Cases Of Impaired Glucose Tolerance Research Articles

Serum Triglyceride and Total Cholesterol in Association with IGT: A Case Control Study among Bangladeshi Adults in Jashore City

Background: Existing researches demonstrated that hyperglycemia was associated with elevated serum Triglyceride (TG) and Total Cholesterol (TC). It is imperative to identify prediabetic conditions like Impaired Glucose Tolerance (IGT) for prevention or delay in the development of Type 2 Diabetes Mellitus (T2DM). It is also quite comprehensible that early diagnosis of IGT provides opportunity for effective interventions like dietary and lifestyle modification.The primary objective of this study was to investigative the association of serum TG and TC with IGT in an urban area of Bangladesh. Materials and methods: This study was an observational study with a case-control design carried out on a total of 102 IGT subjects and 150 age, Body Mass Index (BMI) and Waist-Hip Ratio (WHR) matched control subject, over 2 years of time.Biochemical tests including Fasting Plasma Glucose (FPG) plasma glucose2 hours after 75 grams glucose load (2 h PG) serum TC and serum TG using slandered procedure. IBM SPSS Statistics 25 version was used for statistical analysis. Results: Serum TG level was significantly high in IGT cases when compared with controls.Serum TC was also different in cases when compared to controls, but was not significant statistically. Conclusion: Higher level of serum TG is associated with IGT. The association of high serum TC and IGT was not decisive. IAHS Medical Journal Vol 5(1), June 2022; 12-15

Changes in β-Cell Function in Offspring of Type-2 Diabetic Patients, as per Fasting and Two-Hour Plasma Glucose Levels.

BackgroundThe changes in β-cell function in high-risk populations who are apparently in the normal glucose tolerant stage are still under investigation for designing earlier prevention strategies. This study analyzes changes in β-cell function and insulin sensitivity across fasting and two-hour glucose categories spanning normal glucose tolerance (NGT) to impaired glucose tolerance (IGT), in offspring of subjects with type-2 diabetes mellitus (T2DM) compared to the controls without a known family history of T2DM.MethodsOffspring of T2DM patients (cases) and individuals without a family history of T2DM (controls) were the subjects for this cross-sectional study. All participants underwent a 75 g oral glucose tolerance test and blood samples were collected for plasma glucose, insulin, C-peptide and proinsulin, at zero, 30, 60, and 120 minutes. ResultsA total of 358 cases (age 23.0 ± 10.8 years, 54% males) and 287 controls (age 28.4 ± 8.10 years, 65% males) were the subjects of this study. Cases and controls were divided into subgroups based on fasting and two-hour glucose categories spanning NGT to IGT. Compared to the reference category of controls (< 80 mg/dL for fasting glucose and < 84 mg/dL for two-hour glucose), cases with IGT had ~60% decline in both β-cell compensation (as measured as disposition index {0-120}) and insulin sensitivity (as measured as whole-body insulin sensitivity index {0-120}); adjusted for age, gender, and body mass index. From lower to higher fasting and two-hour glucose categories, there was a continuous and significant decline in β-cell compensation in both cases and controls. Significant reduction in first-phase insulin secretion, as measured as insulinogenic (0-30) index, was only observed among two-hour glucose categories, not among the fasting glucose categories. In the transition from late NGT cases to IGT cases, there was a significant decline in β-cell compensation, first-phase insulin secretion (more prominent than a decline in overall β-cell secretion) and the changes in whole-body insulin sensitivity were not statistically significant.ConclusionsThe decline in β-cell compensation was continuous and significant in offspring of subjects with type-2 diabetes and controls without a known family history of diabetes from early normal glucose tolerant ranges to impaired glucose tolerant ranges. Compared to the strictest glucose controlled category of controls, approximately 60% decline was observed in β-cell compensation and insulin sensitivity, in impaired glucose tolerant offspring of subjects with type-2 diabetes mellitus.

