Increased Glucose Intolerance Research Articles

Fibrinogen, other cardiovascular risk factors and diabetes mellitus in Hong Kong: a community with high prevalence of Type 2 diabetes mellitus and impaired glucose tolerance.

To determine the prevalence of Type 2 diabetes mellitus and impaired glucose tolerance (IGT) and their relationships to fibrinogen and other cardiovascular risk factors in Hong Kong Chinese. A probability sample of 1,316 men and 1,348 women aged 25-74 years were examined in a population-based cross-sectional study. A total of 3.0% (95% confidence interval 2.1-3.9) of men had previously diagnosed (known) and 6.4% (5.0-7.8) newly diagnosed (unknown) diabetes, 14.4% (12.4-16.5) had IGT and 79.2% were normal by 1985 WHO diagnostic criteria; corresponding prevalences in women were 3.7% (2.7-4.7), 5.9% (4.6-7.2), 17% (14.8-19.2) and 73.4%. The age-standardized prevalence of Type 2 diabetes for the 35-64 age group was 9.5% (7.5-11.6) in men and 10.2% (8.0-12.4) in women. Age-adjusted mean fibrinogen levels in these four groups (normal/IGT/unknown diabetes/known diabetes) with decreasing degrees of glucose tolerance (diabetes status) were 2.80, 2.57, 2.51 and 2.47 g/l (P = 0.003) in men, and 2.86, 2.72, 2.67, 2.61 g/l (P = 0.005) in women. Age, obesity, systolic blood pressure and triglycerides were significantly associated with diabetes status in both sexes, fibrinogen in men only and high density lipoprotein cholesterol negatively in women. The prevalence of Type 2 diabetes mellitus was very high especially in older subjects, and fibrinogen was associated with increasing glucose intolerance in men but not in women. The detection and better control of cardiovascular risk factors, particularly hypertension in this developed Chinese community with a high prevalence of diabetes and glucose intolerance, is particularly important.

Birthweight in women with potential gestational diabetes mellitus ‐ an effect of obesity rather than glucose intolerance?

The purpose was to compare the influence of varying levels of glycemia on the perinatal outcome. The data charts of 383 women screened for gestational diabetes mellitus with an oral glucose tolerance test during two birthyears were retrospectively evaluated. In 55 women gestational diabetes mellitus was diagnosed and treated with diet. The non-diabetic women (n=328) were subdivided into a borderline diabetes group (n=74) and a normal group (n= 254) on the basis of the oral glucose tolerance test result. The birth registry of 8196 singleton pregnancies from The Perinatal Research Unit at Skejby University Hospital served as the background population. Birthweight was highest in the borderline group. Weight increase during pregnancy was larger in the non-diabetic than the gestational diabetic women (15 vs. 8 kg p<0.01). The women with less increase of body weight delivered neonates with lower birthweight than those with higher increase. Birthweight was associated with maternal weight during pregnancy (p<0.01). Birthweight ratio increased with increasing glucose intolerance. Vaginal delivery rate was less and cesarean section rate higher in women with gestational diabetes mellitus compared to the non-diabetic women. No significant difference was found in the incidence of hypertensive disorders during pregnancy or neonatal morbidity. Even minor hyperglycemia is associated with increasing birthweight. Birthweight is reduced in GDM when dietary treatment is instituted and effect on weight gain is achieved.

Physical activity in elderly subjects with impaired glucose tolerance and newly diagnosed diabetes mellitus.

