Incidence Of Impaired Glucose Tolerance Research Articles

Women with a history of gestational diabetes mellitus present an accumulation of cardiovascular risk factors at age 46-A birth cohort study.

The incidence of gestational diabetes mellitus (GDM) is globally increasing, and it has been associated with later type 2 diabetes, metabolic syndrome (MetS), and cardiovascular disease (CVD). However, long-term population-based studies investigating common CVD risk factors years after pregnancy are lacking. To evaluate the future mortality and morbidity in cardiovascular and metabolic diseases, we conducted a thorough investigation of midlife risk factors in women with and without previous GDM. A prospective population-based cohort study was conducted of 3173 parous women from the Northern Finland Birth Cohort, 1966. Study participants were obtained from the national register or patient records. Those with a GDM diagnosis formed the GDM cohort (n = 271), and those without a previous GDM diagnosis formed the control cohort (n = 2902). Clinical examinations were performed on participants at the age of 46 and included anthropometric measurements, oral glucose tolerance test (OGTT), biochemical measurements, and cardiovascular assessment. At the age of 46, women in the GDM cohort had a higher body mass index (BMI, 29.0 kg/m2 vs 26.3 kg/m2, p < 0.001) and greater waist circumference (94.1 cm vs 86.5 cm, p < 0.001) than the control cohort. In the GDM cohort, a higher incidence of impaired glucose tolerance (12.6% vs 7.3%, p = 0.002), more previously diagnosed and OGTT-detected type 2 diabetes (23.3% vs 3.9%, p < 0.001), lower high-density lipoprotein (1.53 mmol/L vs 1.67 mmol/L, p = 0.011), higher triglycerides (1.26 mmol/L vs 1.05 mmol/L, p = 0.002) and a higher fatty liver index (6.82 vs 2.47, p < 0.001), were observed even after adjusting for BMI, polycystic ovary syndrome, parity, level of education, physical activity, smoking, and alcohol consumption. The women in the GDM cohort also had more MetS (42.6% vs 21.9%, p < 0.001) and higher risk scores for CVD and fatal events (Framingham 4.95 vs 3.60, p < 0.001; FINRISK 1.71 vs 1.08, p < 0.001). Women with a previous diagnosis of GDM exhibit more risk factors for CVD in midlife and are at a higher risk for cardiovascular events later in life.

Body Fat Distribution Contributes to Defining the Relationship between Insulin Resistance and Obesity in Human Diseases.

The risk for metabolic and cardiovascular complications of obesity is defined by body fat distribution rather than global adiposity. Unlike subcutaneous fat, visceral fat (including hepatic steatosis) reflects insulin resistance and predicts type 2 diabetes and cardiovascular disease. In humans, available evidence indicates that the ability to store triglycerides in the subcutaneous adipose tissue reflects enhanced insulin sensitivity. Prospective studies document an association between larger subcutaneous fat mass at baseline and reduced incidence of impaired glucose tolerance. Case-control studies reveal an association between genetic predisposition to insulin resistance and a lower amount of subcutaneous adipose tissue. Human peroxisome proliferator-activated receptorgamma (PPAR-γ) promotes subcutaneous adipocyte differentiation and subcutaneous fat deposition, improving insulin resistance and reducing visceral fat. Thiazolidinediones reproduce the effects of PPAR-γ activation and therefore increase the amount of subcutaneous fat while enhancing insulin sensitivity and reducing visceral fat. Partial or virtually complete lack of adipose tissue (lipodystrophy) is associated with insulin resistance and its clinical manifestations, including essential hypertension, hypertriglyceridemia, reduced HDL-c, type 2 diabetes, cardiovascular disease, and kidney disease. Patients with Prader Willi syndrome manifest severe subcutaneous obesity without insulin resistance. The impaired ability to accumulate fat in the subcutaneous adipose tissue may be due to deficient triglyceride synthesis, inadequate formation of lipid droplets, or defective adipocyte differentiation. Lean and obese humans develop insulin resistance when the capacity to store fat in the subcutaneous adipose tissue is exhausted and deposition of triglycerides is no longer attainable at that location. Existing adipocytes become large and reflect the presence of insulin resistance.

