Incidence Of Diabetes In Patients Research Articles

Psoriasis and the Risk of Diabetes Mellitus

To compare the prevalence and incidence of type 2 diabetes mellitus between patients with psoriasis and those without psoriasis. MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews between January 1, 1980, and January 1, 2012. Observational (cohort, case-control, and cross-sectional) studies published in English that compared the prevalence or incidence of diabetes among patients with psoriasis with individuals serving as controls. Two independent investigators extracted the data. The quality of evidence was assessed using a 6-point scale. Among 142 identified publications, 27 observational studies were included in the meta-analysis. Five of these studies assessed the incidence of diabetes in patients with psoriasis and were analyzed separately. Among studies assessing the prevalence, psoriasis was associated with an odds ratio (OR) of 1.59 (95% CI, 1.38-1.83) for diabetes. The pooled OR was 1.53 (95% CI, 1.16-2.04) for mild psoriasis and 1.97 (1.48-2.62) for severe psoriasis. Meta-regression of prespecified potential sources of heterogeneity revealed a nonsignificant difference (P= .10) of increased reported strength of association among studies that used medical record review (OR, 1.52 [95% CI, 1.31-1.77]) or patients' report of diabetes (2.79 [1.42-5.48]) compared with studies that used billing data (1.46 [1.01-2.09]). Among studies that assessed incidence, psoriasis was associated with a relative risk of 1.27 (95% CI, 1.16-1.40) for developing diabetes. Psoriasis is associated with an increased prevalence and incidence of diabetes. The association of psoriasis with diabetes may be strongest among patients with severe psoriasis.

Total Pancreatectomy and Islet Auto Transplantation for Chronic Pancreatitis

The endocrine dysfunction deserves a special mention as it results in diabetes, often referred to as, brittle diabetes, because of the management difficulty. Along with a spectrum of hyperglycemia, lethal hypoglycemic episodes are common in these patients. The incidence of overt diabetes in patients with CP is approximately 20%, however up to 70% have altered glucose metabolism [2]. In a series by Gall et al. [3] of patients undergoing total or partial pancreatectomy, half of late deaths were due to iatrogenic hypoglycemia [3]. Hypoglycemia has become an interesting topic as it has been shown that islet transplants result in a profound improvement in hypoglycemic episodes for many patients even if the recipient did not achieve insulin independence [4]. Although, malabsorption and statorrhea can be treated with pancreatic enzyme replacement and diabetes can be treated with insulin, pain management is an extreme challenge.

Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: A systematic review of randomized controlled trials

ObjectiveEvery year over 3.8 million people are dying of diabetes and its complications. Lifestyle intervention was suggested to have beneficial effects in preventing and reducing diabetes incidence. Interventions in patients with impaired glucose tolerance (IGT), who belong to a high risk group in developing diabetes, are supposed to be especially effective. According to the evidence hierarchy, a 1a level of evidence is missing and therefore a systematic review verifying the efficacy of lifestyle intervention is needed. Materials/MethodsSystematic review: The electronic database PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment database were searched. Main inclusion criteria were randomized controlled trials, impaired glucose tolerance, lifestyle intervention with control group and observation time >6months. Outcome measures were all diabetes events, as defined by the authors of each study, all-cause mortality, diabetes mortality, and quality adjusted life years (QALY). Two independent reviewers abstracted the studies by title, abstract and full-text analysis. Furthermore the reporting quality of each study was assessed by using the CONSORT criteria (Consolidated Standards of Reporting Trials) and the methodological quality by SIGN 50 instrument (Scottish Intercollegiate Guidelines Network methodology checklist for randomized controlled trials). The primary outcome measure was diabetes incidence. Secondary outcome measures were overall mortality, disease-specific mortality, quality adjusted life years (QALY), and clinical parameters; body mass index (BMI), weight change, blood pressure, blood parameter, smoking, alcohol consumption. Results7 trials which included 25 relevant publications were identified. Kappa Cohens for title-analysis were К=0.77, (CI=0.71–0.83), abstract-analysis К=0.81 (CI=0.64–0.92) and full-text analysis К=0.78 (CI=0.57–0.98). Overall 5663 patients were analyzed with primary follow-up time: India (3y), Japan (4y), Sweden (5y), Da Qing (6y), SIM (3y), DPP (5y), DPS (4y) and drop-out rate ranges from 5% to 28%. Diabetes incidence ranges from 3% to 46% in the intervention group and 9.3% to 67.7% in the control group. The India study reported ARR=16%, RRR=29% (p=0.018), Japan: ARR=6.3%, RRR=65% (p<0.001), Sweden: ARR=4%, RRR=25% (p=not significant), Da Qing: ARR=22%, RRR=32% (p<0.05), SLIM: ARR=20%, RRR=53% (p=0.025), DPP: ARR=15%, RRR=58% (significant, no p-value reported), and DPS: ARR=12%, RRR=52% (significant, no p-value reported). Mortality and morbidity were only analyzed in Da Qing study which showed no statistical differences (overall mortality: HRR 0.96, CI 0.65–1.41, CVD-mortality: HRR 0.83; CI 0.48–1.40, CVD event: HRR 0.98; CI 0.71–1.37). ConclusionUnder consideration of heterogeneity in lifestyle interventions and follow up time of the included studies, this systematic review illustrated that lifestyle intervention can have a beneficial effect on the incidence of diabetes in patients with impaired glucose tolerance. However, several studies found the effect of lifestyle intervention decreased after intervention was terminated. No long-term benefit in mortality and morbidity was found. Development of standardized lifestyle intervention program is strongly needed and further long-term intervention trials using this program are crucial in evidencing the long-term efficacy.

Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: a systematic review of randomized controlled trials

Background Every year over 3.8 million people are dying of diabetes and its complications. Lifestyle intervention was suggested to have beneficial effects in preventing and reducing diabetes incidence. Especially interventions in patients with impaired glucose tolerance (IGT), who belong to a high risk group in developing diabetes, are supposed to be very effective. According to the evidence heirarchy, a 1a level of evidence is missing and therefore a systematic review verifying the efficacy of lifestyle intervention is needed.

One-Year Results of a Community-Based Translation of the Diabetes Prevention Program

OBJECTIVEAlthough the Diabetes Prevention Program (DPP) and the Finnish Diabetes Prevention Study (FDPS) demonstrated that weight loss from lifestyle change reduces type 2 diabetes incidence in patients with prediabetes, the translation into community settings has been difficult. The objective of this study is to report the first-year results of a community-based translation of the DPP lifestyle weight loss (LWL) intervention on fasting glucose, insulin resistance, and adiposity.RESEARCH DESIGN AND METHODSWe randomly assigned 301 overweight and obese volunteers (BMI 25–40 kg/m2) with fasting blood glucose values between 95 and 125 mg/dL to a group-based translation of the DPP LWL intervention administered through a diabetes education program (DEP) and delivered by community health workers (CHWs) or to an enhanced usual-care condition. CHWs were volunteers with well-controlled type 2 diabetes. A total of 42.5% of participants were male, mean age was 57.9 years, 26% were of a race/ethnicity other than white, and 80% reported having an education beyond high school. The primary outcome is mean fasting glucose over 12 months of follow-up, adjusting for baseline glucose.RESULTSCompared with usual-care participants, LWL intervention participants experienced significantly greater decreases in blood glucose (−4.3 vs. −0.4 mg/dL; P < 0.001), insulin (−6.5 vs. −2.7 μU/mL; P < 0.001), homeostasis model assessment of insulin resistance (−1.9 vs. −0.8; P < 0.001), weight (−7.1 vs. −1.4 kg; P < 0.001), BMI (−2.1 vs. −0.3 kg/m2; P < 0.001), and waist circumference (−5.9 vs. −0.8 cm; P < 0.001).CONCLUSIONSThis translation of the DPP intervention conducted in community settings, administered through a DEP, and delivered by CHWs holds great promise for the prevention of diabetes by significantly decreasing glucose, insulin, and adiposity.

