IGT Group Research Articles

Relationship between pancreatic resection volume and post-operative glucose intolerance in distal pancreatectomy: A retrospective study.

Some researchers are concerned that the performance of pancreatic resection in cases of low malignancy with distal localization will increase, resulting in the occurrence or worsening of post-operative glucose intolerance. Herein, we retrospectively investigated the relationship between the pancreatic resection ratio and post-operative glucose intolerance in distal pancreatectomy (DP). Total 135 patients who underwent DP at our hospital and were followed up for > 12months between January 2013 and December 2022 were included. Of these, 52 patients were included, excluding those with pre-operative diabetes and those who underwent pancreatectomy using other than a stapling device. The pancreatic resection ratio (%) was measured using pancreatic volumetry by manually tracing the pancreatic area on computed tomography images obtained before and after surgery and the relationship with post-operative glucose intolerance was investigated. Among the 52 patients, 13 (25.0%) showed post-operative worsening of glucose tolerance (impaired glucose tolerance [IGT] group). The pancreatic resection ratios were 51.1% and 34.8% in the IGT (13 patients) and non-IGT groups (39 patients), respectively (p = 0.0027). The cut-off value for the IGT group was 46.5%. The resection site was divided into two groups as follows. One group was resected near the portal vein (portal group) and the other group was resected more caudally (caudal group). Mean pancreatic resection ratios were 46.5% and 28.5% in cases of resection of the portal group (30 patients) and caudal group (22 patients), respectively (p < 0.0001). The thickness of the pancreas at the resection site was 13.1mm in the portal group and 17.7mm in the caudal group (p < 0.0001) and the incidence of pancreatic fistula was 6.7% and 9.1%, respectively (p = 0.7472). The incidence of post-operative glucose intolerance was 40.0% (12/30) in the portal group and 4.5% (1/22) in the caudal group (p = 0.0016). In cases of low-grade tumors and benign disease, pancreatic resection with preservation of the remaining pancreatic volume should be considered whenever possible.

Factors Influencing Glucose Response to Exercise Following Oral Glucose Load

PURPOSE: Exercise can reduce postprandial hyperglycemia by increasing contraction-mediated glucose uptake in skeletal muscles. However, postprandial exercise does not always have similar effects in all patients. This study aimed to analyze the factors influencing glucose response to exercise following oral glucose load.METHODS: We enrolled 169 adults with impaired glucose tolerance (IGT, n = 64) and type 2 diabetes (T2D, n = 105). We measured fingertip capillary blood glucose level at 30-minute intervals over 2-hour after the 75-g oral glucose ingestion. In addition, a single bout of moderate-intensity aerobic exercise was conducted at 30 minutes after 75-g oral glucose ingestion. We also measured glycated hemoglobin (HbA1c), insulin, insulin resistance (HOMA-IR), β-cell function (HOMA-β), physical activity level questionnaire and anthropometrics.RESULTS: There was a significant difference in glucose concentration between the IGT and T2D groups (&lt;i&gt;p&lt;/i&gt; &lt;.001). Additionally, we found that patients with short diabetes duration (≤1 year) had significantly more decrease in glucose concentration than long diabetes duration (≥10 years) (&lt;i&gt;p&lt;/i&gt; &lt;.001). A regression analysis showed that waist circumference, visceral fat area, fasting glucose, HbA1c, and HOMA-IR affected glucose response to exercise following oral glucose load in patients with T2D.CONCLUSIONS: Higher volumes of exercise following an oral glucose load may be necessary for individuals with Type 2 Diabetes (T2D) who have a longer disease duration, larger waist circumference, increased visceral fat area, higher HbA1c levels, and elevated HOMA-IR values in order to prevent hyperglycemia.

Elevated triglyceride-glucose (TyG) indexpredicts impaired islet β-cell function: A hospital-based cross-sectional study.

ObjectiveTo explore the relationship between the TyG index and the insulin secretion function of pancreatic β-cells, and to determine the possibility of the TyG index in predicting β-cell dysfunction and the development of diabetes.MethodsA cross-sectional study was performed among 914 participants who took their annual health checkups at the Third Xiangya Hospital. The early- and late-phase pancreatic β-cell secretion was assessed based on the results of the oral glucose tolerance test (OGTT). In addition to anthropometric parameters and laboratory parameters, information about health-related habits and disease histories was obtained from the National Physical Examination Questionnaire. Partial correlation analysis was used to study the relationship between the TyG index and pancreatic β-cell function. The receiver operating characteristic (ROC) curve was used to calculate the cut-off points of the TyG index in predicting β-cell dysfunction. According to the OGTT results and medical history, the participants were categorized into three groups: the normal glucose tolerance group (NGT, n=276), the impaired glucose regulation group (IGT, n=323), and the diabetes group (DM, n=315). The correlation between the TyG index and β-cell function among the three groups and the association between the TyG index and glucose metabolic conditions were further explored.ResultsThe TyG index was negatively correlated with the indexes that reflect the early and late secretory function of β-cells, not only in the NGT group but also in the IGT and DM group. The minimum cut-off values for the TyG index to identify the risk of early- and late-phase β-cell dysfunction are 9.08 and 9.2 respectively. The TyG indexes of the IGT and DM group were higher than that of the NGT group, and with the growth of the TyG index, the risk of prediabetes and diabetes increased significantly.ConclusionIncreased TyG index is associated with impaired β-cell function regardless of the glucose metabolic conditions. The TyG index is an alternative indicator for predicting β-cell dysfunction.

