History Of Impaired Glucose Tolerance Research Articles

Pathogenic variants of Alport syndrome and monogenic diabetes identified by exome sequencing in a family

We present a family of two female Alport syndrome patients with a family history of impaired glucose tolerance. Whole exome sequencing identified a novel heterozygous variant of COL4A5 NM_033380.3: c.2636 C > A (p.S879*) and a rare variant of GCK NM_001354800.1: c.1135 G > A (p.A379T) as the causes of Alport syndrome and monogenic diabetes, respectively. Two independent pathogenic variants affected the clinical phenotypes. Clinical next-generation sequencing is helpful for identifying the causes of patients’ manifestations.

Role of Blood Stasis Syndrome of Kampo Medicine in the Early Pathogenic Stage of Atherosclerosis: A Retrospective Cross-Sectional Study.

In Kampo medicine, blood stasis (BS) syndrome is strongly associated with microangiopathy and can lead to atherosclerosis. Vascular endothelial dysfunction (VED), evaluated through flow-mediated dilation (FMD), plays an important role in the early stages of atherosclerosis. However, the association of BS syndrome with VED, as determined using FMD, has not been reported. This study investigated the association between BS syndrome and VED using FMD. Forty-one patients with normal glucose tolerance or impaired glucose tolerance (IGT) and without macrovascular complications were evaluated using FMD from May 2017 to August 2017. Based on the BS score, the patients were divided into the non-BS (n = 19) and BS syndrome (n = 22) groups. Physical and background characteristics, physiological function test results, and laboratory data were compared. Univariate analysis revealed that FMD and a history of dyslipidemia/IGT were significantly different between the two groups (p < 0.05). Multiple logistic regression analysis showed that BS syndrome was significantly associated with FMD (odds ratio: 6.26; p=0.03) after adjusting for the history of dyslipidemia/IGT. The receiver operating characteristic curve showed that the area under the curve for BS syndrome (0.74; p < 0.001) and history of IGT (p < 0.007) provided good diagnostic accuracy for FMD. The area under the curve for “BS syndrome + IGT” showed very good accuracy (0.80; p < 0.0001) and was higher than that for BS syndrome or IGT alone. In conclusion, the results of this study suggest that the BS score in Kampo medicine could be a useful tool for detecting the early pathogenic stages of atherosclerosis.

Outcomes for Patients with Pre-Existing Diabetes or Hypertension Treated with Copanlisib from the CHRONOS-1 Study in Patients with Relapsed or Refractory Indolent B-Cell Lymphoma

Outcomes for Patients with Pre-Existing Diabetes or Hypertension Treated with Copanlisib from the CHRONOS-1 Study in Patients with Relapsed or Refractory Indolent B-Cell Lymphoma

Are gestational and type II diabetes mellitus associated with the Apgar scores of full-term neonates?

ObjectiveTo compare Apgar scores of full-term newborns of mothers with gestational (GDM) or type II diabetes mellitus (T2DM) with scores of newborns of mothers without impaired glucose tolerance.Study designThis was a retrospective data collection study (n=297). We reviewed 1-minute and 5-minute neonatal Apgar scores of newborns of mothers with GDM (n=100) or T2DM (n=97). Our control group consisted of newborns of mothers without a prior history of impaired glucose tolerance (n=100). ANOVA and linear model with corrected errors were used and adjusted for newborn sex and weight, and maternal age. Chi-squared analysis was performed for newborn sex.ResultsThe mean 1-minute and 5-minute Apgar scores were 7.8 and 8.9 for the GDM group and 7.7 and 8.9 for the T2DM group, respectively. There was no statistical difference in the 1-minute and 5-minute Apgar scores between the GDM group and controls (P=0.89 and P=0.13, respectively) nor in the scores between the T2DM group and controls (P=0.67 and P=0.40, respectively).ConclusionMaternal history of GDM and T2DM does not appear to be associated with the 1-minute and 5-minute Apgar scores of full-term newborns of mothers with GDM and T2DM as compared to newborns of mothers without a history of impaired glucose tolerance.

Trajectories of changes in glucose tolerance in a multiethnic cohort of obese youths: an observational prospective analysis