EPS4.02 Earlier identification of cystic fibrosis diabetes in children with cystic fibrosis – real-world experience on the use of continuous (flash) glucose monitoring

Background: Annual screening for CF diabetes (CFD) is recommended from aged 10 years. A 2 hour blood glucose (BG) reading on OGTT of >11.1 mmol/l is diagnostic for CFD, however data on incidence of impaired glucose tolerance (IGT) are limited. Continuous glucose monitoring (CGM) alongside regular diet better defines daily BG excursions aiding interpretation of glycaemic control.

Incidence of impaired glucose tolerance and diabetes mellitus in transfusion dependent thalassemia patients of rural Bengal - An institutional study

: Thalassemia is the world’s commonest monogenic disorder. Molecular biology and genetics have revealed more than 200 mutations of thalassemia syndrome. These children become symptomatic from progressive haemolytic anaemia. They have to take lifelong treatments with regular packed red blood cell transfusion. Our body has no effective means of iron excretion and this leads to progressive iron accumulation in various organs after prolonged blood transfusion. This results in dysfunction of liver, heart and endocrine system and increased mortality. Iron toxicity to pancreatic beta cell leads to impairment in glucose metabolism. : Our study aims to find out the incidence of impaired glucose tolerance (IGT) and diabetes mellitus (DM) in transfusion dependent thalassemia major patients. This is an observational descriptive study carried out from January 2017 to June 2018. The study included 48 samples. There post-prandial blood sugar level and glycated haemoglobin (HbA1c) was analysed. Any proved case of juvenile diabetes mellitus was excluded from the study. We found that the incidence of IGT and DM were 12.5% and 4.16% respectively in our study population. The blood sugar level was significantly high in study group (p=&amp;#60;0.0001) as compared to the control group. The present study showed strong correlation between units of blood transfusion and blood sugar level as well as HbA1C percentage (in both cases p= &amp;#60;0.00001.)Thalassemia patients receiving regular blood transfusion are at increased risk of developing IGT and DM. Early initiation of chelation and judicious use of blood transfusion must be considered for these patients to prevent such complications.

Relationship between BMI and risk of impaired glucose tolerance and impaired fasting glucose in Chinese adults: a prospective study

BackgroundCurrent studies in most Western countries have largely focused on body mass index (BMI) as an important risk factor for impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), which have different pathophysiological bases. In people with obesity, the prevalence of IGT is higher and the prevalence of IFG is lower. The prevalence of IGT in the Asian population is higher than that in the white population, and the obesity rate in China is still increasing. However, few cohort studies explore the relationship between BMI and the incidence of IGT and IFG in China. We aimed to explore the relationship between BMI and the risk of IGT and IFG in Chinese adults and analyze the differences between them.MethodsThe baseline data were obtained from the 2010 China Chronic Disease and Risk Factor Surveillance, of which 20 surveillance sites were followed up from 2016 to 2017. Finally, in this study, a total of 5,578 studies were grouped into BMI categories of underweight (BMI < 18.5 kg/m2), normal weight (18.5–23.9 kg/m2), overweight (24.0–27.9 kg/m2), and obesity (≥ 28.0 kg/m2). We used the unconditional logistic regression model to analyze the relationship between BMI and the risk of IGT and IFG.ResultsDuring an average follow-up of 6.4 years, 562 developed IGT and 257 developed IFG. After age, gender, urban and rural areas, physical activity, family history of diabetes, hypertension, abdominal obesity, dyslipidemia, and other factors were adjusted, overweight increased the risk of IGT by 35% [odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08–1.70], and obesity increased the risk of IGT by 77% (OR 1.77, 95% CI 1.27–1.47). After the factors consistent with the above were adjusted, only obesity increased the risk of IFG by 122% (OR 2.22, 95% CI 1.39–3.54).ConclusionsIn China, obesity is an important risk factor for IGT and IFG, and the risk of IGT increases during the overweight stage.

