Incidence Of Glucose Intolerance Research Articles

Risk factors associated with early postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a systematic review and meta-analysis.

This meta-analysis was aimed at exploring the incidence and risk factors of glucose intolerance in women with gestational diabetes mellitus (GDM) at 6-12 weeks postpartum to inform the development of preventive strategies. We searched Pubmed, Embase, Web of Science, the Cochrane Library, Ovid, China Knowledge Resource Integrated Database (CNKI), Wanfang Database and China Biology Medicine Database for entries between January 1990 and September 2022. The search terms included gestational diabetes mellitus, postpartum, glucose intolerance and type 2 diabetes. The meta-analysis was conducted using Stata 14.0. We included 37 studies, with 21 and 16 having low and medium risk of bias, respectively. The incidence of glucose intolerance in women with GDM 6-12 weeks postpartum was 27% (95% CI: 0.22-0.33). The following risk factors for GDM 6-12 weeks postpartum were identified: insulin use during pregnancy (OR = 3.23; 95% CI: 2.35-4.44), family history of diabetes (OR = 2.94; 95% CI: 1.98-4.33), abnormal fasting glucose levels at 24-28 weeks of gestation (OR = 1.15; 95% CI: 1.07-1.25), high pre-pregnancy BMI (OR = 1.63; 95% CI: 1.23-2.15), abnormal triglyceride levels during 28-40 weeks of gestation (OR = 2.18; 95% CI: 1.18-4.03), abnormal HbA1c levels at 28-40 weeks of gestation (OR = 6.62; 95% CI: 4.71-9.30), history of previous GDM (OR = 2.11; 95% CI: 1.27-3.49), and high 1-h glucose levels at 24-28 weeks of gestation (OR = 1.16; 95% CI:1.06-1.28). The incidence of glucose intolerance in GDM patients at 6-12 weeks postpartum was high. To prevent early postpartum glucose intolerance, healthcare providers should develop individualized interventions for GDM patients, depending on existing risk factors.

Frequency of consumption of balanced meals, bodyweight gain and incident risk of glucose intolerance in Japanese men and women: A cohort study.

Aims/IntroductionThis cohort study assessed the risk for bodyweight gain and development of glucose intolerance based on the frequency of consumption of balanced meals including grain, fish or meat and vegetables.Materials and MethodsThe participants (8,573 men, 3,327 women) were employees of a company in Japan. A self‐administered questionnaire was used to evaluate the frequency of balanced meal consumption. Bodyweight changes and the incidence of glucose intolerance (glycated hemoglobin >6.0%) during the 3‐year follow‐up period were determined through annual health examinations.ResultsThe mean bodyweight change over a period of 3 years was 0.78 kg for men and 0.84 kg for women. A lower frequency of balanced meals was associated with a higher bodyweight gain for men (P for trend = 0.004), but not for women. During the study, 464 men and 115 women developed glucose intolerance. Overall, the frequency of balanced meals was not associated with the risk of glucose intolerance in either sex. However, the interaction between the frequency of balanced meals and degree of obesity had a significant effect on the incidence of glucose intolerance in men (P = 0.005), with less frequent consumption of balanced meals being associated with a higher risk for glucose intolerance among men with a BMI ≥25.0 kg/m2 (P for trend = 0.007).ConclusionsA higher frequency of balanced meals, including grain, fish or meat and vegetable dishes – important components of healthy Japanese food – was associated with a lower risk of glucose intolerance in obese men, but not in non‐obese men and women.

Analysis of Clozapine Use and Safety by Using Comprehensive National Data From the Japanese Clozapine Patient Monitoring Service.

The aim of this study was to investigate clozapine use and its associated adverse effects in patients in Japan. We analyzed data recorded from July 2009 to January 2016 (N = 3780 patients) in the Clozaril Patient Monitoring Service, which was established in Japan in 2009 and includes all Japanese patients who have been prescribed clozapine. The treatment discontinuation rate was 23.9% (869/3780 cases). The average ± SD treatment duration was 234.9 ± 306.9 days (median, 115 days), and the average ± SD dosage was 186.41 ± 151.6 mg/d. The estimated treatment continuation rates resulting from all-cause discontinuation were 78.2 after 1 year and 72.9% after 2 years of treatment. The incidence of neutropenia/leucopenia was 5.4% (206/3780 cases). The average ± SD dose before discontinuation was 233.36 ± 168.15 mg (median, 200 mg; range, 4-600 mg). The incidence of glucose intolerance was 15.4% (583/3780 cases). Of 3780 patients, 98 (2.67%) developed glucose intolerance before and after taking clozapine administration, whereas 485 patients (12.8%) developed glucose intolerance after taking clozapine. The average ± SD time from treatment initiation to new onset of glucose intolerance was 382.2 ± 420.2 days (median, 216 days; range, 4-2053 days). The data obtained in this study, particularly regarding the incidence of clozapine-induced adverse events, will enable the optimal and safe use of clozapine in Japanese patients with treatment-resistant schizophrenia.

