Including Impaired Fasting Glucose Research Articles

Associations of Traumatic Injury with Abnormal Glucose Metabolism: A Population-Based Prospective Cohort Study.

Empirical data on the association between traumatic injury and abnormal glucose metabolism risk is limited. This study aimed to investigate the association between traumatic injury and abnormal glucose metabolism. This study included 153,162 participants in the Kailuan Study from 2006 to 2013. Participants with abnormal glucose metabolism at baseline were excluded. All participants were monitored every two years until December 31, 2019. During follow-up, 1915 subjects with a first traumatic injury (defined as a physical injury caused by an external force) were identified. For each subject with traumatic injury, one control subject was randomly selected and matched for age (± 3 years) and sex. A total of 3830 subjects were included in the final analysis. Cox proportional hazards models were used to examine the association between traumatic injury and the subsequent risk of abnormal glucose metabolism. During a median follow-up of 6.91 (3.57-9.41) years, 990 abnormal glucose metabolism events occurred. After adjustment for demographics, lifestyle behaviors, and traditional risk factors, those who had traumatic injury compared to controls were 32% more likely to develop any abnormal glucose metabolism (hazard ratio [HR] 1.32; 95% confidence interval [CI]1.16-1.49), including impaired fasting glucose (IFG) (HR 1.29; 95% CI 1.12-1.48) and diabetes (HR 1.37; 95% CI 1.10-1.70). The risks for abnormal glucose metabolism, IFG, and diabetes in subjects with moderate-severe injury were higher than in subjects with mild injury for the 1-year follow-up period, while the association was not significantly different by injury severity for the whole follow-up period. Traumatic injury was associated with an increased risk of abnormal glucose metabolism. However, the risks of outcome events decreased as the follow-up period extended. Improved short- and long-term prevention and management strategies for controlling glucose are needed for individuals with traumatic injury.

Differences in the impact of impaired glucose status on clinical outcomes in younger and older adults: Over a decade of follow-up in the Tehran lipid and glucose study.

Studies found that the impact of dysglycemia on microvascular, macrovascular events and mortality outcomes were different between the younger vs. older population. We aimed to investigate the age-specific association of prediabetes with clinical outcomes including type 2 diabetes (T2DM), hypertension, chronic kidney disease (CKD), cardiovascular disease (CVD), and mortality. A total of 5,970 Iranians (3,829 women) aged ≥30 years, without T2DM, were included. The age-specific (<60 and ≥60 years; minimum p-value for interaction = 0.001) multivariable-adjusted Cox regression was done to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the impaired glucose status including impaired fasting glucose (IFG) vs. normal fasting glucose (NFG), impaired glucose tolerance (IGT) vs. normal glucose tolerance (NGT), and IFG&IGT vs. NFG/NGT with each outcome. Among individuals aged ≥60 years, the prevalence of impaired glucose status (IFG, IGT, or both) was about 2 times higher compared to those aged <60. Age-specific association between prediabetes and incident hypertension was found for those aged <60 years; [HR (95% CI); IFG: 1.38 (1.16-1.65), IGT: 1.51 (1.26-1.81), and IFG&IGT: 1.62 (1.21-2.12)]. For CVD, in all impaired glycemic states, those aged <60 were at higher significant risk [IFG: 1.39 (1.09-1.77), IGT: 1.53 (1.19-1.97), and IFG&IGT: 1.60 (1.14-2.25)]. Stratified analyses showed similar associations for IFG and IGT with non-CV mortality 1.71 (1.04-2.80) and 2.12 (1.30-3.46), respectively, and for all-cause mortality among those aged <60 years [IFG: 1.63 (1.08-2.45) and IGT: 1.82 (1.20-2.76)]. In both age groups, all glycemic status groups were significantly associated with T2DM but not with CKD and CV mortality. The high prevalence of prediabetes particularly among the elderly population, limited resources, and the observed significant age differences in the impact of prediabetes states on different clinical outcomes calls for multicomponent intervention strategies by policy health makers, including lifestyle and possible pharmacological therapy, with the priority for the young Iranian population.

The long-term (five years) effects of prednisone therapy in children with frequently relapsing nephrotic syndrome: A controlled study of anthropometric parameters and metabolic abnormalities.