1194-P: Gender Differences in Incidence of Prediabetes and Diabetes in South Asians

Background: Among South Asians, women have higher prevalence of diabetes than men, but few studies have examined gender differences in incidence. Methods: We analyzed data from 2714 adults aged ≥20 years, enrolled in the Chennai site of prospective Cardiometabolic risk reduction in South Asia (CARRS) study. We defined normal glucose tolerance (NGT) , isolated impaired fasting glucose (iIFG) , impaired glucose tolerance (IGT) , and diabetes based on ADA criteria. We estimated incidence densities for: NGT (n=2205) to iIFG and iIFG (n=641) to diabetes; NGT (n=2205) to IGT; and IGT (n=341) to diabetes. Results: Prevalence of iIFG was higher in women (20.5% vs. 11.8%) , while prevalence of IGT was lower (6.6% vs. 8.5%) than in men. During median 2.6 y (IQR: 0.7, 5.8) of follow-up, 316 individuals progressed from NGT to iIFG, 239 from NGT to IGT, 155 from iIFG to diabetes, and 135 from IGT to diabetes. Overall, incidence (95% CI) of NGT to iIFG was higher than incidence of NGT to IGT (36.3 [32.5, 40.5] vs. 27.4 [24.1, 31.1] per 1,000 person-years [PYR], respectively) . However, the incidence of iIFG to diabetes was lower than incidence of IGT to diabetes (47.3 [40.4, 55.4] vs. 77.1 [65.1, 91.3] per 1,000 PYR, respectively) . Compared with men, women had higher conversion from NGT to iIFG (42.1 [36.9, 48] vs. 27.7 [22.7, 33.8]) , but lower incidence of NGT to IGT, 22.9 (19.2, 27.4) vs. 34.2 (28.5, 40.9) . Women had higher conversation both from iIFG to diabetes [49.0 (40.8,58.8) vs. 43.1 (31.6,58.7) ] and IGT to diabetes (87.7 [70.5,109.0] vs. 65.3 [50.0,85.2]) . In Cox models adjusting for age, BMI and family history of diabetes, women were 1.41 times (95% CI: 1.07,1.84) likely to convert from NGT to iIFG compared to men, but, men are 1.76 (1.33, 2.34) times at risk from NGT to IGT. There was no gender difference for conversion from iIFG or IGT to diabetes. Conclusion: Prevalence and incidence of iIFG is higher in South Asian women than men, while prevalence and incidence of IGT is higher in men. Conversion from iIFG or IGT to diabetes is similar among genders. Disclosure K.Narayan: n/a. H.H.Chang: None. N.Tandon: None. V.Mohan: None. D.Kondal: None. L.R.Staimez: None. R.Anjana: None. U.Gujral: None. M.Deepa: None. S.A.Patel: Research Support; Johnson &amp; Johnson. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck &amp; Co., Inc. D.Prabhakaran: None. Funding The National Heart, Lung, and Blood Institute (NHLBI) , National Institutes of Health (HHSN268200900026C)

Screening of Diabetes in Pregnancy at Nepalgunj Medical College Teaching Hospital Kohalpur

Introduction: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of variable severity or hyperglycemia occuring for the first time during pregnancy but the glucose intolerance reverting back to normal after the puerperium. According to American Diabetic Association, approximately 7% of all pregnancy are complicated by Gestational Diabetes Mellitus, resulting in more than two lakhs cases annually and the prevalence may range from 1-14% of all pregnancies. Gestational Diabetes Mellitus usually develop in the second trimester and carries grave prognosis both for mother and fetus. So screening of diabetes is necessary for early detection of diabetes and prevention of further progression. Aims: Screening of impaired glucose tolerance and gestational diabetes mellitus by glucose challenge test (GCT) and oral glucose tolerance test (OGTT) at 24-28 weeks of pregnancy. Methods: This study was conducted in Nepalgunj Medical College Teaching Hospital over one year period taking 98 pregnant women who came to ANC (Antenatal Check up) out patient department. Screening for diabetes was done giving 50 gm of oral glucose (glucose challenge test) to the pregnant women at 24-28 weeks of gestational age. Results: The incidence of Impaired glucose tolerance and gestational diabetes in this study population was 4.1% and 1% respectively. Conclusion: Screening of Diabetes mellitus in Second trimester of pregnancy is important investigation to be done to prevent the mother and the fetus from many upcoming complications of diabetes.