Maternal urinary phthalate metabolites in relation to gestational diabetes and glucose intolerance during pregnancy

BackgroundPhthalates are common plasticizer chemicals that have been linked to glucose intolerance in the general population, but there is only limited research on their association with gestational diabetes (GDM). ObjectiveWe evaluated the association between 11 urinary phthalate metabolites and GDM, impaired glucose tolerance (IGT), and continuous blood glucose concentration during pregnancy in The Infant Development and Environment Study (TIDES). Based on prior study results, our primary analyses focused on monoethyl phthalate (MEP) in relation to our outcomes of interest. Study designWe used multi-variable logistic regression to examine the odds of GDM and IGT in relation to an interquartile-range (IQR) increase in natural log (ln)-transformed, specific gravity (SG)-adjusted first trimester (T1) and average of T1 and third trimester (T3) (“T1T3avg”) phthalate metabolite concentrations. We fit linear regression models to examine the percent change in blood glucose per IQR increase in ln-transformed, SG-adjusted T1 and T1T3avg phthalates. In sensitivity analyses, we examined interactions between exposure and race. We adjusted for maternal age, maternal body mass index, study center, race/ethnicity, parity, and gestational age at glucose testing. ResultsIn our sample of 705 pregnant women, we observed 60 cases of GDM, 90 cases of IGT, and an average GLT blood glucose of 113.6 ± 27.7 mg/dL. In our primary analysis, T1T3avg MEP was positively associated with GDM ([OR (95% CI) per IQR increase] T1T3avg MEP: 1.61 (1.10, 2.36)). In secondary analyses, most other phthalates were not found to be related to study outcomes, though some associations were noted. Sensitivity analyses indicated possible strong race-specific associations in Asians, though these results are based on a small sample size (n = 35). ConclusionIn alignment with our a priori selection, we documented an association between T1T3avg MEP and GDM. Additional phthalate metabolites were also found to be linked to glucose intolerance, with possible stronger associations in certain racial/ethnic subgroups. Given the prevalence of phthalate exposures and the growing evidence of associations with metabolic outcomes, future studies should continue to examine this question in diverse cohorts of pregnant women, particularly in those who may be at higher risk for GDM and IGT.

Glycemic Status During Different Trimester of Pregnancy

Gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) during pregnancy cause significant fetal and maternal morbidity. Evaluation of glycemic status throughout the pregnancy especially during second and third trimesters is of paramount importance to detect GDM and IGT cases. This can help taking appropriate control measures and to avoid unwanted feto-maternal outcomes. The focus of this research is to understand variation of glycemic status at different trimester and generate a baseline data for Bangladesh using a case study. A total of 300 pregnant women at different trimester of pregnancy were recruited for the study. Plasma glucose levels both fasting and post prandial were done by standard laboratory procedure in all pregnant women included in this study. Glycosylated haemoglobin (HbA1C) level of all pregnant women were also estimated and expressed in percentage (%). Out of 300 pregnant women 57% were in 3rd , 32% were in the 2nd and 11 % were in the 1st trimester. The results found 3%, 6.3% and 4.1% pregnant women in the 1st, 2nd and 3rd trimester respectively had significantly raised level of postprandial blood sugar (PPBS) and HbA1c levels with cumulative prevalence of 4.7%. This finding is consistent with the range of GDM as per World Health Organization (WHO) estimates in different population study. The finding from this research will be beneficial to understand the risk for GDM implement patient screening plan to work effectively in Bangladesh.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 791-794

Correlation of Pancreatic Iron Overload Measured by T2*-Weighted Magnetic Resonance Imaging in Diabetic Patients with β-Thalassemia Major

Diabetes mellitus (DM) is one of the potential complications in patients with transfusion-dependent β-thalassemia major (β-TM). In this case-controlled study, we examined the pancreatic iron levels in outpatients with β-TM. In this study, cases of patients with β-TM and DM were gender- and age-matched with control subjects, who were non-diabetic and had normal blood glucose on standard oral glucose tolerance (OGTT) tests. One of four diagnoses [normal, pre-diabetes, impaired glucose tolerance (IGT), DM] was made according to the American Diabetes Association (ADA) criteria. The T2*-weighted magnetic resonance imaging (T2*-weighted MRI) of the heart, liver, and pancreas was performed using a 1.5 Tesla scanner. The study enrolled 26 diabetic cases, 17 non-diabetic cases, and eight cases of IGT or pre-diabetes cases. The severity of pancreatic and cardiac iron siderosis was significantly different between the groups. We found a statistically significant difference at 5.6 ms in the T2*-weighted MRI values for the pancreas between patients with normal vs. abnormal glucose metabolism [p < 0.009; odds ratio (OR): 11.2; 95% confidence interval (95% CI): 1.32-94.4)]. The receiver operating characteristic (ROC) curve for the 5.6 ms cutoff led to an area under the curve (AUC) of 0.69 (95% CI: 55.0-84.0; p < 0.02), with sensitivity and specificity of 94.0 and 42.0%, respectively. There was a moderate positive correlation between pancreatic and cardiac T2*-weighted MRI (r = 0.4; p < 0.001), and a weak correlation between the pancreas and the liver (r = 0.38; p < 0.005). To conclude, we have introduced a cutoff of 5.6 ms on T2*-weighted MRI of the pancreas for prediction of abnormal glucose metabolism in β-TM patients.