Body mass index is closely correlated to incident diabetes in patients with heart failure or myocardial infarction

Diabetes in patients with heart failure or myocardial infarction (MI) increases morbidity and mortality, but little is known about the impact of obesity on the risk of developing diabetes in these populations. A cohort of patients consecutively hospitalized with heart failure (n = 3472) or MI (n = 5723) was followed in the period 1995-2006. Multivariable Cox proportional-hazard models were used to estimate the risk of developing diabetes according to the World Health Organization body mass index (BMI) classification. Normal weight patients (BMI 18.5-24.9 kg/m(2)) were used as the reference. In both populations, more than half of the patients with a BMI above 34.9 kg/m(2) developed diabetes. In heart failure patients, a BMI above 24.9 kg/m(2) was associated with an increased risk of diabetes for the three BMI groups, i.e. 25.0-29.9 kg/m(2), 30.9-34.9 kg/m(2), and >34.9 kg/m(2), with adjusted hazard ratios (HRs) of 2.16 (95% confidence interval 1.50-3.12), 3.89 (2.61-5.78), and 6.06 (3.79-9.69), respectively. In MI patients, the adjusted HRs in the three corresponding BMI groups were 1.84 (1.44-2.37), 4.31 (3.26-5.69), and 9.50 (6.70-13.46), respectively. Incident diabetes was associated with increased cardiovascular and all-cause mortality risks with adjusted HRs of greater magnitude than in prevalent diabetes. BMI was an independent predictor of incident diabetes in patients with either heart failure or MI. More than half of the patients with a BMI above 34.9 kg/m(2) developed diabetes during follow-up. Incident diabetes carries an increased mortality risk.

Incidence of Diabetes in Patients with Schizophrenia: A Population-Based Study

To detect the incidence of diabetes in patients with schizophrenia in Taiwan. The National Health Research Institute provided a database of 1 million random subjects for study, from which we drew a random sample of 617 068 subjects aged 18 years and older in the year 2000. Subjects who had at least one service claim during this year, with a primary diagnosis of schizophrenia, diabetes, or with a prescription for treatment of diabetes, were identified. We compared initial diagnosis of diabetes between patients with schizophrenia and the general population in 2000. We also followed a cohort of subjects with schizophrenia from 2000 to 2005. The incidence of diabetes was higher in patients with schizophrenia than in the general population (1.46% and 1.12%, respectively; OR 1.47; 95% CI 1.09 to 1.97) in 2000. Compared with the general population, patients with schizophrenia showed a higher incidence of diabetes in the group aged 18 to 29 years; among females; among those with insurance of more than US$1281; among those living in the northern region; and among those residing in urban areas. The average annual incidence of diabetes in patients with schizophrenia was 1.84% from 2000 to 2005. Higher incidence of diabetes in patients with schizophrenia was associated with increased age, females, hypertension, and hyperlipidemia. Patients with schizophrenia had a higher incidence of diabetes for the youngest adult age group and for females than for the general population. Increased age, females, hypertension, and hyperlipidemia were risk factors of diabetes in patients with schizophrenia.

Increased plasma retinol binding protein 4 levels in patients with inflammatory cardiomyopathy

Chronic heart failure (CHF) is associated with a higher risk for diabetes mellitus. Retinol binding protein 4 (RBP 4) is an adipose tissue-derived protein with pro-diabetogenic effects. A complete understanding of the association of CHF and insulin resistance remains elusive. The purpose of this study was to examine the relationship between CHF and diabetes mellitus. Plasma levels of RBP 4, insulin, and interleukins (IL) 2, 8, and 10, were assessed in patients with dilated cardiomyopathy (DCM, n = 53), dilated inflammatory cardiomyopathy (DCMi, n = 54), and controls (n = 20). In addition, a possible mechanism of RBP 4 regulation was examined in adipocytes in vitro. Plasma levels of RBP 4 and insulin were measured by a specific ELISA. Interleukin concentrations were obtained by multiplex ELISA. Cell culture with 3T3-L1 adipocytes was performed to measure RBP 4 mRNA expression after stimulation with IL-8. RBP 4 levels were significantly increased in patients with DCMi (52.95 +/- 20.42 microg/mL) compared with DCM (35.54 +/- 23.08 microg/mL) and the control group (27.3 +/- 18.51 microg/mL). RBP 4 was positively correlated with IL-8 (r=0.416, P < 0.05) in human plasma in patients with DCMi. Moreover, increased insulin resistance was observed in patients with DCMi compared with the control and DCM groups. In vitro, IL-8 induced a significant upregulation of RBP 4 mRNA expression in adipocytes. Elevated RBP 4 plasma concentrations, induced by IL-8, might be one mechanism leading to a higher incidence of diabetes in patients with DCMi.