The authors carried out a study to investigate the association between different indicators of physical activity and the prevalence of impaired glucose tolerance (IGT) and newly diagnosed diabetes (nDM) in a population-based cohort of elderly men and women in the Netherlands. A sample of participants of the Rotterdam Study (n = 1,016) aged 55-75 years who were not known to have diabetes mellitus underwent an oral glucose tolerance test. Physical activity was assessed by means of a self-administered questionnaire and expressed as time spent on activities per week. Associations with the prevalence of IGT and nDM were assessed by logistic regression analysis after adjustment for age, body mass index, waist-hip ratio, family history of diabetes, and smoking. A total of 745 subjects had normal glucose tolerance, 153 IGT, and 118 nDM. The total amount of time spent on physical activity decreased with increasing glucose intolerance. Adjusted for main confounders, vigorous activities such as bicycling (men: odds ratio (OR) = 0.26, 95% confidence interval (CI) 0.14-0.49; women: OR = 0.37, 95% CI 0.18-0.78) and sports (men: OR = 0.28, 95% CI 0.11-0.74) showed an inverse association with the presence of nDM. For IGT, the associations pointed in the same direction but did not reach statistical significance. These results indicate that physical inactivity and glucose intolerance are associated among older adults similar to the way they are associated among middle-aged adults.

Effectiveness of Dexamethasone for Prevention of Shivering Following Cardiac Surgery

Introduction: Post cardiac surgery shivering (PCSS) is common and may be a result of intraoperative hypothermia [1]. Another possible etiology is fever and chills secondary to activation of the inflammatory response and release of cytokines by cardio-pulmonary bypass (CPB) [2]. Dexamethasone (DEX) decreases the gradient between core and skin temperature [3]. The goal of this study is to evaluate whether DEX can prevent PCSS by either resetting thermoregulation or inhibiting inflammatory response and release of cytokines associated with fever. Methods: After Institutional Review Board approval, and informed consent, a prospective, randomized, double blind study was undertaken. 205 patients (pts) for elective coronary and/or valvular surgery were randomly assigned to 2 groups: After induction of anesthesia, but before skin incision, Group D received DEX 0.6 mg/kg, and group P received an equal volume of placebo. All patients received standard monitoring and anesthetic management (combination of benzodiazepines, opiates, and isoflurane). After arrival to the ICU, nurses unaware of the treatment groups recorded visible shivering, as well as skin and pulmonary artery (PA) temperatures (To). Shivering was treated as per the ICU routine with sedation and additional neuro-muscular blockade, as needed. Analysis of shivering rates was done by chi-square tests. Results: Groups D and P were similar in terms of age, gender, duration of anesthesia and CPB, lowest bladder To on CPB, and PA To on admission to the ICU. Skin To on ICU admission was lower in group P (31.8 vs 32.1 [degree sign]C, p=0.036). Compared to group P, group D had a significantly lower incidence of shivering (13.1% vs 33.0%, p<0.001), and a lower peak PA To during the first 6 hours of ICU admission (37.5 vs 37.8 [degree sign]C, p<0.001). When all pts who underwent CPB under hypothermia (lowest bladder To < 35[degree sign]C) were analyzed, DEX pts had a lower incidence of shivering than placebo (17.7% vs 34.3%, p<0.05). When all pts who underwent CPB under normothermia (lowest bladder To >or=to 35[degree sign]C) were analyzed, DEX pts had a lower incidence of shivering than placebo (5.4% vs 30.3%, p<0.01). Group D had a higher peak intraoperative blood glucose than group P (248 vs 234 g/dl, p=0.197). Conclusion: DEX 0.6mg/kg given after induction of anesthesia, but before skin incision reduces the incidence of shivering after cardiac surgery. Although PCSS may result from hypothermia, the effectiveness of DEX in preventing shivering with hypothermic as well as normothermic CPB supports the role of inflammatory response in the etiology of PCSS. Although not statistically significant, the higher blood glucose in group D suggests increased glucose intolerance secondary to DEX.