To Evaluate the Association of Serum Adiponectin with Fasting and Postprandial Plasma Glucose and Fasting Lipids in Control, IGT and T2DM Subjects

Background: Association of adiponectin with insulin resistance occurs early in obesity development; however it remains unclear if this association is of further importance in prediabetes and early stages of type 2 diabetes and remains the same through all glucose intolerance development stages. The present study was undertaken to evaluate the association of dysglycemia and dyslipidemia with adiponectin in prediabetic subjects as well as in T2DM subjects. Objective: The objective of our study was to evaluate adiponectin level in subjects with pre-diabetes and to compare it with the levels in newly diagnosed type 2 diabetes and healthy (normal glucose tolerance) subjects. Method: It was an observational analytic study with a group compare design. The study was conducted in the Biomedical Research Group and Department of Biochemistry &amp; Cell Biology of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. This study was done during the period of July 2012 to June 2013. Results: Bivariate Spearman’s correlation analyses were performed for adiponectin with clinical, anthropometrical and other biochemical variables in the Control, IGT and T2DM groups. Postprandial glucose (p=0.023) and age (p=0.011) had a positive correlation with adiponectin in control subjects. A negative correlation was observed between adiponectin and BMI in IGT subjects (p=0.004). A positive correlation with adiponectin and serum HDL (p=0.03) and a negative correlation with serum LDL (p=0.03) were found in T2DM subjects. Conclusion: From our study we can conclude that, BMI has a negative association with adiponectin in IGT subjects. Serum LDL has a negative association and HDL has a positive association with adiponectin in IGT and T2DM subjects.

DIFFERENCE IN THE EFFECT OF RENAL DENERVATION ON HEART RATE VARIABILITY IN RESISTANT HYPERTENSION WITH AND WITHOUT DISTURBANCE OF GLUCOSE METABOLISM AFTER 12 MONTH FOLLOW-UP

Objective: To investigate the effects of renal denervation (RDN) on heart rate variability (HRV) in resistant hypertension (RHTN) with and without disturbance of glucose metabolism. Design and method: In a single-arm prospective interventional study with renal denervation (NCT02667912 and NCT01499810 on ClinicalTrial.gov) were included 87 patients with RHTN: 39 patients without disturbance of glucose metabolism (RHTN group) (mean age 51.2 ± 8.5years, 20 (51%) men, 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 162.3 ± 19.4/99.6 ± 13.5 mmHg); 34 patients with type 2 diabetes mellitus (RHTN + DM group) (mean age 59.2 ± 7.8 years, 11 (32%) men, 24 h BP 157.8 ± 17.4/80.1 ± 12.4 mmHg, mean HbA1c 6.9 ± 1.4%) and 14 patients with impaired glucose tolerance (RHTN + IGT group) (mean age 54.0 ± 10.0 years, 3 (27%) men, 24 h BP 156.6 ± 14.3/89.5 ± 15.6 mmHg). All patients were underwent ABPM and 24-h Holter monitoring with analysis of time and frequency domain-based HRV. Follow-up after 12 months was completed by 38 patients of RHTN group, 22 patients of RHTN + DM group and 9 patients of RHTN + IGT group. Results: There was a significant decrease in 24 h BP in all groups at 12 months after RDN (p &lt; 0,001). In the RHTN group, there were no significant changes in both high frequency (HF) and low frequency (LF) (for HF from 14.8 (8.6; 24) to 29.5 (19.0; 40), p &gt; 0.05, and for LF (from 23.1 (15, 0; 61) to 61.0 (40.5; 70), p &gt; 0.05). There were also no significant changes in both LF and HF in the RHTN + IGT group (for LF from 52 (38; 61) to 50 (42; 61), p &gt; 0.05, for HF from 37 (30; 50) to 44 (29; 47), p &gt; 0.05). On the contrary, in the RHTN + DM group, there was a significant decrease in LF (from 55 (39; 63) to 50 (42; 61), p = 0.004), which occurred independently from BP effects, and a non-significant increase in HF. Other measured HRV parameters (mean NN, SDNN, SDNN-I, SDANN-I, r-MSSD, pNN50) were unchanged in all groups (p &gt; 0.05). Conclusions: RDN was associated with a reduction of LF, HRV parameters that mainly reflect sympathetic overactivity, only in patients with resistant hypertension and diabetes mellitus.