Routine HbA1c testing in women undergoing major gynecologic surgery to detect prevalence of glucose intolerance

INTRODUCTION:Determine the prevalence of undiagnosed diabetes, prediabetes and overall incidence of glucose intolerance in women undergoing major surgical procedures on the gynecologic oncology service.METHODS:Retrospective review of preoperative HbA1c levels obtained at preadmission testing in wome

Routine HbA1c testing in women undergoing major gynecologic surgery to detect prevalence of glucose intolerance

Objective: To determine the prevalence of undiagnosed diabetes, prediabetes, and overall incidence of glucose intolerance in women undergoing major surgical procedures on the gynecologic oncology service.

Routine HbA1c Testing in Women Undergoing Major Gynecologic Surgery to Detect Prevalence of Glucose Intolerance [20Q

INTRODUCTION: Determine the prevalence of undiagnosed diabetes, prediabetes and overall incidence of glucose intolerance in women undergoing major surgical procedures on the gynecologic oncology service. METHODS: Retrospective review of preoperative HbA1c levels obtained at preadmission testing in women scheduled for major gynecologic surgery at NYU Winthrop Hospital by gynecologic oncologists between July 2014 and July 2016. Exclusion criteria were lack of HbA1c within 90 days of scheduled surgery and all women undergoing minor surgical procedures. Diabetes was defined either by established diagnosis or with HbA1c ≥6.5, and prediabetes if HbA1c ranged 5.7- 6.4. Value less than 5.7 was considered normal. RESULTS: 343 women underwent major procedures and had HbA1c levels obtained. Fifty-eight (16.9%) had a known diagnosis of diabetes, and 285 (83.1%) were presumed non-diabetics. Majority (182, 63.9%) had normal HbA1c, 86 (30.2%) were prediabetic and 17 (6%) met criteria for diabetes, for a 36.2% prevalence of abnormal glucose tolerance in presumed non-diabetics. When all 343 women were considered, the diagnosis of glucose intolerance was present in 161 (46.9%), 64.0% of whom were previously undiagnosed. CONCLUSION: Nearly half of the women undergoing major gynecologic surgery procedures on the oncology service had impaired glucose tolerance. The diagnosis was previously not established in 64.0%. Pre-surgical assessment of HbA1c is warranted in this high risk population.

Prevalence of diabetes mellitus and its relation with obesity in Turaif (Saudi Arabia) in 2017.

BackgroundThe significant increase in the prevalence of obesity over past decades caused the concomitant rise in the incidence of glucose intolerance and diabetes.ObjectiveTo determine the prevalence of diabetes among Saudi nationals in Turaif, Kingdom of Saudi Arabia and to examine the association between diabetes and obesity in the studied population.MethodsThis study was conducted during the period from May 01 to May 31, 2017. Data was collected from 402 individuals aged between 6–63 years via a predesigned questionnaire covering medical history of diabetes, age and sex. Body weight and height was measured to calculate BMI. Data were analyzed by SPSS version 15, using descriptive statistics and Chi-Square test.ResultsMean age (± SD) was 23.27 (±13.509) years, male to female ratio was 38.1% to 61.9%. The total prevalence of DM among the studied population was 4.5%, pre-diabetic cases were 7.5%. There is significant effect of age, sex and BMI on the occurrence of diabetes among the studied population (p<0.05).ConclusionsAwareness campaigns and prevention programs about diabetes should be instituted and control strategies should be implemented. There is a need for a diabetes screening and management programs, focusing on access to health care in the city.

