Diabetes Incidence In Men Research Articles

Sex-specific associations between skeletal muscle mass and incident diabetes: A population-based cohort study.

To investigate the sex-specific associations between predicted skeletal muscle mass index (pSMI) and incident type 2 diabetes in a retrospective longitudinal cohort of Chinese men and women. We enrolled Chinese adults without diabetes at baseline from WATCH (West chinA adulT health CoHort), a large health check-up-based database. We calculated pSMI to estimate skeletal muscular mass, and measured blood glucose variables and assessed self-reported history to identify new-onset diabetes. The nonlinear association between pSMI and incident type 2 diabetes was modelled using the penalized spline method. The piecewise association was estimated using segmented linear splines in weighted Cox proportional hazards regression models. Of 47 885 adults (53.2% women) with a median age of 40 years, 1836 developed type 2 diabetes after a 5-year median follow-up. In women, higher pSMI was associated with a lower risk of incident type 2 diabetes (Pnonlinearity = 0.09, hazard ratio [HR] per standard deviation increment in pSMI: 0.79 [95% confidence interval {CI} 0.68, 0.91]). A nonlinear association of pSMI with incident type 2 diabetes was detected in men (Pnonlinearity < 0.001). In men with pSMI lower than 8.1, higher pSMI was associated with a lower risk of incident type 2 diabetes (HR 0.58 [95% CI 0.40, 0.84]), whereas pSMI was not significantly associated with incident diabetes in men with pSMI equal to or greater than 8.1 (HR 1.08 [95% CI 0.93, 1.25]). In females, a larger muscular mass is associated with a lower risk of type 2 diabetes. For males, this association is significant onlyamong those with diminished muscle mass.

The Incidence of Diabetes Among 2,777,768 Veterans With and Without Recent SARS-CoV-2 Infection.

OBJECTIVETo examine associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection/coronavirus disease 2019 with incident diabetes.RESEARCH DESIGN AND METHODSWe conducted a retrospective cohort study using Veterans Health Administration data. We defined all patients without preexisting diabetes with one or more nasal swabs positive for SARS-CoV-2 (1 March 2020–10 March 2021; n = 126,710) as exposed and those with no positive swab and one or more laboratory tests (1 March 2020–31 March 2021; n = 2,651,058) as unexposed. The index date for patients exposed was the date of first positive swab and for patients unexposed a random date during the month of the qualifying laboratory test. We fit sex-stratified logistic regression models examining associations of SARS-CoV-2 with incident diabetes within 120 days and all follow-up time through 1 June 2021. A subgroup analysis was performed among hospitalized subjects only to help equalize laboratory surveillance.RESULTSSARS-CoV-2 was associated with higher risk of incident diabetes, compared with no positive tests, among men (120 days, odds ratio [OR] 2.56 [95% CI 2.32–2.83]; all time, 1.95 [1.80–2.12]) but not women (120 days, 1.21 [0.88–1.68]; all time, 1.04 [0.82–1.31]). Among hospitalized participants, SARS-CoV-2 was associated with higher risk of diabetes at 120 days and at the end of follow-up in men (OR 1.42 [95% CI 1.22–1.65] and 1.32 [1.16–1.50], respectively) but not women (0.72 [0.34–1.52] and 0.80 [0.44–1.45]). Sex ∗ SARS-CoV-2 interaction P values were all <0.1.CONCLUSIONSSARS-CoV-2 is associated with higher risk of incident diabetes in men but not in women even after greater surveillance related to hospitalization is accounted for.

Sex-Specific Associations of Circulating Uric Acid with Risk of Diabetes Incidence: A Population-Based Cohort Study from Sweden.