HEART RATE VARIABILITY IN RESISTANT HYPERTENSION WITH AND WITHOUT DISTURBANCE OF GLUCOSE METABOLISM

Objective: To evaluate the differences in heart rate variability (HRV) among patients with resistant hypertension (RHTH) with and without disturbance of glucose metabolism. Design and method: A total of 87 patients with RHTN were included in the study: 39 patients without disturbance of glucose metabolism (RHTN group) (mean age 51.2 ± 8.5years, 20 (51%) men, 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 162.3 ± 19.4/99.6 ± 13.5 mmHg); 34 patients with type 2 diabetes mellitus (RHTN + DM group) (mean age 59.2 ± 7.8 years, 11 (32%) men, 24 h BP 157.8 ± 17.4/80.1 ± 12.4 mmHg, mean HbA1c 6.9 ± 1.4%) and 14 patients with impaired glucose tolerance (RHTN + IGT group) (mean age 54.0 ± 10.0 years, 3 (27%) men, 24 h BP 156.6 ± 14.3/89.5 ± 15.6 mmHg). ABPM and 24-h Holter monitoring with analysis of time and frequency domain-based HRV were performed in all patients. Results: Patients of three groups had a comparable systolic BP level and number of antihypertensive drugs. At the same time, patients of the RHTN + DM group was older and had significantly higher level of 24h- diastolic BP (DBP) than patients without disturbance of glucose metabolism (p = 0.001 for age, and p = 0.001 for DBP). Low frequency (LF), HRV parameters that mainly reflect sympathetic overactivity, was significantly higher in patient of the RHTN + DM group compared with the RHTN group (52 (38;61) vs 23.1 (15.0;61) respectively, p = 0.03). High frequency (HF), HRV parameters that mainly reflect parasympathetic overactivity, was significantly higher in patients with disturbance of glucose metabolism compared with patient without it (37 (30;50) for the RHTN + DM group and 31 (24;42) for the RHTN + IGT group vs 14,8 (8,6;24) for the RHTN group, p = 0,00/0,01, respectively). Other measured HRV parameters (mean NN, SDNN, SDNN-I, SDANN-I, r-MSSD, pNN50) were comparable in all groups (p &gt; 0,05). Conclusions: The presence of diabetes mellitus in patients with RHTN is associated with greater autonomic imbalance in the form of an increase in both the sympathetic and parasympathetic tone of the autonomic nervous system, while IGT is characterized by a significant increase in the parasympathetic tonus only to the same extent as in diabetes mellitus.

The relationship between coronary artery severity and insulin resistance in patients with impaired glucose tolerance and metabolic syndrome

BackgroundThe relation between metabolic syndrome (MS) and coronary artery disease (CAD) is multifactorial, and the well-known risk factors can explain only about 25% of the disease as the relation between insulin resistance (IR) on top of MS and severity of CAD still a subject of debate with conflicting data. Also, IR and glucose intolerance are included in the definition of metabolic syndrome only by some associations. So, the aim of this research was to analyze the the relation between CAD severity (measured by the modified Gensini score) and the different components of the metabolic syndrome including insulin resistance and glucose intolerance.ResultsOut of 70 patients enrolled, 71.4% represented impaired glucose tolerance group (IGT group; n = 50) and 28.6% represented normal glucose tolerance group (NGT group; n = 20). The following variables were significantly greater among the IGT group including BMI (30.19 ± 2.27 vs 23.62 ± 2.92; P < 0.001), waist circumference (105.09 ± 8.02 vs 92.89 ± 19.92; P < 0.001), frequency of hypertension (80% vs 50%; P = 0.012), 2 h post prandial glucose (164 ± 30 vs 110 ± 20; P < 0. 04), fasting insulin (9.2 ± 1.2 vs 5.1 ± 4.3; P = 0.003), HOMA-IR (3.03 ± 0.12% vs 1.9 ± 0.12, P < 0.001), serum uric acid (4.8 ± 1.3 vs 5.8 ± 2.6; P = 0.03), mean modified Gensini score (22.3 ± 9.2 vs 15.4 ± 6.8; P < 0.001), while the mean serum HDL was significantly higher among the NGT group (40.8 ± 10.1 vs 50.6 ± 10.2; P < 0.001). There was a positive correlation between HOMA–IR; hs-CRP; MS-related variables (including waist circumflex; BMI; serum uric acid; HDL; TG);and the modified Gensini score (for HOMA, r = 0.63; P < 0.001). Several predictors for high scores of modified Gensini were noted in multiple regression analysis; however, out of those several predictors, HOMA-IR was the strongest one (OR = 4.0, 95% CI = (2.04-7.08).ConclusionIR is an independent risk factor for CAD severity in patients with IGT and MS. In patients with IR; those with aggressive CAD (or with a positive family history of premature CAD), IGT should be managed aggressively even before any evidence of frank diabetes. IR workup should be recommended among the other standard workup for those patients, if documented, interventions targeted against IR should be considered among the other standard management.

A comparative study between isolated gastrocnemius tightness patients and controls by quantitative Gait analysis and baropodometry

BackgroundIsolated gastrocnemius tightness (IGT) has been suggested as an etiologic factor in mechanical disorders of the foot and ankle without a clear pathophysiological mechanism in the literature. We hypothesized that restricted ankle dorsiflexion inducing increased forefoot pressure in IGT patients could be this pathophysiological mechanism. MethodsCase/control experimental observational investigation. Forty lower limbs in 20 asymptomatic IGT patients were included and compared to controls. Quantitative gait analyses coupled with dynamic baropodometry were used for comparison between groups. The primary outcome was maximum ankle dorsiflexion during stance phase. Secondary outcomes were knee flexion and forefoot pressure. ResultsMaximum ankle dorsiflexion and maximum forefoot pressure were similar between groups. Increased knee flexion was found in the asymptomatic IGT group. ConclusionsIGT induced compensatory knee flexion during stance phase, which probably prevents increased pressure on the forefoot by allowing ankle dorsiflexion. Level of evidenceLevel IV, Case/control experimental observational investigation.

