to determine if prediabetes is associated with heart failure (HF) and structural heart disease. Methods: We conducted a cross-sectional study and performed screening echocardiograms to consecutive primary care patients. We calculated the hemoglobin A1c (HbA1c) within 3 months of the echocardiogram and classified patients as having normal glucose, low-risk or high-risk prediabetes or diabetes. Our primary outcome was HF defined as an ejection fraction (EF) <50% and HF with preserved EF. Our secondary outcome was structural heart disease defined as having either a large atrium, left ventricular hypertrophy, or low EF. Results: We included 15,056 patients who underwent a screening echocardiogram and had a recorded HbA1c. Only 2794 patients had a normal blood glucose, 4201 had low-risk prediabetes, 2499 had high-risk prediabetes, and the remainder had diabetes. The adjusted odds ratio (ORs) of HF for low-risk prediabetes, high-risk prediabetes and diabetes were 1.38 [confidence interval (95% CI) 1.07-1.78] (P = 0.01), 1.47 (95% CI 1.05-2.01) (P = 0.01), and 1.60 (95% CI 1.16-2.01) (P < 0.01), respectively, when compared with normoglycemic patients. The adjusted OR of HF with preserved EF for low- and high-risk prediabetes and diabetes were 1.17 (95% CI 0.86-1.60) (P = 0.30), 1.60 (95% CI 1.15-2.21) (P < 0.01), and 1.63 (95% CI 1.24-2.13) (P < 0.01), respectively, when compared with normoglycemic patients. Conclusions: Prediabetes is a prevalent condition associated with structural heart disease and HF.

The association of physical activity and cardiorespiratory fitness with β-cell dysfunction, insulin resistance, and diabetes among adults in north-western Tanzania: A cross-sectional study.

IntroductionResearch on the associations of physical activity and cardiorespiratory fitness with β-cell dysfunction and insulin resistance among adults in Sub-Saharan Africa (SSA) is limited. We assessed the association of physical activity and cardiorespiratory fitness with β-cell function, insulin resistance and diabetes among people living with HIV (PLWH) ART-naïve and HIV-uninfected Tanzanian adults.MethodIn a cross-sectional study, we collected data on socio-demography, anthropometry, fat mass and fat free mass and C-reactive protein. Data on glucose and insulin collected during an oral glucose tolerance test were used to assess β-cell dysfunction (defined as insulinogenic index <0.71 (mU/L)/(mmol/L), HOMA-β index <38.3 (mU/L)/(mmol/L), and overall insulin release index <33.3 (mU/L)/(mmol/L)), oral disposition index <0.16 (mU/L)/(mg/dL)(mU/L)-1, insulin resistance (HOMA-IR index >1.9 (mU/L)/(mmol/L) and Matsuda index <7.2 (mU/L)/(mmol/L), prediabetes and diabetes which were the dependent variables. Physical activity energy expenditure (PAEE), sleeping heart rate (SHR), and maximum uptake of oxygen during exercise (VO2 max) were the independent variables and were assessed using a combined heart rate and accelerometer monitor. Logistic regressions were used to assess the associations.ResultsOf 391 participants, 272 were PLWH and 119 HIV-uninfected. The mean age was 39 ( ± 10.5) years and 60% (n=235) were females. Compared to lower tertile, middle tertile of PAEE was associated with lower odds of abnormal insulinogenic index (OR=0.48, 95%CI: 0.27, 0.82). A 5 kj/kg/day increment of PAEE was associated with lower odds of abnormal HOMA-IR (OR=0.91, 95%CI: 0.84, 0.98), and reduced risk of pre-diabetes (RRR=0.98, 95%CI: 0.96, 0.99) and diabetes (RRR=0.92, 95%CI: 0.88, 0.96). An increment of 5 beats per min of SHR was associated with higher risk of diabetes (RRR=1.06, 95%CI: 1.01, 1.11). An increase of 5 mLO2/kg/min of VO2 max was associated with lower risk of pre-diabetes (RRR=0.91, 95%CI: 0.86, 0.97), but not diabetes. HIV status did not modify any of these associations (interaction, p>0.05).ConclusionAmong Tanzanian adults PLWH and HIV-uninfected individuals, low physical activity was associated with β-cell dysfunction, insulin resistance and diabetes. Research is needed to assess if physical activity interventions can improve β-cell function and insulin sensitivity to reduce risk of diabetes and delay progression of diabetes in SSA.

