Isolated Impaired Glucose Tolerance Research Articles

One-Hour Post-Load Plasma Glucose and Altered Glucometabolic Profile in Youths with Overweight or Obesity.

In youths, two cut-offs (133 and 155 mg/dL) have been proposed to identify high glucose levels at the 1 h (G60) mark during an oral glucose tolerance test (OGTT). We evaluated which cut-off was more closely associated with isolated impaired glucose tolerance (IGT) and cardiometabolic risk (CMR) in 1199 youth with overweight/obesity (OW/OB) and normal fasting glucose and/or HbA1c. The disposition index (DI) was available in 724 youths. The sample was divided by two cut-offs of G60: <133 mg/dL (n = 853) and ≥133 mg/dL (n = 346), or G60 < 155 mg/dL (n = 1050) and ≥155 mg/dL (n = 149). Independent of the cut-off, youths with high levels of G60 showed higher levels of G120, insulin resistance (IR), triglycerides to HDL ratio (TG/HDL), alanine aminotransferase (ALT), and lower insulin sensitivity (IS) and DI than youths with lower levels of G60. The percentage of youths showing IGT, IR, low IS, high TG/HDL ratio, high ALT, and low DI was 50% higher in the G60 ≥ 133 mg/dL group than in the G60 ≥ 155 mg/dL one. In youths with OW/OB and IGT, a cut-off of G60 ≥ 133 mg/dL is more useful than G60 ≥ 155 mg/dL to identify those at high risk of IGT and altered CMR profile.

Sex-differences in insulin sensitivity and insulin secretion in subjects with impaired fasting glucose and impaired glucose tolerance

AimsTo assess sex-related differences in whole-body insulin sensitivity and insulin secretion in a group of Caucasian subjects with varying degrees of glucose tolerance. MethodsSex-related differences in insulin sensitivity using the hyperinsulinemic–euglycemic clamp technique and insulin secretion using validated indexes obtained during an oral glucose tolerance test were examined among 570 non-diabetic offspring individuals having only one parent with type 2 diabetes. Participants were classified as having with NGT, isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined IFG/IGT. ResultsIsolated IFG, isolated IGT, and combined IFG/IGT women exhibited greater relative differences in BMI, waist circumference, and insulin-stimulated glucose disposal than their male counterparts. Formal tests for glucose tolerance status × sex interaction were statistically significant for BMI (P = 0.05) waist circumference (P = 0.04), and insulin-stimulated glucose disposal (P = 0.01) suggesting a sex-specific association. By contrast, tests for glucose tolerance status × sex interaction regarding both insulinogenic and disposition indexes were not significant. ConclusionsThis study suggests that deterioration of glucose homeostasis in women is associated with a greater fat accumulation and worsening in insulin sensitivity as compared with men.

A new formula to improve the screening of impaired glucose tolerance in youths with overweight or obesity

AimTo assess a new formula to improve the screening of isolated impaired glucose tolerance (IGT) in youth with overweight/obesity (OW/OB). Methods and resultsA cross-sectional study was performed in 1189 Caucasian youths with OW/OB aged 5–17 years, in whom impaired fasting glucose and high glycosylated hemoglobin were excluded. The sample was divided into training set (TS) (n = 883) and validation set (VS) (n = 306). Fasting (FG) and post-load plasma glucose, alanine aminotransferase (ALT), lipids and familial history for type 2 diabetes (FD) were available in all individuals. In the TS youths with IGT (n = 58, 7.0%) showed higher prevalence of female sex (FS), FD, and higher levels of FG, post-load glucose, ALT and lower levels of HDL-cholesterol vs individuals without IGT. The linear formula was obtained by logistic regression analysis in the TS: 0.05∗ALT + 0.07∗FG + 0.87∗FD + (0.06∗HDL∗ − 1) + 1∗FS. The best cut-off was 5.84. The performance of the formula vs IGT was: sensitivity: 0.74 and specificity: 0.71. Similar results were obtained in the VS. ConclusionsUsing metabolic and anamnestic data we obtained a simple formula with a good performance for screening isolated IGT. This formula may support pediatricians to identify youths with OW/OB in whom the OGTT may be useful for detecting IGT.

