Intermediate Hyperglycemia Research Articles

A Transient Metabolic Recovery from Early Life Glucose Intolerance in Cystic Fibrosis Ferrets Occurs During Pancreatic Remodeling.

Cystic fibrosis (CF)-related diabetes in humans is intimately related to exocrine pancreatic insufficiency, yet little is known about how these 2 disease processes simultaneously evolve in CF. In this context, we examined CF ferrets during the evolution of exocrine pancreatic disease. At 1 month of age, CF ferrets experienced a glycemic crisis with spontaneous diabetic-level hyperglycemia. This occurred during a spike in pancreatic inflammation that was preceded by pancreatic fibrosis and loss of β-cell mass. Surprisingly, there was spontaneous normalization of glucose levels at 2-3 months, with intermediate hyperglycemia thereafter. Mixed meal tolerance was impaired at all ages, but glucose intolerance was not detected until 4 months. Insulin secretion in response to hyperglycemic clamp and to arginine was impaired. Insulin sensitivity, measured by euglycemic hyperinsulinemic clamp, was normal. Pancreatic inflammation rapidly diminished after 2 months of age during a period where β-cell mass rose and gene expression of islet hormones, peroxisome proliferator-activated receptor-γ, and adiponectin increased. We conclude that active CF exocrine pancreatic inflammation adversely affects β-cells but is followed by islet resurgence. We predict that very young humans with CF may experience a transient glycemic crisis and postulate that pancreatic inflammatory to adipogenic remodeling may facilitate islet adaptation in CF.

Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland

ObjectivesTo clarify the association between glucose intolerance and high altitudes (2900–4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability...

The changing relationship between HbA1c and FPG according to different FPG ranges.

Since the American Diabetes Association included hemoglobin A1c (HbA1c) in the diagnostic criteria for diabetes in 2010, the clinical use of HbA1c has remained controversial. We explored the use of HbA1c for diagnosing diabetes and intermediate hyperglycemia in comparison with fasting plasma glucose (FPG). We screened 3710 adult subjects (mean age = 55.24 years) comprising 1704 males and 2006 females. We drew an receiver operating characteristic (ROC) curve to evaluate the ability of HbA1c to diagnose diabetes and intermediate hyperglycemia according to FPG. We used Kappa coefficient and Pearson's correlation coefficient to evaluate the relationship between HbA1c and FPG in different FPG ranges. The areas under ROC curve to diagnose diabetes and intermediate hyperglycemia were 0.859 (95 % CI 0.827-0.892) and 0.633 (95 % CI 0.615-0.651). The kappa coefficients between FPG and HbA1c for diagnosis of diabetes and intermediate hyperglycemia were 0.601 (P < 0.001) and 0.104 (P < 0.001). The Pearson's correlation coefficient of FPG and HbA1c was 0.640 (P < 0.001), but when we classified FPG as normal, intermediate hyperglycemia and diabetes, the coefficients became 0.07 (P = 0.002), 0.185 (P < 0.001) and 0.760 (P < 0.001), respectively. The relationship between HbA1c and FPG changed according to the different FPG ranges. When FPG was higher, the relationship was stronger. HbA1c and FPG were highly consistent in diagnosing diabetes, but they were not in predicting intermediate hyperglycemia.

High prevalence of diabetes and intermediate hyperglycemia - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BackgroundThe global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes now live in low and middle income countries. Yet, little information is available regarding prevalence of diabetes and intermediate hyperglycemia in these countries, especially when a full range of diagnostic tests is employed. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population.MethodsWe report baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 civil servants aged 35-74 years. Diabetes mellitus was ascertained by self-report of diagnosis, medication use, fasting glucose, an oral glucose tolerance test, and/or glycated hemoglobin. Cut-offs for diabetes and intermediate hyperglycemia followed the recommendations of the World Health Organization and the American Diabetes Association. Adjusted prevalences were estimated through logistic regression.FindingsWith this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed. Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%. Diabetes or intermediate hyperglycemia was present in 79.1% of participants when using the most comprehensive definitions. The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).InterpretationThat four of every five free-living individuals aged 35-74 years working in selected public institutions in six Brazilian state capitals presented either diabetes or intermediate hyperglycemia highlights the advanced stage of the obesity – diabetes epidemic in urban Brazil and indicates the need for urgent action.