Steroids are the main drugs used for the treatment of nephrotic syndrome (NS) in children. We investigated the steroid effect on linear growth and weight gain as well as the prevalence of different metabolic components and dysglycemia in children with NS with multiple relapses for 5 years in relation to the cumulative dose of steroids. Study population and sample size: Data of 30 children with NS were analyzed retrospectively. They received prednisolone treatment as advised by international guidelines. The cumulative dose of prednisolone (CDP) over the 5 years was calculated for each child. Their growth and different metabolic criteria, including impaired fasting glucose (IFG), high LDL and cholesterol, lower HDL, and high blood pressure studied over this period and compared with the data for 66 age-matched obese non-nephrotic children. The mean CDP was 100 ± 63 mg /kg/yr given over an average duration of 5 years. The height-SDS was not affected after 3 years but decreased by -0.4 SD after 5 years. The body mass index-SDS increased from 0.65 to 0.97 and 1.1 after 3 and 5 years, respectively. Obesity and overweight increased from 25% pre-treatment to 59.2% after 5 years of treatment. After 5 years of treatment, IFG was detected in 35 %, hypertension in 40%, high LDL in 77%, and high cholesterol in 80%. In children with frequently relapsing NS, long-term steroid therapy was associated with a higher rate of obesity, short stature as well as the occurrence of different metabolic syndrome (MetS.

Cumulative exposure to impaired fasting glucose and future risk of type 2 diabetes mellitus

AimsThe status of metabolic abnormalities including impaired fasting glucose (IFG) can change over time, yet little is known about how exposure duration to IFG is related to diabetes risk. MethodsUsing nationally representative data from the Korean National Health Insurance system, 2,513,127 people who were free of diabetes and who received four consecutive annual health examinations commencing in 2006 or 2007 were followed up at the end of 2016. IFG was defined as fasting blood glucose levels of 100–125 mg/dL. Participants were classified numerically according to the cumulative number of IFG diagnoses. ResultsOver 4 years, 53% of the population participants remained normoglycemic, while 3% had persistent IFG and 44% had intermittent IFG. The risk of type 2 diabetes mellitus (DM) increased gradually with increasing IFG exposure score. Subjects with an IFG exposure score of 2, 3, or 4 had a 3.75- to 9.77-fold increased hazard ratio (HR) for incident diabetes (IFG exposure score 0 reference; score 2, HR 3.75, 95% confidence interval [CI] 3.67–3.83; score 3, HR 6.21, 95% CI 6.08–6.36; score 4, HR 9.77, 95% CI 9.53–10.02). ConclusionsCumulative IFG exposure was associated with a higher risk of type 2 DM in a dose–response fashion.

Prevalence of glucose metabolism disorders in a cohort of children and adolescents with obesity.

Historically type 2 diabetes (T2DM) was considered a disease affecting adults only. Over the last 30 years, concurrent to a significant increase of childhood obesity, abnormalities in glucose metabolism, including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and even T2DM are more often diagnosed in children and adolescents [1]. This rise in the incidence of abnormalities in glucose metabolism raises challenges in the area of diagnostics and treatment.

Evaluation of Salusin ? in Patients with Prediabetes and Type 2 Diabetes Mellitus

Background: Type 2 Diabetes mellitus is a group of metabolic disease characterized by increase blood glucose level (hyperglycemia) resulting from either defect in insulin production by pancreas or increase insulin resistance that lead to decrease insulin effect in the body. prediabetes It is stage before diabetes mellitus including impaired fasting glucose (IFG)where the fasting glucose level (6.1-7.O mmol/L) and impaired glucose tolerance (IGT after glucose load) glucose level (7.8-11 mmol/L).(salusin-?) It is a newly glass of peptide it is synthesized in many body tissues, like (skeletal muscle, human vascular smooth muscle cells, and endothelial muscle) it have important role in Diabetes pathogenesis it has been reported to involve in vascular inflammation and the relation between salusin ? and diabetes through endothelial injury, salusin ? increase inflammation in diabetes. It have essential role in pathological endothelial dysfunction. Method: by using ELISA kit, we measured serum level of salusin ? in 30 patients with prediabetes and 30 patients with type 2 DM compare with 30 healthy volunteers enlisted as normal controls. Result: serum salusin ? level in patient with type 2 DM were significantly higher than prediabetes group and normal subjects. Salusin ? in prediabetes group no significant higher than in healthy control subjects. Conclusion: Serum Salusin ? level in patients with type 2 DM are expressed at significantly high levels were no difference in Salusin ? level of prediabetes group and normal control subjects.

