Non-diabetic First-degree Relatives Research Articles

Serum Fructosamine and Glycosylated Haemoglobin in Diabetic Subjects and their Non-Diabetic First-Degree Relatives

Serum Fructosamine and Glycosylated Haemoglobin in Diabetic Subjects and their Non-Diabetic First-Degree Relatives

Insulin Resistance in Type II Diabetes Mellitus Patients and Their First Degree Relatives- An Observational Study

Type II diabetes (T2DM) is caused by environmental, genetic, metabolic, and unknown variables. In diabetics, insulin resistance is the most of prolonged hyperglycemia. T2DM is induced by insulin resistance and cell dysfunction. The interaction of genetics and environment further complicates T2DM development. Insulin resistance and beta cell dysfunction are two of the most common Type 2 Diabetes Mellitus symptoms. A vicious triangle of cell failure (80% cell function) and insulin resistance in the muscles and liver causes major physiological issues. A group of diabetes patients (Group I), non-diabetic first-degree relatives of diabetic patients (Group II), and a non-diabetic healthy control group (Group III) were studied. The diabetes patients had the greatest systolic and diastolic blood pressures, followed by first degree relatives and healthy controls. We found that people with diabetes had higher fasting (FBS) and postprandial sugar, glycated haemoglobin (HbA1c) than diabetic offsprings and control group. Moreover, fasting insulin levels are higher in first degree relatives than in diabetes patients in the control group. The HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) levels of diabetics and their progeny do not differ much. The HOMA-IR measures insulin resistance severity. Common reference levels for HOMA-IR insulin resistance range from 0.7 - 2. Insulin resistance in diabetics and their first-degree relatives is evident from the results.

Impact of triglycerides and waist circumference on insulin resistance and \u03b2-cell function in non-diabetic first-degree relatives of type 2 diabetes

BackgroundAlthough there is abundant evidence indicating the relative contribution of insulin resistance (HOMA-IR) and β-cell dysfunction (HOMA-β) among first-degree relatives (FDRs) of Type 2 DM patients, few studies reported the association between HOMA-IR and HOMA-β with metabolic syndrome. Our objective was to evaluate the impact of metabolic syndrome factors on HOMA-IR, HOMA-β and glycoproteins in non-diabetic FDRs.MethodsIn this study, 103 Yemeni male subjects aged 25–42 years, with BMI < 25 kg/m2 were examined, 39 of whom were normal subjects with no family history of diabetes served as control and 64 subjects were non-diabetic FDRs of Type 2 DM patients.ResultsBoth glycoproteins, glycated haemoglobin (HbA1c) and fructosamine as well as insulin, HOMA-IR and HOMA-β were significantly (p = 4.9 × 10−9; 6.0 × 10−8; 6.6 × 10−12; 1.3 × 10−7; 5.5 × 10−12, respectively) higher in non-diabetic FDRs as compared to control group. Fasting plasma glucose, though within normal range, were significantly (p = 0.026) higher in non-diabetic FDRs. Linear regression analysis showed that both TG and WC are the main metabolic syndrome factors that significantly increased HOMA-IR (B = 0.334, p = 1.97 × 10−6; B = 0.024, p = 1.05 × 10−5), HOMA-β (B = 16.8, p = 6.8 × 10−5; B = 0.95, p = 0.004), insulin (B = 16.5, p = 1.2 × 10−6; B = 1.19, p = 8.3 × 10−6) and HbA1c (B = 0.001, p = 0.034; B = 0.007, p = 0.037).ConclusionTriglyceride and WC are the important metabolic syndrome factors associated with insulin resistance, basal β-cell function and insulin levels in non-diabetic FDR men of Type 2 DM patients. Moreover, FDRs showed insulin resistance with compensatory β-cell function (hyperinsulinaemia) suggesting that insulin resistance precede the development of pancreatic β-cell dysfunction in individuals at risk of Type 2 DM.