Association between serum hydrogen sulfide concentrations and dysglycemia: a population-based study

Background and aimHydrogen sulfide (H2S), a signaling gasotransmitter, is involved in carbohydrate metabolism. Here, we aimed to assess the potential association between serum H2S and dysglycemia in the framework of a population-based study.MethodsAdults men and women with completed data (n = 798), who participated in the Tehran Lipid and Glucose Study (2014–2017) were included in the study. Medians of fasting serum H2S concentration were compared across the glycemic status of the participants, defined as type 2 diabetes mellitus (T2DM), isolated impaired fasting glucose (IIFG), isolated impaired glucose tolerance (IIGT), combined IFG-IGT, and normal glycemia [i.e., those with both normal fasting glucose (NFG) and normal glucose tolerance (NGT)]. Multinomial logistic regression was used to assess potential associations between serum H2S and the defined glycemic status.ResultsMean age of the participants was 45.1 ± 14.0 y, and 48.1% were men. Prevalence of T2DM, IIFG, IIGT, and combined IFG-IGT was 13.9, 9.1, 8.1, and 4.8% respectively. No significant difference was observed in serum H2S concentrations between the groups. Lower serum H2S (< 39.6 µmol/L) was associated with an increased chance of having IIGT (OR = 1.96, 95% CI = 1.15–3.34) in the adjusted model.ConclusionReduced serum H2S level may be associated with impaired glucose tolerance.

A Narrative Review of Human Clinical Trials on the Impact of Phenolic-Rich Plant Extracts on Prediabetes and Its Subgroups.

Phenolic-rich plant extracts have been demonstrated to improve glycemic control in individuals with prediabetes. However, there is increasing evidence that people with prediabetes are not a homogeneous group but exhibit different glycemic profiles leading to the existence of prediabetes subgroups. Prediabetes subgroups have been identified as: isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), and combined impaired fasting glucose and glucose intolerance (IFG/IGT). The present review investigates human clinical trials examining the hypoglycemic potential of phenolic-rich plant extracts in prediabetes and prediabetes subgroups. Artemisia princeps Pampanini, soy (Glycine max (L.) Merrill) leaf and Citrus junos Tanaka peel have been demonstrated to improve fasting glycemia and thus may be more useful for individuals with IFG with increasing hepatic insulin resistance. In contrast, white mulberry (Morus alba Linn.) leaf, persimmon (Diospyros kaki) leaf and Acacia. Mearnsii bark were shown to improve postprandial glycemia and hence may be preferably beneficial for individuals with IGT with increasing muscle insulin resistance. Elaeis guineensis leaf was observed to improve both fasting and postprandial glycemic measures depending on the dose. Current evidence remains scarce regarding the impact of the plant extracts on glycemic control in prediabetes subgroups and therefore warrants further study.