Effectiveness of Dexamethasone for Prevention of Shivering Following Cardiac Surgery

Introduction: Post cardiac surgery shivering (PCSS) is common and may be a result of intraoperative hypothermia [1]. Another possible etiology is fever and chills secondary to activation of the inflammatory response and release of cytokines by cardio-pulmonary bypass (CPB) [2]. Dexamethasone (DEX) decreases the gradient between core and skin temperature [3]. The goal of this study is to evaluate whether DEX can prevent PCSS by either resetting thermoregulation or inhibiting inflammatory response and release of cytokines associated with fever. Methods: After Institutional Review Board approval, and informed consent, a prospective, randomized, double blind study was undertaken. 205 patients (pts) for elective coronary and/or valvular surgery were randomly assigned to 2 groups: After induction of anesthesia, but before skin incision, Group D received DEX 0.6 mg/kg, and group P received an equal volume of placebo. All patients received standard monitoring and anesthetic management (combination of benzodiazepines, opiates, and isoflurane). After arrival to the ICU, nurses unaware of the treatment groups recorded visible shivering, as well as skin and pulmonary artery (PA) temperatures (To). Shivering was treated as per the ICU routine with sedation and additional neuro-muscular blockade, as needed. Analysis of shivering rates was done by chi-square tests. Results: Groups D and P were similar in terms of age, gender, duration of anesthesia and CPB, lowest bladder To on CPB, and PA To on admission to the ICU. Skin To on ICU admission was lower in group P (31.8 vs 32.1 [degree sign]C, p=0.036). Compared to group P, group D had a significantly lower incidence of shivering (13.1% vs 33.0%, p<0.001), and a lower peak PA To during the first 6 hours of ICU admission (37.5 vs 37.8 [degree sign]C, p<0.001). When all pts who underwent CPB under hypothermia (lowest bladder To < 35[degree sign]C) were analyzed, DEX pts had a lower incidence of shivering than placebo (17.7% vs 34.3%, p<0.05). When all pts who underwent CPB under normothermia (lowest bladder To >or=to 35[degree sign]C) were analyzed, DEX pts had a lower incidence of shivering than placebo (5.4% vs 30.3%, p<0.01). Group D had a higher peak intraoperative blood glucose than group P (248 vs 234 g/dl, p=0.197). Conclusion: DEX 0.6mg/kg given after induction of anesthesia, but before skin incision reduces the incidence of shivering after cardiac surgery. Although PCSS may result from hypothermia, the effectiveness of DEX in preventing shivering with hypothermic as well as normothermic CPB supports the role of inflammatory response in the etiology of PCSS. Although not statistically significant, the higher blood glucose in group D suggests increased glucose intolerance secondary to DEX.

Body mass index, waist circumference, waist-hip ratio, and glucose intolerance in Chinese and Europid adults in Newcastle, UK.

OBJECTIVE: To compare the prevalence of glucose intolerance (impaired glucose tolerance and diabetes), and its relationship to body mass index (BMI) and waist-hip ratio in Chinese and Europid adults. DESIGN:...

Influence of Aging on Insulin Sensitivity in Essential Hypertensives and Normotensives.

Insulin resistance and hyperinsulinemia have been linked with essential hypertension. Age-associated increases in glucose intolerance and hypertension are also well established. To clarify the influence of aging on the insulin sensitivity, euglycemic hyperinsulinemic glucose clamp technique was carried out in 41 normotensive subjects and 42 patients with essential hypertension. The subjects of these groups were divided into two subgroups: young (< 40 years old) and middle-elderly (> or = 40 years old). Insulin sensitivity was assessed as M-value, the rate at which glucose must be infused to maintain a basal blood glucose level. In normotensive subjects, the young subgroup had a significantly higher M-value than did the middle-elderly subgroup. There was a significant negative correlation between age and M-value in normotensive subjects. On the other hand, there was no significant difference in M-value between the young and middle-elderly subgroups in the patients with essential hypertension. The age did not correlate with M-value in the hypertensive group. The normotensive subjects showed a significantly lower M-value than the hypertensive patients in the young group, but not in the middle-elderly group. These results indicate that 1) insulin sensitivity declines with age in normotensive subjects and that 2) insulin sensitivity is already diminished in the early stage of hypertension, and no further decrease in insulin sensitivity occurs with aging in essential hypertensive patients.