Pharmacological interventions in the prevention of type 2 diabetes

(1) Diabetes is a chronic disease whose incidence is increasing worldwide. The long-term complications of diabetes place a large health and economic burden onto individuals, their families and communities as a whole.(2) Guidelines on the prevention of diabetes recommend lifestyle changes such as smoking cessation and weight loss to decrease type 2 diabetes incidence in patients with impaired glucose tolerance or impaired fasting glucose.(3) The role of lifestyle changes and weight loss in preventing diabetes has been proven in large, randomized, controlled clinical trials. To date, the evidence in favor of pharmacological methods is less robust; however, encouraging results obtained so far suggest a promising future role for these agents.(4) Several oral hypoglycemic agents and the antiobesity drug orlistat have been shown to significantly decrease progression to diabetes. The role of other agents such as statins, oestrogen and antihypertensive agents remains to be clarified in additional well-designed studies of diabetes prevention.

Rosiglitazone Reduced the Incidence of Diabetes in Patients With Impaired Glucose Tolerance

DREAM (Diabetes REduction Assessment with ramipril and rosiglitizone Medication) Trial Investigators; Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, Hanefeld M, Hoogwerf B, Laakso M, Mohan V, Shaw J, Zinman, B, Holman RR: Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet368 : 1096-1105,2006 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Design. A randomized, placebo-controlled, double-blind trial. Subjects. Adults > 30 years of age with impaired fasting glucose (IFG; fasting plasma glucose [FPG] > 110 mg/dl and < 126 mg/dl and 2-hour plasma glucose < 200 mg/dl during oral glucose tolerance test [OGTT]) or impaired glucose tolerance (IGT; FPG < 126 mg/dl and 2-hour plasma glucose 140-200 mg/dl and no previous history of diabetes or cardiovascular disease). Methods. Potentially eligible patients entered a placebo run-in period; those who were successful in taking 80% of doses were then randomized to … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DGerstein%26rft.auinit1%253DH.%2BC.%26rft.volume%253D368%26rft.issue%253D9541%26rft.spage%253D1096%26rft.epage%253D1105%26rft.atitle%253DEffect%2Bof%2Brosiglitazone%2Bon%2Bthe%2Bfrequency%2Bof%2Bdiabetes%2Bin%2Bpatients%2Bwith%2Bimpaired%2Bglucose%2Btolerance%2Bor%2Bimpaired%2Bfasting%2Bglucose%253A%2Ba%2Brandomised%2Bcontrolled%2Btrial.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252806%252969420-8%26rft_id%253Dinfo%253Apmid%252F16997664%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(06)69420-8&link_type=DOI [3]: /lookup/external-ref?access_num=16997664&link_type=MED&atom=%2Fdiaclin%2F25%2F1%2F23.atom [4]: /lookup/external-ref?access_num=000240873000025&link_type=ISI

Ramipril did not reduce incident diabetes in patients with impaired glycemic control

Source Citation Bosch J, Yusuf S, Gerstein HC, et al. Effect of ramipril on the incidence of diabetes.N Engl J Med. 2006;355:1-12. 16980380

Screening for Diabetes and Other Metabolic Abnormalities in Patients With Schizophrenia and Schizoaffective Disorder

To assess the diagnostic properties of 2 different screening guidelines for the detection of diabetes in patients diagnosed with schizophrenia. Over a 2-year period (November 2003-November 2005), 415 patients with schizophrenia were screened with a full laboratory screening and a 75-g oral glucose tolerance test (OGTT). The sensitivity of 2 screening strategies was compared with the "gold standard": the OGTT. The 2 strategies were (1) assessing fasting glucose in all patients, as suggested by the American Psychiatric Association/ American Diabetes Association (APA/ADA), and (2) a screening strategy derived from the guidelines of the World Health Organization of assessing fasting glucose in all patients (step 1) and subsequently performing an OGTT in patients with impaired fasting glucose (step 2). Of the total sample, 6.3% (N = 26) met criteria for diabetes, resulting in a mean annual incidence of diabetes of 3.15% (6.3% incident cases/2 years). A screening based on the APA/ADA guidelines detected diabetes in 12 (46.2%) of the 26 cases identified by the OGTT. The proposed 2-step strategy detected 25 (96.2%) of 26 cases. The data suggest a high incidence of diabetes in patients diagnosed with schizophrenia. However, the guidelines to detect diabetes as proposed by the APA/ADA did not sufficiently detect diabetes in this specific high-risk group. The alternative 2-step strategy was able to detect the vast majority of diabetes cases and should therefore be considered in the clinical routine of screening and monitoring patients with schizophrenia.