The association between urine pH and abnormal glucose tolerance in adults

Aim: Urine Ph (U-pH) is a clinical indicator of acid excretion in the urine and acid load in the diet. The association between low U-pH and net acid secretion with obesity, metabolic syndrome, diabetes, chronic kidney disease, and uric acid nephrolithiasis were showed. The aim of this study is to evaluate the U-pH in patients with different glucose tolerance status.&#x0D; Materials and methods: This study was designed as single-center, retrospective, and cross-sectional. A total of 1666 subjects (male/female: 531/1135) were divided into three groups according to their OGTT results: group 1 = normal glucose tolerance (NGT), group 2 = prediabetes, group 3 = T2DM. Than subjects were divided into five groups according to their OGTT results: group 1 = NGT, group 2 = impaired fasting glucose (IFG), group 3 = isolated impaired glucose tolerance (IGT), group 4 = both IFG and IGT, and group 5 = T2DM. Additionally, patients were divided into three groups according to their glycated hemoglobin (HbA1c) results: group 1 = NGT, group 2 = prediabetes, and group 3 = T2DM. U-pH values and other outcomes were compared between groups.&#x0D; Results: Age, male gender, hemoglobin, creatinine, triglycerides, and OGTT groups showed significant association with low U-pH through univariate logistic regression analyses. In model 1 (with OGTT 3 groups), it was found that creatinine (OR: 3.471; % 95 CI: 1.377-8.749; p=0.008) and triglycerides (OR: 1.001; %95 CI: 1-1.003; p = 0.013) were positively associated with low U-pH. Patients with DM (OR:1.437; %95 CI: 1.015-2.035; p=0.041) had higher risk for low U-pH compared to patients with NGT. In Model 2 (with OGTT 5 groups), creatinine (OR:3.423; %95 CI: 1.354-8.654; p = 0.009) and triglycerides (OR:1.001; %95 CI: 1-1.003; p = 0.014) were identified as independent predictive factors associated with low U-pH. Patients with IFG+IGT (OR:1.522; %95 CI: 1.083-2.138; p=0.015) and DM (OR:1.447; %95 CI: 1.022-2.049; p=0.037) had higher risk for low U-pH compared to patients with NGT.&#x0D; Conclusion: In this study, the frequency of diabetes was found to be increased in patients with low U-pH. More detailed clinical studies are needed to evaluate the relationship between total acid load in the body and U-pH and glucose tolerance disorders.

The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) program: study protocol for a randomized controlled trial

BackgroundCommunity-based diabetes prevention programs varied widely in effectiveness, and the intervention strategy consisting of lifestyle interventions, stepwise addition of metformin, and financial incentives has not been studied in real-world clinical practice settings. The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) trial is a pragmatic trial that aims to compare the effectiveness of a community-based stepwise diabetes prevention program with added financial incentives (intervention) versus the standard of care (control) in reducing the risk of type 2 diabetes over 3 years among overweight or obese individuals with pre-diabetes.MethodsThis is an open-label, 1:1 randomized controlled trial which aims to recruit 846 adult individuals with isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), or both IFG and IGT from Singapore. Intervention arm participants attend 12 group-based sessions (2 nutrition workshops, 9 exercise sessions, and a goal-setting workshop) delivered at community sites (weeks 1 to 6), receive weekly physical activity and nutrition recommendations delivered by printed worksheets (weeks 7 to 12), and receive monthly health tips delivered by text messages (months 4 to 36). From month 6 onwards, intervention arm participants who remain at the highest risk of conversion to diabetes are prescribed metformin. Intervention arm participants are also eligible for a payment/rewards program with incentives tied to attendance at the group sessions and achievement of the weight loss target (5% of baseline weight). All participants are assessed at baseline, month 3, month 6, and every 6 months subsequently till month 36. The primary endpoint is the proportion of participants with diabetes at 3 years. Secondary endpoints include the mean change from baseline at 3 years in fasting plasma glucose, 2-hour plasma glucose, HbA1c, body weight, body mass index, physical activity, and dietary intake.DiscussionThe Pre-DICTED trial will provide evidence of the effectiveness and feasibility of a community-based stepwise diabetes prevention program with added financial incentives for individuals with pre-diabetes in Singapore. The study will provide data for a future cost-effectiveness analysis, which will be used to inform policymakers of the value of a nationwide implementation of the diabetes prevention program.Trial registrationClinicalTrials.govNCT03503942. Retrospectively registered on April 20, 2018.Protocol version: 5.0 Date: 1 March 2019

The Relationship Between Neutrophil/Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) with Microalbuminuria in Participants with Different Glucose Tolerances