PREVALENCE OF ABNORMAL GLUCOSE METABOLISM AMONG THAI OVERWEIGHT AND OBESE CHILDERN AND ADOLESCENTS

Background: The prevalence of childhood obesity is in creasingly worldwide. Abnormal glucose metabolism (ASM) including impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) is a common endocrine complication among overweight and obese children and adolescents. Few studies of AGM are available in Thailand.Objectives: The study aimed to establish the prevalence of AGM and identify associated complications among overweight and obese children and adolescents.Methods: Data of overweight and obese children and adolescents, aged 6 to 18 years, undergoing oral glucose tolerance test (OGTT) at phramongkutklao Hospital were reviewed retrospectively. Fasting blood sugar, Hemoglobin Ale (HbA1c). fasting insulin, triglyceride, high-density lipoprotein, low-density lipoprotein, aspartate transaminase and alanine aminotransferase were derived from fasting measurement. Homeostatic model assessment was calculated to represent the insulin resistance.Result: A total of 204 children and adolescents (122 males) were included. Mean age was 12.1 ± 2.6 years and percent weight for height was 168.8 ± 25.4% The overall prevalence of AGM was 20.6%, 1 % had T2DM, 0.5% had IFG, 36% had IGT and 1.5% had combined IFG/IGT. Among the AGM, IGT was the most frequent subtype representing 92.8% (39/42 cases) but only 2 cases of T2DM were diagnosed in our study. The AGM group had significantly higher FPG (p=0.034), HbA1c (p=0.006) and cholesterol levels (p=0.043) than those of the nonabnormal glucose metabolism (NGM) groupConclusion: Prevalences of AGM among overweight and obese children and adolescents were high. IGT was the most frequent group.

SAT-245 Estimated Insulin Sensitivity Score Predicts Post-OSTT Insulin Secretion and GI Hormone Differences in Adolescents with Obesity and PCOS

Women with polycystic ovarian syndrome (PCOS) have an increased risk for type 2 diabetes and obesity increases this risk. Insulin resistance (IR), along with beta-cell failure, is a precursor for diabetes, yet is hard to measure clinically. The estimate of insulin sensitivity (eIS) score (e^[4.647 -0.0203 (waist, cm) - 0.0977 (HbA1c, %) -0.00235 (TG, mg/dl)]) that we previously developed in adolescents utilizes clinical measures. An eIS of <6.3 in obese girls with PCOS represents the ≤50th percentile of insulin sensitivity assessed by hyperinsulinemic euglycemic clamp. Past attempts to prevent progression of dysglycemia in obese youth have suffered from a lack of understanding of postprandial responses across the spectrum of IR. Our goal was to assess differences in post-oral glucose load responses in a cohort of obese girls with PCOS stratified by eIS score. We recruited 55 untreated obese girls with PCOS (age 16 ± 0.2 years, BMI Z-score 2.1 ± 0.04, free testosterone 9.3 ± 0.7 mg/dL). Fasting lipids and hormones were measured followed by a frequently-sampled 6-hr oral sugar tolerance test (OSTT, 75g glucose +25g fructose). Participants were categorized as eIS < or ≥ 6.3. Baseline and post-OSTT responses were compared, including impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) categories. eIS group differences were compared by t-test, and metabolite curves and timepoint differences by repeat measures ANOVA. In this cohort, 67% (N=37) had an eIS score <6.3. The low eIS group was more obese [BMI Z-score 2.23 (2.04, 2.41) vs. 1.77 (1.62, 2.02); p<0.001] and more Hispanic (57% Hispanic vs 16% Hispanic, p=0.01), but was similar in terms of PCOS clinical severity (acne, hirsutism, menses/year and free testosterone). The groups had similar proportions of IFG (13% vs 12%, p=0.80; <6.3 vs ≥6.3) and IGT (49% vs. 29%, p=0.30), but the glucose curve trended to be greater in eIS<6.3 (p=0.05) in particular at times 60 and 90 min. The insulin and c-peptide curves were greater in eIS<6.3 (p=0.01, p=0.002), and the insulin concentrations from timepoints 45-150 min were greater in eIS<6.3. The insulin peak was delayed to 120 min in eIS <6.3 vs. 30 min in eIS≥6.3. The glucagon curve was also greater eIS<6.3 (p=0.01), but the GLP-1 curves were not different (p=0.61).Obese girls with PCOS who had an eIS<6.3 had expected hypersecretion of insulin and c-peptide. The delayed insulin peak and trend for increased glucose at 60-90 min suggest a relatively inadequate first-phase insulin release relative to the degree of IR. Those with a low eIS also had evidence of alpha-cell dysfunction. Insulin hypersecretion was not mediated by increased GLP-1. Understanding these early hormone differences may be key to the development of strategies to prevent progression of dysglycemia in this high-risk population. Funding: BIRCWH K12, NIDDK K23, Boettcher Webb Waring, Doris Duke FCRS, Colorado CTSI, Children’s Hospital Colorado