Effects of Oral Contraceptives on Glucose Metabolism

Techniques to measure the effect of combined oral contraceptives (OCs) on glucose metabolism include the oral glucose tolerance test (OGTT) intravenous glucose tolerance test (IVGTT) and the euglycemic or hyperglycemic hyperinsulinemic clamp techniques. There is concern about OCs having possible diabetogenic effects. Studies using the OGTT tend to demonstrate that OCs alter carbohydrate metabolism with increased glucose intolerance. The OCs that appear to have the greatest degree of glucose intolerance are those with estrogen doses greater than 50 mcg and those with levonorgestrel. During the OGTT levonorgestrel seems to effect the greatest degree of hyperinsulinema. In studies using the IVGTT levonorgestrel-associated OCs induced the greatest degree of insulin resistance (e.g. 2nd phase insulin increased by 60-90%) but did not change insulin half-life. Their glucose levels decrease more slowly after IVGTT increasing the stimulus of endogenous insulin secretion later in the test. The hyperglycemic hyperinsulinemic clamp examines pancreatic insulin secretion and glucose uptake under hyperglycemic hyperinsulinemic conditions. Euglycemic clamp studies show that OCs may be associated with a decrease in insulin sensitivity under euglycemic hyperinsulinemic conditions suggesting a possible postreceptor defect involving the insulin receptor. Women with insulin-dependent diabetes women with noninsulin-dependent diabetes and women with a past history of gestational diabetes may not be able to rise to an adequate hyperinsulinemic response to the increased glucose challenge during OC use and may have increases in the circulating plasma glucose and insulin levels.

Excessive birth weight and maternal glucose tolerance--a 19-year review.

The incidence of birth-weight of 4,540 g (10 lb) or more rose from 0.87% in the years 1971 to 1977 to 1.16% in the 12 years from 1978 to 1989 with a concomitant increase in hyperglycaemia in our antenatal population. The relationship between excessive birth-weight and maternal glucose tolerance was investigated in the light of these observations. The results from glucose tolerance tests performed routinely during the pregnancies of 510 women who delivered infants with a birth-weight of 4,540 g or more were compared with those from a control series of 5,003 women with consecutively tested pregnancies. Glucose tolerance in subsequent pregnancies was also compared with the control series, and in 1991 the study group women were investigated for emergence of permanent diabetes mellitus. Excessive birth-weight was associated with maternal hyperglycaemia (p < 0.05) but not with gestational diabetes; 79% of infants with birth-weight > or = 4,540 g were born to mothers who were not hyperglycaemic. There was no increase in glucose intolerance in subsequent pregnancies in the study group and only 2 of 49 women with follow-up testing had diabetes mellitus. Birth-weight > or = 4,540 g occurred in 1.1% of the total population and 1.1% of women with gestational diabetes, and was related to maternal hyperglycaemia in about 1 in 5 cases. The increased incidence of excessive birth-weight infants was not related to the increased incidence of gestational diabetes in our pregnant population. Birth-weight > or = 4,540 g had a poor association with later development of diabetes.

A follow-up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis, and bacterial vaginosis

Continuous subcutaneous terbutaline infusion is an exciting new development in treatment of preterm labor. Its use is associated with a significant, albeit transitory, increase in glucose intolerance. This effect may be of little significance for the pregnant woman with normal glucose tolerance. For the woman with impaired glucose tolerance, gestational diabetes, or preexisting insulin-dependent diabetes, subcutaneous terbutaline may cause severe metabolic decompensation with hyperglycemia and ketoacidosis. Careful monitoring of plasma glucose and urine ketones is necessary August 1990 Am J Obstet Gynecol

Association of Fasting Glucose Levels with a Delayed Secretion of Insulin after Oral Glucose in Subjects with Glucose Intolerance*