Circulating Monocyte and Lymphocyte Populations in Healthy First-Degree Relatives of Type 2 Diabetic Patients at Fasting and during Short-Term Hyperinsulinemia.

Aim The development of type 2 diabetes (T2DM) is associated with disturbances of immune status that may be reflected by alterations of the profile of circulating immune cells. In order to study whether there exists genetic predisposition to these alterations, we investigated the relative content of circulating monocyte and lymphocyte subpopulations at fasting condition and upon stimulation by short-term hyperinsulinemia in nondiabetic first-degree relatives (FDR) of T2DM patients and in control subjects. Materials and Methods 19 nondiabetic (FDR) and 19 control subjects without a family history of diabetes (all men) matched for age and BMI underwent 2-hour hyperinsulinemic-euglycemic clamp. Blood samples taken before and at the end of the clamp were used for the flow cytometry analysis of lymphocyte and monocyte populations and for the assessment of cytokine levels. Results At fasting conditions, FDR showed a higher CD4/CD8 ratio of peripheral lymphocytes, a higher percentage of Th17 lymphocytes, and a lower content of intermediate monocytes when compared to controls. The CD4/CD8 ratio correlated with fat mass, insulin, and HOMA-IR in the entire group of subjects. Hyperinsulinemia decreased a relative content of peripheral CD4+ and increased a relative content of CD8+ T lymphocytes, thus decreasing the CD4/CD8 ratio by 18-22% in both groups of subjects. In FDR but not in controls, the decrease of CD4+ T lymphocyte content was partially based on the decrease of TH2 and TH17 lymphocyte subpopulations. In control subjects but not in FDR, the number of intermediate monocytes has declined in response to hyperinsulinemia. Conclusion The alterations of the CD4/CD8 lymphocyte ratio, relative content of TH17 cells, and intermediate monocytes in FDR are features of genetic predisposition to T2DM and may play a role in pathogenesis of T2DM. Short-term hyperinsulinemia affected mostly the immune cell populations deregulated in FDR subjects, which suggests important interplay between immune system homeostasis and insulin levels.

Low-density lipoprotein cholesterol and risk of type 2 diabetes: The Isfahan diabetes prevention study

BackgroundStudies reported that lipid-lowering treatment may increase the risk of diabetes, support the hypothesis that low-density lipoprotein cholesterol (LDLC) may be associated with type 2 diabetes (T2D). ObjectiveThe aim of this study was to assess the association between the LDLC levels and the incidence of T2D in an Iranian high-risk population not treated with lipid-lowering medications. MethodsMean 10-year follow-up data (1819) in non-diabetic first-degree relatives (FDR) of consecutive patients with T2D 30–70 years old, who were not treated with lipid-lowering drugs at baseline were examined. The diagnosis of T2D based on serial oral glucose tolerance test was the primary outcome. Cox proportional hazard model was used to estimate the hazard ratio (HR) for the incidence of T2D within tertiles of LDLC. ResultsA higher LDLC concentration was significantly associated with higher risk of T2D. Compared with the first tertile, the adjusted risk of T2D increased for the second (HR 1.20, 95% CI: 1.07, 1.35, P < 0.01) and third (HR 1.22, 95% CI: 1.08, 1.37, P < 0.01), tertiles of LDLC. ConclusionsWhile these results await confirmation, a higher LDLC level was significantly associated with higher risk of T2D, independent of age, gender, fasting plasma glucose, waist circumference or blood pressure, in high-risk individuals in Iran.