Pre-diabetes diagnosis based on ATR-FTIR spectroscopy combined with CART and XGBoots

A rapid diagnosis model of pre-diabetes was established by using Attenuated total reflectance (ATR)-Fourier transform infrared spectroscopy (FTIR) combined with Classification and Regression Trees (CART) and eXtreme Gradient Boosting (XGBoost) ensemble learning algorithm. First, we collected peripheral blood samples of 112 volunteers and then measured the fasting blood glucose and 2h blood glucose levels of the oral glucose tolerance test, and determined the control group and the disease group according to the WHO diagnostic criteria (including impaired fasting glucose (IFG). Impaired glucose tolerance (IGT).In addition, ATR-FTIR spectra of peripheral blood samples were collected at the same time. The whole spectrum mid-infrared region (4000–600 cm−1) was used as the research object of diagnosis model of pre-diabetes. Second, preprocessing step, Savitzky-Golay (SG) smoothing pretreatment was performed and used PCA to extract spectral features. Finally, a rapid diagnosis model of pre-diabetes was established by using CART and XGBoost. CART model results were: Specificity: 80.00% (20/25), Sensitivity: 95.00% (19/20), Accuracy: 86.67% (39/45); XGBoost model results: Specificity: 100.00% (25/25), Sensitivity were: 85.00% (17/20)), Accuracy: 93.33% (42/45).The results show that the rapid diagnosis model of pre-diabetes was established by SG-PCA-XGBoost which has the best effect. Hence, the model established by ATR-FTIR spectra combined with SG-PCA-XGBoost in the experiment can more effectively diagnose pre-diabetes. This model needs no sample preprocessing; it is characterized by simple operation and time efficiency. Furthermore, the established model provides a fast accurate method for pre-diabetes diagnosis.

TCF7L2 gene variants predispose to the development of type 2 diabetes mellitus among individuals with metabolic syndrome.

Transcription factor 7-like 2 (TCF7L2) gene variants rs12255372 and rs7903146 have been consistently shown to raise genetic risk for type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the possible role of these variants in the development of impaired glucose metabolism (IGM), including impaired fasting glucose (IFG) or T2DM, in patients with metabolic syndrome (MS). The study population consisted of 228 patients with MS who were divided into two groups. The first group consisted of 148 patients with MS and IGM [39M/109F, 59.8 ± 14.6 (mean ± SD) years] and the second group of 80 patients with MS and normoglycemia (NGM) (16M/64F, 56.1 ± 15.8years). The diagnosis of MS was based on the criteria proposed by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) Scientific Statement. Anthropometric parameters including BMI and waist circumference were recorded and blood samples were obtained after overnight fasting for biochemical tests. The rs12255372 and rs7903146 TCF7L2 polymorphisms were genotyped in peripheral blood leucocytes. Analysis of the distribution of the TCF7L2 polymorphic alleles revealed that the frequency of the T allele of the TCF7L2 variant rs12255372 was 38.2% in the study population, while the frequency of the T allele of the TCF7L2 rs7903146 variant was 35.3%. The T allele of the rs12255372 variant was more frequently present in patients with MS and IGM (48.3%) compared to patients with MS and NGM (19.4%, p < 0.001). Also, the T allele of rs7903146 was more frequently present in patients with MS and IGM (44.6%) compared to patients with MS and NGM (18.1%, p < 0.001). Logistic regression analysis followed and revealed that the presence of the T allele for both rs12255372 and rs7903146 TCF7L2 gene variants is a very powerful predictor of the presence of glucose disorders, increasing the risk more than fourfold in patients with MS and after adjustment for potential confounders, such as age, gender, BMI, and waist circumference (TCF7L2 rs12255372: Exp(B) 4.917, p < 0.001 and TCF7L2 rs7903146: Exp(B) 5.460, p < 0.001). The presence of the rs12255372 and rs7903146 TCF7L2 gene variants plays an important role in the development of T2DM among individuals with MS. These findings support the notion that among subjects with MS, those who finally develop T2DM have a genetic predisposition to β-cell dysfunction.

