Impaired Glucose Regulation Group Research Articles

Value of HbA1C in the diagnosis of type 2 diabetes during an epidemiological survey of diabetes in the elderly of Nanchang community

A total of1415 elderly individuals in Nanchang were included in the study and were divided into normal glucose tolerance group, impaired glucose regulation group, and diabetes mellitus group.The results showed that HbA1C was significantly correlated with fasting plasma glucose (FPG) and 2 h postprandial plasma glucose.When HbA1C 6.3% was applied as the cut point of diabetes, the sensitivity was 85.19% and the specifity was 99.45%.When HbA1C 6.5% was applied, the sensitivity was 75.56% and specifity was 99.61%.It seems that HbA1C 6.3% had higher specifity and sensitivity for diagnosing diabetes than HbA1C 6.5% and FPG 7.0mmol/L in studied population. Key words: Epidemiology; HbA1c; Diabetes mellitus, type 2

Relationship between liver fat content and liver enzymes in individuals with various statuses of glucose metabolism

To study the relationship between liver fat content (LFC) and liver enzymes in individuals with various statuses of glucose metabolism. A total of 109 subjects including with impaired glucose regulation (IGR) (n = 31), newly diagnosed type 2 diabetes (NT2DM) (n = 31) and normal glucose tolerance (NGT) (n = 47) were recruited. The level of LFC was measured by (1)H magnetic resonance spectroscopy ((1)H-MRS) to study the relationship between liver fat content (LFC) and alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP) and γ-glutamyltransferase (GGT). The receiver operating characteristic curve (ROC) was employed to obtain the optimal cut-off point of ALT to predict the occurrence of nonalcoholic fatty liver disease (NAFLD). (1) The levels of LFC were progressively raised in NGT, IGR and NT2DM groups respectively [3.83 (2.35 - 7.59)%, 12.82 (8.10 - 21.37)% and 21.99 (11.89 - 34.43)%, P < 0.01]; (2) the subjects were divided into four subgroups by the method of LFC quartile. And quartile subgroups Q1-4 were associated with the increase of LFC. Waist, BMI, systolic blood pressure, triglyceride, total cholesterol, fasting plasma glucose, OGTT 2 h postprandial glucose and HOMA-IR had a rising trend from Q2. But HDL-C showed a declining trend from Q2; (3) ALT and GGT significantly increased from Q3 (P < 0.01) while AST and AKP significantly increased in Q4 (P < 0.01); (4) adjusted by gender, age and body mass index (BMI), LFC was positively correlated with AST (r = 0.329, P < 0.05), ALT (r = 0.454) and GGT (r = 0.378) (All P < 0.01). But it was negatively correlated with AST/ALT (r = -0.364, P < 0.01); (5) the analysis of stepwise regression demonstrated that LFC was a predictor of ALT, AST, GGT and AST/ALT; (6) ALT had a ROC(AUC) of 0.813 (male) and 0.769 (female) (All P < 0.01). The optimal cut-off point of 23.5 U/L (male) and 17.5 U/L (female) might predict the occurrence of NAFLD. Liver enzymes are correlated with LFC even in normal range. The optimal cut-off point of 23.5 U/L (male) and 17.5 U/L (female) might predict the occurrence of NAFLD. The current used ALT upper limit could underestimate the NAFLD.

Function of islet β cell and metabolic features in gout patients with different status of glucose metabolism

Objective To investigate the changes of insulin resistance and islet β cell function in gout patients with different status of glucose metabolism, and to analyse metabolic features in gout patients with hyperglycemia. Methods Ninety-six patients with gout were consecutively enrolled into the study and were divided into normal glucose tolerance group ( NGT, n = 35 ) , impaired glucose regulation group ( IGR, n = 27 ) , and diabetic group (DM, n=34). Height, weight, blood pressure, fasting plasma glucose, fasting insulin, HbA1C,serum uric acid, C-reactive protein (CRP), total cholesterol (TC), and triglycerides were determined in all subjects. Body mass index (BMI), homeostasis model assessment for insulin resistance index (HOMA-IR),homeostasis model assessment for β cell function index (HOMA-B), and insulin sensitivity index (ISI) were calculated. Results Compared with the NGT group, the levels of BMI, 2hPG, fasting insulin, HbA1C,TC,triglycerides, CRP, HOMA-IR in the DM and IGR groups were higher while ISI was lower (0.023±0.018 and 0.024±0.017 vs 0. 052±0. 026, P<0.05 ). HOMA-B was significantly different among the three groups ( 87.6±25. 1,126.46±34. 2, and 173.75±32.1, P<0.05). Family history of diabetes was more commonly seen in DM group than NGT group ( 41.17% vs 11.4%, P< 0.05 ). Logistic analysis showed that age, BMI, systolic blood pres(s)ure, triglyceride, CRP, and ISI were independently associated with diabetes, but not with uric acid.Conclusions Severe insulin resistance, β cell dysfunction, increased BMI and CRP, lipid disorders, and hereditary susceptibility may be the main metabolic features of gout patients with hyperglycemia. Key words: Gout; Insulin resistance; β cell function; Glucose metabolism; C-reactive protein