Type 2 diabetes is preceded by a prediabetic stage of impaired glucose tolerance that affects 10-23% of youth and is expected to double over the next decade. The natural history of impaired glucose tolerance and the determinants of β-cell dynamic response have never been investigated longitudinally in young people. We aimed to investigate the clinical and metabolic determinants of longitudinal glucose tolerance changes and β-cell function in a multiethnic cohort of obese youth. We followed up prospectively a multiethnic cohort of overweight and obese (body-mass index >85th percentile) adolescents with baseline normal glucose tolerance (plasma glucose <140 mg/dL) or impaired glucose tolerance (plasma glucose 140-199 mg/dL) at the Yale Pediatric Obesity Clinic (CT, USA). All participants underwent a 3-h oral glucose tolerance test at baseline and after 2 years to estimate insulin secretion (oral disposition index) in the context of body insulin sensitivity. As part of standard care at the clinic, all participants received dietary advice and underwent dietary assessment every 5-6 months. No structured lifestyle or pharmacological intervention was administered. Between January, 2010, and December, 2016, 526 adolescents (mean age 12·7 years, range 10·6-14·2) were enrolled to our study. At baseline, 364 had normal and 162 had impaired glucose tolerance. Median follow-up was 2·9 years (IQR 2·7-3·1). 105 (65%) of 162 with impaired glucose tolerance at baseline reverted to normal glucose tolerance at follow-up, 44 (27%) had persistent impaired glucose tolerance, and 13 (8%) progressed to type 2 diabetes. A feature of reversion to normal glucose tolerance was a roughly four-fold increase in the oral disposition index (from median 0·94 [IQR 0·68-1·35] at baseline to 3·90 [2·58-6·08] at follow-up; p<0·0001) and a significantly higher oral disposition index at follow-up compared with participants who maintained normal glucose tolerance across the study period (median 3·90 [IQR 2·58-6·08] vs 1·59 [1·12-2·23]; p<0·0001). By contrast, a decrease in insulin secretion was seen in participants who had persistent impaired glucose tolerance (median 1·31 [IQR 1·01-1·85]; p<0·0001) or who progressed to type 2 diabetes (0·20 [0·12-0·58]; p<0·0001), compared with participants who maintained normal glucose tolerance across the study period. Non-Hispanic white ethnic origin conferred five times the odds of reversion to normal glucose tolerance compared with non-Hispanic black ethnic origin (OR 5·06, 95% CI 1·86-13·76; p=0·001), with a two times greater annual increase in the oral disposition index (β 2·32, 95% CI 0·05-4·60; p=0·045). Impaired glucose tolerance is highly reversible in obese adolescents. Ethnic origin is the main clinical modifier of the dynamic β-cell response to prediabetic hyperglycaemia and, thus, determines the reversibility of impaired glucose tolerance, or its persistence. Therapeutic interventions for impaired glucose tolerance should target the specific mechanisms underpinning glucose tolerance changes in high-risk ethnic groups. National Institutes of Health (National Institute of Child Health and Human Development, National Center for Research Resources, and National Institute of Diabetes and Digestive and Kidney Diseases), American Diabetes Association, International Society for Pediatric and Adolescent Diabetes, Robert Leet Patterson and Clara Guthrie Patterson Trust, European Society for Pediatric Endocrinology, American Heart Association, and the Allen Foundation.

Natural history of impaired glucose tolerance in Japanese Americans: Change in visceral adiposity is associated with remission from impaired glucose tolerance to normal glucose tolerance

AimsTo describe the roles of intra-abdominal fat and its change in the remission of impaired glucose tolerance (IGT) to normal glucose tolerance (NGT). MethodsWe followed 157 Japanese Americans with IGT at baseline for 10–11 years without external intervention. We measured intra-abdominal and abdominal subcutaneous fat area (IAFA and ASFA) by computed tomography at baseline and at 5–6 years of follow-up. Change in IAFA and ASFA (ΔIAFA and ΔASFA) were calculated by subtracting baseline fat area from 5–6 year follow-up fat area. Glucose and insulin at fasting and during a 75-g oral glucose tolerance test, insulinogenic index (IGI [Δinsulin/Δglucose (30–0 min)]) and homeostasis model assessment for insulin resistance (HOMA-IR) were measured at baseline. ResultsFourty-four subjects remitted to NGT. Among those with lower IAFA (≤median 91.31 cm2) and the lowest tertile of ΔIAFA, 45% remitted, while with higher IAFA (>91.31 cm2) and the highest tertile of ΔIAFA, only 12.5% remitted. ΔIAFA was significantly associated with remission to NGT (multiple-adjusted odd ratio [1-SD decrease] 1.93, 95% CI 1.10–3.36) independent of IAFA, ASFA, ΔASFA, IGI, HOMA-IR, age, sex, and family history of diabetes. ConclusionsIn the natural history of IGT, change in intra-abdominal fat was associated with remission to NGT.

Mody in pregnancy – a case report and literature review

Case ReportA 26 year old primigravida, was diagnosed with Maturity Onset Diabetes of the Young (MODY) type 2 at the age of 15 after having previous history of impaired glucose...