Antipsychotics and the risk of diabetes: A general data review

Recently, attention has focused on a potential link between schizophrenia and diabetes, with speculation that this potential associationis stronger in patients who are prescribed atypical antipsychotics. Pharmacoepidemiological studies can help to evaluate this potential association. Source data on the incidence of diabetes in patients treated with antipsychotics is available in the FDA MedWatch database, prescription claims databases and other patient registries. These data indicate that antipsychotic drugs may increase the risk of developing diabetes and that there may be an interaction with age. However, current data are insufficient to accurately assess potential differences in the risk of diabetes between users of individual antipsychotic medications. In addition, antipsychotic treatment-emergent diabetes has several distinct features, notably relating to age of onset, gender ratio, rate of deterioration of glycaemic control, and independence from initial treatment emergent weight gain. Nonetheless, guidelines for the control of risk factors for diabetes developed for the general population appear to be applicable to patients with schizophrenia.

Why blockade of the renin–angiotensin system reduces the incidence of new-onset diabetes

Recent trials have suggested that inhibitors of the renin-angiotensin system (RAS), such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), may reduce the incidence of new-onset diabetes in patients with or without hypertension and at high risk of developing diabetes. In this review, we critically evaluate the evidence from recent clinical trials for such a potential preventive effect of ACE inhibitors and ARBs, including a meta-analysis of these recent trials. The reduced incidence of diabetes in patients at high risk of developing diabetes by ACE inhibitors or ARBs has been explained by haemodynamic effects, such as improved delivery of insulin and glucose to the peripheral skeletal muscle, and non-haemodynamic effects, including direct effects on glucose transport and insulin signalling pathways, all of which decrease insulin resistance. There is now evidence that the pancreas may contain an in situ active RAS, which appears to be upregulated in an animal model of type 2 diabetes. Thus, ACE inhibitors and ARBs may act by attenuating the deleterious effect of angiotensin II on vasoconstriction, fibrosis, inflammation, apoptosis and beta-cell death in the pancreas, thereby protecting a critical beta-cell mass essential for insulin production. New evidence is presented that ACE inhibitors and ARBs may delay or prevent the development of insulin resistance and diabetes, for which novel mechanisms are suggested. The actions of agents that interrupt the RAS on insulin resistance, obesity and diabetes warrant further investigation in other animal models. Prospective clinical studies with the primary endpoint of the prevention of diabetes are now indicated to (i) further explore whether the inhibitors of the RAS are superior compared to other antihypertensive agents such as calcium channel blockers (CCBs) and (ii) to evaluate the potential beneficial effects of combination antihypertensive regimens on the development of diabetes.

Side effects of atypical antipsychotic drugs.

Recently there has been increased concern over the side effects of the atypical antipsychotic drugs, including diabetes, hyperlipidemia and obesity. The relationship between diabetes and antipsychotic drugs requires a careful analysis. Patients with schizophrenia are known to suffer from diabetes more often than the general population. In addition, a number of case reports indicate that the conventional antipsychotic as well as atypical antipsychotic drugs produce diabetes. Clozapine and olanzapine, in particular, have been implicated producing diabetes as well as diabetic ketoacidosis. Epidemiological surveys have supplemented the case reports, finding increased incidence of diabetes in patients treated with atypical antipsychotic agents, but these surveys have not yielded consistent results regarding the differential effects of the various atypical antipsychotic drugs. The mechanism by which antipsychotic agents produce diabetes is not elucidated. Weight gain and consequent alteration in triglycerides and cholesterol have been known to occur frequently with olanzapine and clozapine. The ensuing metabolic syndrome itself may cause insulin resistance and diabetes. In the absence of definitive scientific data on the differential effects of antipsychotic drugs in inducing diabetes, clinical prudence and careful monitoring of all patients on atypical antipsychotic drugs is necessary. Aripiprazole and ziprasidone have not been shown to increase weight or produce diabetes, but more information on the diabetogenic effects of ziprasidone and aripiprazole is needed. In order to assess the differential effects of atypical antipsychotic drugs in producing diabetes and the mechanisms by which they produce this reaction, further research is necessary.