Albuminuria in prediabetes: time to intervene?

Prediabetes is a metabolic disorder defined by either isolated impaired fasting glucose (IFG) or isolated Impairment in the prandial or random state glycemia or a combination of the two. The definition is not precise as IFG is also an indication of IGT in literal sense. The preferred definition is IGT in the fasting state or non-fasting state. The broad term prediabetes encompasses all intermediate range hyperglycemia between normal and diabetes. At least 300 million people in the world have the disorder prediabetes [1]. It has attained clinical significance because of the epidemiological association with macrovascular disease and neuropathy and more importantly progression to diabetes. Atherogenic lipid profiles are reported in this state [2, 3]. Lipids worsen before manifest albuminuria, i.e., increasing ACR (albumin/creatinine ratio) even when within normal range in diabetics. Increasing ACR portends worsening lipids which has been reported recently [4]. The report of Nam et al., in the current issue of Endocrine goes one step further and shows albuminuria and abnormal lipids early in the prediabetes state of IFG [5]. The authors studied a large population with IFG and compared the data with those having normal fasting glucose. The strength of the study is the sample size and comes from a national survey. The authors followed standard protocols. Data on the diseases and drugs that affect the reported parameters are missing. It is probable that these effects may be nullified because of the large sample size. They report an increase in atherogenic lipids with microalbuminuria in women. We have previously reported high cholesterol and triglyceride concentrations in diabetics with proteinuria compared with those without proteinuria but with similar glycated hemoglobin levels in a cross-sectional study. Gender differences were apparent with manifest proteinuria. Women had much worse lipid profile with proteinuria [6]. The results are now replicated in IFG in this larger sample. The cause effect relation to lipids is complex. Once proteinuria develops, the positive correlation seen between glycated hemoglobin and each of total cholesterol and triglycerides gets weaker or disappears [6]. This means that the very presence of manifest nephropathy influences the changes in lipid concentrations independently than would have been by glycemic control alone. The components of the metabolic syndrome comprise of prediabetes, dyslipidemias, and microalbuminuria in addition to obesity and hypertension. Insulin resistance is seen at cellular level that in turn leads to hyperinsulinemia which is seen in prediabetes as well as metabolic syndrome. There are differences in the mechanism of hyperglycemia and insulin resistance in IFG and IGT [7, 8]. In subjects with IFG alone, there is a diminished first phase insulin response, while in IGT there is impairment of beta cell function. Reduced hepatic sensitivity is seen early in IFG. There is a well described association of microalbuminuria and components of the metabolic syndrome. A J-shaped association exists between BMI and albuminuria as shown in a large population (n = 118314) study [9]. In the current study, the subjects with IFG have higher BMIs. It is hypothetical to say that microalbuminuria and prediabetes are the insults from a common agent. Whether diabetic or non-diabetic, there is sufficient evidence V. R. R. Kodali (&) Western Australia Centre for Rural Health, University of Western Australia, Crawley, WA, Australia e-mail: venkata.kodali@health.wa.gov.au

Increased glycemic variability and decrease of the postprandial glucose contribution to HbA1c in obese subjects across the glycemic continuum from normal glycemia to first time diagnosed diabetes