ObjectiveTo explore the longitudinal, as well as sex-specific, associations between circulating uric acid (UA) and diabetes incidence.MethodsA cohort study of the Malmö Diet Cancer-cardiovascular Cohort (Malmö, Sweden) consisting of 3140 individuals without diabetes at baseline, was followed up until the end of 2018. Incident diabetes cases were identified by linking to local and national diabetes registers. Cox proportional hazard regression was used to assess plasma UA levels in relation to diabetes incidence with adjustment for established confounders.ResultsAt baseline, with increasing levels of UA, subjects were more likely to be older and have significantly higher body mass index, waist circumference, triglycerides, C-reactive protein, fasting glucose and 2-h plasma glucose postoral glucose tolerance test, and lower levels of high-density lipoprotein. During a mean follow-up period of 8.09±2.24 years, 315 (10.0%) participants developed diabetes, and diabetes incidence rates were 7.89, 9.48 and 18.11 per 1000 person-years for subjects in the 1st, 2nd, and 3rd tertiles of UA, respectively (log-rank test: p<0.001). With adjustment for potential confounders, elevated UA levels were significantly associated with increased risks of diabetes incidence, with the adjusted hazard ratio (HR) (95% confidence interval) for per standard deviation increment of UA of 1.22 (1.08–1.39, p=0.002). Compared with the 1st tertile of UA, the 3rd tertile showed significantly increased risk of diabetes incidence with the adjusted HR of 1.74 (1.24–2.45, p=0.002), and there was a significant trend between increasing tertiles of UA and diabetes incidence (trend test: p<0.001). Stratified analyses showed that elevated circulating UA levels were independently associated with increased risks of diabetes incidence in men but not in women, although the interaction between sex and UA was not statistically significant.ConclusionElevated circulating UA was independently associated with increased risk of diabetes incidence, especially for men.

Predicting the Development of Type 2 Diabetes in a Large Australian Cohort Using Machine-Learning Techniques: Longitudinal Survey Study.

BackgroundPrevious conventional models for the prediction of diabetes could be updated by incorporating the increasing amount of health data available and new risk prediction methodology.ObjectiveWe aimed to develop a substantially improved diabetes risk prediction model using sophisticated machine-learning algorithms based on a large retrospective population cohort of over 230,000 people who were enrolled in the study during 2006-2017.MethodsWe collected demographic, medical, behavioral, and incidence data for type 2 diabetes mellitus (T2DM) in over 236,684 diabetes-free participants recruited from the 45 and Up Study. We predicted and compared the risk of diabetes onset in these participants at 3, 5, 7, and 10 years based on three machine-learning approaches and the conventional regression model.ResultsOverall, 6.05% (14,313/236,684) of the participants developed T2DM during an average 8.8-year follow-up period. The 10-year diabetes incidence in men was 8.30% (8.08%-8.49%), which was significantly higher (odds ratio 1.37, 95% CI 1.32-1.41) than that in women at 6.20% (6.00%-6.40%). The incidence of T2DM was doubled in individuals with obesity (men: 17.78% [17.05%-18.43%]; women: 14.59% [13.99%-15.17%]) compared with that of nonobese individuals. The gradient boosting machine model showed the best performance among the four models (area under the curve of 79% in 3-year prediction and 75% in 10-year prediction). All machine-learning models predicted BMI as the most significant factor contributing to diabetes onset, which explained 12%-50% of the variance in the prediction of diabetes. The model predicted that if BMI in obese and overweight participants could be hypothetically reduced to a healthy range, the 10-year probability of diabetes onset would be significantly reduced from 8.3% to 2.8% (P<.001).ConclusionsA one-time self-reported survey can accurately predict the risk of diabetes using a machine-learning approach. Achieving a healthy BMI can significantly reduce the risk of developing T2DM.

The Relationship of Lean Body Mass With Aging to the Development of Diabetes.

Older adults have the greatest burden of diabetes; however, the contribution of age-related muscle loss to its development remains unclear. We assessed the relationship of lean body mass with aging to incident diabetes in community-dwelling adults. We studied participants in the Baltimore Longitudinal Study of Aging with median follow-up of 7 years (range 1-16). Cox proportional hazard models with age as the time scale were used. Time-dependent lean body mass measures were updated at each follow-up visit available. Participants included 871 men and 984 women without diabetes who had ≥ 1 assessment of body composition using dual x-ray absorptiometry. Incident diabetes, defined as self-reported history and use of glucose-lowering medications; or fasting plasma glucose ≥ 126 mg/dL and 2-hour oral glucose tolerance test glucose ≥ 200 mg/dL either at the same visit or 2 consecutive visits. The baseline mean [standard deviation] age was 58.9 [17.3] years. Men and women with a higher percentage of total lean body mass had lower fasting and 2-hour glucose levels, and less prediabetes (all P < 0.01). Among men, comparing highest versus lowest quartiles, percentage of total lean body mass (hazard ratio [HR], 0.46; 95% confidence interval, 0.22-0.97), percentage leg lean mass (HR, 0.38; 0.15-0.96), and lean-to-fat mass ratio (HR, 0.39; 0.17-0.89) were inversely associated with incident diabetes after accounting for race and attenuated after adjustment for height and weight. Conversely, absolute total lean body mass was positively associated with incident diabetes among women, with similar trends in men. No associations were observed with muscle strength or quality. Relatively lower lean body mass with aging is associated with incident diabetes in men and partially related to anthropometrics, but not so in women.

