Impaired Glucose Tolerance In Patients Research Articles

Impaired Glucose Tolerance in Patients with Polycystic Ovarian Syndrome

Background: Polycystic ovary syndrome first described by Stein and Leventhal, is a complex genetic trait of unclear etiology characterized by Oligomenorrhea or anovulation, biochemical or clinical hyperandrogenism and polycystic ovarian morphology on ultrasonography. Women with polycystic ovarian syndrome have an increased risk of developing impaired glucose tolerance and type 2 diabetes mellitus. This study aims to determine the prevalence of impaired glucose tolerance in patients with polycystic ovary syndrome. Study Design: Cross-sectional study Study Duration: This study was conducted in the Department of Endocrinology Ayub Teaching Hospital Abbottabad from 1st Nov 2021 to 30th April 2022. Materials and Methods: All patients with age range 16 to 40 years who were diagnosed with polycystic ovarian syndrome were included in the study. Age, ovarian volume, clinical signs of hyperandrogenism, menstrual abnormalities, serum testosterone, blood glucose at baseline and following 75g of oral glucose load, Body mass index etc. were recorded. Data was analyzed using SPSS-23. Results: Among 139 patients, 35(25.2%) were in the age range 16-25 years while 104(74.8%) were in the age range 26-40 years. Mean age was 28.6(SD±4.2) years. 69(49.6%) patients had BMI> 30 Kg/m2, 60(43.2%) had BMI between 25-29.9 Kg/m2, while only 10(7.2%) patients had their BMI within normal range (18.5-24.9). Mean BMI was 30.7 Kg/m2 (SD±4.4). 47(33.8%) patients had ovarian volume less than 25ml while, 92(66.2%) had ovarian volume greater than 25ml. Mean ovarian volume was 25.5(SD±6.7). 106(76.3%) patients had serum testosterone less than 70ng/dl while, 33(23.7%) had serum testosterone greater than 70ng/dl. Mean serum testosterone was 48.8(SD±26.4). Hirsutism and Acne was observed in 92 (66.2%) and 91(65.5%) patients respectively. 75 (54%) women had positive family history of Diabetes, 56 (40.3%) had family history of polycystic ovary syndrome and 71 (51.1%) patients had past or current history of oral contraceptive pills. Impaired glucose tolerance was found in 52(37.4%) patients. Post stratification results were statistically significant. Conclusions: The prevalence of impaired Glucose tolerance with polycystic ovary syndrome can be as high as 37.4%. Increasing age and Body Mass Index, raise serum testosterone level and increasing ovarian volume are significant predictors for developing impaired glucose tolerance in women with polycystic ovary syndrome. Keywords: Polycystic Ovarian Syndrome, Impaired Glucose Tolerance, Predictive Factors.

The effects of dietary fiber on common complications in critically ill patients; with a special focus on viral infections; a systematic reveiw.

BackgroundViral infections are mostly highly contagious and may cause widespread health problems. Some studies reported that the dietary fiber (DF) may be effective in reducing the complications of viral infections in intensive care unit (ICU) patients. The present review study aimed to investigate the effect of DF on common complications in critically ill patients with viral infections.MethodsA literature review was conducted for the published papers in English from January 2001 to July 2021 using related keywords. Studies with clinical trial or case‐control design described the effects of fiber intake on the complications of viral infections in patients admitted to the ICU were collected.ResultsDF may reduce the mortality rate of viral infections through modulating inflammatory processes. A higher intake of DF intake may improve hyperglycemia and impaired glucose tolerance in patients with viral infections. A high‐fiber formula in enteral nutrition was reported to reduce the risk of diarrhea in patients with viral infections.ConclusionDF may reduce the complications of viral infections such as inflammation, diarrhea, hyperglycemia, and mortality in critically ill patients. Future longitudinal studies on the amount and type of DF are warranted.

High Albumin Level Is Associated With Regression of Glucose Metabolism Disorders Upon Resolution of Acute Liver Inflammation in Hepatitis B-Related Cirrhosis.