ObjectiveThe contribution of postprandial glycemia (PPG) to hyperglycemia has been shown to decrease as HbA1c increased in type 2 diabetic patients. This study aimed at examining, in a series of overweight/obese patients without known glycemic disorder, the contribution of PPG to a “relative” hyperglycemia (glucose values ≥5.5mmol/L) and the presence of glycemic variability according to HbA1c levels. MethodsSeventy overweight/obese inpatients (body mass index 35.2±6.8kg/m2) without known glycemic disorder were included. Participants were classified according to an oral glucose tolerance test (according to the American Diabetes Association criteria) as patients with normoglycemia (n=33), with intermediate hyperglycemia (n=24) or diabetes (n=13). They were separated into HbA1c quartiles (Q1 to Q4). A 24hour continuous glucose monitoring was used under a 1800kcal diet and minimal physical activity. We assessed PPG contribution (3hour period after each meal) to the “relative” 24hour hyperglycemia (glucose values ≥5.5mmol/L); the remaining time was considered as the fasting/post-absorptive period. ResultsHbA1c range was from 5.1% to 7.4% (32 to 57mmol/mmol). From the lowest to the highest HbA1c quartile, the area under the curve (AUC) for the “relative” hyperglycemia presented a 17-fold increase for the fasting/post-absorptive (p<0.001) period and a 7-fold increase postprandially (p<0.001). The percent of PPG contribution to the “relative” hyperglycemia was calculated with the following formula [100×(postprandial 3hour AUC−3h AUC for a constant 5.5mmol/L glycemia)/(total 24h AUC−24h AUC for constant 5.5mmol/L glycemia)] and decreased from Q1 to Q4 of HbA1c (81.2%, 66%, 65.8%, 57%; p<0.001). Increasing HbA1c quartiles were associated with higher daily mean blood glucose level (p<0.001) and higher levels of daily glucose variability indices, including mean amplitude of glycemic excursions (p<0.01). ConclusionsIn overweight/obese patients, HbA1c was associated with lower PPG contribution to “relative” hyperglycemia and greater glycemic variability. The present findings support the importance of postprandial period in glycemic exposure even before the appearance of diabetes.

Diminished systemic and antigen-specific type 1, type 17, and other proinflammatory cytokines in diabetic and prediabetic individuals with latent Mycobacterium tuberculosis infection.

Diabetes mellitus type 2 (DM) is known to be a major risk factor for the development of active tuberculosis, although its influence on latent Mycobacterium tuberculosis infection (hereafter, "latent infection") remains poorly characterized. We examined circulating plasma cytokine levels in individuals with latent infection with DM or pre-DM (ie, intermediate hyperglycemia) and compared them to levels in patients with latent infection and normal glycemic control. In persons with DM or pre-DM, latent infection is characterized by diminished circulating levels of type 1 (interferon γ, interleukin 2, and tumor necrosis factor α) and type 17 (interleukin 17F) cytokines. This was associated with decreased systemic levels of other proinflammatory cytokines (interleukin 1β and interleukin 18) and the antiinflammatory cytokine interleukin 10 but not with decreased systemic levels of type 2 cytokines. Moreover, latently infected individuals with DM had diminished levels of spontaneous and M. tuberculosis antigen-specific levels of type 1 and type 17 cytokines when antigen-stimulated whole blood was examined. Finally, there was no significant correlation between the levels of any of the cytokines measured (with the exception of interleukin 22) with hemoglobin A1c levels. Our data reveal that latent infection in the presence of DM or pre-DM, is characterized by diminished production of cytokines, implicated in the control of M. tuberculosis activation, allowing for a potential immunological mechanism that could account for the increased risk of active tuberculosis in latently infected individuals with DM.

Speaking to Patients About Diabetes Risk: Is Terminology Important?

I t is estimated that 79 million people in the United States (35% of adults ≥ 20 years of age and 50% of adults ≥ 65 years of age) have mild degrees of hyperglycemia and are thereby at risk for developing type 2 diabetes.1 Scientific jargon such as “impaired glucose tolerance” (IGT), “impaired fasting glucose” (IFG), and “elevated A1C” may be too technical or cumbersome to use with most patients. Accordingly, preferred terminologies such as “prediabetes” and “at high risk for diabetes” have entered the clinical lexicon and are felt to be simple enough to be understood by the average patient and also sufficiently motivating to encourage lifestyle change to prevent further deterioration to type 2 diabetes. However, there is debate in the literature regarding which term is most suitable to describe this stage in the development of diabetes. In 2009, the International Expert Committee criticized the term “prediabetes” because it suggests unequivocal progression to diabetes—not an inevitable occurrence2—and advocated for use of the “high risk” terminology instead. The American Diabetes Association, however, has continued to use “prediabetes,” considering it an appropriate description of this at-risk category.3 Other groups, including the World Health Organization and the International Diabetes Federation, have been using different terms for increased diabetes risk, such as “intermediate hyperglycemia,” as well as the more technical IGT and IFG.4,5 However, those descriptors are not routinely used by practitioners in the United States. The American Association of Clinical Endocrinologists preferred “prediabetes” in its 2011 guidelines.6 Prediabetes is usually an asymptomatic state. However, it has been associated with certain morbidities, including early stages of neuropathy and macrovascular disease.7 For health care providers (HCPs), recognition of this stage is essential because it provides opportunities for patient education about the importance of initiating …