Dietary anti-inflammatory index, metabolic syndrome and transition in metabolic status; a gender-specific analysis of ATTICA prospective study

AimsTo examine the association between dietary anti-inflammatory index (D-AII) and metabolic syndrome (MetS)prevalence, 10-year (2002–2012) diabetes, hypertension, hypercholesterolaemia incidence and 10-year transition from healthy (absence of all MetS traits, excluding waist circumference) to unhealthy metabolic status. MethodsIn 2001–2002, n = 1514 men and n = 1528 women (>18 years old) in Athens, Greece, free of cardiovascular disease were recruited. MetS was defined according to the revised NCEP ATP III (2005) or the IDF criteria or the harmonized criteria. The validated D-AII was calculated using a standardized procedure (range 10–77). ResultsInverse associations were observed between D-AII and transition from healthy to unhealthy metabolic status (Odds Ratio (OR)3rd vs. 1st tertile = 0.88 95% Confidence Interval (95%CI)(0.73, 0.98)) and diabetes (OR3rd vs. 1st tertile = 0.55, 95%CI(0.29, 0.77)). In women, D-AII was inversely associated with transition from healthy to unhealthy metabolic status (OR3rd vs. 1st tertile = 0.55, 95%CI(0.26, 0.90), diabetes (OR3rd vs. 1st tertile = 0.41, 95%CI(0.18, 0.64) and hypertension (OR3rd vs. 1st tertile = 0.75, 95%CI(0.20, 0.95), yet only with diabetes incidence in men (OR3rd vs. 1st tertile = 0.62, 95%CI(0.38, 0.93). ConclusionsDiet with high anti-inflammatory load seems an effective preventive measure to retain a metabolically benign status, principally in terms of glycemic control.

Triglyceride to high-density lipoprotein cholesterol ratio is associated with incident diabetes in men: A retrospective study of Chinese individuals.

Aims/IntroductionDyslipidemia is commonly present in type 2 diabetes mellitus patients. Recently, the triglyceride : high‐density lipoprotein cholesterol (TG/HDL‐C) ratio, a novel parameter of lipid abnormality, has been seen as an independent predictor for incident diabetes. However, the correlation of the TG/HDL‐C ratio with incident diabetes in the Chinese population and how this relationship is impacted by sex have been rarely studied. In the present study, the correlation of the TG/HDL‐C ratio with incident diabetes is investigated between different sexes of the Chinese population.Materials and MethodsA total of 116,855 participants who were free of diabetes at baseline were enrolled in the study. The participants were grouped by the median value (0.82) of the TG/HDL‐C ratio. Then, participants were further analyzed according to their sex. Cumulative incidence and person‐years incidence were used to express the incidence rate. The predictive value of the TG/HDL‐C ratio for incident diabetes was probed by the Cox regression proportional hazards model.ResultsThe mean age of the participants was 44.1 ± 12.9 years, and 53% of participants (n = 62,868) were the men. A total of 2,685 incident diabetes cases occurred during the 3.1 years of the median follow‐up period. The cumulative incidence in total incident diabetes patients, men and women was 2.30% (2.21–2.38%), 3.01% (2.87–3.14%) and 1.47% (1.37–1.57%), respectively. After the adjustment of multivariate factors, the multivariate Cox regression analysis results showed that a higher TG/HDL‐C ratio was the independent predictive factor of incident diabetes in men (hazard ratio 1.30, 95% confidence interval 1.03–1.64), compared with women (hazard ratio 0.85, 95% confidence interval 0.53–1.38).ConclusionsAmong the Chinese population, the TG/HDL‐C ratio is an independent predictor for incident diabetes in male patients.

Longitudinal Changes of Body Composition Phenotypes and Their Association with Incident Type 2 Diabetes Mellitus during a 5-Year Follow-up in Koreans.