Interventional effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus.

To investigate the effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus (GDM). One hundred and twelve patients with GDM in the second trimester of pregnancy were recruited from Women's Hospital, Zhejiang University School of Medicine. Patients were randomized into two groups with 56 in each group: the control group received basic nutrition support; while the dietary fiber group were given additional dietary fiber ( total dietary fiber per day) before meals in addition to basic nutrition support. Intervention for all cases lasted for 8 weeks. Fasting blood glucose and postprandial blood glucose (2 h BG) were measured every week, and oral glucose tolerance test (OGTT) was performed at 42 d postpartum to evaluate the glycemic outcomes. Perinatal outcomes were recorded. The dietary fiber intervention markedly improved 2 h BG in patients with GDM and significantly elevated the glucose compliance rate from the 3rd to 8th week compared to the control group ( <0.05 or <0.01). OGTT 2 h glucose and the incidence of impaired glucose tolerance in the dietary fiber group were significantly lower than those in the control group, while the glucose compliance rate was significantly higher than that in the control group (all <0.01). Moreover, the rates of adverse perinatal outcomes, such as premature rupture of membranes and neonatal hyperbilirubinemia were declined in the dietary fiber group (<0.05 or <0.01). Dietary fiber intervention can ameliorate hyperglycemia in GDM patients, improve perinatal outcomes and reduce the incidence of postpartum impaired glucose tolerance.

To assess clinical profile of oral glucose tolerance in pulmonary tuberculosis patient

Introduction: Tuberculosis (T.B), which is one of the oldest disease known to affect human and is likely to have existed in pre hominids, is a major cause of death worldwide. This disease is caused by bacteria of the mycobacterium tuberculosis complex and usually affects the lungs, although other organs are involved in upto one- third of cases. Diabetes Mellitus (D.M.) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.Subject and Methods: In this study 75 newly diagnosed cases of pulmonary tuberculosis patients were evaluated. A cross section of both male and female diagnosed case of pulmonary tuberculosis attending the outdoor and indoor of various department were taken into study. A detailed history, clinical examination and relevant investigations were performed. Collected data were analysed by using appropriate software.Result: This study of 75 cases showed overall incidence of impaired glucose tolerance as 17.33% in patients with pulmonary tuberculosis. Among 82.67% patients GTT was normal (Fasting 126mg/dl and 2hours >200 mg/dl) was diagnosed.Conclusion: This study showed no statistically significant association of sex, age and chest X-ray findings in patients with pulmonary tuberculosis and diabetes mellitus.

Gestational diabetes mellitus in a multiethnic population in Spain: Incidence of and factors associated to impaired glucose tolerance one year after delivery

Background and aimWomen with history of gestational diabetes mellitus (GDM) are at increased risk for diabetes. Ethnicity may modify such risk, but no studies have been conducted in our environment. The aim of this study was to assess the incidence of type 2 diabetes mellitus and prediabetes one year after delivery in women with GDM and in a multiethnic background and to identify the associated factors. Patients and methodsA retrospective analysis of a prospective, observational cohort of women with GDM who attended annual postpartum follow-up visits at Hospital del Mar from January 2004 to March 2016. ResultsThree hundred and five women attended postpartum follow-up visits. Of these, 47.2% were Caucasian, 22% from South-Central Asia, 12% from Latin America, and 10% from Morocco and East Asia. Incidence rates of type 2 diabetes mellitus and prediabetes in these patients were 5.2 and 36.6%, respectively. In a multivariate analysis, non-Caucasian origin (OR=3.15, 95% CI [1.85–5.39]), recurrent gestational diabetes (OR=2.26, 95% CI [1.11–4.59]), and pre-pregnancy body mass index (OR=1.09, 95% CI [1.04–1.15]) were independent predictors of impaired glucose tolerance. ConclusionsIn a multiethnic Spanish population of women with GDM, incidence of impaired glucose tolerance in the first year after delivery was 41.8%, with a three-fold increased risk for women of non-Caucasian ethnicity.