Risk of a Recurrent Cardiovascular Event in Individuals With Type 2 Diabetes or Intermediate Hyperglycemia

OBJECTIVETo investigate risk of a recurrent cardiovascular event and its predictors in a population-based cohort.RESEARCH DESIGN AND METHODSParticipants of the Hoorn Study who had experienced a first cardiovascular event after baseline (n = 336) were followed with respect to a recurrent event. Absolute risk of a recurrent event was calculated for individuals with normal glucose metabolism, intermediate hyperglycemia, and type 2 diabetes. Cox regression models were used to investigate which variables, measured before the first vascular event, predicted a recurrent event using the stepwise backward procedure.RESULTSDuring a median follow-up of 4.1 years, 44% (n = 148) of the population developed a recurrent vascular event. The rate of recurrent events per 100 person-years was 7.2 (95% CI 5.8–8.7) in individuals with normal glucose metabolism, compared with 9.8 (6.6–14.0) in individuals with intermediate hyperglycemia and 12.5 (8.5–17.6) in individuals with type 2 diabetes. Higher age (hazard ratio 1.02 [95% CI 1.00–1.04]), male sex (1.56 [1.08–2.25]), waist circumference (1.02 [1.02–1.03]), higher systolic blood pressure (1.01 [1.01–1.02]), higher HbA1c (%, 1.13 [0.97–1.31]/ mmol/mol, 1.01 [1.00–1.03]), and family history of myocardial infarction (1.38 [0.96–2.00]) predicted a recurrent cardiovascular event.CONCLUSIONSIndividuals with type 2 diabetes, but not individuals with intermediate hyperglycemia, are at increased risk for a recurrent vascular event compared with individuals with normal glucose metabolism. In people with a history of cardiovascular disease, people at increased risk of a recurrent event can be identified based on the patient’s risk profile before the first event.

Preserved GLP-1 and exaggerated GIP secretion in type 2 diabetes and relationships with triglycerides and ALT

To i) compare incretin responses to oral glucose and mixed meal of diabetic patients with the normoglycaemic population and ii) to investigate whether incretin responses are associated with hypertriglyceridaemia and alanine aminotransferase (ALT) as liver fat marker. A population-based study. A total of 163 persons with normal glucose metabolism (NGM), 20 with intermediate hyperglycaemia and 20 with type 2 diabetes aged 40-65 years participated. Participants received a mixed meal and oral glucose load on separate occasions. Glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and glucagon profiles were analysed as total area under the curve (tAUC) and incremental area under the curve. In diabetic patients compared with persons with NGM, we found increased GLP-1 secretion (tAUC per hour) following oral glucose (23.2 pmol/l (95% CI 17.7-28.7) vs 18.0 (95% CI 16.9-19.1), P<0.05) but not after the mixed meal. GIP secretion among diabetic patients was increased on both occasions (82.9 pmol/l (55.9-109.8) vs 47.1 (43.8-50.4) for oral glucose and 130.6 (92.5-168.7) vs 83.2 (77.5-88.9) for mixed meal, both P<0.05). After oral glucose, GLP-1 (tAUC per hour) was inversely related to fasting triglycerides. GIP (tAUC per hour) was positively related to fasting and postprandial triglycerides. Higher fasting GIP levels were related to higher fasting and postprandial triglyceride levels and ALT. This study confirms that in type 2 diabetes, GLP-1 secretion is generally preserved and that GIP secretion is exaggerated. The mechanism underlying the divergent associations of GLP-1 and GIP metabolism with fat metabolism and liver fat accumulation warrants further study.