BackgroundTo elucidate longitudinal changes of complex body composition phenotypes and their association with incident type 2 diabetes mellitus.MethodsA total of 17,280 (mean age, 48.1±8.2 years) Korean adults who underwent medical check-ups were included. The mean follow-up duration was 5.5±0.5 years. Body compositions were assessed using a bioelectrical impedance analysis. Four body composition phenotypes were defined using the median of appendicular skeletal muscle mass (ASM) index and fat mass index: low muscle/low fat (LM/LF); high muscle (HM)/LF; LM/high fat (HF); and HM/HF groups.ResultsOf the individuals in the LM/LF or HM/HF groups, over 60% remained in the same group, and over 30% were moved to the LM/HF group. Most of the LM/HF group remained in this group. In the baseline HM/LF group, approximately 30% stayed in the group, and the remaining individuals transitioned to the three other groups in similar proportions. Incident diabetes was significantly lower in participants who remained in the HM/LF group than those who transitioned to the LM/LF or LM/HF group from the baseline HM/LF group in men. ASM index was significantly associated with a decreased risk for incident diabetes in men regardless of obesity status (adjusted odds ratio [OR], 0.71 per kg/m2; 95% confidence interval [CI], 0.52 to 0.97 in non-obese) (adjusted OR, 0.87; 95% CI, 0.77 to 0.98 in obese) after adjusting for other strong risk factors (e.g., baseline glycosylated hemoglobin and homeostasis model assessment of insulin resistance).ConclusionMaintenance of ASM may be protective against the development of type 2 diabetes mellitus in men, regardless of obesity status.

Testosterone Levels and Type 2 Diabetes-No Correlation with Age, Differential Predictive Value in Men and Women.

Most studies reporting on the association of circulating testosterone levels with type 2 diabetes in men are of cross-sectional design. Reports on the relevance of altered testosterone levels in women are scarce. Here, we evaluate the role of low serum testosterone levels for incident diabetes in men and women in a population setting of 7706 subjects (3896 females). During a mean follow up time of 13.8 years, 7.8% developed type 2 diabetes. Significant correlations of testosterone with high density lipoprotein (HDL)-cholesterol (R = 0.21, p < 0.001), body-mass-index (R = −0.23, p < 0.001), and waist-to-hip-ratio (R = −0.21, p < 0.001) were found in men. No correlation was found with age in men; in women, the correlation was negligible (R = 0.04, p = 0.012). In men, low testosterone levels predicted high risk of type 2 diabetes, while in women this relationship was opposite. Men with low testosterone levels showed increased risk of future diabetes (hazard ratio (HR) 2.66, 95% confidence interval (CI) 1.91–3.72, p < 0.001 in basic model; HR 1.56 95%, CI 1.10–2.21, p = 0.003). In women, low testosterone levels indicated lower risk with (HR 0.53, 95% CI 0.37–0.77, p = 0.003), while the association lost significance in the fully adjusted model (HR 0.72, 95% CI 0.49–1.05, p = 0.09). Low levels of testosterone predicted future diabetes in men. A borderline opposite association was found in women.

The Visceral Adiposity Index Is a Significantly Stronger Predictor of Incident Diabetes in Men than in Women

The visceral adiposity index (VAI) is a validated tool for the evaluation of visceral adiposity, using waist circumference, serum triglycerides, age and gender to diagnose this metabolic abnormality. We aimed at investigating the power of the VAI to predict diabetes incidence in men and in women. We prospectively recorded diabetes incidence in a large consecutive cohort of 1282 patients undergoing coronary angiography for the evaluation of established or suspected coronary artery disease who did not have diabetes at baseline. The VAI was calculated according to the Amato formula; diabetes was diagnosed according to ADA criteria. At baseline, the VAI score did not differ significantly between men (n=845) and women (230±199 vs. 238±239; p=0.247). Prospectively, 133 patients newly developed diabetes during a follow-up period of 3.7±0.9 years; diabetes incidence did not differ significantly between men and women (13.3 vs. 9.8%; p=0.093. The VAI significantly predicted incident diabetes in men but not in women both univariately (standardized odds ratios (ORs) of 1.71 [1.40-2.10]; p&amp;lt;0.001 and 1.09 [0.81-1.49]; p=0.565, respectively) and after multivariate adjustment (standardized adjusted ORs 1.56 [1.24-1.97]; p&amp;lt;0.001 and 1.[0.75-1.46]; p=0.790, respectively). An interaction term VAI x gender was statistically significant (p=0.017), indicating that the VAI was a significantly stronger predictor of diabetes incidence among men than women. We conclude that the VAI is a significantly stronger predictor of diabetes incidence in men than in women. Disclosure C.H. Saely: None. A. Vonbank: None. C. Heinzle: None. D. Zanolin: None. B. Larcher: None. A. Mader: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.