Two hundred and nineteen second generation Japanese-American men were classified with a 75-g oral glucose tolerance test: 77 with normal glucose tolerance, 74 with impaired glucose tolerance (IGT), and 68 with noninsulin-dependent diabetes mellitus (NIDDM). The peak insulin response to the oral glucose load was progressively delayed with each of the 3 glucose tolerance categories. A similar finding was observed with the peak C-peptide response to oral glucose, except for the absence of distinction between IGT and NIDDM. Variables measuring the initial rate of insulin or C-peptide secretion (0-30 min) after oral glucose also demonstrated a progressive diminution with increasing glucose intolerance. The relative incremental insulin response at 30 min and the relative incremental C-peptide response at 30 min were highly correlated with the fasting glucose levels (r = -0.61 and r = -0.62; P less than 0.0001, respectively). Variables measuring the 0-30 min secretory response had high variances, whereas the variance for fasting glucose was low. Twelve men who were initially classified as IGT subsequently developed NIDDM. These 12 men had significantly higher fasting glucose levels at baseline than the remaining men who did not develop diabetes, but the 30 min secretory parameters after oral glucose, although lower in those who subsequently developed diabetes, were not significantly different at baseline. However, if fasting glucose is used as a surrogate measure of secretory response, these 12 men appear to have had an impairment of oral glucose-stimulated insulin secretion antedating the development of NIDDM. The inability of the secretory parameters to detect the abnormality may be due to a type II statistical error, which may be resolved by a larger sample size.

Development of IDDM After Donating Kidney to Diabetic Sibling

The goal of this study was to describe a patient who developed insulin-dependent diabetes mellitus (IDDM) after donating a kidney to his sibling and to suggest a possible solution to prevent such an occurrence. A 42-yr-old man was found to have islet cell autoantibodies (ICAs) as part of a screening program of first-degree relatives with IDDM. Two years previously, he had donated his kidney to his HLA-identical sibling with long-standing IDDM. Both oral and intravenous glucose tolerance tests demonstrated a gradual loss of insulin secretion and increasing glucose intolerance until the patient developed IDDM 6 yr after the nephrectomy. Whether the presence of ICA is an absolute contraindication to being a kidney donor could be debated. Nonetheless, ICA should be used as a screening test to identify individuals at risk for subsequent IDDM. For those found to be positive, counseling should be provided.

Chronic undernutrition may accentuate the β cell dysfunction of type 2 diabetes

Seven undernourished and seven obese, insulin-requiring type 2 diabetic subjects, who were matched for age, sex, and duration of diabetes, were subjected to oral glucose tolerance tests. Although fasting glucose and free insulin levels were similar in both groups, glucose tolerance was markedly worse in the undernourished subjects, with a mean incremental glucose area (± SE) of 22.8 ± 2.3 mmol/l.h vs. 12.4 ± 1.3 in the obese diabetic subjects ( P < 0.001). The incremental insulin response (area under the curve) to oral glucose in the undernourished group (39.3 ± 7.9 mU/l.h) was 50% lower than the response in both the obese group (89.2 ± 19.9, P < 0.001) and a group of non-diabetic, normal weight-for-height subjects (77.1 ± 5.7, P < 0.01). Peak insulin levels were similarly reduced to approximately half the levels seen in the obese and control groups ( P < 0.01). Undernutrition is known to impair both glucose tolerance and insulin secretory reserve by reducing the β cell number, size, and granulation. It is concluded that chronic undernutrition accentuates β cell dysfunction in undernourished diabetics, leading to increased glucose intolerance.

Glucose tolerance in Papua New Guinea: ethnic differences, association with environmental and behavioural factors and the possible emergence of glucose intolerance in a highland community

That Melanesians of non-Austronesian genetic ancestry may be relatively resistant to glucose intolerance was supported by the results of a study of two semitraditional non-Austronesian villages in the Papua New Guinean highlands in 1983, in which an absence of diabetes and a high degree of glucose tolerance and insulin sensitivity were observed. The second of this series of surveys was conducted in 1985 in three non-traditional communities: a periurban, non-Austronesian village in the highlands, and rural and periurban Austronesian villages in coastal locations. Although an absence of diabetes was demonstrated once again in the highlanders, these periurban subjects showed an unexpectedly high insulin response which may be a precursor of glucose intolerance. The notion that highland communities that are living in non-traditional circumstances in Papua New Guinea presently are in "metabolic transition" towards diabetes and other non-communicable diseases, if correct, is of importance to the public health of the nation. In the periurban, coastal-dwelling Austronesians, diabetes with severe hyperglycaemia was demonstrated, and there was some evidence of a secular trend towards increasing glucose intolerance. The two-hour plasma glucose concentrations were shown to be associated with obesity, modernity and Seventh-Day Adventist religious persuasion. However, important and unexplained differences in glucose tolerance remained between rural and periurban coastal dwellers after taking these factors into account.