Serum levels of proamylin and amylin in normal subjects and patients with impaired glucose regulation and type 2 diabetes mellitus

Amylin is the major constituent of pancreatic islet amyloid whose accumulation characterizes patients with type 2 diabetes mellitus (T2DM). Although amylin is tightly linked with T2DM, in many cases, proamylin may be the more toxic species. As the precursor of amylin, however, the pathophysiological role of proamylin remains unknown. In this study, we investigate whether serum levels of proamylin or amylin or the proamylin/amylin ratios are different among normal subjects and patients with impaired glucose regulation (IGR) and T2DM. Totally 79 subjects were divided into three groups according to the results of oral glucose tolerance test (OGTT); they were T2DM group (32 cases), IGR group (23cases), and normal glucose tolerance (NGT) group (24cases). Serum levels of amylin and proamylin were measured with an enzyme-linked immunosorbent assay (ELISA). The relationships between serum levels of proamylin, amylin, their ratios and anthropometric and metabolic parameters were also analyzed. The serum levels of proamylin were significantly higher in patients with IGR and T2DM than in control subjects. The serum levels of proamylin were significantly associated with IGR and T2DM, with the odds ratios of 1.589 (95%CI, 1.228-2.055, P < 0.01) and 1.860 (95%CI, 1.342-2.587, P < 0.01), respectively. Both fasting serum levels of proamylin and proamylin/amylin ratios were found to correlate negatively with HOMA-B and DeltaI30/DeltaG30. Serum levels of proamylin, amylin, and their ratios were positively correlated with HOMA-IR. BMI and HOMA-B were independent related factors with serum levels of proamylin. Our results suggest that proamylin may play an important role in amyloid deposit in patients with IGR and T2DM.

Changes of serum omentin-1 levels in normal subjects and in patients with impaired glucose regulation and with newly diagnosed and untreated type 2 diabetes

Aims To assay the levels of serum omentin-1 in subjects with different levels of glucose regulation and to analyze the relationship between serum omentin-1 levels and body mass index (BMI), glycoslated hemoglobin (HbA1c), plasma glucose, insulin resistance index (HOMA-IR), TNF-α and IL-6 levels. Methods Forty-six patients with impaired glucose regulation (IGR), 55 patients with newly diagnosed and untreated type 2 diabetes mellitus (T2DM), and 50 subjects with normal glucose tolerance (NGT) were enrolled in this study. The levels of serum omentin-1 and plasma glucose at fasting and at 2 h after glucose load and fasting serum levels of TNF-α, IL-6, insulin, and HbA1c were measured. HOMA-IR was calculated. Results The levels of serum omentin-1 were lower in the IGR and T2DM groups than in the NGT group. Within groups, omentin-1 levels were no significant difference before and after glucose load. The level of serum omentin-1 was negatively correlated to BMI, HOMA-IR, fasting insulin, TNF-α, IL-6, plasma glucose. HOMA-IR and BMI were independent related factors that influenced the levels of serum omentin-1. Conclusions Serum omentin-1 levels were decreased in impaired glucose regulation subjects. Lack of omentin-1 may contribute to the development of insulin resistance and T2DM.

The impact of family history of type 2 diabetes on pancreatic β-cell function

Aims To study the impact of genetic factor on pancreatic β-cell function in the Chinese population. Methods 233 first-degree relatives of patients with type 2 diabetes (T2D) with no history of blood glucose abnormalities and their 190 spouses, who did not have a family history of T2D, underwent a 75-g oral glucose tolerance test (OGTT). Based upon the OGTT, these two groups were further divided into three subgroups, including groups with normal glucose tolerance (NGT), impaired glucose regulation (IGR), and type 2 diabetes. Insulin resistance (IR) was evaluated using the homeostasis model assessment–IR (HOMA-IR), β-cell function indices of basal and first-phase were measured by DI1 (HOMA-β/HOMA-IR) and DI2 (ΔI30/ΔG30/HOMA-IR), respectively. Results Among the first-degree relatives and their spouses, the HOMA-IR was highest in the T2D group and lowest in the NGT group. However, the HOMA-β, DI1 and DI2 declined significantly with progressive reductions in glucose tolerance ( P < 0.01 or 0.05). DI1 and DI2 of the NGT group of first-degree relatives (FNGT) were significantly lower than those of the spouse NGT (SNGT) group ( P < 0.05). DI1 and DI2 of the IGR of first-degree relatives (FIGR) group were significantly lower than those of the spouse IGR (SIGR) group. Conclusions Defects in pancreatic β-cell function exist in the first-degree relatives, who have different glucose tolerance statuses, of T2D patients. These defects are more profound in FNGT and FIGR when compared to their spouses in corresponding glucose tolerance subgroups. However, there is no difference in IR between the corresponding glucose tolerance subgroups of the first-degree relatives and their spouses. It suggests that the genetic factor possibly aggravates β-cell lesion.