Standardizing Process for Managing High Risk Diabetes Mellitus Patients in Perioperative Setting

<h3>Background Information</h3> Approximately 10% of the United States population is affected by Type 2 diabetes. Data from 2016 to 2020 shows over 35,000 oncology patients with diabetes mellitus received care at MD Anderson Cancer Center. There was no consistency in the ownership of care or process in managing these patients. Opportunities for improvement in pre, intra and post-operative management was identified. <h3>Objectives of Project</h3> To standardize the process of managing high risk diabetes patients in Operating Room (OR) and out of OR procedure areas with the aim of reducing non-compliance by 50% over the course of six months. <h3>Process of Implementation</h3> A Process Flow Chart (PFC) was created to streamline the process of glucose management for all Type1 diabetic patients with or without an insulin pump, and Type 2 diabetic patients with insulin pumps. The PFC included identifying high risk patients and developing a plan for appropriate interventions during pre, intra and post procures. An icon was created to identify diabetic patients on the status boards. Patients were contacted the day before surgery as reminder to bring their supplies to hospital. Smart phrases were developed for pre-op conversations, patient education, & discharge instructions. A High-Risk email group was created to notify upcoming high risk diabetic patients with recommendations of care from Endocrine. Staff education was initiated to improve awareness and chart audits were created to assess compliance. Noncompliance was addressed individually. <h3>Statement of Successful Practice</h3> The baseline data showed 62% non-compliance to the standard process for managing pre- and post-operative management of high-risk diabetes. The implementation of the pilot study resulted in the reduction of non-compliance from 62% to 7%, exceeding the goal of 31%. Creation of the diabetes icon in status boards and the group email increased early identification of high-risk patients. Endocrine recommendations and staff education improved awareness of the management of high-risk patients. <h3>Implications for Advancing the Practice of Paranesthesia Nursing</h3> Not having a standard process to identify and manage high-risk patients in perioperative settings can lead to postoperative hypo/ hyper glycemic crisis. The workflow developed to improve identification and management of high-risk patient can be generalized to similar settings.

Increased Adiposity and Low Height-for-Age in Early Childhood Are Associated With Later Metabolic Risks in American Indian Children and Adolescents

BackgroundGrowth abnormalities in childhood have been related to later cardiometabolic risks, but little is known about these associations in populations at high risk of type 2 diabetes. ObjectivesWe examined the associations of patterns of growth, including weight and height at ages 1–59 months, with cardiometabolic risk factors at ages 5–16 years. MethodsWe linked anthropometric data collected at ages 1–59 months to cardiometabolic data obtained from a longitudinal study in a southwestern American Indian population at high risk of diabetes. Analyses included 701 children with ≥1 follow-up examination at ages 5–16 years. We derived age- and sex-specific weight-for-height z-scores (WHZ) and height-for-age z-scores (HAZ) at ages 1–59 months. We selected the highest observed WHZ and the lowest observed HAZ at ages 1–59 months and analyzed associations of z-scores and categories of WHZ and HAZ with cardiometabolic outcomes at ages 5–16 years. We used linear mixed-effects models to account for repeated measures. ResultsOverweight/obesity (WHZ >2) at ages 1–59 months was significantly associated with increased BMI, fasting and 2-hour postload plasma glucose, fasting and 2-hour insulin, triglycerides, systolic blood pressure, diastolic blood pressure, and decreased HDL cholesterol at ages 5–16 years relative to normal weight (WHZ ≤1). For example, at ages 5–9 years, 2-hour glucose was 10.4 mg/dL higher (95% CI: 5.6–15.3 mg/dL) and fasting insulin was 4.29 μU/mL higher (95% CI: 2.96–5.71 μU/mL) in those with overweight/obesity in early childhood. Associations were attenuated and no longer significant when adjusted for concurrent BMI. A low height-for-age (HAZ < −2) at ages 1–59 months was associated with 5.37 mg/dL lower HDL (95% CI: 2.57–8.17 mg/dL) and 27.5 μU/mL higher 2-hour insulin (95% CI: 3.41–57.6 μU/mL) at ages 10–16 years relative to an HAZ ≥0. ConclusionsIn this American Indian population, findings suggest a strong contribution of overweight/obesity in early childhood to cardiometabolic risks in later childhood and adolescence, mediated through persistent overweight/obesity into later ages. Findings also suggest potential adverse effects of low height-for-age, which require confirmation.