Background and AimTo investigate the short-term dynamic changes and the factors associated with regression of glucose metabolism disorders in patients with hepatitis flare of chronic hepatitis B virus (HBV) infection.MethodsIn this study, 118 patients with severe hepatitis flare of chronic HBV infection were prospectively studied. Oral glucose tolerance test was performed on admission and during follow-up to evaluate dynamic changes in glucose metabolism disorders. The factors associated with regression of glucose metabolism disorders were identified using univariate and multivariate logistic regression analyses.ResultsThe prevalence of diabetes was significantly higher in 70 (47.1%) patients with liver cirrhosis than that in 48 (16.8%) patients without liver cirrhosis. The prevalence of impaired glucose tolerance in patients with liver cirrhosis (35.7%) was significantly lower than that in patients without liver cirrhosis (47.8%). After a follow-up of 20.0 ± 18.7 days, 28 of 31 (90.3%) patients without liver cirrhosis experienced regression of glucose metabolism disorders. Additionally, 30 (54.5%) patients with liver cirrhosis experienced regression of glucose metabolism disorders after 42.0 ± 36.2 days. In patients with liver cirrhosis, those with regression of glucose metabolism disorders had significantly higher levels of homeostasis model assessment-β-cell function, albumin (ALB), and a significantly lower level of fibrosis-4 score. ALB was identified as an independent factor associated with the regression of glucose metabolism disorders in patients with liver cirrhosis.ConclusionSevere acute liver inflammation aggravates glucose metabolism disorders in patients with hepatitis B-related liver cirrhosis and high ALB level is associated with regression of glucose metabolism disorders upon resolution of acute liver inflammation.

Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Patients with Covid-19

Objective: The aim of this study is to determine the prevalence of diabetes mellitus and impaired glucose tolerance in patients with COVID-19. Study Design:Cross-sectional study Place and Duration:Conducted at department of Medicine, Khyber Teaching Hospital (KTH),Peshawer and Avicenna Teaching Hospital, Lahorefor the duration from July 2020 to December 2020. Methods: There were one hundred and fifteen patients of both genders had coronavirus disease were included in this study.Patients ranged in age from 25 to 80 years.After obtaining informed written permission, we collected detailed demographic information on all of the registered patients, including their age, gender, BMI, educational attainment and place of residence. All of the patients had their blood tested for corona disease using RT-PCR. After screening positive (fasting capillary glucose >100 mg/dl and 200 mg/dl) and each sixth consecutive negative (fasting capillary glucose <100 mg/dl) subjects, the 75-g oral glucose tolerance test was administered. The SPSS 23.0 software was used for analyzing of data. Results:Included patients had mean age 59.4±12.55 years with mean body mass index 29.12±11.76 kg/m2. There were 70 (60.9%) male patients and 45 (38.1%) females. Majority of the patients were illiterate 65 (56.5%) and 49 (42.6%) patients were from urban areas. Most common co-morbidities were hypertension, hyperlipidemia, chronic kidney disease and coronary artery disease. We found 62 (53.9%) patients had diabetes mellitus in which majority of the cases were pre-existing. Frequency of impaired glucose tolerance was found among 26 (22.6%) cases in which majority of the cases had pancreatic cancer. 28 (24.4%) cases had intubation. Overall mortality was found among 18 (15.3%) cases. Conclusion:This research found that people with diabetes and poor glucose metabolism are more likely to have severe Covid-19. A previously undiagnosed symptom of primary infection has been linked to a disorder in glucose metabolism. Pathways through which SARS-CoV-2 affects glucose metabolism must be investigated if disease aetiology is to be fully understood. Keywords:Coronavirus, DM, IGT, Co-morbidities, Mortality

High prevalence of undiagnosed impaired glucose tolerance in patients with rheumatoid arthritis.

Objectives:Although the risk of diabetes mellitus has been recognised in rheumatoid arthritis, undiagnosed dysglycaemia remained under-reported. The study aimed to determine the prevalence and associated factors of dysglycaemia among patients with rheumatoid arthritis, utilising the oral glucose tolerance test.Methods:This cross-sectional study involved patients with rheumatoid arthritis, aged ⩾30 years. Following an oral glucose tolerance test, they were divided into two: dysglycaemia and normoglycaemia. Demographic and laboratory parameters were compared using logistic regression analyses.Results:There were 35.5% (55/155) patients with dysglycaemia (including 25.8% impaired glucose tolerance, 7.1% diabetes mellitus and 1.9% with both impaired fasting glucose and impaired glucose tolerance). Patients with dysglycaemia were heavier (65.5 ± 12.3 versus 60.7 ± 10.6 kg, p = 0.01), had wider waist (89.0 ± 12.5 versus 83.1 ± 9.6 cm, p < 0.01), lower high-density lipoprotein cholesterol (1.4 ± 0.3 versus 1.5 ± 0.4 mmol/L, p = 0.02), higher triglyceride (1.3 (0.9–1.8) versus 0.9 (0.8–1.2) mmol/L, p < 0.01) and intercellular adhesion molecule-1 (361.79 (290.38–481.84) versus 315.92 (251.45–407.93) ng/mL, p = 0.01). History of smoking (odds ratio: 5.70, confidence interval: 1.27–25.7), elevated triglyceride (odds ratio: 2.87, confidence interval: 1.33–6.22) and intercellular adhesion molecule-1 (odds ratio: 1.003, confidence interval: 1.001–1.006) were significantly associated with dysglycaemia.Conclusions:Prevalence of undiagnosed dysglycaemia, particularly impaired glucose tolerance, was high in these patients with rheumatoid arthritis, using a 75-g oral glucose tolerance test, which was not associated with disease activity or corticosteroid use. Those with high triglyceride, history of smoking and elevated intercellular adhesion molecule-1 were the two significant predictors for dysglycaemia in our patients with rheumatoid arthritis. Oral glucose tolerance test could be an important laboratory investigation for dysglycaemia in these high-risk patients.