Prognostic Cut Points for Prediabetes Glucose Levels and HbA1c Values in Predicting All-Cause Mortality—A Systematic Review and Meta-analysis

Elevated but nondiabetic glucose levels, including impaired fasting glucose (IFG), 2-hour impaired glucose tolerance (IGT), and glycosylated hemoglobin A1c (HbA1c), are associated with increased risk for all-cause mortality. However, the glucose measures may differ in their abilities to predict adverse outcomes. The World Health Organization (WHO) and the American Diabetes Association (ADA) also differ in their definitions of IFG, and it remains unclear which definition best predicts future adverse outcomes. The objective of this study was to evaluate the prognostic value of different cut-points of prediabetic glucose measures for predicting all-cause mortality in individuals without diabetes. In databases including MEDLINE, PubMed, Embase, Clinicaltrials.gov, WHO International Clinical Trials Registry Platform, and Cochrane, we searched prospective cohort studies with minimum 3 years of follow-up, in adults without diabetes at enrollment. Data from eligible studies were pooled to synthesize results for each glucose measure. Random effect regression model was used to calculate pooled hazard ratio or relative risk for all-cause mortality. We screened over 4,000 abstracts and identified 170 eligible studies with mean follow-up of 10.2 years. Compared with individuals with normal glycemia, those with IFG defined by the WHO criteria had 1.14 times increased risk for all-cause mortality. There was no significant increase in mortality risk among those with IFG diagnosed by the ADA criteria. Individuals with IGT had 1.17 times higher risk for all-cause mortality compared with individuals with normal glycemia. HbA1c as low as 5.5% was associated with an increased risk for mortality. The WHO criteria for IFG seems to have better predictive value for all-cause mortality than the ADA criteria. Furthermore, individuals with HbA1c levels at 5.5% may have higher risk for mortality. Disclosure M. Huang: None. U. Gujral: None. S. He: None. R. Jagannathan: None. J. Wei: None. L.R. Staimez: None. K. Narayan: None.

Pretransplantation Oral Glucose Tolerance Test Can Prevent Posttransplant Diabetes Mellitus After Renal Transplantation: Preliminary Study

Posttransplant diabetes mellitus (PTDM) adversely affects renal graft and patient survival. Fasting plasma glucose (FPG) alone underestimates diagnosis of glucose metabolism disorders (GMD) detected using the oral glucose tolerance test (OGTT-75). Prediabetes including impaired fasting glucose (IFG): 100 to 125 mg/dL (5.6–6.9 mmol/L) and impaired glucose tolerance (IGT): 140 to 199 mg/dL (7.8–11 mmol/L) 2 hours post 75-g OGTT in the pretransplant period can have a connection with the occurrence of PTDM after renal transplantation (RTx).The aim of our study was to assess the benefit of performing OGTT-75 in dialyzed chronic kidney disease (stage 5) patients on the waiting list for kidney transplantation as a useful tool to prevent PTDM. Materials and MethodsPretransplant glucose testing using OGTT-75 was performed in nondiabetic dialyzed chronic kidney disease patients on the waiting list for renal transplantation in the southwest region of Poland. GMD were diagnosed according to current criteria. Patients with recognized prediabetic stage were recommended a low carbohydrate diet, lifestyle modification, and increased physical activity. In the 12-month posttransplant period we estimated the prevalence of PTDM in the study group based on FPG >126 mg/dL (7 mmol/L) in 2 measurements or random blood glucose >200 mg/dL (11.1 mmol/L). ResultsA total of 80 nondiabetic dialysis patients (65 hemodialysis/15 peritoneal dialysis; 47 male/33 female) met initial entry criteria. In pretransplant glucose testing prediabetes was found in 31 out of 80 patients (39%). Among them, 5 patients (6.25%) had combined IGT/IFG, 18 patients (22.5%) had IGT, and 8 patients (10%) had IFG. One year after RTx we recognized PTDM in 14% of all analyzed patients (11/80) and noticed a significant frequency of glucose disorders status change after RTx (P = .002). ConclusionOur findings suggest early detection of prediabetes using the OGTT-75 test in nondiabetic dialysis patients waiting for RTx to prevent occurrence of PTDM.