Glycosylated serum proteins and glycosylated haemoglobin in normal pregnancy.

Glycosylated haemoglobin (HbA1) and glycosylated serum protein concentrations (fructosamine) were monitored in 162 normal pregnancies. The response to the standard 75 g oral glucose tolerance test (OGTT) was used to exclude gestational diabetes. A significant increase in glucose intolerance, measured from the area under the OGTT-curve (r = 0.29, P less than 0.0005) and a highly significant decrease in serum albumin concentration (r = -0.79, P less than 0.0005) due to the redistribution of body water, as occurs during pregnancy, resulted in a statistically significant decrease in serum fructosamine concentration (r = -0.23, P less than 0.01) when related to gestational age in weeks.

Insulin response in obese and nonobese offspring of conjugal Indian diabetic parents with increasing glucose intolerance.

Pancreatic beta cell function in response to glucose was assessed in three different groups of offspring of conjugal diabetic parents (OCDP): those with normal glucose tolerance, those with impaired glucose tolerance (IGT), and those with diabetes. Serum immunoreactive insulin (IRI), C-peptide (CP), insulin/glucose (I/G) ratio, and IRI/CP ratios were estimated at fasting and 90 min after glucose load. Insulin secretion, measured as CP, was found to be low even in normal nonobese OCDP, but the change was not reflected in IRI value as the IRI/CP ratio was found to be elevated. The values decreased with increasing glucose intolerance. In obese OCDP, all the parameters were abnormal even among those with normal glucose tolerance, and further deterioration occurred with increasing glucose intolerance. The study shows that insulin secretory defects are detectable even in normal OCDP, and these changes deteriorate with increasing glucose intolerance. Differences are noted in the peripheral concentrations of IRI and CP between obese and nonobese OCDP before development of diabetes. After development of diabetes mellitus, these differences disappear, and the CP and IRI values in both groups are similar and low.

NONCONTRACEPTIVE ESTROGEN USE AND CARDIOVASCULAR DISEASE

To summarize, estrogens have powerful effects on certain biologic parameters, the alteration of which could influence cardiovascular disease risk. Estrogens have long been known to influence lipid and lipoprotein levels by decreasing LDL (the atherogenic lipoprotein) and by increasing HDL (the protective lipoprotein). THese lipid alterations could favorably influence the risk of cardiovascular disease. Estrogens also temporarily increase glucose intolerance and lower fasting glucose levels; although the former event could adversely affect cardiovascular disease risk, the clinical significance of increased glucose intolerance with low fasting levels has not been determined. There is no consistent evidence that menopausal estrogens adversely affect coagulation or blood pressure levels, although both of these parameters could be affected in selected individuals. Overall, the estrogenic effects on lipid/lipoprotein levels appear to be the most consistent and the most powerful; given this assumption, estrogens should protect against cardiovascular disease. There is another interpretation of the biologic effect of estrogens on cardiovascular risk. It is possible that estrogens may increase the risk of a thromboembolic event due to an adverse influence on coagulation parameters and, at the same time, decrease the risk of an atherogenic event (via favorably altered lipid/lipoprotein levels). This proposed dual action of estrogens may explain the apparently conflicting results of increased risks of thromboembolism and decreased risks of atherosclerosis or myocardial infarction in men treated with high doses of estrogen (36, 196, 197). In women, there is some suggestion that (low-dose) postmenopausal estrogens may increase the risk of thromboembolism (79, 204), although the majority of studies report no such increase. The difference in risk of thromboembolism between men and women using estrogens may be due to several factors. First, the dose (potency) of the estrogen used by men is usually higher than that used by postmenopausal women, and the risk of estrogen-induced thrombus formation may be dose-dependent. Second, men tend to have more atherosclerotic lesions than women and thus would have more substrate available for thrombus formation. (This hypothesis is supported by the observation that the increased risk of thromboembolism was evident in men using estrogens for the secondary prevention of cardiovascular disease.) Indirect evidence supporting the hypothesis that endogenous estrogen levels are protective against cardiovascular disease is most consistent for women.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral contraceptive use: Prospective follow-up of women with suspected glucose intolerance