A study of heart rate variability among non-diabetic offspring of type 2 diabetic parents

Background: Type 2 diabetes mellitus is an inheritable condition that runs in families as a disorder of impaired glycemic control and its complications. Among the complications of diabetes, autonomic neuropathy contributes to the development of cardiovascular disease states besides diabetic vascular complications. Sympathovagal imbalance is reported to be observed among the non-diabetic first-degree relatives of diabetic population. Aims and Objectives: To assess the heart rate variability (HRV) parameters in non-diabetic normotensive offspring of diabetic parents and infer the impairment in sympathovagal balance in them by comparing with the HRV findings of non-diabetic offspring of non-diabetic parents. Materials and Methods: This cross-sectional observational study was conducted on 30 healthy non-diabetic, normotensive volunteers with parental history of Type 2 diabetes and 30 non-diabetic normotensive volunteers without parental history of diabetes. The volunteers were between the age of 17 and 25 years with normal body mass index and no health condition that could influence the cardiovascular health. The basal cardiovascular parameters and a 5 min lead II electrocardiogram for short-term HRV analysis were recorded to assess the sympathovagal balance. Results: The HRV analysis reveals a statistically significant increase in the sympathetic components and decreased parasympathetic components in the nondiabetic offspring of diabetic parents when compared to the non-diabetic offspring of non-diabetic parents. Conclusion: From our study, it could be observed that the non-diabetic offspring of diabetic parents have enhanced sympathetic activity and attenuated vagal activity even in their non-diabetic state, thus inferring an early onset of sympathovagal imbalance that could predispose them to hypertension and its sequel.

Risk of diabetes according to the metabolic health status and degree of obesity

AimTo determine the progression rates from metabolically healthy or unhealthy normal weight, overweight and obese phenotype to type 2 diabetes (T2D) in a non-diabetic high risk population in Isfahan, Iran. MethodsT2D incidence during a mean (SD) follow-up of 10.1 (2.3) years was examined among 1,982 non-diabetic first-degree relatives (FDR) of patients with T2D 30–70 years old. Participants were divided into 6 groups based on body mass index and metabolic syndrome component, except waist circumference, at baseline: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW) and metabolically unhealthy obese (MUO). ResultsThe MHO, MUOW, and MUO individuals at baseline were associated with incidence of T2D, independently of age and gender. MHO were 3 times (OR 2.96; 95% CI 1.07, 8.24) and MUOW were 2.75 times (95% CI 1.17, 6.45) more likely to develop T2D than those with MHNW. There was excess risk in MUO than MHO (OR 3.86; 95% CI 1.64, 9.11). ConclusionsObesity was a risk factor for T2D, even in the absence of any metabolic abnormalities. Metabolic abnormalities were a stronger predictor of incident T2D than obesity.

The Visceral Adiposity Index in Comparison with Easily Measurable Anthropometric Markers Did Not Improve Prediction of Diabetes.

We evaluated the ability of the visceral adiposity index (VAI) compared to hypertriglyceridemic-waist (HTGW) phenotype, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) as a possible predictor of diabetes in a nondiabetic high-risk population. We analyzed 7-year follow-up data in nondiabetic first-degree relatives of consecutive patients 30 to 70 years of age with type 2 diabetes and with at least 1 follow-up examination (N=1720). The primary outcome was the diagnosis of type 2 diabetes based on repeated oral glucose tolerance tests. We examined the incidence of type 2 diabetes across quintiles of the VAI and plotted a receiver operating characteristic (ROC) curve to compare the abilities of predicting type 2 diabetes of the VAI, BMI, WC, WHR and WHtR. The highest quintile of VAI compared with the lowest quintile was associated with type 2 diabetes in age- and gender-adjusted models (OR 2.45; 95% CI 1.56, 3.86). Those with the HTGW phenotype were 2.36 times (OR 2.36; 95% CI: 161, 3.44) more likely to develop type 2 diabetes than those with normal WCs and normal triglyceride levels. On ROC curve analysis, almost similar areas under the ROC were found for BMIs (60.9%; 95% CI: 57.1, 64.6); WC (61.0%, 95% CI 57.4, 64.5); WHtR (62.6%; 95% CI: 59.1, 66.2); WHR (55.7%; 95% CI 52.2, 59.3) and VAI (58.3%; 95% CI: 54.5, 62.1). These data provide further evidence that VAI and HTGW are robust predictors of type 2 diabetes, but the predictive power was similar to that of BMI, WC, WHtR and WHR in our study population.