Bone Tissue Composition in Postmenopausal Women Varies With Glycemic Control From Normal Glucose Tolerance to Type 2 Diabetes Mellitus.

The risk of fragility fracture increases for people with type 2 diabetes mellitus (T2DM), even after controlling for bone mineral density, body mass index, visual impairment, and falls. We hypothesize that progressive glycemic derangement alters microscale bone tissue composition. We used Fourier-transform infrared (FTIR) imaging to analyze the composition of iliac crest biopsies from cohorts of postmenopausal women characterized by oral glucose tolerance testing: normal glucose tolerance (NGT; n = 35, age = 65 ± 7 years, HbA1c = 5.8 ± 0.3%), impaired glucose tolerance (IGT; n = 26, age = 64 ± 5 years, HbA1c = 6.0 ± 0.4%), and overt T2DM on insulin (n = 25, age = 64 ± 6 years, HbA1c = 9.13 ± 0.6). The distributions of cortical bone mineral content had greater mean values (+7%) and were narrower (-10%) in T2DM versus NGT groups (p < 0.05). The distributions of acid phosphate, an indicator of new mineral, were narrower in cortical T2DM versus NGT and IGT groups (-14% and -14%, respectively) and in trabecular NGT and IGT versus T2DM groups (-11% and -10%, respectively) (all p < 0.05). The distributions of crystallinity were wider in cortical NGT versus T2DM groups (+16%) and in trabecular NGT versus T2DM groups (+14%) (all p < 0.05). Additionally, bone turnover was lower in T2DM versus NGT groups (P1NP: -25%, CTx: -30%, ucOC: -24%). Serum pentosidine was similar across groups. The FTIR compositional and biochemical marker values of the IGT group typically fell between the NGT and T2DM group values, although the differences were not always statistically significant. In summary, worsening glycemic control was associated with greater mineral content and narrower distributions of acid phosphate, an indicator of new mineral, which together are consistent with observations of lower turnover; however, wider distributions of mineral crystallinity were also observed. A more mineralized, less heterogeneous tissue may affect tissue-level mechanical properties and in turn degrade macroscale skeletal integrity. In conclusion, these data are the first evidence of progressive alteration of bone tissue composition with worsening glycemic control in humans. © 2020 American Society for Bone and Mineral Research (ASBMR).

THE EFFICACY OF GLYCATED ALBUMIN IN DIAGNOSIS OF TYPE 2 DIABETES AMONG INDIAN CHILDREN AND YOUNG ADOLESCENTS.

Objective the main objective of our study to evaluate the diagnostic precision of Glycated Albumin (GA) in better screening of Type 2 Diabetes in children and young adolescents having asymptomatic glycosuria along with Fasting plasma glucose (FPG), 2 hours oral glucose tolerance test (OGTT) and Glycated hemoglobin (HbA1c). Materials & Methods 157 children aged between 9 to 15 years enrolled for this study and all went for 2 hours OGTT to confirm diabetes. Found on OGTT results we have divided all the subjects into three groups, the children and young adolescents having normal glucose tolerance placed in NGT group (n=95), with impaired glucose tolerance placed in IGT group (n=43) and third group DM had confirmed diabetes Mellitus (n=19). Serum samples were collected and analyzed for glucose (Fasting and OGTT) GA and HbA1c with lipid profile. All the three groups, FPG and 2 hrs. OGTT values compared to the GA, side-by-side to HbA1c for accuracy of its diagnostic precision. Results Based on GA values 84 (53.5%) subjects were with normal glucose tolerance, 47 (29.90 %) subjects were with impaired glucose tolerance and 26 (16.56 %) subjects are in Diabetic group. The Mean GA level is 18 % to FPG and 2 hrs. OGTT were 108.2 mg/dl and 175 mg/dl. The values of GA correlated well with 2 hrs. OGTT compared to FPGG values in DM group with confirmed Diabetes. The cut off value of GA in prediction of prediabetes along with HbA1c (6.15%) is 16 4% with sensitivity of 98.70%. Conclusion In the Indian children and young adolescents who are obese or having asymptomatic glycosuria, GA can be a additive with the value of 18 % in better screening of type 2 diabetes along with FPG, OGTT and HbA1c. Our study also proposes GA level of 16.4% as the excellent cut-off point to diagnose pre Diabetes.