Increased glycated albumin levels in patients with acromegaly related to glucose fluctuation caused by growth hormone excess but not albumin metabolism.

Acromegaly is often complicated by impaired glucose tolerance. The accuracy of glycated hemoglobin (HbA1c) and glycated albumin (GA) levels in representing glycemic profiles in patients with endocrine disorders, such as acromegaly, is unclear. This retrospective study reviewed data from patients whose GA levels had been recorded. 14 patients with acromegaly without diabetes mellitus (DM) (the acromegaly group), 15 patients with severe adult GH deficiency without DM (the growth hormone deficiency (GHD) group), and 55 nondiabetic patients (the control group) were included in this study. GA levels were significantly increased in the acromegaly group compared with the control and GHD groups, but no significant differences were observed between the control and GHD groups. The three groups were matched using propensity score matching (13 patients with acromegaly, 13 with GHD, and 13 control patients). Nonetheless, the results after matching were the same as those before matching. GA levels in the acromegaly group were significantly associated with plasma glucose (PG) levels at 0, 30, and 120 min after a 75-g oral glucose tolerance test (OGTT). Further, GH levels at 120 min after a 75-g OGTT in the acromegaly group were significantly correlated with GA levels and the difference in PG levels at baseline and 30 min. Our findings suggest that increases in PG levels attributable to excess GH after glucose loading are related to increases in GA levels in patients with acromegaly without DM. Hence, both HbA1c and GA should be checked to accurately assess impaired glucose tolerance in patients with acromegaly.

Association of Acrochordons with Diabetes Mellitus - A Hospital based Case Control Study

Introduction Acrochordons or skin tags are common benign cutaneous tumors that occur especially over the neck and major flexures. A possible association with diabetes mellitus and dyslipidemia is observed in numerous past studies with varying results. We aim to find out the association of diabetes mellitus with acrochordons Methods: One hundred patients were enrolled in our study. Among them, 50 (27 males and 23 females) with skin tags were selected as cases and 50 with other dermatologic diseases after matching age and gender were taken as controls. Blood glucose levels including both fasting and post-prandial glucose levels were determined for both cases and controls and compared. Results: There was a higher frequency of Diabetes Mellitus and impaired glucose tolerance in patients with skin tags in comparison to controls (p&lt;0.001). Moreover, there were higher odds of acquiring skin tags in patient with abnormal blood glucose levels. Conclusions: There is an increased risk of developing DM in patients with skin tags. It is highly recommended that suspicion for Diabetes Mellitus is to be done in patients with skin tags for early screening and diagnosis of diabetes.

Identification of Significant Predictors for the Need of Insulin Therapy and Onset of Postpartum Impaired Glucose Tolerance in Gestational Diabetes Mellitus Patients.

BackgroundGestational diabetes mellitus (GDM) during pregnancy can greatly increase the risk for a number of adverse prenatal and postpartum consequences, including postpartum impaired glucose tolerance (IGT). Determining the need for insulin therapy is critical for controlling the glycemic level in GDM patients. The study contains two major purposes: 1) to identify the potential predictors for the need of insulin therapy in GDM patients; 2) to identify the factors that are related to the onset of postpartum IGT.Materials and MethodsHere, we performed a retrospective study on 112 GDM patients in China to identify the significant predictors for the need of insulin therapy and onset of postpartum IGT in patients with GDM.ResultsAge and gestational weeks at GDM diagnosis, pregestational BMI, family history of diabetes mellitus (DM), plasma glucose levels assessed by 75-g OGTT at both the 1-hour and 2-hour time points (PG-1h and PG-2h) and HbA1c level were all significantly different between the patients that received insulin therapy and those did not. During postpartum, family history of DM, PG-1h PG-2h and HbA1c level were found to be significantly different between the patients with normal glucose tolerance and those with IGT.ConclusionOur results reveal a number of factors that are closely associated with the need of insulin therapy and onset of postpartum IGT, especially the PG-1h and PG-2h levels. These findings will provide valuable indications on selection of treatment strategy for GDM and GDM-induced postpartum IGT.