Sex differences in urine metabolites related with risk of diabetes using NMR spectroscopy: results of the study of health in pomerania

Recently research provides evidence that blood metabolite profiles predicted type 2 diabetes. We aimed to assess the relation of urine metabolites measured via nuclear magnetic resonance spectroscopy with incident type 2 diabetes in a sample of 1353 men and 1356 women. Within 5 years, 87 men and 50 women developed diabetes. Five and 16 urine metabolites were associated with incident diabetes in men and women, respectively. Only three of these metabolites (glucose, lactate and glycine) were found in both sexes. In women, e.g. acetate, carnitine, N,N-dimethylglycine, trigonelline, 3-hydroxyisovalerate, alanine, formate, glycolate, trimethylamine N-oxide and tau-methylhistidine were positively related with diabetes. Receiver operating characteristic (ROC) analysis revealed that compared with a standard model, a model additionally adjusted for urine glucose, trigonelline and trimethylamine N-oxide levels showed a better discrimination between incident diabetes cases and non-cases in women (AUC = 0.874 and 0.903, p = 0.019). In men, valine and 4-hydroxyphenylacetate were found as markers of diabetes. However, ROC analysis did not reveal any improvement in discrimination based on urine metabolites. In conclusion, we confirmed the potential of metabolomics to assess the risk of type 2 diabetes and detected pronounced sex differences. Moreover, we demonstrated the practicability of spot urine samples as potential non-invasive diabetes screening approach.

The association between caffeine and cognitive decline: examining alternative causal hypotheses

Numerous studies suggest that higher coffee consumption may reduce the rate of aging-related cognitive decline in women. It is thus potentially a cheap and widely available candidate for prevention programs provided its mechanism may be adequately understood. The assumed effect is that of reduced amyloid deposition, however, alternative pathways notably by reducing depression and diabetes type 2 risk have not been considered. A population study of 1,193 elderly persons examining depressive symptomatology, caffeine consumption, fasting glucose levels, type 2 diabetes onset, serum amyloid, and factors known to affect cognitive performance was used to explore alternative causal models. Higher caffeine consumption was found to be associated with decreased risk of incident diabetes in men (HR = 0.64; 95% CI 0.42-0.97) and increased risk in women (HR = 1.51; 95% CI 1.08-2.11). No association was found with incident depression. While in the total sample lower ratio Aβ42/Aβ40 levels (OR = 1.36, 95% CI 1.05-1.77, p = 0.02) were found in high caffeine consumers, this failed to reach significance when the analyses were stratified by gender. We found no evidence that reduced risk of cognitive decline in women with high caffeine consumption is moderated or confounded by diabetes or depression. The evidence of an association with plasma beta amyloid could not be clearly demonstrated. Insufficient proof of causal mechanisms currently precludes the recommendation of coffee consumption as a public health measure. Further research should focus on the high estrogen content of coffee as a plausible alternative explanation.

Cohort Study of Non-alcoholic Fatty Liver Disease, NAFLD fibrosis score, and the Risk of Incident Diabetes in a Korean population

No study has evaluated an association between non-alcoholic fatty liver disease (NAFLD) severity and the incidence of diabetes. We examined whether NAFLD and its severity-using the NAFLD fibrosis score (NFS)-predict the development of diabetes. A cross-sectional study was performed in 43,166 apparently healthy Koreans aged 30-59 years, who underwent a health checkup in 2005 and 2006. Of these, 38,291 subjects without diabetes were followed annually or biennially until December 2011 for the cohort study. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. The NFS was used to categorize the severity of fibrosis. Diabetes was defined as fasting serum glucose ≥126 mg/dl, glycated hemoglobin (HbA1c) ≥6.5%, or medication use for diabetes. During 175,996 person-years of follow-up, 2,025 participants developed diabetes. An increase across NAFLD categories was positively associated with an increased risk of diabetes in both the cross-sectional and cohort studies in a dose-response manner (P-trend <0.001). In multivariate-adjusted models, the hazard ratios (95% confidence intervals) for diabetes comparing NAFLD with low NFS and NAFLD with intermediate or high NFS vs. no NAFLD were 2.00 (1.79-2.24) and 4.74 (3.67-6.13), respectively. This association remained significant even in subjects with fasting glucose <100 mg/dl and subjects with HbA1c <5.8%. In this cohort study of a healthy Korean population, NAFLD and its severity using NFS were independently and strongly associated with increased incidence of diabetes in men and women-even with a euglycemic range of glucose and HbA1c.