Incidence of postpartum glucose intolerance among women with gestational diabetes in Siriraj Hospital

Objectives: To determine the incidence of postpartum glucose intolerance among women with gestational diabetes (GDM) and its associated factors. Methods: A total of 110 GDM women who delivered at Siriraj Hospital were enrolled. A 2-hour 75-gram glucose tolerance test and were offered at 6-12 weeks postpartum to determine incidence of glucose intolerance, which include impaired glucose tolerance (IGT), and type 2 diabetes (T2DM). Demographic data, GDM risks and diagnosis data, and delivery data were collected. Incidence of glucose intolerance was estimated. Comparison was made between glucose intolerance groups to determine possible associated factors. Results: Mean age was 33.7±5.1 years, and 46% were nulliparous. According to pre-pregnancy BMI, 45.5% were overweight/obese, and 24.5% gained weight greater than recommendation. Majority was GDM A1 (85.5%), and 63.6% were diagnosed before 20 weeks of gestation. Mean postpartum follow up time was at 6.2 ± 0.9 weeks. Incidence of postpartum IGT and T2DM were 35.5% and 10% respectively. No difference was found between groups in terms of pre-pregnancy BMI, gestational weight gain, weight retention, and severity of GDM. However, HbA1c level was significantly greater among women with postpartum T2DM than IGT and normal results (6.1±0.5%, 5.6±0.4%, and 5.4±0.3% respectively, p 6% significantly increased the chance of T2DM (33.3% vs. 53.4%, p=0.001). Conclusion: Among GDM pregnant women, incidence of postpartum glucose intolerance was 45.5% (35.5% IGT and 10% T2DM). HbA1c level of >6% significantly increased the chance of postpartum T2DM.

Effect of Dose and Duration of Micronized Progesterone Treatment during the First Trimester on Incidence of Glucose Intolerance and on Birth Weight

Objective: The aim was to investigate the potential effect of oral progesterone therapy during the first trimester on glucose metabolism and on birth weight, and to assess the existence of dose-related differences. Methods: One hundred and fifty women with a history of imminent abortion and who used micronized progesterone (MicP) (200-600 µg/day for 4-6 weeks), and 150 healthy pregnant women as a control group, were included in the study. Fasting blood glucose (FBG), hemoglobin A1c (HbA1c) and OGL were measured between 24 and 28 weeks of gestation. Patients were followed up to term and birth weight was recorded. Results: Risk of abnormal FBG and OGL was increased by 4.5- and 9.4-fold, respectively, in patients receiving MicP (p < 0.001). Median birth weight and gestational age were 3,599 g (500) and 39.0 weeks (1.3) for the MicP exposed group and 3,120 g (210) and 39.4 weeks (1.5) for the control group, respectively. Median birth weight was significantly higher in the MicP-exposed group for a similar gestational age (p < 0.001). There were no dose-related differences between groups. Conclusion: MicP therapy during the first trimester of pregnancy might have undesirable effects on glucose metabolism, which stresses the need of larger studies to confirm this association.

6: Can differences in obstetric outcomes be explained by differences in the care provided?