Abstract P056: Prognostic Cut-Points of Prediabetic Plasma Glucose and HbA1c Values in Predicting Cardiovascular Disease Morbidity and Mortality: A Systematic Review and Meta-Analysis

Background: Prediabetes are often characterized by various measurements of elevated but non-diabetic glucose values, including impaired fasting glucose (IFG), 2-hour impaired glucose tolerance (IGT), and glycosylated hemoglobin A1c (HbA1c), and represent increased risk for cardiovascular disease (CVD) morbidity and mortality. However, it remains unclear how each glucose measurement differs in their abilities to predict risk for CVD outcomes. Currently, the World Health Organization (WHO) and the American Diabetes Association (ADA) also differ in their IFG definitions, and there has been debate as to which definition best predicts future CVD risk. Objectives: In this systematic review and meta-analysis, we sought to evaluate the prognostic value of different cut-points of non-diabetic glucose measurements (IFG, IGT, and HbA1c) for predicting CVD morbidity and mortality in individuals at increased risk. Methods: We searched the MEDLINE, PubMed, Embase, Clinicaltrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform, and Cochrane database. We searched prospective cohort studies in adults without diabetes aged 18 years or older, or control groups in clinical trials, with a minimum follow-up of 3 years. We included studies that reported an association between any of the glucose measurements with CVD morbidity, including non-fatal myocardial infarction, non-fatal stroke, peripheral artery disease, a composite measure of any CVD outcomes, and CVD mortality. Retrospective cohort studies will only be investigated if there are not at least two prospective cohort studies for a given outcome. Data from eligible studies were pooled to synthesize results for each glucose measurement. Random effect model was used to calculate pooled hazard ratio or relative risk data. Results: We screened over 4,000 abstracts and identified 170 eligible prospective cohort studies with 2,826,296 individuals, with a mean follow-up of 10.2 years. Compared to individuals with normal glycaemia, individuals with IFG defined by the WHO criteria had 1.11 and 1.21 times increased risk for CVD morbidity and mortality, respectively. There was no significant increase in risk among those with IFG diagnosed by the ADA criteria compared to those with normal glycaemia. Compared to those with normal glycaemia, individuals with IGT had 1.15 and 1.24 times higher risk for CVD morbidity and mortality, respectively. HbA1c as low as 5.5% was associated with an increased risk of CVD outcomes. Conclusions: The WHO criteria for IFG seems to be a better predictor of CVD outcomes than the ADA criteria. The current criteria for IGT is a slightly strong predictor for CVD events and mortality than IFG. HbA1c levels as low as 5.5% could be used as a predictor for adverse health outcomes in non-diabetic individuals.

Impaired glucose metabolism in subjects with the Williams-Beuren syndrome: A five-year follow-up cohort study.

ObjectiveThe Williams-Beuren syndrome (WS) is associated with impaired glucose metabolism (IGM) early in adulthood. However, the pathophysiology of IGM remains poorly defined, due to the lack of longitudinal studies investigating the contribution of β-cell dysfunction and impaired insulin sensitivity. This study aimed at assessing incidence of IGM and the underlying mechanisms in WS adults.MethodsThis observational, longitudinal (5-year), cohort study enrolled thirty-one consecutive WS subjects attending a tertiary referral center. An oral glucose tolerance test (OGTT) was performed yearly and used to classify patients as normal or IGM, including impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and diabetes mellitus (DM), and to calculate surrogate measures of insulin secretion and/or sensitivity.ResultsIGM patients were 18 (58.1%, three DM) at baseline and 19 (61.3%, five DM) at end-of-follow-up. However, 13 individuals changed category of glucose homeostasis in both directions during follow-up (8 progressors, 5 regressors) and 18 did not (8 non-progressors, 10 non-regressors). New cases of IGM and DM were 11.1 and 2.53 per 100 persons-year, respectively, and were treated non-pharmacologically. In the whole cohort and, to a higher extent, in progressors, indices of early-phase insulin secretion and insulin sensitivity decreased significantly from baseline to end-of-follow-up, with concurrent reduction of the oral disposition index and insulin secretion-sensitivity index-2 (ISSI-2), compensating insulin secretion for the level of insulin resistance. No baseline measure independently predicted progression, which correlated with change from baseline in ISSI-2. Compared with patients with normal glucose homeostasis, IGT subjects had impaired insulin sensitivity, whereas insulin secretion was reduced only in those with IFG+IGT or DM.ConclusionsIGM incidence is high in young adults with WS, suggesting the need of early screening and timed intervention. As in classical type 2 diabetes, impaired insulin sensitivity and β-cell dysfunction contribute, in this sequence, to progression to IGM and DM.

Retrospective study of the associations between hepatitis C virus infection and metabolic factors.