DNA damage and cytotoxicity in adult subjects with prediabetes

Prediabetes (intermediate hyperglycemia) is a high-risk state for diabetes that is defined by higher than normal glycemic levels that are below the level required for a diagnosis of diabetes. Prediabetes is characterized by oxidative stress, yet the associated DNA damage and cytotoxicity remain unknown to date. Therefore, we evaluated the relationship between glycemic alterations, DNA damage and cytotoxicity in the lymphocytes of individuals with pre-diabetes. Fasting plasma glucose (FPG) and glycated hemoglobin (A1C) levels were quantified and used as inclusion criteria. Anthropometric parameters were also evaluated. The cytokinesis-block micronucleus cytome assay (CBMN Cyt) was used to evaluate DNA damage and cytotoxicity. FPG correlated with A1C (r=0.562, p=0.002). Because A1C is the best predictor of diabetes complications, the association between A1C and the evaluated variables was assessed. The waist–hip ratio correlated with A1C (p<0.01). Regarding DNA damage, the frequency of nucleoplasmic bridges correlated with A1C (p<0.05). Both apoptosis and necrosis correlated with A1C (p<0.05). The overall frequency of DNA damage and cytotoxicity also correlated with A1C (p<0.01). Additional studies evaluating cell cycle and cell death patterns in prediabetes are necessary.

HbA1c versus oral glucose tolerance test as a method to diagnose diabetes mellitus in vascular surgery patients

BackgroundThe diagnosis of diabetes mellitus (DM) is based on either fasting plasma glucose levels or an oral glucose tolerance test (OGTT). Recently, an HbA1c value of ≥ 48 mmol/mol (6.5%) has been included as an additional test to diagnose DM. The purpose of this study was to validate HbA1c versus OGTT as a method to diagnose DM in vascular surgery patients.MethodsThe study population consisted of 345 patients admitted consecutively due to peripheral arterial disease. Sixty-seven patients were previously diagnosed with DM. Glucose levels of OGTT and HbA1c values were analyzed in 275 patients. The OGTT results were categorized into three groups according to the World Health Organization 1999 criteria: 1) DM defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L and/or two-hour value (2-h-value) ≥ 11.1 mmol/L; 2) intermediate hyperglycaemia, which consists of IGT (FPG < 7.0 mmol/L and a 2-h-value between 7.8 mmol/L and 11.1 mmol/L), and IFG (fasting glucose value between 6.1 mmol/L and 7.0 mmol/L with a normal 2-h-value); and 3) normal glucose metabolism defined as FPG < 6.1 mmol/L and a 2-h-value < 7.8 mmol/L.ResultsOf the 275 patients on whom OGTT was performed, 33 were diagnosed with DM, 90 with intermediate hyperglycaemia and 152 had normal glucose metabolism. An HbA1c value of ≥ 48 mmol/mol (6.5%) detected DM with a 45.5% sensitivity and a 90% specificity compared with the OGTT results. Combining the measurements of the HbA1c value with the fasting plasma glucose level (≥7.0 mmol/L) increased the sensitivity to 64%. The total prevalence of DM and intermediate hyperglycaemia was 85% based on HbA1c values and 45% based on the OGTT.ConclusionsCompared with the OGTT the HbA1c cut-off value of ≥ 48 mmol/mol (6.5%) had a 45.5% sensitivity to diagnose DM in patients with peripheral arterial disease. OGTT and HbA1c categorized different individuals with DM and intermediate hyperglycaemia. The total prevalence of pathologic glucose metabolism was substantially higher based on HbA1c values than based on OGTT. The high prevalence of DM and intermediate hyperglycaemia when using HbA1c in this study may reflect a high chronic glycaemic burden in patients with peripheral arterial disease. Further studies on vascular surgery patients are needed to identify which method, OGTT or HbA1c, is the better in predicting DM and future clinical development of vascular disease.Trial registrationREK vest 14109

Haemoglobin glycation may partly explain the discordance between HbA1c measurement and oral glucose tolerance test to diagnose dysglycaemia in overweight/obese subjects