Metabolic characteristics of subjects with normal glucose tolerance and 1‐h hyperglycaemia

Nondiabetic subjects with a 1-h plasma glucose >or= 11.1 mmol/l during an oral glucose tolerance test (OGTT) drew our attention to their somewhat confusing status and relative frequency among Chinese patients. The aim of this study was to clarify the metabolic characteristics of these subjects. A total of 2549 Chinese subjects were included in this study. Based on results of OGTT, these subjects were classified into three groups: normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes mellitus (DM). Then, according to the level of 1-h plasma glucose, the NGT and IGR groups were subclassified, respectively, as: NGT without 1-h hyperglycaemia (NGTN), NGT with hyperglycaemia at 1 h (NGT1H), IGR without 1-h hyperglycaemia (IGRN), and IGR with hyperglycaemia at 1 h (IGR1H). After adjustments for age and gender, the insulinogenic index (IGI) of NGT1H and IGR1H was found to be lower than for those with NGTN and of IGRN, respectively (P < 0.05). No statistical differences, however, were found in oral glucose insulin sensitivity (OGIS) between either of the 1-h hyperglycaemic groups or of the corresponding NGTN or IGRN groups. Homeostasis model assessment for beta-cell function (HOMA-B) of NGT1H was lower than that of NGTN (P < 0.05), while IGRN and IGR1H showed no difference. No differences in homeostasis model assessment for insulin resistance (HOMA-IR) were found among NGTN, NGT1H, IGRN and IGR1H groups. The levels of triglycerides (TG) were not significantly different among NGT1H, IGRN and IGR1H, while TG in these groups were significantly higher than in NGTN (P < 0.05). LDL-C was significantly higher and HDL significantly lower in NGT1H than in all other groups (P < 0.05).The IGR group was also subclassified as: isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined glucose intolerance (CGI). The IGI of the NGT1H group was similar to the IGI that of combined glucose intolerance group but lower than those of IFG and IGT (P < 0.05).The OGIS of the NGT1H group was the highest among all groups (P < 0.05). HOMA-B of IGT and NGT1H were higher than that of IFG (P < 0.05). There was no difference among all groups in HOMA-IR. Plasma lipid levels were not significantly different between NGT1H and any other group. Chinese NGT subjects with a 1-h plasma glucose >/= 11.1 mmol/l are characterized by metabolic abnormalities, which may be caused by the impairment of early insulin release rather than aggravated insulin resistance.

Evidence of a Relationship Between Infant Birth Weight and Later Diabetes and Impaired Glucose Regulation in a Chinese Population

The aim of this study was to determine the influence of birth weight, a marker of fetal growth, on the development of later impaired glucose metabolism throughout the life span of people living in China. We recorded detailed anthropometric data including height, weight, and health status and measured blood glucose levels and insulin concentrations after fasting and at 120 min of a standard oral glucose tolerance test from 2,019 eligible subjects born between 1921 and 1954 to investigate the risk of developing type 2 diabetes and impaired glucose regulation (IGR). The diabetes and IGR groups were characterized by significantly lower birth weight (P < 0.001), smaller head circumference (P < 0.001), smaller ponderal index (P = 0.007), and shorter length (P = 0.004) compared with those in the normal glucose tolerance group. Using multiple logistic regression analysis, we observed that birth weight remained significantly associated with diabetes and IGR after adjustments for possible confounding variables at birth and in adult life such as sex, age, central obesity, smoking status, alcohol consumption, dyslipidemia, family history of diabetes, and occupational status (P = 0.027). There was a significantly increased risk of getting diabetes and IGR for those with low birth weight (odds ratio 1.748 [95% CI 1.018-3.001], P = 0.043). The results confirm that lower birth weight is an independent risk factor for later diabetes or IGR and show for the first time that this risk factor also applies for a Chinese population.