151-OR: Radiologic Evidence that Hypothalamic Tissue Is Abnormal in Adults with Obesity and Type 2 Diabetes or Impaired Glucose Homeostasis

Gliosis, a cellular response to injury in neural tissue, is linked to diet-induced obesity in rodent models. Growing evidence also implicates reactive gliosis and inflammation of the mediobasal hypothalamus (MBH) as a potential mechanism connecting obesity to insulin resistance. We tested for radiologic evidence of MBH gliosis in humans in relation to impaired glucose homeostasis and type 2 diabetes (T2D), independent of obesity. Adults with obesity and 1) T2D not on insulin (N=17), 2) impaired glucose tolerance (IGT; N=21), or 3) normal glucose tolerance (NGT; N=29) by OGTT underwent magnetic resonance imaging to measure mean bilateral T2 relaxation time (ms) in the MBH and 3 control regions. Longer T2 relaxation time is a marker of gliosis. Groups were matched for race, sex, BMI and % body fat (P=0.99), but age differed (T2D 54 ± 8 y, IGT 46 ± 11 y, NGT 45 ± 12 y; P=0.02). Group differences in T2 relaxation time varied by brain region (interaction: chi2(6) = 65, P&amp;lt;0.0001, adjusted for sex and age). Bonferroni-corrected post-tests confirmed that MBH, but not control region, T2 relaxation times were longer in T2D (180 ± 26 ms) than IGT (160 ± 26 ms, P&amp;lt;0.0001) or NGT (152 ± 17 ms, P&amp;lt;0.0001) groups. Among all 67 subjects, fasting glucose, 2-hr post-glucose, and hemoglobin A1c values were each positively associated with MBH, but not control region, T2 relaxation times (interactions by region all P&amp;lt; 0.0001, MBH all P&amp;lt; 0.0001, control regions all NS). Among the 50 subjects without T2D, interactions remained significant (all P&amp;lt;0.0001), and greater 2-hr post-glucose and hemoglobin A1c were associated with longer MBH T2 relaxation times (β = 0.22 ms, P&amp;lt;0.0001 and β = 14.8 ms, P=0.002, respectively) whereas a trend was present for fasting glucose concentrations (β = 0.38 ms, P=0.06). These data provide novel evidence that the degree of inflammation and gliosis in glucose-regulating areas of the brain is related to impaired glucose homeostasis and T2D in adults with obesity. Disclosure J.L. Rosenbaum: None. L.E. Sewaybricker: None. S. Chandrasekaran: None. M. De Leon: None. M. Webb: None. S.J. Melhorn: None. E. Schur: None. Funding American Diabetes Association (1-17-ICTS-085 to E.S.)

Characteristics of patients who developed glucose intolerance in the early period after partial pancreatectomy

New-onset diabetes mellitus (DM) often develops after partial pancreatectomy. Little is known regarding how soon patients develop glucose intolerance after partial pancreatectomy. We investigated the incidence of and factors contributing to the development of glucose intolerance during hospitalization after partial pancreatectomy. We retrospectively analyzed the cases of 38 patients with normal glucose tolerance pre-surgery who underwent a partial pancreatectomy (pancreaticoduodenectomy, n = 23; distal pancreatectomy, n = 15). The patients' glucose tolerance and insulin secretory/sensitivity values were determined by a normal meal tolerance test (NMTT) within 2months post-surgery during their hospitalization. The post-surgery NMTT values revealed that 11 (28.9%) patients developed new-onset impaired glucose tolerance (the IGT group); the other 27 (71.1%) patients maintained normal glucose tolerance (the NGT group). The pre-operative hemoglobin A1c (HbA1c) levels were significantly higher in the IGT group (5.84%) versus the NGT group (5.58%, p = 0.034). There were no significant between-group differences in age, sex ratio, body mass index, the ratio of operative procedure (either pancreaticoduodenectomy or distal pancreatectomy), or post-operative insulin secretory values including the fasting/postprandial C-peptide index. The IGT group showed significantly higher insulin resistance assessed by the homeostasis model assessment of insulin resistance (HOMA-IR) versus the NGT group (1.52 ± 0.67 vs. 0.65 ± 0.42, p < 0.001). After undergoing a partial pancreatectomy, approximately 30% of the patients developed glucose intolerance during the hospitalized period. Our findings indicate that pre-operative HbA1c and post-operative HOMA-IR values can be associated with developing glucose intolerance just after partial pancreatectomy.

MON-LB114 CGM in Cystic Fibrosis Patients to Predict Cystic Fibrosis-Related Diabetes Onset