The extracellular volume fraction of the pancreas measured by dual-energy computed tomography: The association with impaired glucose tolerance

PurposeTo investigate the clinical value of measuring the ECV fraction of the pancreas by DECT in association with an impaired glucose tolerance (IGT) estimated by the hemoglobin A1C (HbA1C) value in patients with or without cirrhosis. Materials and MethodsThis retrospective study included patients who underwent contrast-enhanced dynamic CT with dual-energy mode between March 2018 and February 2019. The ECV fraction of the pancreas was calculated from iodine map images created from equilibrium-phase contrast-enhanced DECT images. The cross-sectional areas of the pancreas were also measured. ResultsIn total, 51 patients were analyzed (median age, 69 years old; 22 women). The ECV fraction of the pancreas showed a significant negative correlation with the HbA1c value in the cirrhotic group (ρ=-0.346, p = 0.048), while there was no significant correlation in the non-cirrhotic group (ρ=-0.086, p = 0.734). In the elevated HbA1C group, the ECV fraction of the pancreas in the cirrhotic patients (median, 0.247; interquartile range [IQR], 0.098) was significantly lower than that in the non-cirrhotic patients (0.332, IQR 0.113) (p = 0.024). In the elevated HbA1C group, the cross-sectional area of the pancreas was significantly larger in the cirrhotic patients than that in the non-cirrhotic patients (median [IQR]; 2945 [904] vs. 1885 [909] mm2, p = 0.019). ConclusionA reduction in the ECV fraction of the pancreas measured by DECT as well as the enlargement of the pancreatic parenchyma was observed in cirrhotic patients with IGT. These findings suggest that the measurement of the pancreatic ECV fraction by DECT may help clarify the pathophysiology of IGT in patients with cirrhosis.

Role of Wnt signaling pathways in type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) has become a major global public health issue in the twenty-first century and its incidence has increased each year. Wnt signaling pathways are a set of multi-downstream signaling pathways activated by the binding of Wnt ligands to membrane protein receptors. Wnt signaling pathways regulate protein expression and play important roles in protecting the body's normal physiological metabolism. This review describes Wnt signaling pathways, and then aims to reveal how Wnt signaling pathways participate in the occurrence and development of T2DM. We found that Wnt/c-Jun N-terminal kinase signaling was closely associated with insulin resistance, inflammatory response, and pancreatic β-cell and endothelial dysfunction. β-catenin/transcription factor 7-like 2 (TCF7L2)-mediated and calcineurin/nuclear factor of activated T cells-mediated target genes were involved in insulin synthesis and secretion, insulin degradation, pancreatic β-cell growth and regeneration, and functional application of pancreatic β-cells. In addition, polymorphisms in the TCF7L2 gene could increase risk of T2DM according to previous and the most current results, and the T allele of its variants was a more adverse factor for abnormal pancreatic β-cell function and impaired glucose tolerance in patients with T2DM. These findings indicate a strong correlation between Wnt signaling pathways and T2DM, particularly in terms of pancreatic islet dysfunction and insulin resistance, and new therapeutic targets for T2DM may be identified.

Glucose tolerance status in patients with newly diagnosed papillary thyroid carcinoma

Introduction: Thyroid cancer is one of the most common endocrine system malignancies with 9 out of 100,000 estimated annual incidence and papillary carcinoma is the most common type of thyroid cancer. Papillary thyroid cancer (PTC) increases blood insulin levels by creating insulin resistance. Many studies have suggested the role of insulin resistance in the prognosis of PTC. Objectives: The aim of the present study was to determine the prevalence of impaired glucose tolerance in patients with PTC and to compare the relationship between insulin resistance and disease severity, lymph node involvement and distant metastasis. Patients and Methods: In this cross-sectional study, 68 patients with PTC diagnosis examined for metastasis by whole body scan and cervical lymph nodes by ultrasound were included in this study. A 75 g oral glucose tolerance test was also performed on subjects. Results: In this study 68 patients (76.5% female and 23.5% male) were enrolled. The mean age of the patients was 44.2±13.8 years. The mean serum level of fasting blood glucose (FBG in patients was 103.14±21.8 mg/dL and the mean 2 hours past-prandial was 145.12±22.37 mg/dL. Statistically significant lymphatic involvement was observed in 25% of patients between insulin resistance and nodal involvement (P=0.03). A significantly higher metastasis was also observed in 16.2% of patients with glucose intolerance (P&lt;0.05). Conclusion: The results indicated that the rate of insulin resistance in PTC patients is significantly higher and glucose intolerance in these patients is associated with increased lymphatic involvement and increased risk of metastasis and poor prognosis.