Incidencia y factores asociados al metabolismo alterado de la glucosa un año después del parto en una población multiétnica de mujeres con diabetes mellitus gestacional en España

Background and aimWomen with history of gestational diabetes mellitus (GDM) are at increased risk for diabetes. Ethnicity may modify such risk, but no studies have been conducted in our environment. The aim of this study was to assess the incidence of type 2 diabetes mellitus and prediabetes one year after delivery in women with GDM and in a multiethnic background and to identify the associated factors. Patients and methodsA retrospective analysis of a prospective, observational cohort of women with GDM who attended annual postpartum follow-up visits at Hospital del Mar from January 2004 to March 2016. ResultsThree hundred and five women attended postpartum follow-up visits. Of these, 47.2% were Caucasian, 22% from South-Central Asia, 12% from Latin America, and 10% from Morocco and East Asia. Incidence rates of type 2 diabetes mellitus and prediabetes in these patients were 5.2 and 36.6%, respectively. In a multivariate analysis, non-Caucasian origin (OR=3.15, 95% CI [1.85-5.39]), recurrent gestational diabetes (OR=2.26, 95% CI [1.11-4.59]), and pre-pregnancy body mass index (OR=1.09, 95% CI [1.04-1.15]) were independent predictors of impaired glucose tolerance. ConclusionsIn a multiethnic Spanish population of women with GDM, incidence of impaired glucose tolerance in the first year after delivery was 41.8%, with a three-fold increased risk for women of non-Caucasian ethnicity.

A cohort follow-up study of the relationship between serum liver enzymes and the incidence of impaired glucose tolerance in middle-aged and elderly Chinese people

Objective To study the relationship between liver enzymes [alanine transaminase(ALT), gamma-glutamyltransferase(GGT), aspartate amino transferase(AST)] and the incidence of impaired glucose tolerance(IGT)in middle-aged and elderly people. Methods A group of middle-aged and elderly residents who participated in the REACTION study in 2011 from Guiyang community were enrolled in our study. Of which, a total of 4 228 participants with normal blood glucose detected by oral glucose tolerance test(OGTT)and serum ALT levels were investigated as baseline population. The baseline survey included questionnaire survey and physical examination(height, weight, waist circumference, blood pressure, etc.), and the serum ALT, AST, GGT, total cholesterol(TC), triglyceride(TG), high density lipoprotein-cholesterol(HDL-C), low density lipoprotein-cholesterol(LDL-C), fasting blood glucose, postprandial 2h plasma glucose(2hPG)in OGTT, and fasting insulin(FINS)were tested. After 3 years of follow-up, all subjects received quartile grouping according to the basal liver enzyme levels, and the incidence of IGT was respectively calculated. One-way analysis of variance was used to compare the differences of basal liver enzyme levels between IGT and normal blood glucose groups. The risk of IGT based on quartile grouping was assessed by multivariate regression analysis, and the odds ratios(ORs)were estimated by the logistic regression model. Results After eliminating the 35 died patients, 3 188 participants were followed over 3 years. Among them, 2 400 subjects revealed normal blood glucose level, 61 developed into type 2 diabetes mellitus(T2DM), 91 developed into IFG, and 636 developed into IGT. The incidence of IGT increased along with the elevation of serum ALT level(P<0.01). After adjusting the risk factors including body mass index, regular smoking, regular drinking, regular exercise, family history of diabetes, homeostasis model assessment for insulin resistant index(HOMA-IR), post-load 2h blood glucose, and GGT, the results manifested that patients in high basal ALT level group had 1.462-fold chance of susceptibility in developing IGT compared with that in the low level group, with 95%CI of 1.129 to 1.891. The analysis based on gender showed that the incidence of IGT was associated with basal ALT level in the female group. The OR value was estimated to be 1.481(95%CI 1.107-1.981)in high basal ALT level group as compared with the low level group. Basal serum GGT and AST levels were not associated with the incidence of IGT. Conclusion Even an elevated level of ALT within normal reference range also tends to be a risk factor for IGT in middle-aged and elderly women. (Chin J Endocrinol Metab, 2018, 34: 16-23) Key words: Alanine transaminase; Gamma-glutamyltransferase; Aspartate aminotransferase; Impaired glucose tolerance; Cohort study