Background: Therapeutic progress and improvement on resources enabled the emergence of new comorbidities in cystic fibrosis (CF), such as cystic fibrosis-related diabetes (CFRD). About 20% of adolescents and 40-50% of adults are affected. CFRD and glucose intolerance reduce life expectancy in this population, highlighting the importance of early diagnosis and treatment. Up to 15% of CF patients have hypoglycemia during OGTT and its etiology remains unclear. Some authors associate hypoglycemia with CFRD onset, while others do not agree with this association. Objective: To determine whether abnormal CGM (hypo/hyperglycemia) can predict CFRD onset, pulmonary function and BMI decline in CF patients. Methods: Prospective single center study. All CF patients between 10-19yo from our outpatient clinic were screened for CFRD through OGTT following the World Health Organization (WHO) protocol. The enzymatic colorimetric method was used to classify them as per the ADA. Non-diabetic CF patients performed 3-day CGM, forced expiratory volume in the first second (FEV1), BMI and OGTT. All tests except for CGM were then reassessed after a long follow-up. The WHO’s 2006 curve was used to calculate the z scores for individuals ≤19yo and WHO cut-off values for >19yo. Oral corticoid use during data collection, pregnancy and solid organ transplantation were exclusion criteria. Results: Thirty-nine patients were recruited and 34 completed an average of 3.1 years (±0.51) follow-up. No clinical or laboratory variables could predict diabetes progression or hypoglycemic events. The cohort had an increase in mean BMI (17.80±3.65 vs 18.36±3.49; p=0.025) and a reduction in mean FEV1 (66.91±25.79% vs 56.32±29.57%; p=0.001) between the two evaluations. Patients who developed diabetes showed statistically significant worse FEV1 in the end of the follow-up (22.67±5 vs 59.58±28.9; p=0.041), and lower BMI at both start (14.37±1.23 vs 18.13±3.65; p=0.049) and end (14.81±0.66 vs 18.71±3.46; p=0.029) of follow-up. A logistic regression of the effect of time adjusted for independent variables for progression to CFRD was conducted. A higher possibility of evolution among participants with IGT (odds ratio [OR] 21.67; 95% confidence interval [CI] 7.03-67.36; p<0.01), and a lower possibility among participants with NGT (OR 1.84; 95% CI 1.06-3.19; p=0.031). Conclusion: CGM was not a useful tool to predict early diabetes onset in this population with the current cut-off values. However, the IGT group seems to be the riskiest group. The CF population has particular characteristics and may not have the same diagnostic criteria for DM as the non-CF population. More studies are necessary to determine the appropriate CGM cut-off values for CFRD.

Impact of introducing the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria on pregnancy outcomes in Japan.

To estimate pregnancy complications in women newly diagnosed with gestational diabetes mellitus (GDM) according to the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and verify the validity of introducing the IADPSG criteria in Japan. This retrospective study included data from women with singleton delivery at 22 weeks or later at a tertiary hospital during 2000-2009. We compared pregnancy outcomes between women who would now be diagnosed with GDM according to the IADPSG criteria but not by the old JSOG criteria (IGT group, n = 503) and women with normal glucose tolerance according to both the criteria (NGT group, n = 2,789). Multivariate analysis was performed and adjusted for background factors. Maternal age at delivery and pre-pregnancy BMI were significantly higher in the IGT group than in the NGT group, while gestational weeks at delivery did not differ between the groups. No difference was observed in the rates of GDM-related composite complications (defined as cases with at least one of the following: macrosomia, shoulder dystocia, neonatal hypoglycemia, neonatal hyperbilirubinemia, or neonatal respiratory distress syndrome) at 11.9% and 8.8% (adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 0.90-1.87, p = 0.16). Pregnancy outcomes did not differ significantly between the IGT and NGT groups, except for frequencies of total neonatal admissions at 10.5% and 7.1%, respectively (adjusted OR 1.55, 95% CI 1.12-2.13, p < 0.01).

Elevated Hedgehog-Interacting Protein Levels in Subjects with Prediabetes and Type 2 Diabetes.

Background: The prevalence of diabetes is rapidly increasing worldwide and is highly associated with the incidence of cancers. In order to prevent diabetes, early diagnosis of prediabetes is important. However, biomarkers for prediabetes diagnosis are still scarce. The hedgehog-interacting protein (Hhip) is important in embryogenesis and is known to be a biomarker of several cancers. However, Hhip levels in subjects with diabetes are still unknown. Methods: In total, 314 participants were enrolled and divided into normal glucose tolerance (NGT; n = 75), impaired fasting glucose (IFG; n = 66), impaired glucose tolerance (IGT; n = 86), and newly diagnosed diabetes (NDD; n = 87) groups. Plasma Hhip levels were determined by an ELISA. The association between the Hhip and the presence of diabetes was examined by a multivariate linear regression analysis. Results: There were significant differences in the body mass index, systolic and diastolic blood pressure, fasting plasma glucose (FPG), post-load 2-h glucose, hemoglobin A1c (A1C), C-reactive protein, total cholesterol, triglyceride, and high- and low-density lipoprotein cholesterol levels among the groups. Concentrations of the Hhip were 2.45 ± 2.12, 4.40 ± 3.22, 4.44 ± 3.64, and 6.31 ± 5.35 ng/mL in subjects in the NGT, IFG, IGT, and NDD groups, respectively. In addition, we found that A1C and FPG were independently associated with Hhip concentrations. Using NGT as a reference group, IFG, IGT, and NDD were all independently associated with Hhip concentrations. Conclusions: Hhip was positively associated with prediabetes and type 2 diabetes mellitus.

Fasting plasma mannose levels are associated with insulin sensitivity independent of BMI in Japanese individuals with diabetes