6 Can differences in obstetric outcomes be explained by differences in the care provided? William Grobman For the Eunice Kennedy Shriver National Institute of Health and Human Development, Maternal-Fetal Units Network, Bethesda, MD OBJECTIVE: Although many obstetric outcomes have been suggested as quality indicators, there is little direct evidence that institutional differences in these indicators are related to differences in the care provided. The objective of this study was to determine whether variation in the frequency of potential quality indicators could be related to differences in care. STUDY DESIGN: Data were obtained by trained abstractors, with ongoing data edits and audits, from all deliveries on 365 randomly selected days at 25 hospitals over a three-year period. Four outcome measures, selected a priori and rigorously defined, were chosen as potential quality indicators: severe postpartum hemorrhage (PPH), maternal peripartum infection (INF), perineal trauma (3rd or 4th degree laceration) at SVD (LAC), and a composite adverse neonatal outcome (NEO). Because the frequency of outcomes may be related to other patient, physician (e.g. years of experience), and institutional (e.g. in-house obstetrician 24 hours daily) factors, these characteristics were assessed for their associations with the above outcomes of interest through the use of hierarchical logistic regression, which was used to account for potential confounding and clustering of observations. Selected care processes were then placed into the model to assess whether these were independently associated with the outcomes. RESULTS: Data were collected on 115,502 women. After adjustment for patient, physician, and institutional characteristics, differential use of labor induction, cesarean delivery, and episiotomy, were associated with the outcomes of interest (Table). CONCLUSION: After controlling for differences in patients, physicians, and institutional factors, several care processes were found to be associated with variation in predefined adverse outcomes. These associations support the use of these outcomes as quality indicators, and also may suggest process measures that also are reasonable to use as quality indicators. 7 ROLO study: a randomized control trial of low glycemic index diet to prevent macrosomia in euglycemic women Jennifer Walsh, Rhona Mahony, Michael Foley, Fionnuala McAuliffe UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland OBJECTIVE: The macrosomic fetus is predisposed to a variety of adverse obstetric and neonatal outcomes, and significantly increases the risk of birth complications for the mother. In the long term, infants that are at the highest end of the distribution for weight are more likely to be obese in childhood. Eating primarily a high glycaemic carbohydrate diet can result in feto-placental overgrowth, excessive maternal weight gain and fetal macrosomia. Our hypothesis was that altering the source of maternal dietary carbohydrate could prevent macrosomia in euglycemic women. STUDY DESIGN: This is a randomised control intervention trial of 720 secundigravid women whose first baby was macrosomic (birth weight 4.0 Kg). Women were randomized to receive either no dietary intervention or a low glycemic index (GI) diet from early pregnancy. Those with pre-existing or previous gestational diabetes were excluded. The low GI group attended a small group dietetic session at 14-18 weeks’ gestation and continued the diet until term with written information and regular re-enforcement. The primary endpoint of the study was the difference in birth weight. Secondary outcomes included gestational weight gain and the development of glucose intolerance. RESULTS: There was no difference between the control and intervention groups in birthweight, customized birthweight centile or birthweight z-score. Fetal macrosomia recurred in 51% (n 184) of the intervention group and in 52 % (n 187) of controls. Women in the low GI group had significantly less gestational weight gain than those without any dietary intervention. (12.2kg vs 13.6kg p 0.01). The incidence of glucose intolerance was also significantly less in the low GI arm with 16.7% having a glucose challenge test result of 7.8 mmol/L compared with 23.4% of controls (p 0.04). CONCLUSION: Infant birthweight is a complex interplay of environmental and genetic factors. Despite a significant reduction in maternal gestational weight gain and glucose intolerance, a low GI diet in pregnancy has no effect on infant birthweight.

Variants of transcription factor 7-like 2 (TCF7L2) gene and incident glucose intolerance in Japanese-Brazilians

Common variants of the transcription factor 7-like 2 (TCF7L2) gene have been found to be associated with type 2 diabetes in different ethnic groups. The Japanese-Brazilian population has one of the highest prevalence rates of diabetes. Therefore, the aim of the present study was to assess whether two single-nucleotide polymorphisms (SNPs) of TCF7L2, rs7903146 and rs12255372, could predict the development of glucose intolerance in Japanese-Brazilians. In a population-based 7-year prospective study, we genotyped 222 individuals (72 males and 150 females, aged 56.2 ± 10.5 years) with normal glucose tolerance at baseline. In the study population, we found that the minor allele frequency was 0.05 for SNP rs7903146 and 0.03 for SNP rs12255372. No significant allele or genotype association with glucose intolerance incidence was found for either SNP. Haplotypes were constructed with these two SNPs and three haplotypes were defined: CG (frequency: 0.94), TT (frequency = 0.027) and TG (frequency = 0.026). None of the haplotypes provided evidence for association with the incidence of glucose intolerance. Despite no associations between incidence of glucose intolerance and SNPs of the TCF7L2 gene in Japanese-Brazilians, we found that carriers of the CT genotype for rs7903146 had significantly lower insulin levels 2 h after a 75-g glucose load than carriers of the CC genotype. In conclusion, in Japanese-Brazilians, a population with a high prevalence of type 2 diabetes, common TCF7L2 variants did not make major contributions to the incidence of glucose tolerance abnormalities.