Incidence of Impaired Glucose Tolerance Assessed by Glycated Hemoglobin and Fasting Plasma Glucose in Patients with Acute Coronary Syndromes and its Impact on Clinical and Angiographic Outcomes

Impaired glucose tolerance (IGT); diabetes and prediabetes, is common among patients with CAD. Diabetic patients usually have a worse clinical course, so it is important to detect diabetes and even prediabetes, since progress to T2DM can be retarded by lifestyle interventions. It is known that OGTT is recommended in patients with CAD, but still HbA1c and FPG are more clinically applicable. Our study aimed to assess the incidence of IGR in patients with ACS using HbA1 and FPG as most of previous studies used OGTT and to study the impact of IGR on in hospital clinical outcomes and severity of coronary arteries lesions using Syntax score.

Time-cumulated blood pressure exposure and incident impairment of glucose tolerance and diabetes mellitus

BackgroundWith the marked increase in the prevalence of diabetes mellitus, it was the purpose of our study to assess a potential association of time-cumulated exposure to systolic (CumSBP) and of diastolic blood pressure (CumDBP) with onset of impaired glucose tolerance and diabetes mellitus.MethodsThe prospective investigation included participants of the longitudinal Kailuan Study with three baseline examinations in 2006–2007, 2008–2009 and 2010–2011, re-examination in 2012–2013, and no diabetes mellitus at baseline. Cumulative blood pressure (BP) was calculated as cumBP = [(BP1 + BP2)/2 × time1–2] + [(BP2 + BP3)/2 × time2–3]. Based on cumSBP, the study population was stratified into four groups (cumSBP < 480mmHgxyear;n = 15,339; 480mmHgxyear ≤ cumSBP < 520mmHgxyear;n = 7214; 520mmHgxyears ≤ cumSBP < 560mmHgxyears;n = 5675; and cumSBP ≥ 560mmHgxyears;n = 10,576).ResultsAfter adjusting for demographic, anthropomorphic, biochemical, socioeconomic and lifestyle parameters and as compared with the first group, the second, third and fourth group showed a significantly higher incidence of diabetes (P-trend < 0.001;hazard ratio (HR);95% confidence interval (CI):1.28(1.08,1.51),1.54(1.29,1.84), and 2.33(1.98,2.73), respectively), higher incidence of impairment of glucose tolerance (P-trend < 0.001;HR;95% CI1.17(1.02,1.33), 1.43(1.25,1.64), and 2.09(1.85,2.37), respectively), and higher incidence of diabetes developing out of an impairment of glucose tolerance (P-trend < 0.001;HR;95% CI:1.22(0.97,1.54),1.47(1.16,1.86), and 2.01(1.62,2.50), respectively). An increase in cumSBP by 10 mmHg/year or an increase in cumDBP by 5 mmHg/year was associated with a hazard ratio of incident diabetes of 1.04 (95% CI:1.03,1.04) and 1.02(1.02,1.03), respectively, with a hazard ratio of incident impairment of glucose tolerance of 1.04(95% CI:1.03,1.04) and 1.03(95% CI:1.02,1.03), respectively, and with a hazard ratio of incident diabetes developing from impairment of glucose tolerance of 1.04(95% CI:1.03,1.04) and 1.03(95% CI:1.02,1.03), respectively.ConclusionsTime-cumulated exposure to elevated blood pressure was significantly associated with an elevated incidence of impaired glucose tolerance and diabetes.

Incidence of Impaired Glucose Tolerance Test in Non-Diabetic Patients of Acute Coronary Syndrome and its Adverse Outcomes

Background: Myocardial infarction, it still continues to be a major health problem worldwide. The aim of the study is to find out incidence of impaired glucose tolerance in non-diabetic patients with acute coronary syndrome. Methods: The study includes 50 patients. All the cases and controls were subjected to standard 75 gms. Oral Glucose Tolerance Test (OGTT) on admission, at the time of discharge and at three months follow-up and the observations were recorded. Results: Post prandial blood sugar at time 3 month follow up were 6 (12%) in cases and 9 (18%) in control but not significant statistically. There were 17 (34%) cases and 7 (14%) in control with IGT values which was statistically significant p= 0.034. Post prandial blood sugar at time of admission were 131.18 ± 21.52 in cases, 121.86 ± 21.47 in controls and at the time discharge in cases and controls were 139.10 ± 21.27 and 128.88 ± 9.44 respectively with p=0.003. Conclusion: Patients with acute coronary syndrome who have IGT on admission have longer hospital stay and more complications related to acute MI.