AIMTo evaluate the bidirectional association between metabolic syndrome (MS) components and antiviral treatment response for chronic hepatitis C virus (HCV) infection.METHODSThis retrospective cohort study included 119 HCV + patients treated with pegylated-interferon-α and ribavirin. Metabolic characteristics and laboratory data were collected from medical records. Differences in baseline clinical and demographic risk factors between responders and non-responders were assessed using independent samples t-tests or χ2 tests. The effects of sustained viral response (SVR) to antiviral treatment on de novo impairments in MS components, including impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM), were assessed using univariable and multivariable logistic regression analysis, while the effect of MS components on SVR was assessed using univariable logistic regression analysis.RESULTSOf the 119 patients, 80 (67%) developed SVR over the average 54 ± 13 mo follow-up. The cumulative risks for de novo T2DM and IFG were 5.07- (95%CI: 1.261-20.4, P = 0.022) and 3.87-fold higher (95%CI: 1.484-10.15, P = 0.006), respectively for non-responders than responders, when adjusted for the baseline risk factors age, sex, HCV genotype, high viral load, and steatosis. Post-treatment triglyceride levels were significantly lower in non-responders than in responders (OR = 0.27; 95%CI: 0.069-0.962, P = 0.044). Age and HCV genotype 3 were significantly different between responders and non-responders, and MS components were not significantly associated with SVR. Steatosis tended to attenuate SVR (OR = 0.596; 95%CI: 0.331-1.073, P = 0.08).CONCLUSIONSVR was associated with lower de novo T2DM and IFG incidence and higher triglyceride levels. Patients infected with HCV should undergo T2DM screening and antidiabetic treatment.

Detecting Prediabetes and Diabetes: Agreement between Fasting Plasma Glucose and Oral Glucose Tolerance Test in Thai Adults.

Aim. To evaluate an agreement in identifying dysglycemia between fasting plasma glucose (FPG) and the 2 hr postprandial glucose tolerance test (OGTT) in a population with high risk of diabetes. Methods. A total of 6,884 individuals aged 35–65 years recruited for a community-based diabetes prevention program were tested for prediabetes including impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and diabetes. The agreement was assessed by Kappa statistics. Logistic regression was used to examine factors associated with missed prediabetes and diabetes by FPG. Results. A total of 2671 (38.8%) individuals with prediabetes were identified. The prevalence of prediabetes identified by FPG and OGTT was 32.2% and 22.3%, respectively. The proportions of diabetes classified by OGTT were two times higher than those identified by FPG (11.0% versus 5.4%, resp.). The Kappa statistics for agreement of both tests was 0.55. Overall, FPG missed 46.3% of all prediabetes and 54.7% of all diabetes cases. Prediabetes was more likely to be missed by FPG among female, people aged <45 yrs, and those without family history of diabetes. Conclusion. The detection of prediabetes and diabetes using FPG only may miss half of the cases. Benefit of adding OGTT to FPG in some specific groups should be confirmed.

The relationship between high blood glucose and socio-economic position in childhood and adulthood in Korea: findings from the Korean National Health and Nutrition Examination, 2007-09

Unlike the older birth cohort (1943-65), the younger birth cohort (1966-79) has enjoyed much improved standards with dramatic developments in Korea. This article investigated the relationship between socio-economic position (SEP) and risk of high blood glucose, including impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2D) by birth cohort. Of the 11 830 persons, 9792 persons aged 30-64 years participated in National Health and Nutrition Examination Surveys. We categorized four SEP groups based on education level in childhood and adulthood within two birth cohorts. High blood glucose included IFG (n = 2594) and T2D (n = 738). Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression. There was a significantly higher risk of high blood glucose in the younger cohort than in the older cohort. In the younger cohort, the ORs for males of declining SEP and of stable low SEP were OR: 1.50 (95% CI 1.12-2.00) and OR: 1.45 (95% CI 1.08-1.93), respectively. After adjustments, corresponding ORs were 1.47 (95% CI 1.09-1.98) and 1.54 (95% CI 1.14-2.08), respectively. In younger women, the corresponding ORs were 1.68 (95% CI 1.17-2.41) and 1.87 (95% CI 1.30-2.69), respectively; however, obesity attenuated the former relationship. For women in the older cohort, this inverse relationship was found only among those with a stable low SEP (OR 1.31, 95% CI 1.04-1.66); no significance was found after adjustments. There was no significant inverse relationship in the older cohort for men. The relationship between lower SEP and elevated risk of high blood glucose was stronger in the younger birth cohort, and obesity attenuated this inverse relationship in women only.