The relationship between severe mental illness and diabetes.

This article reviews what is known about the incidence of diabetes in patients with severe mental illness. Studies performed before antipsychotic medications and atypical antipsychotics were introduced are discussed. Most but not all of these studies found elevated rates of diabetes in patients with schizophrenia and bipolar disorder compared with the general population, although many of these studies had a number of methodological limitations. Possible mechanisms that may account for an increased risk of diabetes in patients with psychotic and bipolar disorders are then considered, including biological, demographic, socioeconomic, and behavioral hypotheses.

Enalapril reduces the incidence of diabetes in patients with chronic heart failure. Insight from the Studies of Left Ventricular Dysfunction (SOLVD)

A 5-year randomized, double blind, placebo-controlled study was carried out to determine the effect of the angiotensin-converting enzyme (ACE) inhibitor enalapril (E) on the progress of renal function and histology in subjects with type 1 diabetes and microalbuminuria. Seventy three type 1 diabetic patients with BP <140/90 and with persistent albuminuria (AER 20–200 μg/min) and normal renal function were randomly assigned to receive E (n=37) or placebo (n=36). A percutaneous renal biopsy was successfully performed in 69 patients and repeated in 59 patients after 5 years. The mean glomerular volume (MGV), mesangial volume (Vv mes) and glomerular basement membrane thickness (GBMT) were measured histomorphometrically. Before treatment, both groups had similar clinical characteristics, blood pressure, HbA1c, albumin excretion rate (AER), glomerular filtration rate (GFR), serum creatinine and renal structural damage. Blood pressure was well controlled in both groups. In the patients treated with E, albuminuria decreased significantly (P<0.05) and only 8.1% (3/37) of subjects progressed to clinical albuminuria (AER >300 mg/24 h) compared with 30.5% (11/36) in the placebo group. The E treatment resulted in absolute risk reduction of 22.4 percentage points for the development of clinical albuminuria over a 5-year period (P<0.01). After 5 years of treatment, GBM thickness showed a consistent, though statistically insignificant, increase in the placebo group, whereas it remained stable in the E group. A significant increase in MGV and Vv mes was also observed in the placebo group on completion of the study. The present study indicates that long term therapy with E may decrease or delay the progression of structural glomerular damage in microalbuminuric diabetic subjects without marked hypertension (BP <140/90).

Applying the Lessons of the DPP to Clinical Practice

Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403, 2002 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Objective . To determine whether improvement in risk factors for type 2 diabetes (mild hyperglycemia, overweight, sedentary lifestyle) with lifestyle change or metformin (Glucophage) can prevent or delay diabetes. Design. A multicenter (27 sites), randomized, clinical trial. Subjects and methods. A total of 3,324 adults with impaired glucose tolerance (IGT) and elevated fasting plasma glucose (FPG) (95–125 mg/dl) were randomized to receive placebo, metformin (850 mg twice daily), or intensive lifestyle change (weight loss ≥7% body weight and moderate physical activity ≥150 minutes per week), and followed for 3 years. Results. At baseline, the mean age was 50.6 years, body mass index (BMI) was 34.0 kg/m2, FPG was 106.5 mg/dl, and 2-hour plasma glucose was 164.6 mg/dl. Non-white ethnic patients comprised 45% of the study population. The incidence of diabetes during an average follow-up of 2.8 years was 11.0, 7.8, and 4.8 cases per 100 person-years in the three assignment groups, respectively. The incidence of diabetes was reduced by 58% in the lifestyle group and by 31% in the metformin group. Conclusion. Lifestyle intervention and metformin therapy both reduced the incidence of diabetes in patients at high risk, with the former being more effective than the latter. The Diabetes Prevention Program (DPP) assessed the long-held notion that diet and exercise could prevent or delay type 2 diabetes. Using different study designs in smaller cohorts, the effectiveness of … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DDiabetes%2BPrevention%2BProgram%2BResearch%2BGroup%26rft.auinit1%253D%2B%26rft.volume%253D346%26rft.issue%253D6%26rft.spage%253D393%26rft.epage%253D403%26rft.atitle%253DReduction%2Bin%2Bthe%2Bincidence%2Bof%2Btype%2B2%2Bdiabetes%2Bwith%2Blifestyle%2Bintervention%2Bor%2Bmetformin.%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa012512%26rft_id%253Dinfo%253Apmid%252F11832527%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa012512&link_type=DOI [3]: /lookup/external-ref?access_num=11832527&link_type=MED&atom=%2Fdiaclin%2F21%2F2%2F91.atom [4]: /lookup/external-ref?access_num=000173686400002&link_type=ISI