C-reactive protein as a moderator and insulin resistance as a mediator for the association between Endothelin-1 and dysglycemia among African Americans: Jackson Heart Study

To explore high sensitivity C-reactive protein (hsCRP) as a moderator and homeostatic model assessment of insulin resistance (HOMAIR) as a mediator for endothelin-1 (ET-1)-glycemic progression association in African Americans. 1692 participants free of dysglycemia (prediabetes and diabetes) at baseline were assessed for: 1) risk ratios (RR) and 95% confidence intervals (CI) for dysglycemia by Zou's modified Poisson multivariable models; 2) moderation effect of hsCRP in a multivariable adjusted model; and 3) mediation effect of HOMAIR on dysglycemia through ET-1 by Valeri and VanderWeele's mediation approach. Compared to quartile 1 (<0.9 pg/mL) of ET-1, quartile 2 (0.9–1.2 pg/mL) was associated with higher risk of diabetes (RR = 1.19 [95% CI 1.02, 1.40]). Plasma ET-1 level and hsCRP level had a synergistic effect on risk of diabetes (RR = 1.06 [95% CI 1.02, 1.09]). The association between plasma ET-1 and dysglycemia was mediated by HOMAIR with a proportion of 47%. African Americans with higher ET-1 levels have an increased risk of glycemic progression. When hsCRP elevates, increased ET-1 facilitates diabetes. HOMAIR involved in glucose imbalance leads to dysglycemia.

Clustering-based COPD subtypes have distinct longitudinal outcomes and multi-omics biomarkers

IntroductionChronic obstructive pulmonary disease (COPD) can progress across several domains, complicating the identification of the determinants of disease progression. In our previous work, we applied k-means clustering to spirometric and...

Assessment of Prevalence and Associated Risk Factors of NAFLD in People Living with Diabetes in India: A Retrospective, Multicenter, Electronic Medical Records Based Study.

Nonalcoholic fatty liver disease (NAFLD) has become a leading cause of liver disease worldwide. The prevalence of NAFLD varies depending on population studied and type of diagnostic tools used to screen or diagnose the patients. There is a strong relationship between metabolic syndrome components and NAFLD prevalence. This study aims to understand the prevalence of NAFLD along with the associated risk factors and their interaction with other comorbidities among people living with diabetes in Indian context. It is a retrospective, observational study based on data retrieved from electronic medical records (EMRs) of people living with diabetes from more than 250 individual diabetes centers located in more than 30 cities across 14 states in India. Medical records of 171,996 adults living with diabetes were included in the analysis. The assessment of prevalence of NAFLD in diabetes was done using algorithm based on alanine transaminase (ALT) and aspartate aminotransferase (AST). Overall, 44.48% of people living with diabetes were found to have NAFLD. A significantly higher proportion of males (58.64%) had NAFLD compared to females (36.91%) (p&lt;0.001). Nonalcoholic fatty liver disease prevalence was &gt;50% in seven of the states. People living with diabetes along with dyslipidemia and hypertension had a significantly higher prevalence of NAFLD (p&lt;0.001). Obesity (57.1%), dyslipidemia (59.1%), and hypertriglyceridemia (42.3%) had significantly higher odds of NAFLD among people living with diabetes. This study highlighted high-risk categories for NAFLD in diabetes, like young, obese, hypertriglyceridemia, poor glycemic control, etc. This information will help health care providers in prioritizing screening among high-risk diabetes population.

Associations of Physical Activity, Kidney Function, Diet, and Inflammatory Markers in High-Risk Type-2 Diabetes With Early-Stage Chronic Kidney Disease (CKD)

OBJECTIVES Quantitative information and associations of physical activity, kidney function, diet, and inflammation are dearth in high-risk diabetes. Yet could delay type-2 diabetes, late-stage chronic kidney disease (CKD) and could be useful in designing effective interventions. The study aims to quantify the associations of physical activity, kidney function, diet and inflammation in adults with high-risk type-2 diabetes (and early CKD) recruited to a lifestyle education programme.METHODS Baseline, 12-month dietary, accelerometery, and circulating inflammatory markers, Interleukin-6 (IL-6) and C-reactive protein (CRP) data were assessed from 159 (104 male) high-risk diabetes with stage 2 CKD (mean (SD) estimated glomerular filteration rate (eGFR); 77.5(7.6) ml/min/1.73m2, age; 66(6) years, BMI; 31.8(4.2) kg/m2) who were recruited to a lifestyle education programme. Linear regression examined the effects and associations of the outcome measures.RESULTS eGFR decreased by -2.0 (1.7) ml/min/1.73 m2 (P = 0.04) after 12-months, but mean daily steps, moderate to vigorous physical activity (MVPA) levels, intakes of fibre, total and unsaturated fat, and circulating IL-6 and CRP did not change. However, inter-individual responses were highly variable. eGFR correlated positively with baseline IL-6 (r = 0.17, P = 0.02). Unadjusted, there were no associations between change in eGFR (12_0) and change in any of the activity, inflammatory or dietary outcomes. However, the regression models of these outcomes for change in eGFR (12_0) became significant with multiple covariates.CONCLUSION A combination of healthy lifestyle behaviours should be encouraged for a positive effect on future kidney function.