Impact of Common Type 2 Diabetes Risk Polymorphisms in the DESIR Prospective Study

The emerging picture of type 2 diabetes genetics involves differently assembled gene variants, each modestly increasing risk with environmental exposure. However, the relevance of these genes for disease prediction has not been extensively tested. We analyzed 19 common polymorphisms of 14 known candidate genes for their contribution to prevalence and incidence of glucose intolerance in the DESIR (Data from an Epidemiological Study on the Insulin Resistance syndrome) prospective study of middle-aged Caucasian subjects, including 3,877 participants (16.8% with hyperglycemia and 7.9% with diabetes after the 9-year study). The GCK (Glucokinase) -30A allele was associated with increased type 2 diabetes risk at the end of the follow-up study (adjusted OR 1.34 [95% CI 1.07-1.69]) under an additive model, as supported in independent French diabetic case subjects (OR 1.22, P = 0.007), with increased fasting glycemia (0.85% per A allele, P = 6 x 10(-5)) and decreased homeostasis model assessment of beta-cell function (4%, P = 0.0009). IL6 (Interleukin- 6) -174 G/C interacts with age in disease risk and modulates fasting glycemia according to age (1.36% decrease over 56 years, P = 5 x 10(-5)). These polymorphisms together with KCNJ11 (Kir6.2)-E23K and TCF7L2-rs7903146 may predict diabetes incidence in the DESIR cohort. Each additional risk allele at GCK, TCF7L2, and IL6 increased risk by 1.34 (P = 2 x 10(-6)), with an OR of 2.48 (95% CI 1.59-3.86), in carriers of at least four at-risk alleles compared with those with none or one risk allele. Our data confirm several at-risk polymorphisms for type 2 diabetes in a general population and demonstrate that prospective studies are valuable designs to complement classical genetic approaches.

PREVALENCE OF OBESITY AND TYPE 2 DIABETES AMONG CHILDREN IN A REMOTE FIRST NATIONS COMMUNITY.

Background Type 2 diabetes mellitus (T2D) in children and adolescents is becoming a growing public health concern and reflects the increasing rates of obesity in our society. The prevalence of T2D in Canadian Aboriginal children and youth has been documented to be as high as 1%, with the highest prevalence in the Plains Cree people of Central Canada. However, no such pediatric data are available for any First Nations community in British Columbia. Hartley Bay is an isolated First Nations community in BC, accessible only by air or water, with a population of 184 members living on reserve. Members of this community have multiple known risk factors for developing T2D, including First Nations ethnicity, obesity, and a family history of T2D. Purpose The purpose of this study was to determine the prevalence of obesity, glucose intolerance, and metabolic syndrome in the community of Hartley Bay. Methods All children in the community of Hartley Bay, ages 6 to 18, were invited to participate in the study. A medical history was obtained to document risk factors and symptoms associated with T2D. Measurements including height, weight, blood pressure, and waist and hip circumferences were documented. Body mass index (BMI) was standardized for age and sex. Overweight was defined as a BMI ≥ 85th percentile and obese was defined as a BMI ≥ 95th percentile for age and sex. Presence of acanthosis nigricans, hirsutism, and acne were recorded. Children fasted overnight, and a standard oral glucose tolerance test was administered the following morning. Baseline and 2-hour levels of glucose and insulin were measured. Glycosylated hemoglobin, fasting C-peptide, and fasting lipid profile were also obtained. Results There were 33 eligible children, and 29 children (88%) (age 11.8 years ± 3.4; 16 females and 13 males) participated in the study. Nine (31%) of the children were obese and 5 (17%) were overweight, with a total of 48% obese or overweight. One child had fasting and 2-hour glucose levels consistent with impaired glucose tolerance. One other child, absent from the community at the time of the screening, was previously recently diagnosed by this team to have T2D. The incidence of glucose intolerance (T2D/IGT) in this community is 2/34 (5.9%), which is greater than previously reported in other pediatric Aboriginal populations in Canada. Conclusions Our findings suggest that the prevalence of obesity and overweight as well as glucose intolerance in this population is higher than previously reported in other pediatric Aboriginal populations in Canada. This study will generate interest, knowledge, and the willingness within the community to support modifications in lifestyle and nutrition practices required for the primary and secondary prevention of T2D.

Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study

Objective To assess whether active and passive smokers are more likely than non-smokers to develop clinically relevant glucose intolerance or diabetes.Design Coronary artery risk development in young adults (CARDIA) is...