AimThis study assessed whether the poor correlation between HbA1c and oral glucose tolerance test (OGTT) for dysglycaemia diagnosis may be explained by haemoglobin glycation (HbG). MethodsA total of 1033 consecutive overweight or obese patients with no known diabetes underwent OGTT and measurement of HbA1c to diagnose diabetes and dysglycaemia (American Diabetes Association criteria). For each OGTT result category, low, medium and high HbG was defined according to the mean HbA1c/fructosamine ratio and mean fructosamine. High HbG was defined as values greater than mean values in each OGTT category for both HbA1c/fructosamine ratio and fructosamine levels, and low HbG was defined as lower values of both. The remaining patients were considered medium HbG. ResultsBased on OGTT and HbA1c values, 267 (25.8%) and 443 (42.8%) patients had intermediate hyperglycaemia, and 66 (6.4%) and 95 (9.2%) patients had diabetes, respectively. The results were discordant for intermediate hyperglycaemia or diabetes diagnosis in 41.7% and for diabetes diagnosis in 10.0% of the patients. The proportion of patients with HbA1c≥6.5%, but without OGTT-diagnosed diabetes, was 0%, 3.8% and 32.8% in the low-HbG, medium-HbG and high-HbG groups, respectively. In contrast, the proportion of patients with HbA1c<5.7%, but with an abnormal OGTT, was 30.4%, 11.1% and 0%, respectively. The AUROC of HbA1c to detect OGTT-diagnosed diabetes was better in the medium-HbG group [0.874 (0.816–0.931)] than in those with low or high HbG [0.628 (0.489–0.768); P<0.01]. Only age was independently associated with high-HbG status [10-year OR: 1.3 (1.1–1.5); P<0.0001]. ConclusionHaemoglobin glycation may explain many of the discordant results between HbA1c and OGTT when used for dysglycaemia diagnosis.

Fasting Glucose, Obesity, and Metabolic Syndrome as Predictors of Type 2 Diabetes

BackgroundTo determine risk for type 2 diabetes in subjects with fasting glucose levels in the ranges of normoglycemia, mild hyperglycemia, and intermediate hyperglycemia and to assess the effect of obesity...

The relationship between mean platelet volume and fasting plasma glucose differs with glucose tolerance status in a Korean general population: Gender differences

Mean platelet volume (MPV), which is used to measure platelet size, can reflect platelet activity. The objective of the present study was to evaluate the relationship between MPV and fasting plasma glucose (FPG) according to glucose tolerance (GT) status in a general population. We retrospectively studied 3098 Korean adults who underwent voluntary regular health check-ups at the Health Promotion Center of our hospital from January 2009 to December 2011. MPV was analysed within 2 hours of blood collection. A multiple linear regression analysis indicated that MPV had a significant negative correlation with FPG when the confounding variables of normal glucose tolerance (β ± SE, −0.112 ± 0.033, R2, 0.109, men; −0.102 ± 0.034, 0.132, women) and intermediate hyperglycemia (−0.072 ± 0.027, 0.130, men; −0.111 ± 0.035, 0.100, women) were adjusted for. However, MPV had a significant positive relationship with FPG after adjusting for diabetes in women as a confounding factor (0.097 ± 0.037, 0.442). We observed a contrasting relationship between MPV and FPG in the presence and absence of diabetes. This result suggests that the positive relationship between an increased glucose level and increased MPV is a unique phenomenon of diabetes itself. To our knowledge, this is the first study to demonstrate a different relationship between MPV and FPG according to glucose tolerance status in a general population.

Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: a systematic review and economic evaluation.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the UK and worldwide. Before the onset of T2DM, there are two conditions characterised by blood glucose levels that are above normal but below the threshold for diabetes. If screening for T2DM in introduced, many people with impaired glucose tolerance (IGT) will be found and it is necessary to consider how they should be treated. The number would depend on what screening test was used and what cut-offs were chosen. To review the clinical effectiveness and cost-effectiveness of non-pharmacological interventions, including diet and physical activity, for the prevention of T2DM in people with intermediate hyperglycaemia. Electronic databases, MEDLINE (1996-2011), EMBASE (1980-2011) and all sections of The Cochrane Library, were searched for systematic reviews, randomised controlled trials (RCTs) and other relevant literature on the effectiveness of diet and/or physical activity in preventing, or delaying, progression to T2DM.The databases were also searched for studies on the cost-effectiveness of interventions. The review of clinical effectiveness was based mainly on RCTs, which were critically appraised. Subjects were people with intermediate hyperglycaemia, mainly with IGT. Interventions could be diet alone, physical activity alone, or the combination. For cost-effectiveness analysis, we updated the Sheffield economic model of T2DM. Modelling based on RCTs may not reflect what happens in routine care so we created a 'real-life' modelling scenario wherein people would try lifestyle change but switch to metformin after 1 year if they failed. Nine RCTs compared lifestyle interventions (predominantly dietary and physical activity advice, with regular reinforcement and frequent follow-up) with standard care. The primary outcome was progression to diabetes. In most trials, progression was reduced, by over half in some trials. The best effects were seen in participants who adhered best to the lifestyle changes; a scenario of a trial of lifestyle change but a switch to metformin after 1 year in those who did not adhere sufficiently appeared to be the most cost-effective option. Participants in the RCTs were volunteers and their results may have been better than in general populations. Even among the volunteers, many did not adhere. Some studies were not long enough to show whether the interventions reduced cardiovascular mortality as well as diabetes. The main problem is that we know what people should do to reduce progression, but not how to persuade most to do it. In people with IGT, dietary change to ensure weight loss, coupled with physical activity, is clinically effective and cost-effective in reducing progression to diabetes. The National Institute for Health Research Health Technology Assessment programme.