Early Diagnosis of Gestational Diabetes Mellitus in Patients With Elevated Body Mass Index [300

INTRODUCTION: Increased body mass index (BMI, calculated as weight (kg)/[height (m)]2) in a pregnant patient can put her at risk of gestational diabetes mellitus (GDM) by altering her insulin resistance early in pregnancy. The objective of this study was to determine a one-step test for GDM as early as 16 weeks of gestation in patients with increased BMI, thus minimizing fetal and maternal complications. METHODS: Between February 2008 and February 2012, 200 pregnant patients with BMI greater than 25 were registered for this prospective double-blind randomized study. Group A received 50 g glucola and group B received 100 g at 16 weeks of gestation. Patients who had impaired glucose tolerance (130–139 mg) received counseling about exercise and diet and those who had abnormal glucola (greater than 140 mg) also received a consult with perinatologists. Student's t test, χ2 test, and statistical analyses were run using SPSS 21. RESULTS: A total of 176 patients completed (A=89, B=87) glucola at 16 weeks of gestation. Impaired glucose tolerance was noted in 11 patients (A=6.7%, B=5.7%). Abnormal glucose tolerance was noted in 37 patients (A=12.3%, B=29.8%). Additionally 30 new cases of impaired glucose tolerance were diagnosed at 28 weeks of gestation with 50 g glucose (A=12.2%, B=4.4%). The data demonstrated that there was no statistically significant difference in weight gain, hemoglobin, hematocrit, platelet, blood pressure, mode of delivery or fetal weight between patient groups who had abnormal glucose screening test and received counseling and those who had normal glucose screening. CONCLUSION: This study showed that diagnosing impaired glucose tolerance in early pregnancy in patients with elevated BMI and providing them counseling helped to prevent GDM complications. A one-step test using a 100-g glucola test in early pregnancy in patients with elevated BMI is promising.

The impact of thiamine supplementation on blood pressure, serum lipids and C-reactive protein in individuals with hyperglycemia: a randomised, double-blind cross-over trial

BackgroundThe adverse effects of hyperglycemia may be potentiated when it is accompanied with hypertension and dyslipidemia. This study assessed the effects of high dose thiamine on blood pressure, serum lipids and C-reactive protein (hs-CRP) in individuals with impaired glucose metabolism. MethodsThis was a double-blind, randomised trial, where 12 hyperglycemic subjects (10 cases of impaired glucose tolerance and 2 new cases of type 2 diabetes mellitus) received both placebo and thiamine capsules (3×100mg/day) for six weeks in a cross-over manner. Anthropometric measurements, systolic and diastolic blood pressure (SBP & DBP), serum cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, hs-CRP and thiamine status were evaluated at the start, after three weeks and on the completion of each arm. ResultsDBP was significantly decreased in participants consuming thiamine supplements for six weeks (67.9±5.8mm Hg) relative to baseline (71.4±7.4mm Hg, p=0.005) and week 3 (70.9.±5.8mm Hg, p=0.02). This was accompanied with a tendency toward a lower SBP at week six relative to baseline (116.5±11.0 vs. 120.7±15.3mm Hg, p=0.06). Also, mean arterial pressure (MAP) determined in the supplement arm after six weeks was significantly lower than baseline (84.1±6.5 vs. 87.8±9.0, p=0.005). These variables did not change in the placebo arm. No significant change was detected in the supplement or placebo arms when lipid profile and hs-CRP were assessed. Conclusion/interpretationHigh dose thiamine supplementation may have beneficial effects on the blood pressure of individuals with hyperglycemia at early stages, and may have a role in the prevention of further vascular complications. Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000051943