Insulinresistenz: Bedeutung in Anästhesie und Intensivmedizin - Insulinresistenz und Proteinkatabolie bei kritisch Kranken

Hyperglycemia is a frequently observed phenomenon in critically ill patients, affecting numerous patients without a history of impaired glucose tolerance or diabetes. During critical illness, hyperglycemia may result from decreased peripheral glucose uptake and/or utilisation in presence of normal or elevated plasma insulin levels (peripheral insulin resistance) as well as an increase in hepatic glucose production due to augmented glycogenolysis and gluconeogenesis resulting from stress and/or central (hepatic) insulin resistance. As there are a number of factors that cause or aggravate hyperglycemia / insulin resistance during the intensive care unit (ICU) stay, a multifactorial etiology is likely. Furthermore, animal models of sepsis suggest a decrease in anabolic insulin signalling within skeletal muscle.

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.

Brachial artery pulse pressure and common carotid artery diameter: mutually independent associations with mortality in subjects with a recent history of impaired glucose tolerance.

Decreased large artery function, as reflected by increased brachial artery pulse pressure and increased carotid artery diameter and stiffness, may contribute to the increased mortality risk that is observed in subjects with impaired glucose tolerance. We therefore investigated the association between brachial artery pulse pressure and carotid artery diameter and stiffness, which are estimates of central artery stiffness and arterial remodelling, respectively, and mortality in subjects with a recent history of impaired glucose tolerance. A prospective, population-based cohort study. We measured brachial artery pulse pressure by oscillometric blood pressure measurements, and common carotid artery diameter and distensibility and compliance coefficients by ultrasound in 140 subjects with a recent history of impaired glucose tolerance. During a median 6.6-year follow-up, 16 subjects died. Brachial artery pulse pressure and common carotid artery diameter were positively related to all-cause mortality [hazard ratios per standard deviation, 1.7 (1.2-2.5) and 2.1 (1.3-3.3), respectively]. Results were similar after adjustment for gender, age, waist-to-hip ratio, body mass index, total cholesterol concentration, pre-existent cardiovascular disease, and hypertension, and after additional mutual adjustment. Common carotid artery distensibility and compliance coefficients were not statistically significantly associated with mortality. Among subjects with a recent history of impaired glucose tolerance, brachial artery pulse pressure and common carotid artery diameter are independently associated with mortality risk. Stiffness of the central arteries may explain the association between pulse pressure and mortality risk. The association between carotid diameter and mortality risk is more likely to reflect arterial remodelling in response to atherosclerosis than that in response to increased local stiffness.

Case Study: A 68-Year-Old Man With Diabetes and Peripheral Neuropathy

C.T. is a 68-year-old man with a 3-year history of impaired glucose tolerance. His only other medical problem is hypertension treated with a small dose of an angiotensin-converting enzyme (ACE) inhibitor. He quit smoking 20 years ago. He has no dyslipidemia and has had stress electrocardiograms every 2 years with normal results. He uses no alcohol. He is retired from an office job with the government and presently teaches part-time at a local college. His glucose intolerance was discovered on routine laboratory testing. He was sent for diabetes education, learned home glucose monitoring, and followed a diet and exercise program suggested by our diabetes educator. He was not obese and led a physically active life, playing golf frequently and taking vigorous walks almost daily. He lost 10 lb and was able to normalize his blood glucose levels with this regimen. Approximately 3 months ago, he noticed some burning and tingling in his feet. He admitted that he had not felt as well as usual and that his walking was becoming more of a chore. He denied chest pain or shortness of breath. He denied any other symptoms and had no fever or chills, cough, bloody stools, or hematuria. When seen in the office, he had gained 5 lb. His physical examination was normal except for some hyperesthesia of both feet as well as decreased vibratory sensation. His thyroid, reflexes, and pulses …

Change in common carotid artery diameter, distensibility and compliance in subjects with a recent history of impaired glucose tolerance: a 3-year follow-up study.

To assess the development of common carotid artery properties (diameter, distensibility and compliance) in a cohort of 140 subjects (mean age 65.8 years, SD 7.5 years) originally diagnosed as impaired glucose tolerant in a population-based study, and to explore determinants of changes observed. An observational, longitudinal study over a 3-year-period. Vessel wall movement detector system based on ultrasonography, linear generalized estimating equations. Carotid artery diameter rose from 6.87-7.02 mm (+ 2.2%, P<0.001). Distensibility decreased from 11.8 to 10.9 x 10-3 kPa-1 (-8.3%, P=0.009). Compliance decreased from 0.44-043 mm2 kPa-1 (P=0.17). Changes in blood pressure level were negatively associated with changes in distensibility and compliance. Baseline fasting glucose levels were positively associated with changes in diameter, while fasting insulin levels were negatively associated with changes in distensibility and compliance in men, but not in women. In subjects with a recent history of impaired glucose tolerance, we observed an increase in carotid artery diameter and a decrease in distensibility. Change in blood pressure level and baseline fasting glucose and HbA1c levels were positively related to the increase in diameter. In men, but not in women, baseline fasting insulin levels were associated with an acceleration of these changes.