Neutrophil/lymphocyte ratio (NLR) is a simple and inexpensive marker of subclinical inflammation for chronic diseases. Mean platelet volume (MPV) is a platelet function index. This study aimed to evaluate the relationship of NLR and MPV with microalbuminuria in participants with different glucose tolerances. 951 patients (male/female=302/649) were divided into five groups according to their oral glucose tolerance test (OGTT) results: group 1=normal glucose tolerance (NGT), group 2=impaired fasting glucose (IFG), group 3=isolated impaired glucose tolerance (IGT), group 4=both IFG and IGT, and group 5=type 2 diabetes mellitus (DM). Additionally, patients were divided into three groups according to their glycated hemoglobin (HbA1c) results: group 1=NGT, group 2=prediabetes, and group 3=type 2 DM. Outcomes were compared between groups. According to the OGTT, HbA1c, and OGTT+HbA1c criteria, there was a significantly positive correlation of microalbuminuria with MPV and NLR in all DM patients (p<0.001). Additionally, according to the OGTT, HbA1c, and OGTT+HbA1c criteria, there was a significantly positive correlation between MPV and microalbuminuria in all NGT patients (p<0.001). According to the OGTT and OGTT+HbA1c criteria, there was no significant correlation between NLR and microalbuminuria in prediabetic patients (p>0.05); however, there was a significantly positive correlation between NLR and microalbuminuria in the group with HbA1c 5.7–6.49 (p<0.001). Except isolated IFG and IGT, there was a significantly positive correlation between MPV and microalbuminuria in all prediabetic patients according to the OGTT, HbA1c, and OGTT+HbA1c criteria (p<0.001). NLR and MPV levels may be reliable predictive markers for the detection of microalbuminuria in prediabetes and DM.

Sex Differences in the Prevalence of and Risk Factors for Abnormal Glucose Regulation in Adults Aged 50 Years or Older With Normal Fasting Plasma Glucose Levels.

AimsAbnormal glucose regulation, which can present as diabetes and prediabetes, has become one of the most common chronic conditions. However, sex differences in the prevalence of and factors associated with abnormal glucose regulation remain unclear. Thus, we aimed to explore sex differences in the prevalence of and factors associated with abnormal glucose regulation in low-income adults in China aged ≥50 years with normal fasting plasma glucose levels.Materials and MethodsA total of 2,175 individuals aged ≥50 years with normal fasting plasma glucose levels were recruited into this study. After an overnight fast of at least 10 h, individuals underwent an oral glucose tolerance test. Fasting and 2-h plasma glucose levels were measured to determine the state of glucose regulation.ResultsWomen were more likely than men to have isolated-impaired glucose tolerance (i-IGT) overall (24.7% vs 20.8%; P= 0.034), among individuals aged <65 years (21.7% vs 15.9%; P= 0.012). Among men, independent risk factors for i-IGT were an age of ≥65 years, hypertension, and high serum uric acid (SUA) and triglyceride levels; independent risk factors for diabetes mellitus (DM) were an age of ≥75 years and alcohol consumption. Among women, independent risk factors for i-IGT were central obesity and high levels of high-sensitivity C-reactive protein and SUA; independent risk factors for DM were low education and an elevated white blood cell count.ConclusionsOur findings suggest that conventional cardiovascular disease risk factors (i.e., age, hypertension, and dyslipidemia) associated with high risk of developing DM in men, but poor life style (i.e., obesity) and low education attainment in women. It is necessary for delay or stopping the development of DM among low-income adults in China to implement the personalized scheme of prevention DM between men and women, especially highlight control the risk factors in young and middle aged women.

Vitamin D level in Patients with Prediabetes

Purpose&#x0D; Vitamin D deficiency may cause glucose intolerance, diabetes mellitus, and metabolic syndrome. However, there are conflicting data the relationship between vitamin D levels and prediabetes in the literature. Our aim in this study is to evaluate serum 25-hydroxyvitamin D levels in prediabetic patients and to determine if vitamin D deficiency or insufficiency is a factor for developing prediabetes. &#x0D; Material and Method:&#x0D; Our study included a total of 220 patients, including 85 with isolated Impaired Fasting Glucose (IFG), 50 with isolated Impaired Glucose Tolerance (IGT), and 85 with combined IFG and IGT, and 80 healthy normoglycemic individuals similar in age, gender and BMI. &#x0D; Results&#x0D; The mean vitamin D levels between the patient group diagnosed as IGT and IFG+IGT and the control group were statistically significantly different (IGT: 11.69±6.48 ng/ml vs. control group: 16.63±9.78 ng/ml, p

Clinical Characteristics and Associated Risk Factors of Prediabetes in the Southwestern Region of Korea from 2010-2019.