Perceived diabetes risk and actual risk level in relatives of individuals with type 2 diabetes: Its relationship with promotive and protective health behaviors

It is a known fact that diabetes can mostly be prevented or delayed with health-promoting and protective lifestyle changes in people at high risk of diabetes. In addition, awareness of the risk of diabetes in the relatives of individuals with diabetes may also contribute to the prevention of the disease. This study was carried out to determine the relationship between perceived and actual diabetes risk level with promotive and protective health behaviors in relatives of individuals with type 2 diabetes. This cross-sectional study included 596 individuals. Of the participants, 62.7% stated that they perceive their risk of developing diabetes at a high-very high level in the next 10 years. The participants had promotive and protective health behaviors at a moderate level. No significant difference was found between the perceived diabetes risk level and promotive and protective health behaviors. Health professionals should take more responsibility for risk identification and risk management.

Nonlinear association between changes in fasting plasma glucose and the incidence of diabetes in a nondiabetic Chinese cohort

BackgroundLimited data show that changes in fasting plasma glucose (FPG changes) are related to the incidence of type 2 diabetes (T2D). We aimed to correlate FPG changes with incident diabetes and evaluate FPG changes as a marker to screen participants at high risk of T2D in China.MethodsA total of 116,816 individuals were followed during a median follow-up of 3.10 years by secondary analysis in a nondiabetic Chinese cohort. The turning points were derived from a receiver operating characteristic curve. Hazard ratios (HRs) were evaluated by Cox proportional hazards models.ResultsA total of 2669 cases of T2D were identified (788 women and 1881 men). The age-standardized incidence of diabetes was 12.87 per 1000 person-years (women: 11.04; men: 14.69). A nonlinear relationship between FPG changes and incident diabetes is shown by the fitting curves. The curves were categorized into three stages by two turning points (-0.04 and 1.25 mmol/L) and conformed to the hook-like pattern: an initial decrease (stage-1), then a transient sharp elevation (stage-2), followed by a slow increase (stage-3). HRs per SD of FPG changes on incident diabetes varied with stage: stage-1: 0.16 (0.12, 0.23), stage-2: 0.20 (0.15, 0.28) and stage-3: 0.22 (0.16, 0.31). Compared with stage-1, the HR in stage-3 was significantly higher at 28.05 (23.99, 32.79), while the increase in stage-2 was slight at 2.16 (1.79, 2.61), and the HR in stage-3 rose to 30.09 (25.02, 36.19).ConclusionsFPG changes had a strong correlation with the incidence of T2D and was a steady indicator that was used to distinguish the participants at high risk of diabetes.

Impacts of Triglyceride Glucose-Waist to Height Ratio on Diabetes Incidence: A Secondary Analysis of A Population-Based Longitudinal Data.

BackgroundThe anthropometric indices (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WHtR]), triglyceride-glucose (TyG) index and TyG-related indicators (TyG-WHtR, TyG-BMI, TyG-WC) have been well documented to be highly correlated with insulin resistance (IR) and type 2 diabetes mellitus (T2DM). However, it was not immediately obvious which indicator would be optimal for screening people at risk of T2DM. Hence, this study intended to compare the predictive effects of the aforementioned markers on T2DM and to investigate the relation between baseline TyG-WHtR and incident T2DM.MethodsThis longitudinal study included 15464 study population who were involved in the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study from 2004 to 2015. The TyG index was defined as ln [FPG (mg/dL) ×fasting TG (mg/dL)/2]. And the TyG-WHtR was calculated as TyG index ×WHtR. We divided the participants into four groups according to the TyG-WHtR quartiles. The primary endpoint was the incidence of diabetes.ResultsAfter a median follow-up of 5.4 years, 2.4% (373/15464) participants developed diabetes. The incidence of diabetes increased with ascending TyG-WHtR quartiles (P for trend<0.001). Multivariable Cox proportional hazard analysis showed that a one-unit increase in TyG-WHtR was independently correlated with a 2.714-fold higher risk of diabetes [hazard ratio (HR) 2.714, 95% confidence interval (CI) 1.942-3.793; P<0.001). Stratification analysis revealed that increased TyG-WHtR (per 1-unit) was consistently correlated with diabetes incidence in different subgroups. Moreover, TyG-WHtR outperformed the other parameters by presenting the biggest area under the ROC curve (AUC) in men (AUC 0.746, 95% CI 0.716-0.776, P<0.001). However, all pairwise comparisons of AUC between TyG-WHtR and other indicators were not statistically different except TyG-WHtR vs. WHtR in women.ConclusionsA high TyG-WHtR is an important predictor of the increased cumulative risk of diabetes development. TyG-WHtR outperforms TyG, WHtR, TyG-WC and TyG-BMI in screening individuals who are susceptible to T2DM, especially in men.