Discrepancies in Results of Low-and High-dose Dexamethasone Suppression Tests for Diagnosing Preclinical Cushing's Syndrome

According to the diagnostic criteria for adrenal preclinical Cushing's syndrome (PreCS) established by a group headed by the Ministry of Health, Labor and Welfare (MHLW), low- and high-dose dexamethasone suppression tests (DSTs) must be performed to prove autonomous cortisol secretion, i.e., > or =3 microg/dL serum cortisol following 1-mg DST administration, and > or =1 microg/dL serum cortisol following 8-mg DST administration. However, discrepancies have been documented in the results of low-and high-dose DSTs. We therefore investigated the validity of the DST for diagnosing PreCS by performing 1-mg and 8-mg DSTs in 39 patients with adrenal incidentaloma, but no characteristic Cushingoid symptoms. In about half of these patients (20/39, 51.3%), high-dose DST was positive but low-dose was negative, and one or more of the other abnormalities of hypothalamus-pituitary-adrenal axis dysfunction was seen in 75% of these patients. Furthermore, no significant difference in incidence of glucose intolerance and hypertension was noted in patients with positive high-dose DST and negative low-dose DST compared with patients with positive low- and high-dose DST. Under the current MHLW diagnostic criteria, patients with positive high-dose DST and negative low-dose DST are not diagnosed with PreCS, but some of these patients should be. Discrepancies in the results of low- and high-dose DSTs appear attributable to the current cutoff values, and further investigations are necessary to resolve these discrepancies.

Adverse events with rhGH treatment of patients with chronic renal insufficiency and end-stage renal disease

Objective Recombinant human growth hormone (rhGH) has been used to improve the growth retardation associated with chronic renal insufficiency (CRI) and end-stage renal disease. We determined the incidence of one of four targeted adverse events (AEs): malignancy, slipped capital femoral epiphysis (SCFE), avascular necrosis (AN), and intracranial hypertension (ICH). Study design During a 6.5-year period, we prospectively assessed patients enrolled in the CRI, dialysis, and transplant registries of the North American Renal Transplant Cooperative Study. The availability of an untreated control population facilitated determining whether or not there was the association between the AE and rhGH treatment. Results Of the targeted AE, the only significant relation with rhGH treatment was the presence of ICH in patients with CRI; however, in all 3 instances, ICH occurred 2, 50, and 1131 days after discontinuation of rhGH. Considering that the mechanism of ICH in rhGH-treated patients is thought to be increased CSF production, rhGH probably had no role in the development of ICH in at least 2 of the 3 patients with CRI. A number of nontargeted AE were identified that have been associated with rhGH treatment in patients without renal disease. The incidence of glucose intolerance, pancreatitis, progressive deterioration of renal function, acute allograft rejection, and fluid retention were not more frequent in those receiving rhGH treatment compared with the control population. Conclusions This report validates the importance of a control population in ascribing AE to any therapeutic intervention. Previously identified AE associated with rhGH treatment are infrequent in patients with CRI and end-stage renal disease. (J Pediatr 2003;142:539-45)

Diabetic family history is an isolated risk factor for gestational diabetes after 30 years of age

Family history of diabetes is regarded as a risk factor for gestational glucose intolerance. Most selective screening policy includes family history as an indication of oral glucose tolerance test. However, few studies had evaluated the actual incidence of glucose intolerance in this group of women. Pregnant women with oral glucose tolerance test performed for family history of diabetes over two consecutive years were identified. Receiver operating curve was used to identify the age cut-off that give the highest sensitivity and specificity. The incidence of glucose intolerance was compared between women with age above and below this cut-off. One hundred and eighty-seven women were identified. The age cut-off selected was 30.5 years. In young women (age <or= 30 years) with family history alone, the incidence of glucose intolerance is similar to that in the low risk pregnant population (12.5% and 6.3% for 8.0 mmol/L and 9.0 mmol/L cut-off for two hour value of 75 g oral glucose tolerance test, respectively). In women aged above 30 years, the incidence of glucose intolerance raised by three fold (35.2% and 22.0% for 8.0 mmol/L and 9.0 mmol/L cut-off, respectively). The risk of glucose intolerance in young women with positive family history is similar to that in the background pregnant population. Standard oral glucose tolerance test may not be necessary in this group of women if selective screening policy is adopted.