PENGARUH KONSUMSI KOPI TERHADAP KEJADIAN DIABETES MELITUS TIPE 2 (Studi Follow up Gangguan Toleransi Glukosa di Depok Jawa Barat Tahun 2001-2008)

EFFECT OF COFFEE CONSUMPTION FOR THE INCIDENCE OF TYPE 2 DIABETES MELLITUS (Follow up Study for Impaired Glucose Tolerance in Depok, West Java 2001-2008) Coffee consumption is known to increase the risk of the incidence of Type 2 Diabetes Mellitus. Effect of coffee consumption on the occurrence of Type 2 diabetes has been investigated in 289 cases of impaired glucose tolerance (IGT) through prospective cohort studies since 2001 in Depok City, West Java. Coffee drinking habits was collected through measure of caffeine content were consumed. Caffeine content was measured by Atomic Absorption Spectrophotometer (AAS) using the method High Performance Liquid Chromatography (HPLC). Diagnosis of IGT determined based on examination results of fasting blood glucose levels ie lower 126 mg / dL and 2 hours after 75 g glucose load blood glucose levels ie 140-199 mg / dL. Diagnosis of diabetes melitus determined by the basis of the results of clinical examination and results of fasting blood glucose levels, ie ≥ 126 mg / dL and/or results of blood glucose 2 hours after glucose load, ie ≥ 200mg/dl. The follow-up study, to confirm these effects was conducted in 2008. Multinomial logistic multivariate analysis of coffee consumption habits and all variables equally harmful risk of incident type 2 diabetes suggests that coffee consumption with caffein content of 240-359,9 mg caffein had high risk of type 2 diabetes with RR value 3.88 (95% CI 1.20, 8.75), and RR for coffee consumption with caffein content >= 360 mg caffein daily was 5.46 (95% CI 1.57, 11.86). Another factors was contribut to the incidence of type 2 diabetes mellitus is high fat consumption with RR 4.64 (95% CI 1.90, 10.28), obesity with RR 4.04 (95% CI 1.31, 8.27 ), and hypertriglyceride with RR 4.99 (95% CI 1.55, 10.19). High fiber consumption, and high physical activity was found to prevent Type 2 diabetes with RR 0.37 (95% CI 0.10, 0.70) and RR 0.42 (95% CI 0.18, 0.68). Keywords : coffee consumption, type 2 Diabetes Mellitus

Prenatal depressive symptoms and abnormalities of glucose tolerance during pregnancy among Hispanic women

The aim of this study is to prospectively examine the association between maternal depressive symptoms in early pregnancy and risk of abnormal glucose tolerance (AGT) and impaired glucose tolerance (IGT) in mid-pregnancy. We evaluated this association among 934 participants in Proyecto Buena Salud, a prospective cohort study of Hispanic (predominantly Puerto Rican) women in Western Massachusetts. Depressive symptoms were assessed in early pregnancy using the 10-item Edinburgh Postnatal Depression Scale. Scores ≥13 indicated at least probable minor depression and scores ≥15 indicated probable major depression. AGT and IGT were diagnosed using American Diabetes Association criteria. In early pregnancy, 247 (26.5%) participants experienced at least minor depression and 163 (17.4%) experienced major depression. A total of 123 (13.2%) were classified with AGT and 56 (6.0%) were classified with IGT. In fully-adjusted models, the odds ratio for AGT associated with minor depression was 1.20 (95% CI 0.77-1.89) and for major depression was 1.34 (95% CI 0.81-2.23). The odds ratio for IGT associated with minor depression was 1.22 (95% CI 0.62-2.40) and for major depression was 1.53 (95% CI 0.73-3.22). We did not observe an association with continuous screening glucose measures. Findings in this prospective cohort of Hispanic women did not indicate a statistically significant association between minor or major depression in early pregnancy and AGT or screening glucose values in mid-pregnancy. Due to the small number of cases of IGT, our ability to evaluate the association between depression and IGT risk was constrained.