Prevalence of Diabetes and Intermediate Hyperglycemia Among Adults From the First Multinational Study of Noncommunicable Diseases in Six Central American Countries

OBJECTIVEThe increasing burdens of obesity and diabetes are two of the most prominent threats to the health of populations of developed and developing countries alike. The Central America Diabetes Initiative (CAMDI) is the first study to examine the prevalence of diabetes in Central America.RESEARCH DESIGN AND METHODSThe CAMDI survey was a cross-sectional survey based on a probabilistic sample of the noninstitutionalized population of five Central American populations conducted between 2003 and 2006. The total sample population was 10,822, of whom 7,234 (67%) underwent anthropometry measurement and a fasting blood glucose or 2-h oral glucose tolerance test.RESULTSThe total prevalence of diabetes was 8.5%, but was higher in Belize (12.9%) and lower in Honduras (5.4%). Of the screened population, 18.6% had impaired glucose tolerance/impaired fasting glucose.CONCLUSIONSAs this population ages, the prevalence of diabetes is likely to continue to rise in a dramatic and devastating manner. Preventive strategies must be quickly introduced.

Quantifying the association between tuberculosis and diabetes in the US: a case-control analysis

Historically, an association between tuberculosis and diabetes was recognised clinically, and the recent global rise in diabetes prevalence has reignited interest. We therefore quantified the tuberculosis-diabetes association using US survey data. A case-control analysis was performed using cross-sectional data from the second National Health and Nutrition Examination Survey (1976-1980; civilian non-institutionalised US population aged 20-74). Cases were respondents ever diagnosed with tuberculosis, and controls were respondents who reported never receiving a tuberculosis diagnosis. Exposure to diabetes and intermediate hyperglycaemia was defined using a self-reported measure, an oral glucose tolerance test, or both. We used logistic regression to estimate an adjusted odds ratio, controlling for potential major confounders. In relation to the main exposure measure, the adjusted odds ratio for the association between tuberculosis and diabetes varied between 2.31 (95% confidence interval 1.36-3.93) and 2.36 (95% confidence interval 1.40-3.97), depending on the model. No association was found for intermediate hyperglycaemia, with adjusted odds ratio varying between 1.33 (95% confidence interval 0.49-3.64) and 1.34 (95% confidence interval 0.50-3.62), depending on model. Irrespective of the exposure measure and the confounders controlled for, diabetes was associated with an increased tuberculosis risk. This study may underestimate the true association due to exposure misclassification.

Diabetes and intermediate hyperglycaemia in Kisantu, DR Congo: a cross-sectional prevalence study

ObjectivesTo study the prevalence and risk markers of diabetes mellitus and intermediate hyperglycaemia (IH) in Kisantu, a semirural town in Bas-Congo province, The Democratic Republic of Congo.DesignA cross-sectional population-based survey.SettingsA...

Do antidiabetic medications play a specific role in differentiated thyroid cancer compared to other cancer types?

The risk for differentiated thyroid cancer, like for many other types of cancer, is increased in obese individuals and people with intermediate hyperglycaemia. The incidence of all cancers, with the exception of thyroid cancer, is also increased in type 2 diabetes mellitus patients. The review compares the prevalence of thyroid carcinoma and other cancers in obese, people with intermediate hyperglycaemia and patients with diabetes and summarizes mode of action and anti-tumourigenic effect of common antidiabetic medications. The over-expression of dipeptidyl peptidase IV in the tumours, not seen in the other cancer types, is suggested as a potential reason for the unique situation in thyroid cancer.