BackgroundRecently, an integrated network analysis has revealed dysregulation in the metabolism of mannose, a glucose epimer, in severely obese individuals without diabetes. In addition, fasting plasma mannose levels (M0) are associated with insulin resistance independent of BMI. Since the association between mannose and insulin sensitivity (IS) in those with impaired glucose tolerance remains unknown, we aimed to investigate this association in individuals without severe obesity but with varying degrees of glucose tolerance.MethodsBased on 75 g OGTT data in Japanese individuals without diabetic medication, individuals were classified as having normal glucose tolerance (NGT), impaired glucose metabolism (IGM), or diabetes (DM). In each group, 25 individuals were consecutively recruited [total 75 individuals, age: 65 ± 11 (mean ± SD); BMI: 24.9 ± 3.8 kg/m2]. QUICKI and Matsuda index (MI) were calculated as IS indices. M0 was assayed using HPLC. Normally-distributed loge-transformed (ln-) values were used for MI and leptin.ResultsIn the simple regression analysis, ln-MI was negatively correlated with BMI (NGT: r = − 0.639, IGM: r = − 0.466, DM: r = − 0.613) and ln-leptin (NGT: r = − 0.480, IGT: r = − 0.447, DM: r = − 0.593) in all 3 groups. Ln-MI was not significantly correlated with M0 in NGT (r = 0.241, P = 0.245) and IGT (r = − 0.296, P = 0.152) groups, it was moderately and negatively correlated in the DM group (r = − 0.626, P < 0.001). Similar results were obtained, when QUICKI was used instead of MI as an index of IS. In multiple regression analysis in the DM group, QUICKI (Q) and ln-MI (M) were independently predicted by BMI (Q: β = − 0.413; M: β = − 0.400) and M0 (Q: β = − 0.413, M: β = − 0.426), accounting for 51.2% (P = 0.0004) and 51.2% (P = 0.0004) of the variability, respectively, which was larger than the prediction for BMI alone (Q: 38.4%, M: 37.6%).ConclusionFasting plasma mannose was associated with IS independent of BMI in Japanese individuals with DM.

Comparison of HbA1c and OGTT for the diagnosis of type 2 diabetes in children at risk of diabetes

The aim of this study was to evaluate the correlation between plasma glucose and HbA1c and the diagnostic accuracy of HbA1c as a screening tool to identify asymptomatic diabetes mellitus in children and adolescents with obesity or asymptomatic glucosuria. A total of 190 subjects who underwent an oral glucose tolerance test (OGTT) to confirm diabetes were categorized into normal glucose tolerance (NGT; n=117), impaired glucose tolerance (IGT; n=33), and diabetes (DM; n=40) according to the OGTT. Forty-seven patients with DM were diagnosed by either OGTT or HbA1c levels. The diagnostic accuracy for the detection of diabetes is based on 47 patients. Laboratory tests were performed after 12h of fasting. According to the HbA1c criterion, 107 (55.3%) subjects were in the NGT group, 41 (21.6%) were in the IGT group, and 42 (22.1%) were in the DM group. Diagnostic sensitivities of HbA1c and 2-hour plasma glucose level following OGTT (2-h OGTT) for DM were significantly higher than that of fasting plasma glucose, FPG (89.4, 85.1 vs. 63.8%). In addition, the area under the curves of diagnostic criteria was 0.970 for HbA1c, 0.939 for FPG and 0.977 for 2-h OGTT. Mean FPG and 2-h OGTT for HbA1c level >6.5% were 115.2mg/dL and 181.8mg/dL, respectively. The optimal HbA1c level cut-off point for predicting DM is 6.15%, with a sensitivity of 95.7% in Korean children and adolescents. The HbA1c criterion ≥6.5% was adequate to detect DM among Korean children and adolescents with obesity or asymptomatic glucosuria. We also recommend HbA1c level of 6.15% as the optimal cut-off point for detecting DM in Korean children and adolescents.

Comparison of health-related quality of Life (HRQOL) among patients with pre-diabetes, diabetes and normal glucose tolerance, using the 15D-HRQOL questionnaire in Greece: the DEPLAN study

BackgroundDiabetes mellitus is usually preceded by a pre-diabetic stage before the clinical presentation of the disease, the influence of which on persons’ quality of life is not adequately elucidated. The purpose of this study was to compare the Health-Related Quality of Life (HRQOL) of persons with pre-diabetes with that of diabetes or normal glucose tolerance (NGT), using the validated HRQOL-15D questionnaire.MethodsThe HRQOL-15D scores of 172 people with pre-diabetes (108 with Impaired Fasting Glucose [IFG], 64 with Impaired Glucose Tolerance [IGT], aged 58.3 ± 10.3 years) and 198 with NGT (aged 54.4 ± 10.1 years) from the Greek part of the DEPLAN study (Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional Intervention), were compared to 100 diabetes patients’ scores (aged 60.9 ± 12.5 years, diabetes duration 17.0 ± 10.0 years, HbA1c 7.2 ± 1.2%), derived from the outpatient Diabetes Clinic of a University Hospital.ResultsThe diabetes patients’ HRQOL-15D score (0.8605) was significantly lower than the pre-diabetes’ (0.9008) and the controls’ (0.9092) (p < 0.001). There were no differences in the total score between the controls and the group with pre-diabetes. However, examination of individual parameters of the score showed that people with IGT had lower scores compared to the control group, as related to the parameters of “mobility” and “psychological distress”. No differences were found in any component of the HRQOL-15D score between the control group and the IFG group, nor between the two groups with pre-diabetes (IFG vs. IGT).ConclusionsPersons with pre-diabetes had a similar HRQOL score with healthy individuals, and a higher score than persons with diabetes. Specific components of the score, however, were lower in the IGT group compared to the controls. These findings help clarify the issue of HRQOL of persons with pre-diabetes and its possible impact on prevention.