Elevated liver enzymes are related to progression to impaired glucose tolerance in Japanese men

To investigate whether the elevation of liver enzymes is associated with the progression from normal to impaired glucose tolerance. A historical cohort study was conducted in 594 male workers at public schools, who had normal glucose tolerance at baseline. The progression to impaired glucose tolerance and impaired fasting glycaemia during a mean follow-up of 3.1 years was measured using an oral glucose tolerance test. Overall, 141 (23.7%) subjects developed impaired glucose tolerance and 68 (11.4%) subjects developed impaired fasting glycaemia, 23 of whom had combined impaired fasting glycaemia/impaired glucose tolerance. The incidence of impaired glucose tolerance increased significantly with increasing quartiles of serum aspartate aminotransferase, alanine aminotransferase and γ-glutamyltransferase (P for trend <0.01). In Cox proportional hazards regression analysis, after adjusting for comprehensive risk factors, including plasma glucose levels, BMI and homeostatic model assessment of insulin resistance, the risk of progression to impaired glucose tolerance was significantly higher in the highest quartile of alanine aminotransferase than in the lowest quartile (hazard ratio 2.5; 95% CI 1.1-5.7). A significant association between alanine aminotransferase and the progression to impaired glucose tolerance was found after further adjustments for other liver enzymes or after the sample was limited to those with BMI < 25.0 kg/m(2) or with fasting plasma glucose < 5.5 mmol/l. A higher level of alanine aminotransferase was independently associated with progression from normal to impaired glucose tolerance in Japanese men. The elevation of alanine aminotransferase may be a change that occurs early in the evolution of diabetes.

Comparative Effect of Antihypertensive Therapy on Blood Glucose Level in Hypertensive Patients in an Indian Population

Hypertensive patients have higher prevalence of insulin resistance and are at increased risk of developing type 2 diabetes mellitus (DM). There is scarcity of data on the relationship between antihypertensive therapies and glycaemic control in Indian population. Thus, the present study was designed to investigate such association among Indian population in a University teaching hospital.The study was carried out on 177 hypertensive patients (with new onset of diabetes or without diabetes) visiting the OPD of medicine department at Majeedia hospital, New Delhi. The drug history of hypertensive patients and blood glucose levels following 1-5 yrs of antihypertensive therapy were recorded.The gender distribution of hypertensive patients reveals a higher percentage of incidences in males (53.7%) as compared to females (46.3%). Hypertensive patient without DM on beta blockers and on thiazide shows higher incidence of impaired glucose tolerance (IGT) (17.5%, 18.5%) and DM (10%, 11%) as compared to patient receiving other antihypertensive therapy. While in patients of new onset diabetes the incidence was higher with β-blockers (56.2%) than with thiazides (31.3%) followed by calcium channel blockers (CCBs) (12.5%). There was proportionate increase in incidence with the duration of therapy (3-5 years). None of the patients who were on ACE inhibitors or on angiotensin receptor blockers (ARBs) reported any incidence of IGT or DM.To conclude, β-blockers and thiazides increases the risk of type 2 diabetes mellitus with long term antihypertensive therapy requiring regular monitoring. CCBs have lowered risks while ACE inhibitors and ARBs are relatively free of such metabolic adverse effects.

Glucose intolerance states in women with the polycystic ovary syndrome

The polycystic ovary syndrome (PCOS), the most common hyperandrogenic disorder affecting 4-7% of women, is often associated with metabolic alterations, chiefly insulin resistance and obesity. Based on available scientific evidence, PCOS should be regarded as an independent risk for the development of glucose intolerance states. This short review summarizes the available literature on the prevalence and incidence of impaired glucose tolerance and Type 2 diabetes in this disorder. In addition, some insights on potential factors responsible for individual susceptibility are discussed. Targeted intervention studies focused on prevention and treatment of glucose intolerance states in PCOS are warranted.