Higher plasma C-reactive protein and lower plasma adiponectin are associated with increased carotid artery intima-media thickness in patients with impaired glucose regulation

Background: Impaired Glucose Regulation (IGR) is a term that refers to blood glucose levels that are higher than the normal range, but lower than Type 2 diabetes mellitus (T2DM). Objective: We aimed to test the role of plasma adiponectin (APN) and plasma C-reactive protein (CRP) in predictingnthe risk of cardiovascular disease in patients with different degrees of impaired glucose regulation (IGR). Methods: A total of 210 outpatients for physical examination were divided into 4 groups: 42 cases of normal glucose tolerance (NGT), 36 cases of impaired fasting glucose (IFG), 92 cases of impaired glucose tolerance (IGT) and 40 cases of IFG+IGT. Body mass index (BMI), blood pressure, lipids, insulin resistance (homeostasis modelassessment, HOMA-IR), APN, CRP and carotid intima-media thickness (CIMT) were measured. Results: In IGT and IFG+ IGT groups, CIMT and CRP were significantly higher, whereas APN was significantly lower compared with IFG and NGT groups (p Conclusion: Increased CIMT in prediabetes state may in part be explained by lower plasma adiponectin and higher C-reactive protein levels. Keywords: Adiponectin, carotid intima-media thickness, C-reactive protein, fasting plasma glucose, impaired glucose regulation, impaired glucose tolerance

High-dose thiamine supplementation improves glucose tolerance in hyperglycemic individuals: a randomized, double-blind cross-over trial

To assess the effect of high-dose oral thiamine supplements on glucose tolerance in patients with impaired glucose metabolism. Twelve hyperglycemic subjects (10 cases of impaired glucose tolerance and 2 new cases of type 2 diabetes) completed this randomized, double-blind trial, where all participants received both placebo and thiamine capsules (3×100mg/day) for 6weeks in a cross-over manner. The main endpoint was changes in 2-h plasma glucose. Fasting plasma glucose and insulin, 2-h plasma insulin, the hemostatic model assessment of insulin resistance (HOMA-IR), renal function measurement and thiamin status were also evaluated at the commencement and completion of each treatment period. Thiamine supplementation resulted in significant decrease in 2-h plasma glucose relative to baseline (8.78±2.20 vs. 9.89±2.50mmol/l, p=0.004), with no significant change in the placebo arm. Fasting plasma glucose and insulin, and HOMA-IR increased significantly from baseline after 6weeks in the placebo arm (p=0.003, p=0.04 and p=0.02, respectively). These variables did not change with thiamine supplementation. There were no significant changes in 2-h plasma insulin or renal function marker, within or between arms. Supplementation with high-dose thiamine may prevent deterioration in fasting glucose and insulin, andimprove glucose tolerance in patients with hyperglycemia. High-dose thiamine supplementation may prevent or slow the progression of hyperglycemia toward diabetes mellitus in individuals with impaired glucose regulation.

Postpartum Outcomes in Women with Gestational Diabetes and their Offspring: POGO Study Design and First-Year Results

Gestational diabetes mellitus (GDM) is a risk factor for mothers to develop type 2 diabetes (T2D) postpartum, and for their children to develop obesity. The aim of the ongoing POGO study is to identify long-lasting changes in the maternal and fetal metabolism and microbiome, after GDM, which contribute to subsequent development of T2D and obesity. Women screened for GDM are asked to attend a postpartum study visit together with their offspring. At the visit, demographic, nutritional, and anthropometric data are recorded. Additionally, data about physical activity, metabolism, and genetic susceptibility are collected using accelerometers, breath gas analyses, 75g oral glucose tolerance tests (OGTT), and bio-samples such as blood and stool. To date, 121 women (median follow-up time postpartum: 5.5 years) have been enrolled together with 133 index children. GDM has been diagnosed using OGTT in 105 women (and 117 children). It showed that 47 mothers had abnormal glucose tolerance, including 19 cases of impaired glucose tolerance, 19 of impaired fasting glucose, eight with T2D, and one with type 1 diabetes (T1D). The prevalence of obesity in the offspring of GDM mothers was 5.1%. Of 61 children tested by OGTT, three were diagnosed with impaired glucose tolerance, another three with impaired fasting glucose, and none with T1D or T2D. The POGO study will contribute to the understanding of the pathogenesis of T2D and obesity after GDM, and will thus help to develop appropriate prevention and intervention strategies. This article presents the first results of the ongoing study, which are looking promising.

E0306 Serum concentrations of resistin and adiponectin in cases with impaired glucose tolerance

ObjectiveRecent studies indicated that resistin and adiponectin take some roles in the glucose homeostasis and suggested there were associations among resistin, adiponectin and glucose tolerance. Therefore we investigate the serum...