A reduced serum level of total osteocalcin in men predicts the development of diabetes in a long‐term follow‐up cohort

Osteocalcin (OC), an osteoblast-specific protein, has been demonstrated to affect glucose metabolism in both animals and humans. Studies in animals have shown an effect of undercarboxylated OC (ucOC) on beta-cell proliferation and insulin resistance. It remains unclear whether OC is associated with the future development of diabetes in humans, as well as the relative importance of ucOC vs OC. The aim of this study was to examine serum OC and its post-translational forms as potential biomarkers for future the development of type 2 diabetes. This was a nested case-control study using data from the Electricity Generating Authority of Thailand (EGAT). We identified 63 men without diabetes in the exploratory cohort at baseline who developed type 2 diabetes (DM) during the 10-year follow-up period from 1998-2008, and also 63 men age- and BMI-matched for a non-diabetes control group (non-DM). Serum N-mid OC and ucOC were measured in baseline blood samples. Logistic regression models were used to explore and identify baseline factors, including OC and ucOC, that predicted the subsequent development of diabetes. The mean age and BMI were similar in both non-DM and DM groups (47·2 ± 0·5 vs 47·8 ± 0·8 years and 25·2 ± 0·5 vs 25·9 ± 0·5 kg/m(2) , respectively). Only baseline mean serum N-mid OC (15·2 ± 0·5 vs 13·0 ± 0·5 μg/l, P < 0·05) and fasting plasma glucose (4·92 ± 0·04 vs 5·28 ± 0·07 mmol/l, P < 0·05) were significantly different between the two groups. Multiple logistic regression analysis showed that baseline serum N-mid OC and glucose, but not ucOC, were independent risk factors for the development of diabetes in this long-term study cohort. Circulating total OC is associated with incident diabetes in men. Further studies to evaluate the potential utility of OC as a biomarker to predict the development of type 2 diabetes are warranted.

Incidence of diabetes and serum adipokines in Catalonian men. The ADIPOCAT study

Aims. To investigate the relationship of body mass index and serum adipokines with incidence of diabetes in men. Material and methods. Ten-year cohort study of a random population sample of 1011 men aged 35–69 years from the MONICA-Catalonia survey (1986–1988). WHO-MONICA protocol and the US Hispanic NHANES diabetes questionnaire were applied. Fasting serum glucose and lipids were measured by enzymatic methods, adipokines and insulin by Luminex xMAP technology,and hs-CRP by nephelometry in stored baseline samples (–80°C). Type2 diabetes was defined as fasting glucose ≥ 7.0 mmol/L or diagnosed diabetes. Incident diabetes was defined as absence of these criteria at baseline but presence at re-examination. Cox regression analysis was used. Results. Incidence of diabetes (n = 85) was 10.3/1000 person-years, increasing significantly with BMI but decreasing by quartiles of adiponectin. Incidence increased above median BMI and glucose (45.3/1000 person-years, OR = 19.97). Log-adiponectin associated with reduced risk of diabetes after multivariate adjustment (HR = 0.24, 95% CI 0.08–0.72), with significant modification of this effect by baseline glycaemia. C-reactive protein was not a significant factor. Leptin lost strength when adjusted for BMI. Conclusions. In a population with relatively high diabetes incidence, BMI and glucose were strong risk factors, while adiponectin protected against diabetes, especially in men with high glycaemic level.