Diabetic family history is an isolated risk factor for gestational diabetes after 30 years of age

Background. Family history of diabetes is regarded as a risk factor for gestational glucose intolerance. Most selective screening policy includes family history as an indication of oral glucose tolerance test. However, few studies had evaluated the actual incidence of glucose intolerance in this group of women. Methods. Pregnant women with oral glucose tolerance test performed for family history of diabetes over two consecutive years were identified. Receiver operating curve was used to identify the age cut-off that give the highest sensitivity and specificity. The incidence of glucose intolerance was compared between women with age above and below this cut-off. Results. One hundred and eighty-seven women were identified. The age cut-off selected was 30.5 years. In young women (age ≤ 30 years) with family history alone, the incidence of glucose intolerance is similar to that in the low risk pregnant population (12.5% and 6.3% for 8.0 mmol/L and 9.0 mmol/L cut-off for two hour value of 75 g oral glucose tolerance test, respectively). In women aged above 30 years, the incidence of glucose intolerance raised by three fold (35.2% and 22.0% for 8.0 mmol/L and 9.0 mmol/L cut-off, respectively). Conclusions. The risk of glucose intolerance in young women with positive family history is similar to that in the background pregnant population. Standard oral glucose tolerance test may not be necessary in this group of women if selective screening policy is adopted.

7-yr incidence of glucose intolerance in a population-based study of Japanese-Brazilians: Preliminary data

7-yr incidence of glucose intolerance in a population-based study of Japanese-Brazilians: Preliminary data

Chromium status of tannery workers in relation to metabolic disorders.

Chromium (Cr), being an excellent tanning agent, is widely used in the leather industry. In the process of leather production, tannery workers are exposed to either inorganic Cr(III) compounds or Cr bound to proteins (leather dust). The total Cr content in tannery air (1-54 microg m(-3)) is rather high in comparison to ambient air (4-6 ng m(-3)) but the amount of Cr in inhalable particles (<10 microm) is two to three orders of magnitude less (20-60 ng m(-3)). The total daily intake of Cr was estimated by the analysis of diet (24.3 +/- 4.0 microg Cr day(-1)), drinking water (0.3 +/- 0.1 microg Cr dm(-3)) and ambient air. The contribution of the latter was dominant for tannery workers and almost negligible (8%) for the unexposed population. Chromium is an essential nutrient required for sugar and fat metabolism. The normal dietary intake of Cr for the occupationally unexposed population is found to be suboptimal (<30 microg Cr day(-1)) whereas tannery workers receive on average 150-325 microg of supplemental Cr day(-1). Assessment of the Cr status of both populations was made on the basis of the Cr contents of their scalp hair, pre-shift urine and thermally induced sweat. The median Cr contents in these tissues and fluids were significantly higher (P<0.01) in tannery workers (hair: 4 microg Cr g (-1), urine: Cr/creatinine 1.7 microg Cr g(-1), sweat: 25 microg Cr dm(-3)) in comparison with the control group (hair: 0.16 microg Cr g(-1), urine: Cr/creatinine 0.13 microg Cr g (-1), sweat: 0.7 microg Cr dm(-3)). Tannery workers absorbed up to 13 times more Cr in comparison to controls, the amount varying considerably depending on the workplace and duration of exposure. The main route of Cr absorption appears to be through the gastrointestinal tract, where medium to large particles play a dominant role. The absorption of Cr from leather dust may be more efficient in comparison to inorganic Cr(III) compounds. Under normal circumstances sweat Cr losses represent at least 20% of urinary Cr excretion. The incidence of glucose intolerance and disturbed lipid metabolism was compared between the unexposed (control) population (n=150) and a population of tannery workers (n=138) from the same residential area. The percentage of glucose-intolerant subjects was significantly (P<0.01) lower in the older subgroup (age>48 years), who were even more obese, but not in the whole tannery population in comparison to controls. In the group of subjects displaying glucose intolerance, those from the control population showed a significantly higher body mass index (BMI) of 32.3 and a considerably larger proportion of females (86%) in comparison to subjects from the tannery population (28.2 and 60%, respectively). There was no significant difference in total serum cholesterol levels between the groups. Results of other lipid variables, such as high-density lipid (HDL) cholesterol, low-density lipid (LDL) cholesterol and triglycerides, are controversial: namely, the HDL/LDL ratio was higher for the controls, who showed in contrast significantly higher serum triglyceride levels in comparison to the older subgroup of tannery workers. The possible effects of other parameters on serum HDL-cholesterol level are outlined but the influence of Cr on lipid metabolism in tannery workers remains unclear.