The importance of postpartum glucose tolerance testing after pregnancies complicated by gestational diabetes

To review postpartum glucose tolerance in women with gestational diabetes and evaluate the role of formal 75 g oral glucose tolerance testing vs. fasting plasma glucose in screening for persistent abnormalities. Retrospective study of 985 pregnancies over a 10 year period in a mixed ethnic cohort of women who underwent follow-up glucose tolerance testing at 6 weeks postpartum. Diagnosis obtained by oral glucose tolerance test was tested against that from the fasting plasma glucose value. There were 272 abnormal postpartum oral glucose tolerance test results (27.6%), with 109 women identified as having frank diabetes. Eleven of these (10%) had fasting plasma glucose < or =6.0 mmol/l, as did 62 of 114 cases of impaired glucose tolerance. A fasting plasma glucose concentration of > or =6.1 mmol/l correctly identified abnormal glucose tolerance in 199 of 272 cases (sensitivity 0.73). South Asian women were much more likely to have persistent abnormalities of glucose tolerance than were Europeans (32 vs. 15%, chi(2)P < 0.0001). A postpartum fasting plasma glucose measurement alone is not sensitive enough in our population to classify glucose tolerance status accurately. A formal postpartum oral glucose tolerance test is therefore needed to facilitate early detection and treatment.

Impact of adiponectin and ghrelin on incident glucose intolerance and on weight change

Adiponectin and ghrelin are associated with adiposity and type 2 diabetes in several studies. We sought to prospectively determine the interaction of adiponectin and ghrelin in the development of adiposity and hyperglycaemia. Prospective observational study. 393 community-dwelling Afro-Jamaicans (mean age 47 +/- 13 years; BMI 27.3 +/- 6.3 kg/m(2); 63% women) without glucose intolerance at baseline. Anthropometry, fasting plasma glucose, 2-h plasma glucose, insulin resistance (HOMA-IR), adiponectin and ghrelin concentrations were measured at baseline and 4.1 +/- 0.9 years later. Multivariate analyses were used to explore the associations of HOMA-IR, adiponectin and ghrelin with weight change and glycaemia. Results The mean weight change was 2.6 +/- 5.5 kg. There were 114 incident cases of impaired glucose tolerance (IGT) and 35 cases of diabetes mellitus. Adiponectin was positively correlated with age and female sex (P-values < 0.01). After adjusting for age and sex, adiponectin and ghrelin were significantly correlated with weight at baseline and follow-up. However, they were not associated with weight change even after further adjustment for baseline weight. Adiponectin, but not ghrelin, was associated with 2-h glucose concentrations at follow-up even after adjusting for age, sex, HOMA-IR and BMI (P = 0.04). In the fully adjusted logistic regression model, adiponectin predicted incident IGT (OR 0.93; 95% CI: 0.87-0.99) and attenuated the effect of BMI on incident IGT. These longitudinal data show that adiponectin and ghrelin may not be causally involved in the development of obesity. However, adiponectin is independently associated with decreased risk of incident IGT.

The Joint British Societies’ algorithm for the diagnosis of diabetes mellitus in routine clinical practice

The diagnosis of diabetes mellitus (DM) requires a logical approach to identify new cases while not subjecting every patient to an oral glucose tolerance test (OGTT). The Joint British Societies' (JBS2) have recommended an algorithm for the diagnosis of DM. We retrospectively obtained the results of 100 OGTTs requested by primary care physicians, along with previous glucose results and whether the patient was fasting or not with a view to determining how many OGTTs could be avoided by following the recommended algorithm. We found that 47% of the OGTTs could have been avoided, of which the algorithm would have identified all but 4%. Two cases of DM and eight cases of impaired glucose tolerance (IGT) would have been missed. We conclude that following the JBS2 algorithm for the diagnosis of DM will significantly reduce the number of OGTTs, with only a few patients with IGT or DM being missed when such a policy is used.