A natural history of impaired glucose tolerance in North Jordan

AbstractThe objective of the study was to determine the conversion rate of subjects with impaired glucose tolerance (IGT) to Type 2 diabetes mellitus (NIDDM) and to identify factors which predict such conversion.Sixty eight subjects previously diagnosed with IGT in a survey conducted in 1995 in Sikhra, a Jordanian town of 10,000 people located in North Jordan, were reassessed for conversion to Type 2 diabetes two years later. A control group of 144 participants in the 1995 survey with normal glucose tolerance was also similarly reassessed for conversion to Type 2 diabetes. Diagnosis of IGT and NIDDM was based on WHO criteria1.Of the 68 IGT cases, 10 (14.7%) progressed to Type 2 diabetes, 27 (29.7%) reverted to normal, and the remainder persisted with IGT. A positive family history was a significant predictor of progression to diabetes irrespective of the IGT status. During the two year follow‐up period a significantly larger increase in systolic blood pressure (SBP) was observed among those who progressed to Type 2 diabetes compared with those who did not. Age ±40 and hypertension were consistent with a higher rate of progression to Type 2 diabetes but the association failed to attain statistical significance at the 0.05 level (p = 0.055 and 0.07 respectively).

Hypertension, hyperinsulinaemia and obesity in middle-aged Finns with impaired glucose tolerance.

The aim of the study was to analyse the data obtained from a 2-year follow-up study of middle-aged Finnish subjects (n = 183) with a previous history of impaired glucose tolerance (IGT) in order to elucidate the longitudinal relationships between hypertension, fasting hyperinsulinaemia and obesity. Hypertension was defined as either a systolic blood pressure (BP) of > or =160 mm Hg or a diastolic BP of > or =95 mm Hg or being on anti-hypertensive medication regardless of the BP value. Multiple logistic regression analysis adjusted for glucose tolerance status, serum lipids, exercise behaviour and alcohol consumption shows that the odds ratios of one unit (mU/l) increase in the baseline fasting insulin concentration were 1.13 (95% confidence interval 1.00-1.28) for the 2-year incidence of hypertension in subjects with IGT at baseline. Baseline body mass index (BMI) also predicted the 2-year incidence of hypertension, with an odds ratio of 1.20 (95% CI 1.02-1.42). BMI correlated positively with fasting insulin level (r = 0.54, P < 0.001). It is concluded that an elevated fasting insulin concentration as well as an increased BMI preceded the onset of hypertension in subjects with IGT. It may suggest a causal relationship between hypertension and hyperinsulinaemia.

Natural History of Impaired Glucose Tolerance: Follow‐up at Joslin Clinic

The goal of this study was to examine follow-up data on the offspring of two parents with NIDDM who have IGT to identify predictors of progression to NIDDM. The study group consisted of 80 individuals with IGT (WHO criteria), 28 of whom had IGT at baseline, and 52 who developed it during follow-up. Both an oral glucose tolerance test (OGTT) and an intravenous glucose tolerance test (IVGTT) were performed at baseline. After a median follow-up interval of 8 years, 35% had progressed to NIDDM, 37% had reverted to normal glucose tolerance, and 29% still had IGT. Those who progressed were younger and more obese than non-progressors. Glucose and insulin values from the OGTT that established the diagnosis of IGT were analysed by multiple logistic regression to determine which time points best discriminated between progressors and non-progressors. High insulin, but not glucose, values at 0 and 120 min distinguished progressors from non-progressors. Values at other sample times that were significantly different (p < 0.05) in progressors were: higher glucose values at 30, 45, and 60 min and higher insulin values at 90 and 180 min. Multiple logistic regression analysis of Bergman's minimal model parameters obtained from the IVGTTs performed at baseline demonstrated that, once IGT is established, low acute phase insulin secretion as well as low insulin sensitivity are significant predictors of progression to NIDDM.

Haemoglobin A 1c measurement for diabetes among subjects with a previous history of impaired glucose tolerance

Haemoglobin A 1c (HbA 1c) measurement for diagnosis of diabetes and impaired glucose tolerance (IGT) was assessed during a prospective study of subjects with IGT; 183 of the 207 IGT persons underwent the second oral glucose tolerance tests (OGTT) 2.1 years, on the average, after the first tests. HbA 1c was administered to every participant before the second OGTTs. The results of HbA 1c were compared with those of the second OGTTs. The sensitivity of HbA 1c test was 71% for diabetes and 41% for IGT, when the specificity was 93% at a cutoff point of 4.81%. The conclusion is that the HbA 1c test is moderately sensitive for diabetes but insensitive for IGT, when it is specific. However, it may be useful for selecting and reducing the total number of subjects referred to 2-h OGTTs in a follow-up study of subjects with IGT, if the rate of progression to diabetes is not high.