Clinical effect of thiazolidinediones in subjects with disorders of carbohydrate metabolism in case of polymorphism rs1801282

BACKGROUND: The polymorphism rs1801282 (Pro12Ala) may be one of the reasons for the heterogeneous response of patients with carbohydrate metabolism disorders to thiazolidinedione therapy. Studies of this polymorphism in patients with metabolic syndrome (MS) will help identify a group of patients in whom the use of thiazolidinedione is advisable.&#x0D; AIMS: To assess the clinical effect of thiazolidinediones in patients with metabolic syndrome, depending on the presence of polymorphism rs1801282.&#x0D; MATERIALS AND METHODS: All patients with newly diagnosed MS with impaired carbohydrate metabolism were included in the open cohort study. All patients were recommended a diet, expansion of physical activity and pioglitazone at a dose of 30 mg per day. After the appointment of the therapy, the patients come to the center back at 12 weeks.&#x0D; The main outcome in the study assessed in patients with impaired glucose tolerance (IGT) was fasting glycemia and 2 hours after glucose tolerance test, in patients with type 2 diabetes HbA1c.&#x0D; RESULTS: 109 patients were included in the study. Of these, 14 were carriers of rs1801282, the other 95 had a typical PPAR genotype. After the appointment of therapy in the groups of IGT and type 2 diabetes, improvement of glycemic control was observed. The degree of decrease in fasting plasma glucose and after glucose tolerance test was more pronounced with IGT in patients with polymorphism rs1801282 compared with the rest (plasma fasting plasma glucose level was -0.7 [-0.9, -0.7] vs. -0, 4 [-0.5, -0.3] mmol/L, p=0.001; plasma glucose level 2 hours after glucose tolerance test was -1.1 [-1.8, -0.3] vs. -0.5 [-0.7, -0.1] mmol/L, p=0.031). In patients with type 2 diabetes, no data were obtained for the statistically significant effect of rs1801282 polymorphism on the results of pioglitazone, but there was a tendency for a greater decrease in fasting plasma glucose in the case of carrying the polymorphic gene (-1.9 [-2.2, -1.8] against -1,5 [-1,7, -1,2] mmol/l, p=0,073).&#x0D; CONCLUSIONS: The study shows the effect of polymorphism rs1801282 on the results of pioglitazone in patients with MS, both in IGT and in type 2 diabetes. Carrying polymorphism leads to a significant decrease in fasting glycemia and after glucose tolerance test in patients with IGT. The tendency to improve the parameters of carbohydrate metabolism (fasting glycemia, HbA1c) was noted in a subgroup of patients with type 2 diabetes.

Prediction of Persistent Impaired Glucose Tolerance in Patients with Minor Ischemic Stroke or Transient Ischemic Attack

Background: Impaired glucose tolerance (IGT) in patients with ischemic stroke can return to normal, reflecting an acute stress response, or persist. Persistent IGT is associated with an increased risk of recurrent stroke, other cardiovascular diseases and unfavorable outcome after stroke. We aim to validate our previously developed model to identify patients at risk of persistent IGT in an independent data set, and, if necessary, update the model. Methods: The validation data set consisted of 239 nondiabetic patients with a minor ischemic stroke or TIA and IGT in the acute phase (2-hour post-load glucose levels between 7.8 and 11.0 mmol/l). The outcome was persistent versus normalized IGT, based on repeated oral glucose tolerance test after a median of 46 days. The discriminative ability of the original model was assessed with the area under the ROC curve (AUC). The updated model was internally validated with bootstrap resampling and cross-validated in the development population of the original model. Results: One-hundred eighteen of 239 (49%) patients had persistent IGT. The original model, with the predictors age, current smoking, statin use, triglyceride, hypertension, history of cardiovascular diseases, body mass index (BMI), fasting plasma glucose performed poorly (AUC .60). The newly developed model included only BMI, hypertension, statin use, atrial fibrillation, 2-hour post-load glucose levels, HbA1c, large artery atherosclerosis, and predicted persistent IGT more accurately (internally validated AUC 0.66, externally validated AUC .71). Conclusions: This prediction model with simple clinical variables can be used to predict persistent IGT in patients with IGT directly after minor stroke or TIA, and may be useful to optimize secondary prevention by early identification of patients with disturbed glucose metabolism.