Glucose Homeostasis in Hypertensive Subjects

The objective of this study was to estimate the prevalence of undiagnosed impaired glucose homeostasis in hypertensive subjects in the general population. The most reasonable screening strategy for glucose disorders was also assessed. We carried out an oral glucose tolerance test for 1106 hypertensive subjects aged 45 to 70 years without previously diagnosed diabetes or cardiovascular disease. Blood pressure, waist circumference, body mass index, and plasma lipids were also measured. Type 2 diabetes was found in 66 (6%) of the subjects, impaired glucose tolerance in 220 (20%), and impaired fasting glucose in 167 (15%). If we had carried out an oral glucose tolerance test only for those hypertensive subjects with fasting plasma glucose >or=5.6 mmol/L, we would have missed approximately 40% of the patients with impaired glucose tolerance. The International Diabetes Federation criteria of metabolic syndrome identified 96% of all the cases of type 2 diabetes and 88% of all the cases of impaired glucose tolerance. The prevalence of central obesity was alarming: 90% of the women and 82% of the men had a waist circumference >or=80 cm or >or=94 cm, respectively. Impaired glucose homeostasis and central obesity are common in hypertensive subjects. An oral glucose tolerance test is reasonable to carry out at least for the hypertensive subjects with metabolic syndrome. Weight stabilization is an important goal to treat hypertensive patients.

Community intervention to promote healthy habits and early diagnostic of impaired glucose tolerance and type 2 diabetes

Aim: To promote healthy habits in our community and to find new cases of impaired glucose tolerance and type 2 diabetes.

Metabolic Risks among College Students: Prevalence and Gender Differences

Little is known about the rate of metabolic dysfunction and gender differences in late adolescence or early adulthood. We report here the prevalence of and gender differences in components of the metabolic syndrome (MetS) in a college sample. Three hundred students (2/3 female) with no prior diagnosis of illness from the University of Kansas, Lawrence, participated in a cross-sectional measurement of weight, height, fasting blood, and 2-hour oral glucose tolerance test. Prevalence of metabolic risks was determined using the Adult Treatment Panel (ATP) III, World Health Organization or International Diabetes Federation criteria. Gender differences in both continuous and dichotomous metabolic variables were tested. The prevalence of MetS was low, but the rate of having at least one abnormal component ranged from 26% to 40%. Different criteria identified different individuals with the MetS. Prevalence was high for low levels of high-density lipoprotein cholesterol (24%), impaired fasting glucose (9%), and hypertriglyceridemia (9%). Fasting insulin was useful in capturing at-risk individuals in addition to ATP-III criteria. Males were more obese, hypertensive, and hypertriglyceridemic than females, but all 9 cases of impaired glucose tolerance were female. The college age and setting are a unique opportunity to monitor and intervene on early risk factors of chronic disease. Undiagnosed metabolic dysfunction is high and problematic in this age group. Unique gender differences in glucose metabolism warrant further research and should be considered in the design of intervention strategies.

Long‐term changes and variability in diabetes risk factors prior to the development of impaired glucose homeostasis

To determine whether rate of change and variability in risk factors provides insight into the development of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or Type 2 diabetes (DM). In a nested case-control study, repeated risk factor measurements (mean number 4.3, duration 11.4 years) culminated in 59 men developing IFG (n = 37), IGT (n = 14) and/or DM (n = 11). For each case, two control subjects were matched for age and equivalence of follow-up. Rates of change and variability in diabetes risk factors prior to diagnosis were quantified by regression analysis. Changes between penultimate and diagnostic visits were also analysed. The age-related rise in body mass index (BMI) was attenuated prior to IFG compared with control subjects (+0.102 vs. +0.772 kg/m2/decade, P = 0.02). There was also some evidence for this prior to IGT and DM (IGT: -1.530 vs. +0.158 kg/m2/decade, P = 0.09; DM: -1.146 vs. +0.332 kg/m2/decade, non-significant). Prior to onset, IGT cases were distinguished by higher inflammatory marker levels, a decline in insulinogenic index and greater variability in oral glucose tolerance test (OGTT) insulin, and DM cases by lower insulin sensitivity and higher liver enzyme activities. Fasting and OGTT glucose levels changed little during the mean 8.9 years prior to onset of IFG, IGT or DM. The transition to IGT or DM was accompanied by a fall in insulin sensitivity. Except for BMI, change or variability in risk factor levels appears relatively unimportant in the development of clinically elevated glucose levels. Deterioration in glucose levels to IGT or DM occurs as a rapid, incremental increase accompanied by a decline in insulin sensitivity.