This study investigated the clinical characteristics and associated risk factors of prediabetes in the southwestern region of Korea. A total of 323 subjects from 13 prediabetes studies were included in the data analysis. Subjects with prediabetes were divided into the following subtypes: (1) normal glucose tolerance (NGT) with HbA1c 5.7%–6.4%; (2) isolated impaired fasting glucose (I-IFG); (3) isolated impaired glucose tolerance (I-IGT); and (4) combined I-IFG and I-IGT (C-IFG/IGT). Clinical and biochemical variables were compared among subtypes, and multivariate logistic regression analysis was used to identify risk factors for prediabetes subtypes. The overall proportion of subjects with NGT, I-IFG, I-IGT and C-IFG/IGT was 8.4%, 20.7%, 33.1% and 37.8%, respectively. In men, C-IFG/IGT was the most common subtype, while in women, I-IGT was the most common. The parameters related to dysglycemia, atherosclerosis and liver dysfunction were higher in subjects in the C-IFG/IGT subtype than in other subtypes. Multiple linear regression analysis revealed independent risk factors for increased FPG, 2h-PPG and HbA1c levels. This study identified the clinical features and independent risk factors for prediabetes subtypes.

Abstract 19: Cost-effectiveness of the Stepwise Approach to Diabetes Prevention in India

Introduction: Expert guidelines recommend a stepwise approach (lifestyle modification followed by addition of metformin in those not meeting goals) in high-risk people to delay progression to diabetes. However, there is scant evidence on the cost-effectiveness of implementing stepwise diabetes prevention. We estimated the 3-year within trial cost-effectiveness of a stepwise diabetes prevention approach in the Diabetes Community Lifestyle Improvement Program (D-CLIP) study in Chennai, India. Hypothesis: We assessed the cost-effectiveness of a stepwise diabetes prevention approach in India. Methods: The D-CLIP study was a randomized, controlled, translation trial in 578 overweight/obese Asian Indian adults with isolated impaired glucose tolerance (IGT) and/or isolated impaired fasting glucose (IFG), comparing a 6-month lifestyle modification curriculum and stepwise addition of metformin vs. standard lifestyle advice. We assessed direct medical costs including costs to deliver the intervention, general health care utilization, and direct non-medical costs. We also calculated costs for screening which included identifying and recruiting eligible individuals with IGT and/or IFG. Health effects were measured as absolute reductions in cumulative diabetes risk and in quality adjusted life years (QALYs) gained. Generalized linear regressions models adjusted for age, sex and baseline levels were fitted to estimate incremental costs and health effects. Bootstrapping was applied to describe the uncertainty around incremental cost-effectiveness ratios (ICER). Results: Over 3 years, the intervention resulted in incremental direct medical costs of 211 USD; incremental direct non-medical costs of 34 USD, an absolute diabetes risk reduction of 10.2%, and incremental QALYs gained of 0.098 per person. The absolute diabetes risk reduction in people with IFG was 6.4%, with IGT was 9% and with both IFG and IGT was 8.1%. ICERs from a multi-payer perspective (including the screening costs) averaged 4,275 USD per diabetes case prevented/delayed. That figure was 5,220 USD in people with IFG, 2,627 USD with IGT and 3,312 USD with both IFG and IGT. ICERs from a multi-payer perspective (including the screening costs) averaged 4,472 USD per QALY gained. That figure was 4,589 USD in people with IFG, 4,270 USD with IGT and 4,335 USD with both IFG and IGT. ICERs from a societal perspective were slightly higher. In the sensitivity analysis, with the scenario of a 50% increase/decrease in screening and intervention costs, from a multi-payer perspective, the average of ICERs varied 1,907 to 6,420 USD per diabetes case prevented, from 1,995 to 6,715 USD per QALY gained. Conclusions: In conclusion, a stepwise approach for diabetes prevention is likely to be cost-effective over a three-year time horizon.