Value of admission glucose to predict impaired coronary microcirculation in acute ST-elevation myocardial infarction

Background: Acute hyperglycemia is frequently observed in non-diabetic ST-elevation myocardial infarction (STEMI) patients. It is thought to be associated with the release of stress-mediators like noradrenalin and cortisol, which antagonize insulin and promote glycogenolysis and hyperglycemia, or with the high incidence of impaired glucose tolerance among STEMI patients. Hyperglycemia recently was shown to be associated with the no-reflow phenomenon, which is mainly a manifestation of microvascular dysfunction. We recently showed that no-reflow (or not achieving TIMI 3 flow) with primary PCI for STEMI had independent prognostic value with regard tot 30-day, as well as 1-year mortality, next to admission glucose. Although no reflow in this study was an indirect measure of microvascular dysfunction, the significant association between no-reflow and increasing admission glucose and the attenuation of the effect of no-reflow by glucose concentration in multivariate analysis indicate the role of acute hyperglycemia in the pathophysiology of microvascular dysfunction. Methods: In 76 patients with a first anterior wall STEMI, baseline and minimal microvascular resistance in IRAs and non-IRAs immediately after reperfusion and at 1-week and 6-month follow-up were calculated as the ratio of mean transvascular pressure gradient to mean baseline and to adenosine-induced hyperemic blood flow velocity, respectively. Patients were divided in two groups, glucose below 11.0 mmol/L (group A) and glucose equal or higher than 11 mmol/L (group B), according to a cut-off level of the American Diabetes Association and the Euro Heart Survey. Results: Minimum microvascular resistance, defined as the ratio of mean distal pressure to average peak blood flow velocity during maximum hyperemia, showed a large variability (overall range, 0.75 to 4.89 mm Hg cm-1 s-1) and was significantly higher in group B than in group A immediately after reperfusion and at 1-week. Conclusion: In conclusion, minimal microvascular resistance is higher in anterior STEMI patients with hyperglycemia equal or above 11.0 mmol/L compared to patients with glucose leven lower than 11.0 mmol/L. Hyperglycemia in STEMI patients could prove to be an important predictor of microvacular dysfunction and obstruction.

The association between self-reported lack of sleep, low vitality and impaired glucose tolerance: a Swedish cross-sectional study

BackgroundThe increased incidence of impaired glucose tolerance (IGT), are serious public health issues, and several studies link sleeping disorders with increased risk of developing type 2 diabetes, impaired glucose tolerance and insulin resistance (IR). This study explore how self-reported lack of sleep and low vitality, are associated with IGT in a representative Swedish population.MethodsA cross-sectional survey conducted in two municipalities in South-western Sweden. Participants aged 30–75 were randomly selected from the population in strata by sex and age. Altogether, 2,816 participants were surveyed with a participation rates at 76%. Participants with normal glucose tolerance (n=2,314), and those with IGT (n=213) were retained for analyses. The participants answered a questionnaire before the oral glucose tolerance test (OGTT). Associations for questions concerning sleeping disorders, vitality and IGT were analysed using logistic regression and were expressed as odds ratios (OR) with 95% CI.ResultsIn men a statistically significant age-adjusted association was found between self-reported lack of sleep and IGT: OR 2.4 (95% CI: 1.1-5.4). It did not weaken after further adjustment for body mass index (BMI), smoking, education, and leisure time physical activity 2.3 (1.0-5.5, p=0.044). No such associations were found in females. Corresponding age-adjusted associations between low vitality and IGT in both men 2.8 (1.3-5.8), and women 2.0 (1.2-3.4) were successively lost with increasing adjustment.ConclusionsInsufficient sleep seems independently associated with IGT in men, while low vitality was not independently associated with IGT neither in men nor women, when multiple confounders are considered. IGT should be considered in patients presenting these symptoms, and underlying mechanisms further explored.