Enalapril reduces the incidence of diabetes in patients with chronic heart failure: insight from the Studies Of Left Ventricular Dysfunction (SOLVD).

Diabetes mellitus is a predictor of morbidity and mortality in patients with heart failure. The effect of angiotensin-converting enzyme (ACE) inhibitors on the prevention of diabetes in patients with left ventricular dysfunction is unknown. The aim of this retrospective study was to assess the effect of the ACE inhibitor enalapril on the incidence of diabetes in the group of patients from the Montreal Heart Institute enrolled in the Studies of Left Ventricular Dysfunction (SOLVD). Clinical charts were evaluated for fasting plasma glucose (FPG) levels by blinded reviewers. A diagnosis of diabetes was made when a FPG > or =126 mg/dL (7 mmol/L) was found at 2 visits (follow-up, 2.9+/-1.0 years). Of the 391 patients enrolled at the Montreal Heart Institute, 291 were not diabetic (FPG <126 mg/dL without a history of diabetes), 153 of these were on enalapril and 138 were on placebo. Baseline characteristics were similar in the 2 groups. Forty patients developed diabetes during follow-up, 9 (5.9%) in the enalapril group and 31 (22.4%) in the placebo group (P<0.0001). By multivariate analysis, enalapril remained the most powerful predictor for risk reduction of developing diabetes (hazard ratio, 0.22; 95% confidence intervals, 0.10 to 0.46; P<0.0001). The effect of enalapril was striking in the subgroup of patients with impaired FPG (110 mg/dL [6.1 mmol/L] < or =FPG <126 mg/dL) at baseline: 1 patient (3.3%) in the enalapril group versus 12 (48.0%) in the placebo group developed diabetes (P<0.0001). Enalapril significantly reduces the incidence of diabetes in patients with left ventricular dysfunction, especially those with impaired FPG.

Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients.

To compare the effects of metoprolol and atenolol on carbohydrate and lipid metabolism and on insulin response to an intravenous glucose load. Randomised, double blind, double dummy, controlled crossover trial. University Hospital, Uppsala, Sweden. 60 Patients with primary hypertension (diastolic blood pressure when resting supine 95-119 mm Hg on at least two occasions during four to six weeks of treatment with placebo) randomised to receive either metoprolol (n = 30) or atenolol (n = 30) during the first treatment period. Placebo was given for a run in period of four to six weeks. Metoprolol 100 mg twice daily or atenolol 25 mg twice daily was then given for 16 weeks. The two drugs were then exchanged and treatment continued for a further 16 weeks. Evaluation of effects of treatment with metoprolol and atenolol on glucose, insulin, and lipid metabolism and glucose disposal mediated by insulin. Reduction of blood pressure was similar and satisfactory during treatment with both drugs. Glucose uptake mediated by insulin was measured during a euglycaemic hyperinsulinaemic clamp to evaluate patients' sensitivity to insulin. Glucose uptake decreased from 5.6 to 4.5 mg/kg/min when patients were taking metoprolol and from 5.6 to 4.9 mg/kg/min when they were taking atenolol. Both drugs caused a small increase in fasting plasma insulin and blood glucose concentrations and glycated haemoglobin concentration. Despite decreased sensitivity to insulin the increase in insulin concentration in response to an intravenous glucose tolerance test was small, suggesting inhibition of release of insulin. Very low density lipoprotein and low density lipoprotein triglyceride concentrations were increased with both drugs and high density lipoprotein cholesterol concentration was decreased. Low density lipoprotein cholesterol concentration was not affected. Long term use of metoprolol and atenolol causes metabolic abnormalities that may be related to the increased incidence of diabetes in patients with hypertension who are treated pharmacologically. These results may help to explain why the two drugs have failed consistently to reduce the incidence of coronary heart disease in several large scale studies.