First Report on Association of Hyperuricemia with Type 2 Diabetes in a Vietnamese Population.

Background Uric acid is a powerful free-radical scavenger in humans, but hyperuricemia may induce insulin resistance and beta-cell dysfunction. The study aimed to evaluate the association between hyperuricemia and hyperglycemia, considering the confounding factors in a Vietnamese population. Methods A population-based cross-sectional study recruited 1542 adults aged 50 to 70 years to collect data on socioeconomic status, lifestyle factors, and clinical patterns. Associations between hyperuricemia and hyperglycemia (isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), combined IFG-IGT, and type 2 diabetes (T2D)) were evaluated by multinomial logistic regression analysis in several models, adjusting for the confounding factors including socioeconomic status, lifestyle factors, and clinical measures. Results Uric acid values were much higher in IFG, IFG-IGT, and T2D groups compared to those in the normal glucose tolerance (NGT) group. The significant association of hyperuricemia with IFG, IFG-IGT, and T2D was found in the model unadjusted and remained consistently in several models adjusted for socioeconomic status, lifestyle factors, and clinical patterns. In the final model, the consistent hyperglycemia risk was found in total sample (OR = 2.23 for IFG, OR = 2.29 for IFG-IGT, and 1.75 for T2D, P ≤ 0.006) and in women (OR = 2.90 for IFG, OR = 3.96 for IFG-IGT, and OR = 2.49 for T2D, P < 0.001) but not in men. Conclusions It is the first report in Vietnamese population suggesting the significant association of hyperuricemia with IFG, IFG-IGT, and T2D; and the predominant association was found in women than in men, taken into account the confounding factors.

Decrease of FGF19 contributes to the increase of fasting glucose in human in an insulin-independent manner.

The ileum-derived fibroblast growth factor 19 (FGF19) plays key roles in hepatic glucose homeostasis in animals in an insulin-independent manner. Here, we analyzed the association of FGF19 with glucose effectiveness (GE, the insulin-independent glucose regulation), as well as hepatic glucose production (HGP) in Chinese subjects. GE was measured by frequently sampled intravenous glucose tolerance test (FSIVGTT) in normal glucose tolerance (NGT), isolated-impaired glucose tolerance (I-IGT), and isolated-impaired fasting glucose (I-IFG) subjects. The oral glucose tolerance test-derived surrogate of GE (oGE) was determined in NGT, I-IFG, combined glucose intolerance (CGI), and type 2 diabetes (T2DM) subjects. HGP was assessed by labeled ([3-3H]-glucose) hyperinsulinemic-euglycemic clamp in NGT subjects. Insulin secretion and sensitivity were calculated by the hyperglycemic and hyperinsulinemic-euglycemic clamps in a subgroup of NGT, I-IGT, and I-IFG subjects. Serum FGF19 levels were determined by ELISA. FGF19 positively correlated with GE (r = 0.29, P = 0.004) as determined by FSIVGTT. The result was further confirmed by oGE (r = 0.261, P < 0.001). FGF19 was negatively associated with FPG (r = - 0.228, P = 0.025), but the association no longer existed after adjusting for GE (r = - 0.177, P = 0.086). FGF19 was negatively associated with basal HGP (r = - 0.697, P = 0.006). However, the correlation between FGF19 and insulin secretion and sensitivity were not found. FGF19 levels are associated positively with GE and negatively with HGP. The increase of FPG in human is at least partially due to the decrease of FGF19 in an insulin-independent manner.

Sexual functioning and depressive symptoms in men with various types of prediabetes: a pilot study.