593 women from a cohort of 8,652 healthy women failed a 1-hr glucose screening test. These 593 women with suspected glucose intolerance were classified as normal or as having impaired glucose tolerance (IGT) or diabetes mellitus (DM) after an oral standard glucose tolerance test (SGTT) and were followed over a mean 8.55 years. No permanent change in glucose status as a result of oral contraceptive use was found in an analysis for impaired glucose tolerance, diabetes mellitus, diabetic symptoms, or use of oral agents and/or insulin. Increased glucose intolerance was observed for women who were older, had a positive family history of diabetes, or were of greater relative weight. Diabetic symptoms correlated most closely with the onset of persistent fasting hyperglycemia.

Cardiovascular risk factors among urban American Indians: Blood pressure, serum lipids, smoking, diabetes, health knowledge, and behavior

We measured cardiovascular disease (CVD) risk factors and their relationship to glucose intolerance in a Native Canadian population with very high rates of Type 2 diabetes mellitus. Five hundred and twenty five study-eligible Ojibwa-Cree individuals age 18 and over in the community of Sandy Lake, Canada who had participated in a population-based survey were studied. Diabetes status, plasma concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), calculated low density lipoprotein-cholesterol (LDL-C), waist/hip ratio (WHR), BMI, systolic and diastolic BP, and history of smoking were compared to a standard national population. Extremely high rates of obesity (BMI and WHR) were identified in the study population and were associated with increasing glucose intolerance for both males and females. Rates of smoking exceeded 70 and 80% in females and males, respectively. Interestingly, despite obesity individuals who had normal glucose tolerance had significantly lower rates of high risk TC, TG, LDL-C, and HDL-C levels compared to a national Canadian population survey. However, with worsening glucose intolerance, TC, TG, LDL-C and HDL-C dramatically deteriorated in comparison to nationally published levels. These changes in cardiovascular risk factors, as a consequence of diabetes, appear to result in increased clinical outcomes. Admission to hospital for Ischemic Heart Disease (IHD) for Sandy Lake residents increased from a rate of 34.8/10 000 to 109.1/10 000 in 15 years. Although this and similar populations have historically reported low rates of CVD, the impact of diabetes on lipid risk factor is having devastating consequences on cardiovascular outcomes. This trend is expected to continue unless the high rates of diabetes can be modified.

The relationship of insulin response to a glucose stimulus over a wide range of glucose tolerance.

Oral glucose (75 g) tolerance tests were performed on 189 urbanized Micronesians with an age range of 15 to 70 years. The subjects were divided into 6 groups on the basis of the 2 h plasma glucose and the pattern of insulin response examined. Fasting plasma insulin levels were not significantly different over the entire range of glucose tolerance. The 2 h plasma insulin levels were highest in the group with 2 h plasma glucose value of 140–199 mg/100 ml. There was a progressive fall in 2 h plasma insulin with increasing glucose intolerance, so that in the group with a 2 h plasma glucose ⩾ 400 mg/100 ml, the 2 h plasma insulin level was significantly less than that in all the other groups. Obesity was the most important factor influencing both fasting and 2 h insulin levels and no effect of corresponding plasma glucose level was demonstrated. In maturity-onset diabetes, a wide range of insulin responses may be seen and the earlier controversy regarding patterns of insulin response has arisen from equating groups of diabetic subjects with varying degrees of glucose intolerance.