Abstract P025: Perceived Stress and Incidence of Type 2 Diabetes: a 35-Year Follow-up Study of Middle Aged Swedish Men

OBJECTIVE_ To explore the incidence cases of diabetes over 35 years of follow-up in middle-aged Swedish men in relation to their severity of stress at baseline. RESEARCH DESIGHN AND METHODS_ This was a population-based random sample of 7 495 men derived from the Primary Prevention cohort study (Gothenburg) aged 47-55 years and without prior history of diabetes at baseline (1970-1973). Self-perceived psychological stress during the previous years was assessed with a single-item in the questionnaire. Incident diabetes from hospital discharge and death registries was collected during the 35 years follow-up. Cox proportional hazards regression was used to evaluate association of stress with incidence of diabetes. RESULTS_ During the follow up of 35 years, 884 men developed diabetes. The crude incidence rate was 46.32 per 1000 persons-years. At baseline, 15.5% men reported to experience permanent stress. The age-adjusted cumulative incidence of type diabetes in men who had permanent stress was 16%, compared with 12% for those with no or periodic stress. In age-adjusted Cox regression analysis, men with permanent stress had a higher risk of diabetes incident (hazard ratio 1.52 [95% CI 1.26-1.82]) compared with men with periodic or no stress (referent). The excess risk of diabetes incident associated with permanent stress remained significant after adjusting for age, socioeconomic status (SES), smoking, physical inactivity, alcohol abuse, height, BMI, serum-cholesterol, hypertension, systolic and diastolic blood pressure. CONCLUSIONS_ Perceived permanent stress in middle aged Swedish men was an important long-term predictor of diabetes incidence. The association of stress was independent of SES, lifestyle and other conventional type 2 diabetes risk factors. The significant impact of stress on diabetes, as demonstrated in this study, emphasizes need for prevention strategies including intervention programmes for people with permanent stress.

Risk factors for incident type 2 diabetes in individuals with a BMI of &lt;27 kg/m2: the role of γ-glutamyltransferase. Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR)

Risk factors for incident type 2 diabetes, in particular, hepatic markers, have rarely been studied in leaner individuals. We aimed to identify the metabolic and hepatic markers associated with incident diabetes in men and women with a BMI of <27 kg/m(2) and to compare them with those in individuals with a BMI of >or=27 kg/m(2). Risk factors for 9 year incident diabetes were compared in the French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) cohort. Comparisons were made between the 2,947 participants with a BMI of <27 kg/m(2) and the 879 with a BMI of >or=27 kg/m(2). There were 92 incident cases of diabetes in individuals with a BMI of <27 kg/m(2) and 111 in those with a BMI of >or=27 kg/m(2). Among those who were not markedly overweight, classical biological markers were associated with 9 year incident diabetes, glycaemia being the strongest predictor. gamma-Glutamyltransferase (GGT), either considered as a continuous variable or at levels >or=20 U/l, was associated with incident diabetes, with a stronger effect in the BMI <27 kg/m(2) group: OR 1.59 (95% CI 1.29-1.97, p < 0.001) in comparison with OR 1.07 (95% CI 0.82-1.38, p = 0.63) for those with a BMI of >or=27 kg/m(2) (results after adjustment for alcohol intake, alanine aminotransferase, waist circumference and the HOMA insulin resistance index). In individuals with a BMI of <27 kg/m(2), GGT was the strongest predictor of diabetes after fasting hyperglycaemia. This association with incident diabetes remained after adjustment for conventional markers of insulin resistance, suggesting potential interactions between GGT, enhanced hepatic neoglucogenesis and/or early alterations of insulin secretion.

High Incidence of Diabetes in Men With Sleep Complaints or Short Sleep Duration

The aim of this study was to investigate the possible relationship among sleep complaints, sleep duration, and the development of diabetes prospectively over a 12-year period in a middle-aged Swedish population. A random sample of 2,663 subjects aged 45-65 years living in mid-Sweden were sent a postal questionnaire including questions about sleep complaints, sleep duration, sociodemographic characteristics, behavioral risk factors, medical conditions, and depression (response rate 70.2%). Twelve years later, a new questionnaire with almost identical questions was sent to all the survivors (n = 1,604) in 1995, and the questionnaire was answered by 1,244 subjects (77.6%). Men reporting new diabetes at follow-up more often reported short sleep duration (< or =5 h per night) (16.0 vs. 5.9%, P < 0.01), difficulties initiating sleep (16.0 vs. 3.1%, P < 0.001), and difficulties maintaining sleep (28.0 vs. 6.3%, P < 0.001) at baseline than men who did not develop diabetes. Women reporting new diabetes at follow-up reported long sleep duration (> or =9 h per night) more often at baseline than women not developing diabetes (7.9 vs. 2.4%, P < 0.05). In multiple logistic regression models, the relative risk (95% CI) for development of diabetes was higher in men with short sleep duration (2.8 [1.1-7.3]) or difficulties maintaining sleep (4.8 [1.9-12.5]) after adjustment for age and other relevant risk factors. Short or long sleep duration or sleep complaints did not influence the risk of new diabetes in women. Difficulties maintaining sleep or short sleep duration (< or =5 h) are associated with an increased incidence of diabetes in men.