No study has compared sexual functioning and depressive symptoms in male subjects with various types of prediabetes. Our study included four age- and weight-matched groups of apparently healthy men (25-50 years old): subjects with isolated impaired fasting glucose (IFG) (n = 16), men with isolated impaired glucose tolerance (n = 17), individuals with the presence of both IFG and impaired glucose tolerance (n = 16), as well as men with normal glucose tolerance (n = 18). All included men completed questionnaires evaluating male sexual functioning (IIEF-15) and assessing the presence and severity of depressive symptoms (BDI-II). Men with both IFG and impaired glucose tolerance obtained lower domain scores for erectile function, sexual desire, and overall satisfaction, as well as the higher overall BDI-II score. Individuals with isolated impaired glucose tolerance (IGT) and IFG were characterized by lower domain score only for sexual desire. In all study groups, domain score for erectile function correlated with the BDI-II score, while scores for erectile function and sexual desire correlated with a degree of insulin resistance. The obtained results suggest that prediabetes may impair sexual functioning in young men. The risk is particularly high in individuals with the presence of both IFG and IGT.

Identical anthropometric characteristics of impaired fasting glucose combined with impaired glucose tolerance and newly diagnosed type 2 diabetes: anthropometric indicators to predict hyperglycaemia in a community-based prospective cohort study in southwest China

ObjectivesTo assess the anthropometric characteristics of normoglycaemic individuals who subsequently developed hyperglycaemia, and to evaluate the validity of these measures to predict prediabetes and diabetes.DesignA community-based prospective cohort study.ParticipantsIn total,...

Evaluating FINDRISC as a screening tool for type 2 diabetes among overweight adults in the PREVIEW:NZ cohort

AimsThis study aimed to evaluate the efficacy of a high (≥12) Finnish diabetes risk (FINDRISC) score in identifying undiagnosed prediabetes and type 2 diabetes (T2D) in an New Zealand population of overweight and obese individuals, across a variety of ethnic groups. MethodsWe estimated the efficacy of elevated FINDRISC scores in predicting prediabetes and T2D in 424 overweight adults with no prior diagnosis recruited for the PREVention of diabetes through lifestyle Interventions in Europe and Worldwide (PREVIEW) study. All participants who completed the FINDRISC questionnaire during a pre-screening phase with a score of ≥12 were then screened using a 2h oral glucose tolerance test (2h-OGTT) to identify undiagnosed dysglycaemia. ResultsOf the 424 participants, 65% (n=280) were pre-diabetic and 7% (n=32) had undiagnosed T2D. A higher FINDRISC score was significantly associated with prediabetes and T2D (P=0.02). There was a significant association between ethnicity and glycaemic status (normal vs prediabetes/T2D, P=0.02). Increasing the FINDRISC cut-off to ≥15 resulted in a non-significant increase in the proportion of participants correctly classified with dysglycaemia. ROC-AUC=0.6 with sensitivity=0.6026 (95% CI: 0.5459–0.6573) and specificity=0.5536 (95% CI: 0.4567–0.6476). Isolated impaired fasting glucose (IFG) was more efficient in predicting dysglycaemia than isolated impaired glucose tolerance (IGT). ConclusionsThe FINDRISC questionnaire is a useful and efficacious screening tool to identify unknown prediabetes and T2D in overweight New Zealanders, particularly in Maori individuals.

Lowered fasting chenodeoxycholic acid correlated with the decrease of fibroblast growth factor 19 in Chinese subjects with impaired fasting glucose

The gut-derived hormone Fibroblast growth factor 19 (FGF19) could regulate glucose metabolism and is induced by bile acids (BAs) through activating Farnesoid X Receptor (FXR). FGF19 was found to decrease in subjects with isolated-impaired fasting glucose (I-IFG) and type 2 diabetes mellitus (T2DM). However, the reason for the change of FGF19 in subjects with different glucometabolic status remained unclear. Here we measured six BAs including chenodeoxycholic acid (CDCA), cholic acid, deoxycholic acid, their glycine conjugates and FGF19 levels during oral glucose tolerance test (OGTT) in normal glucose tolerance (NGT), isolated-impaired glucose tolerance, I-IFG, combined glucose intolerance (CGI) and T2DM subjects. After OGTT, serum FGF19 peaked at 120 min in all subjects. Glycine conjugated BAs peaked at 30 min, while free BAs did not elevated significantly. Consistent with the decrease trend in FGF19 levels, fasting serum CDCA levels in subjects with I-IFG, CGI and T2DM were significantly lower than NGT subjects (P < 0.05). Fasting serum CDCA was independently associated with FGF19. CDCA strongly upregulated FGF19 mRNA levels in LS174T cells in a dose- and time-dependent manner. These results suggest that the decrease of FGF19 in subjects with I-IFG was at least partially due to their decrease of CDCA acting via FXR.