Endocrine and exocrine pancreatic insufficiency after acute pancreatitis: long-term follow-up study

Introduction. Patients could develop endocrine and exocrine pancreatic insufficiency after acute pancreatitis (AP), but the morbidity, risk factors and outcome remain unclear. The aim of the present study was to evaluate the incidence of endocrine and exocrine pancreatic insufficiency after AP and the risk factors of endocrine pancreatic insufficiency through a long-term follow-up investigation.&#x0D; Methods. Follow-up assessment of the endocrine and exocrine function was conducted for the discharged patients with AP episodes. Oral Glucose Tolerance Test (OGTT) and faecal elastase-1(FE-1) test were used as primary parameters. Fasting blood-glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin HBA1c, 2-h postprandial blood glucose (2hPG), Homa beta cell function index (HOMA-β), homeostasis model assessment of insulin resistance (HOMA-IR) and FE-1 were collected. Abdominal contrast-enhanced computed tomography (CECT) was performed to investigate the pancreatic morphology and the other related data during hospitalization was also collected.&#x0D; Results. One hundred thirteen patients were included in this study and 34 of whom (30.1%) developed diabetes mellitus (DM), 33 (29.2%) suffered impaired glucose tolerance (IGT). Moreover, 33 patients (29.2%) developed mild to moderate exocrine pancreatic insufficiency with 100μg/g&lt;FE-1&lt;200μg/g and 7 patients (6.2%) were diagnosed with severe exocrine pancreatic insufficiency with FE-1&lt;100μg/g. The morbidity of DM and IGT in patients with pancreatic necrosis was significant higher than that in the non-pancreatic necrosis group (χ2 = 13.442,P = 0.001). The multiple logistic regression analysis showed that extent of pancreatic necrosis&lt;30% (P = 0.012, OR = 0.061) were the protective factors of endocrine pancreatic insufficiency. HOMA-IR (P = 0.002, OR = 6.626), Wall-off necrosis (WON) (P = 0.013, OR = 184.772) were the risk factors.&#x0D; Conclusion. The integrated morbidity of DM and IGT after AP was 59.25%, which was higher than exocrine pancreatic insufficiency. 6.2% and 29.2% of patients developed severe and mild to moderate exocrine pancreatic insufficiency, respectively. The extent of pancreatic necrosis&gt;50%, WON and insulin resistance were the independent risk factors of new onset diabetes after AP.

The Outcome of Patients with Acute Coronary Syndrome Those Associated with Impaired Glucose Tolerance in AL-Nasiriya Governorate / Iraq

Prediabetes in the form of impaired glucose tolerance (IGT) is common among patients with acute coronary syndrome (ACS). IGT in patients admitted for ACS is associated with increased mortality. We aimed to determine the prevalence of prediabetes in the form of IGT among ACS patients who were known to be neither diabetic nor prediabetic and referred to early coronary angiography. The study included 284 participants. We divided into 2 groups: patients group and control group. The patients group were include 138 patients admitted in AL-Hussein teaching hospital with acute coronary syndrome in the form of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). 98 patients with NSTEMI and 40 patients with STEMI. The control group were 146 participants in the form of medical staff and patients visiting the hospital with conditions other than the ischemic coronary artery disease. All participants were neither diabetic nor prediabetic. 2 hour post prandial blood sugar, blood sugar at 3 days and blood sugar after 6 weeks were done. 22% of the patients group and 6% of the control group were found to have IGT at 2 hour postprandial with highly statistically significant value (P value < 0.0001). 16.6% of the patients group and 7.5% of the control group were found to have IGT at 3 days after the admission with highly statistically significant value (P value < 0.001). 11% of the patients group and 2% of the control group were found to have IGT after 6 weeks of the presentation with also significant statistical value (P value < 0.005). IGT was found in 62% of the female and 38% of the male in patients group. 42% of NSTEMI and 28% of STEMI patients were ended with early percutaneous coronary angiography. There were 11 patient with IGT in the patients group died during the first week of presentation in comparison to 2 patients with normal sugar died during the same period with highly statistically significant value (P value < 0.0001). IGT is common in patients admitted with ACS. IGT is associated with higher mortality among those patients with previously unreported as diabetes mellitus and should be screened for.

Predicting persistent impaired glucose tolerance in patients with gestational diabetes: The role of high sensitivity CRP and adiponectin.