The Metabolic Syndrome and Incident Diabetes: Assessment of Four Suggested Definitions of the Metabolic Syndrome in a Chinese Population with High Post-prandial Glucose

To assess the sensitivity and specificity of the four definitions of the metabolic syndrome for incident diabetes in both men and women. The screening survey for type 2 diabetes was conducted in 1994. A follow-up study on 627 high-risk non-diabetic individuals at baseline was carried out in 1999 in Beijing area. 70 men and 76 women developed diabetes during the five-year follow-up. Sensitivity and specificity of four definitions of the metabolic syndrome based on the NCEP, WHO, EGIR and AACE recommendations were compared by McNemar's test. The metabolic syndrome based on all four definitions identified men at a 3.7-4.5-fold and women at a 1.6-2.8-fold risk of developing diabetes during 5-year follow-up. The AACE definition had the highest sensitivity for predicting diabetes (men: 0.61; women: 0.58) and lowest specificity (men: 0.71; women: 0.70). The WHO definition identified 53 % of male and 42 % female incident diabetes. The NCEP definition of adiposity as waist girth > 102 cm was the least sensitive, detecting only 27 % of incident diabetes in men; however, it was the most specific (0.91). The EGIR definition identified the lowest number of female cases (28 %) and fewer male cases (28 %) of incident diabetes, but was specific (women: 0.87; men: 0.91). Further studies on definition of the metabolic syndrome should focus on the potential ethnic differences in insulin resistance and anthropometric indicators for obesity.

#31-S interaction between childhood socioeconomic position, adult body mass index and 34-YEAR incidence of type 2 diabetes mellitus

Abstract PURPOSE: To examine the relationship between childhood socioeconomic position (SEP), adult body mass index (BMI), and the cumulative incidence of Type 2 diabetes in 5,913 adults from Alameda County, CA. METHODS: Childhood SEP was assessed by the respondent's father's occupational category (white- or blue-collar) or years of education. Covariates included sociodemographics, height, blood pressure, depression, behavior, health care access, education, income and occupation. Cox proportional hazard models estimated the risk of incident diabetes in men and women from 1965-1999. Effect modification was assessed by stratified analyses and tests for statistical interaction between childhood SEP and adult BMI (obesity, overweight or normal weight). RESULTS: Low or moderate childhood SEP was associated with a higher incidence of Type 2 diabetes. The effect of childhood SEP was stronger for women, even after adjustment for all covariates [relative hazard: MEN: low childhood SEp = 1.12 (95%CI = 0.7–1.8) /moderate = 1.22 (95%CI = 0.8–1.8) and WOMEN: low childhood SEp = 1.55 (95%CI = 1.0–2.4) /moderate = 1.82 (95%CI = 1.3–2.6)]. Adult BMI modified the impact of childhood SEP on diabetes risk. Obese subjects with low/moderate childhood SEP were at greatest risk. The effect of BMI remained after all model adjustments. The effect of SEP was explained by covariate adjustment for men, but persisted for women [full model relative hazard: low/moderate childhood SEP-obese (RH = 4.38 (95%CI = 2.1–9.3) for men and 5.39 (95%CI = 2.8–10.3) for women), high SEP-obese (RH = 4.27 (95%CI = 1.7–10.7) for men and 3.13 (95%CI = 1.4–6.9) for women) and low/moderate SEP-normal weight (RH = 1.19 (95%CI = 0.7–2.1) for men and 1.46 (95%CI = 1.0–2.2) for women)]. CONCLUSION: Childhood SEP is a robust predictor of incident Type 2 diabetes, although the effect is stronger in women and not completely removed by adjustment for covariates. Multiplicative and additive models suggest a positive interaction between childhood SEP and adult BMI for both men and women.