Metabonomics and phospholipid metabolic profiling of abnormal glucose metabolism based on high performance liquid chromatography-electrospray mass spectrometry

Abnormal glucose metabolism (AGM) has received more and more attention since its incidence is increasing. Metabonomics and phospholipid metabolic profiling methods based on high performance liquid chromatography-electrospray mass spectrometry (HPLC/ESI-MS) have been applied in the study of AGM. The two different stages of AGM, including impaired fasting glucose (IFG) and newly-diagnosed diabetes (NDD), were investigated. The raw data of both metabonomics and phospholipid metabolic profiling collected from HPLC/ESI-MS were transformed and the peak lists were gained through commercial software. The differentiations among the three groups of NDD, IFG and normal fasting glucose (N) were found through the peak lists were performed with orthogonal signal correction and partial least-squares (OSC-PLS). The metabolic differentiation compounds were selected when their variable importance values were more than 1, and p < 0.05 in phospholipid metabolic profiling data. There were more changes in the NDD group than those in the IFG group. The metabolic differentiation compounds were free fatty acids, lysophosphatidylcholine, phosphatidylethanolamine, sphingomyelin and phosphatidylcholine. This research provided some new information of what had happened in the people with AGM.

Prevalence of abnormal glucose metabolism and preliminary investigation of its pathogenesis in patients being alive over 3 years after liver transplantation

Objective To evaluate the status of abnormal glucose metabolism in patients being alive over 3years after liver transplantation and discuss the possible mechanism of post-transplant diabetes mellitus ( PTDM ).Methods In this study, the clinical data of patients with liver transplantation were collected from April 2001 to December 2008. Patients with diabetes mellitus before operation and those who had died and failed to appear during follow-up were exluded. 199 patients living over 3 years after liver transplantation were follow-up. The prevalence of PTDM was evaluated according to fasting plasma glucose(FPG). Among those without diabetes according to FPG,32patients underwent 75 g oral glucose tolerance test (OGTT) , and fasting and 2 h plasma glucose and insulin were determined. 32 patients were divided into three groups [normal, impaired glucose regulation ( IGR ) , and PTDM groups], proportion of PTDM and homeostasis model assessment ( HOMA ) index were calculated. Results In patients alive over 3 years after liver transplantation, the prevalence of PTDM was 34.67% according to FPG. The OGTT result showed that the proportion of PTDM was 9.38%, IGR, including impaired fasting glucose(IFG) and impaired glucose tolerance ( IGT ) , was 56. 25% , while 34. 37% remained normal. The homeostasis model assessment β cell function index( HOMA-β ) decreased progressively from normal group, IGR group to PTDM group,and that in PTDM group was significantly lower than those in normal and IGR group( P＜0.01 ). IGR group had the highest homeostasis model assessment for insulin resistance (HOMA-IR) and PTDM group the next, and HOMA-IR in IGR group was significantly higher than normal group. Conclusion In patients alive over 3 years after liver transplantation, the prevalence of PTDM reached 44.05%. Insulin resistance existed during early period of impaired glucose regulation, while the degeneration of β cell progressed with the worsening of impaired glucose regulation. Key words: Liver transplantation; Post-transplant diabetes mellitus; Prevalence; Pathogenesis

Community-based population data indicates the significant alterations of insulin resistance, chronic inflammation and urine ACR in IFG combined IGT group among prediabetic population

Aims To investigate alterations of insulin resistance (IR), chronic inflammation and urine albumin-to-creatinine ratio (ACR) in Chinese community-based prediabetic population. Materials and methods 252 prediabetics [prediabetes (PD), including impaired fasting glucose (IFG), 91; impaired glucose tolerance (IGT), 123; IFG + IGT, 38] and 38 newly diagnosed-diabetics (NDDM) aged over 35 years older were screened from 2336 community individuals. 123 age and gender matched individuals with normal glucose tolerance (NGT) were selected as controls. Serum adiponectin, interleukin-6 (IL-6) levels and urine ACR were determined, HOMA-IR and Gutt's index were calculated to evaluate IR and insulin sensitivity, respectively. Results The data displayed significant difference of serum adiponectin, IL-6, ACR and Gutt's index among PD, NDDM and NGT groups. Adiponectin level and Gutt's index decreased, but IL-6 level and ACR increased gradually among NGT, PD and NDDM groups ( P < 0.01). Unlike adiponectin and IL-6, ACR analysis indicates a gradual increase from NGT, IFG, IGT, IFG + IGT to NDDM individuals ( P < 0.01). Gutt's index showed significant difference between IFG and NDDM, IFG + IGT and NDDM ( P < 0.01), but HOMA-IR index did not. Conclusions IR, chronic inflammation and endothelial dysfunction dose exist in prediabetic individuals, especially in IFG + IGT population. Gutt's index and ACR might seem to be more sensitive than adiponectin and HOMA-IR index as IR and chronic inflammation maker in prediabetic population.