Is there a connection between postprandial hyperglycemia and IGT related sensory nerve dysfunction?

Background and aimsTo assess the risk factors for sensory nerve dysfunction in subjects with isolated impaired glucose tolerance (IGT). Methods and resultsSeventy-two people with isolated IGT (WHO 1999 criteria) and 39 gender and age-matched healthy volunteers underwent detailed clinical and neurological assessment including quantitative sensory testing using the Neurometer device (current perception threshold measurement on four limbs at three different frequencies). Sensory nerve dysfunction was defined as at least two abnormalities on any frequencies on the upper or lower limbs.Sensory nerve dysfunction was more prevalent among subjects with IGT compared to controls (58.3 vs. 10.3%, OR: 11.23, 95%CI: 3.57–35.35). This association was not influenced by BMI, systolic and diastolic blood pressure, heart rate and autonomic neuropathy (multiple adjusted OR: 13.87, 95%CI: 3.18–60.58), but further adjustment for glycaemic measures abolished the association (OR: 1.58, 95%CI: 0.07–35.68). Assessing the components of glycaemic measures separately, the association between sensory nerve dysfunction and IGT was not affected by HbA1c (OR: 13.94, 95%CI: 1.84–105.5). It was, however, substantially attenuated by fasting plasma glucose (OR: 6.75, 95%CI: 1.33–34.27) while the significance was lost after adjustment for 120 min postload glucose level (OR: 3.76, 95%CI: 0.26–54.10). In the pooled population assessed, independent determinants of sensory nerve dysfunction were older age, 120 min glucose, higher height and cardiovascular autonomic neuropathy at near significance. ConclusionsSensory nerve dysfunction amongst subjects with IGT was not explained by cardiovascular covariates, only by glycaemic measures. In addition to 120 min glucose, cardiovascular autonomic neuropathy at borderline significance, age, and height were the independent determinants of sensory nerve dysfunction.

Mechanisms Underlying the Pathogenesis of Isolated Impaired Glucose Tolerance in Humans

Prediabetes is a heterogeneous disorder classified on the basis of fasting glucose concentrations and 2-hour glucose tolerance. We sought to determine the relative contributions of insulin secretion and action to the pathogenesis of isolated impaired glucose tolerance (IGT). The study consisted of an oral glucose tolerance test and a euglycemic clamp performed in two cohorts matched for anthropometric characteristics and fasting glucose but discordant for glucose tolerance. An inpatient clinical research unit at an academic medical center. Twenty-five subjects who had normal fasting glucose (NFG) and normal glucose tolerance (NGT) and 19 NFG/IGT subjects participated in this study. Subjects underwent a seven-sample oral glucose tolerance test and a 4-hour euglycemic, hyperinsulinemic clamp on separate occasions. Glucose turnover during the clamp was measured using tracers, and endogenous hormone secretion was inhibited by somatostatin. We sought to determine whether hepatic glucose metabolism, specifically the contribution of gluconeogenesis to endogenous glucose production, differed between subjects with NFG/NGT and those with NFG/IGT. Endogenous glucose production did not differ between groups before or during the clamp. Insulin-stimulated glucose disappearance was lower in NFG/IGT (24.6 ± 2.2 vs 35.0 ± 3.6 μmol/kg/min; P = .03). The disposition index was decreased in NFG/IGT (681 ± 102 vs 2231 ± 413 × 10-14 dL/kg/min2 per pmol/L; P < .001). We conclude that innate defects in the regulation of glycogenolysis and gluconeogenesis do not contribute to NFG/IGT. However, insulin-stimulated glucose disposal is impaired, exacerbating defects in β-cell function.