To evaluate whether maternal serum adiponectin and high-sensitivity C-reactive protein (hsCRP) levels at the time of gestational diabetes mellitus (GDM) diagnosis are associated with persistent glucose intolerance in GDM women at 6 to 12weeks postpartum. This is a secondary analysis of prospective randomized trial of GDM women enrolled in a behaviour education programme. Women with a GDM diagnosis ≥20weeks were included. At the time of randomization, serum adiponectin and hsCRP levels were drawn. After delivery, women underwent a 2-hour 75-g oral glucose tolerance test at 6 to 12weeks postpartum. Persistent impaired glucose tolerance (P-IGT) was defined as impaired fasting glucose, impaired glucose tolerance, or a diagnosis of type 2 diabetes mellitus. Regression models and receiver operator curves were used to evaluate the association between midpregnancy adiponectin and hsCRP and persistent impaired glucose tolerance. Of 100 women in the trial, 63 completed postpartum glucose testing. Twenty (31.7%) of the women had P-IGT. Median hsCRP levels were higher at randomization (22-34wk) in women with persistent impaired glucose tolerance compared with women with normal glucose tolerance (5.1 vs 3.8, P=.01). After adjustment for the original study intervention, the association between hsCRP and P-IGT persisted (odds ratio, 3.45; 95% confidence interval, 1.34-8.92; P=.01) and had good diagnostic performance with an area under the curve of 0.73. There was no difference in median adiponectin levels between groups (44.8 vs 52.0, P=.57) or in odds of P-IGT (odds ratio, 0.81; 95% confidence interval, 0.33-1.99; P=.65), and area under the curve=0.54. Midpregnancy high sensitivity CRP is a potential predictor of persistent impaired glucose tolerance diagnosed on the postpartum 2-hour 75-g oral glucose tolerance test in GDM women in the immediate postpartum period. Further investigation is needed in a larger population of women prior to using specific cut-offs for diagnostic purposes. High-sensitivity C-reactive protein levels in the immediate postpartum period should be seen as an adjunct, not a replacement, for the standard long-term screening of women with a history of a GDM pregnancy.

Endocrine and exocrine pancreatic insufficiency after acute pancreatitis: long-term follow-up study

BackgroundPatients could develop endocrine and exocrine pancreatic insufficiency after acute pancreatitis (AP), but the morbidity, risk factors and outcome remain unclear. The aim of the present study was to evaluate the incidence of endocrine and exocrine pancreatic insufficiency after AP and the risk factors of endocrine pancreatic insufficiency through a long-term follow-up investigation.MethodsFollow-up assessment of the endocrine and exocrine function was conducted for the discharged patients with AP episodes. Oral Glucose Tolerance Test (OGTT) and faecal elastase-1(FE-1) test were used as primary parameters. Fasting blood-glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin HBA1c, 2-h postprandial blood glucose (2hPG), Homa beta cell function index (HOMA-β), homeostasis model assessment of insulin resistance (HOMA-IR) and FE-1 were collected. Abdominal contrast-enhanced computed tomography (CECT) was performed to investigate the pancreatic morphology and the other related data during hospitalization was also collected.ResultsOne hundred thirteen patients were included in this study and 34 of whom (30.1%) developed diabetes mellitus (DM), 33 (29.2%) suffered impaired glucose tolerance (IGT). Moreover, 33 patients (29.2%) developed mild to moderate exocrine pancreatic insufficiency with 100μg/g<FE-1<200μg/g and 7 patients (6.2%) were diagnosed with severe exocrine pancreatic insufficiency with FE-1<100μg/g. The morbidity of DM and IGT in patients with pancreatic necrosis was significant higher than that in the non-pancreatic necrosis group (X2 = 13.442,P = 0.001). The multiple logistic regression analysis showed that extent of pancreatic necrosis<30% (P = 0.012, OR = 0.061) were the protective factors of endocrine pancreatic insufficiency. HOMA-IR (P = 0.002, OR = 6.626), Wall-off necrosis (WON) (P = 0.013, OR = 184.772) were the risk factors.ConclusionThe integrated morbidity of DM and IGT after AP was 59.25%, which was higher than exocrine pancreatic insufficiency. 6.2% and 29.2% of patients developed severe and mild to moderate exocrine pancreatic insufficiency, respectively. The extent of pancreatic necrosis>50%, WON and insulin resistance were the independent risk factors of new onset diabetes after AP.