Effects of laparoscopic sleeve gastrectomy on insulin secretion patterns in morbidly obese patients

To assess the effects of laparoscopic sleeve gastrectomy (LSG) on insulin secretion mode and metabolism of glucose and lipid in morbidly obese patients. Clinical data of 65 morbidly obese patients [body mass index (BMI) ≥30 kg/m2] undergoing LSG at Shanghai 10th People's Hospital from August 2012 to December 2016 were retrospectively analyzed. According to the result of OGTT, these obese patients were divided into three groups: normal glucose tolerance (NGT, 23 cases), impaired glucose tolerance (IGT, 22 cases) and type 2 diabetes mellitus (DM, 20 cases) groups. Twenty-two healthy people [BMI (23.1±1.4) kg/m2] were used as control group. The anthropometries parameters [weight, BMI, waist circumference, body fat percentage, excess weight loss(%EWL)], glucose metabolic indices [fasting plasma glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), homeostasis model assessment-insulin resistance index (HOMA-IR)], lipid profile (TC, TG, HDL-C, LDL-C) and inflammatory factor (UA, TNF-α) of 3 groups were detected before operation and at postoperative 1-, 3-, 6-month. These variables were analyzed among morbidly obese groups before and after surgery and compared to control group. Clinical registration number of this study was ChiCTROCSl2002381. Body weight, waist circumference and BMI of morbidly obese patients all decreased at postoperative 1-, 3-, 6-month. Postoperative %EWL increased obviously to (71.5±24.7)% with the highest range in DM group. Percentage of successful weight loss (%EWL>50%) in NGT, IGT and DM groups was 63.6%, 83.9% and 90.0% at postoperative 6-month respectively, and DM group was also the highest. At postoperative 6-month, HbA1c of 3 morbidly obese groups became normal; FPG and postprandial 2-hour glucose of IGT and DM group decreased to normal level; insulin level of 3 morbidly obese groups decreased obviously compared to pre-operation (all P<0.05), especially FINS and postprandial 2-hour insulin became normal without significant difference of control group (P>0.05), while postprandial 30-minute and 60-minute insulin levels in 3 groups were still higher as compared to control group. The insulin secretion curves of morbidly obese groups showed hyperinsulinemia before surgery. The peak of insulin secretion curve in IGT and DM group moved back to postprandial 120-minute before operation, and returned to 60-minute after operation, with basic normal rhythm of secretion curve. Preoperative HOMA-IR in all 3 morbidly obese groups was higher than that in control group (all P<0.05) and remarkably lower at postoperative 6-month compared to pre-operation(P<0.05). In 3 morbidly obese groups after operation, TG decreased, HDL-C increased, UA and TNF-α decreased significantly compared to before operation (all P<0.05). At postoperative 6-month, the HOMA-IR of DM group was positively correlated with BMI (r=0.236, P=0.004) and TNF-α (r=0.228, P=0.033), and was not correlated with HDL-C(P>0.05). LSG can effectively ameliorate hyperinsulinemia and insulin secretion curve, and improve metabolic disorder and insulin resistance of different stage in obesity patients with glucose metabolic disorder. Insulin resistance is correlated with body weight and inflammatory factors.

839: 3h-GTT single pathological value during pregnancy is a risk factor for developing future diabetes mellitus

To evaluate the association of 3 hours 100g Glucose Tolerance Test (GTT) results and the development of future diabetes mellitus. Retrospective cohort study of women between 18 to 45 years who underwent a 3 hours GTT during pregnancy and delivered in a tertiary affiliated medical center between the years 2007-2014. According to GTT values, patients were divided into three groups: (A) Normal GTT; (B) Impaired Gestational Glucose Tolerance (single pathological GTT value, IGT) and (C) Gestational Diabetes Mellitus (two or more pathological values, GDM). Future diagnosis of diabetes mellitus was recorded among the groups. 1) Overall, 5011 parturients who underwent a 3 hour GTT were detected and followed for a median period of 64 months (interquartile range of 32). 2) Compared with controls, women with GDM or IGT tended to be older, had a higher rate of ART treatment, were less likely to be primipara and had a higher rate of multiple pregnancy (table 1). When pregestational cardiovascular risk factors were compared, women with GDM and IGT had a higher rate of obesity and hyperlipidemia compared to controls, but rates of chronic hypertension, ischemic heart disease and cerebrovascular disease were not different. Future diabetes mellitus was diagnosed at a higher rate in women with GDM or IGT (7.0% for GDM, 2.7% for IGT compared with 0.6% for normal GTT, p<.001). Using a survival multivariable analysis (Fig. 1), GDM and IGT were significantly associated with a higher rate of future diabetes (adjusted HR 3.7 for IGT and 12.2 for GDM, P<0.001). In a sub-analysis of the IGT group, all single pathological values were found to be associated with a higher chronic DM rate, though abnormal fasting glucose had the highest rate (8.8% compared with 5.8% for GTT_60, 5.5% for GTT_120 and 6.6% for GTT_180). Our study shows that both IGT and GDM during pregnancy are independently associated with a significant higher rate of future diabetes mellitus, although their effect is influenced by other contributing factors.View Large Image Figure ViewerDownload Hi-res image Download (PPT)