ПОШИРЕНІСТЬ HELICOBACTER PYLORI СЕРЕД ПАЦІЄНТІВ З ЦУКРОВИМ ДІАБЕТОМ 2 ТИПУ ТА ХРОНІЧНИМ ГАСТРИТОМ

РЕЗЮМЕ. Helicobacter pylori (HP) є однією з найпоширеніших бактеріальних інфекцій у світі, близько половини людства є інфікованими. Не менш поширеною є ця інфекція у хворих на цукровий діабет (ЦД).Мета – виявити ступінь поширення НР-інфекції серед пацієнтів з цукровим діабетом 2 типу (ЦД 2 типу) та хронічним гастритом (ХГ).Матеріали і методи. На базі ендокринологічного та гастроентерологічного відділень ЗОКЛ імені А. Новака обстежено 95 пацієнтів віком від 35 до 65 років (середній вік складав (51,2±3,4)). У 65 обстежених виявлено ЦД 2 типу та ХГ, які склали І групу пацієнтів. Дане дослідження проводили за участі 37 (57,0 %) жінок та 28 (43,0 %) чоловіків. Для порівняння було сформовано ІІ групу, яка включила 30 пацієнтів з ХГ без ДЦ ІІ типу. В ІІ групі чоловіків було 18 (60,0 %), жінок – 12 (40,0 %). Середній вік осіб ІІ групи склав (44,6±6,8) років. У контрольну групу ввійшли 20 практично здорових осіб (чоловіків було 12 (60,0 %), жінок – 8 (40,0 %). Середній вік складав (41,5±4,2) років.Висновки. 1. Поширеність НР-інфекції серед пацієнтів з ЦД 2 типу та ХГ є нижчою, ніж серед осіб з хронічним гастритом (без ЦД 2 типу), а саме 52,0 % та 77,0 % відповідно.2. У хворих на ЦД 2 типу з ХГ НР-інфікування вище у віковій групі від 46 до 55 років і становить 67 %, що може свідчити про інфікування НР вже на фоні ЦД 2 типу.3. Встановлена пряма кореляційна залежність між інфікуванням НР та порушенням толерантності до глюкози у хворих на ЦД 2 типу та ХГ (між НР-інфікованістю та рівнем HbA1c (r=0,85, р&lt;0,01) та рівнем глюкози крові натще (r=0,54, р&lt;0,05).

Diabetes: Prevalence, prognosis and management of a potent cardiovascular risk factor.

This review highlights the increased risk of cardiovascular disease and the dismal prognosis after acute coronary events when diabetes is present. Although there have been improvements in this area, diabetes still confers an increased risk. In order to achieve successful outcomes in individuals with diabetes, extensive treatment of risk factors and the use of all available evidence-based therapies are needed. In this context, glucose-lowering therapies and antithrombotic and revascularisation strategies are detailed in this review. Emerging data indicate that novel glucose-lowering drugs may impact cardiovascular outcome with mechanisms that are beyond glucose control. In addition, this review addresses hidden diabetes and impaired glucose tolerance in patients with acute and stable coronary artery disease and how they influence future cardiovascular risk.

Low alcohol consumption increases the risk of impaired glucose tolerance in patients with non-alcoholic fatty liver disease.

Fatty liver disease is associated with glucose intolerance and hepatic insulin resistance. However, there are distinct etiologies for alcoholic versus non-alcoholic fatty liver disease (NAFLD), and it is unknown whether alcohol consumption influences the onset of glucose intolerance in fatty liver disease patients. Therefore, we investigated the relationship between fatty liver disease and the onset of impaired fasting glucose (IFG) with respect to alcohol consumption. The records of 6804 Japanese subjects were reviewed to identify those meeting the criteria for IFG. Male and female subjects were classified into five and four groups, respectively, based on average alcohol consumption (g/week). IFG onset was defined as fasting plasma glucose levels ≥110mg/dl. In the non-drinker, >0-70g/week, >70-140g/week, >140-210g/week (men only), and >210g/week (men only) or >140g/week (women only) groups, 7.3, 6.7, 6.4, 9, and 6.4% of men and 2, 1.7, 3.1, and 3.2% of women, respectively, developed IFG. Fatty liver was positively associated with the onset of IFG in men of the >0-70g/week group (adjusted hazard ratio [aHR], 2.808; 95% confidence interval [CI] 1.605-5.049, p<0.001) and women of the >70-140g/week group (aHR, 4.193; 95% CI, 1.036-14.584, p=0.045) after adjusting for previously reported IFG risk factors. No associations were observed in the other groups. A small amount of alcohol consumption is a significant risk factor for the onset of IFG in NAFLD patients; onset risk differs according to the amount of alcohol consumption.