Utility of hypertriglyceridemic waist phenotype for predicting incident type2 diabetes: The Isfahan Diabetes Prevention Study.

Aim/IntroductionWe evaluated the association between hypertriglyceridemic waist (HTW) phenotype and the risks of type 2 diabetes in an Iranian high‐risk population.Materials and MethodsWe analyzed 7‐year follow‐up data (n = 1,865) in non‐diabetic first‐degree relatives of consecutive patients with type 2 diabetes aged 30–70 years. The primary outcome was the diagnosis of type 2 diabetes based on repeated oral glucose tolerance tests. We used multiple logistic regressions to estimate the odds ratio (OR) for incident type 2 diabetes across four groups according to baseline fasting serum triglycerides (TG) level and waist circumference (WC): normal WC and normal TG, normal WC and high TG, enlarged WC and normal TG, and HTW (enlarged WC high TG).ResultsThe HTW phenotype at baseline was associated with the incidence of type 2 diabetes. Those with HTW were 2.4‐fold (OR 2.36, 95% confidence interval 1.61–3.44), those with normal WC high TG were 1.9‐fold (OR 1.87, 95% confidence interval 1.29–2.70) and those with enlarged WC but normal TG were 2.8‐fold (OR 2.84, 95% confidence interval 1.96–4.13) more likely to develop type 2 diabetes than those with normal WC and normal TG.ConclusionsThese data provide further evidence that the HTW phenotype is a robust predictor of type 2 diabetes in high‐risk individuals in Iran, and the predictive power is not higher than that of simple enlarged WC and normal TG, emphasizing the importance of enlarged WC to the development of type 2 diabetes.

Altered Concentrations of Copper, Zinc, and Iron are Associated With Increased Levels of Glycated Hemoglobin in Patients With Type 2 Diabetes Mellitus and Their First-Degree Relatives.

BackgroundThe altered levels of some essential trace elements and antioxidant minerals have been observed in diabetic patients.ObjectivesThe aim of the present study was to compare the concentrations of essential trace elements, copper (Cu), zinc (Zn), and iron (Fe) in the serum of patients who have type 2 diabetes mellitus (T2DM) with those of their non-diabetic first-degree relatives (FDR) and control subjects. The association between glycated hemoglobin (HbA1c) and levels of metals was also evaluated.Patients and MethodsWe studied 46 subjects with T2DM, 46 FDR, and 50 control subjects matched for age and sex. Serum concentrations of Cu, Zn, and Fe were measured by colorimetric kit. Fasting blood glucose (FBG) and HbA1c were assayed using the standard kit.ResultsAn imbalance in the levels of the studied metals was observed in both patients with T2DM and FDR. We found significantly decreased levels of Zn and higher levels of Cu and Fe in the patients with T2DM and FDR when compared with the control subjects (P < 0.05). HbA1c levels were positively correlated with Cu and Fe and inversely correlated with Zn in the patients with T2DM and FDR (P < 0.05).ConclusionsThe patients with T2DM and FDR had altered contents of Cu, Zn, and Fe that might be a predisposing factor to the development of diabetes in future or vice versa the result of diabetes development. Impaired metabolism of these elements may contribute to the augmented risk of developing type 2 diabetes mellitus later in the life of their first-degree relatives.

Utility of serum lipid ratios for predicting incident type 2 diabetes: the Isfahan Diabetes Prevention Study.

In this study, we evaluate the association between triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio and total cholesterol (TC) to HDL (TC/HDL) ratio and the risks of type 2 diabetes (T2D) in an Iranian high-risk population. We analysed 7-year follow-up data (n = 1771) in non-diabetic first-degree relatives of consecutive patients with T2D 30-70years old. The primary outcome was the diagnosis of T2D based on repeated oral glucose tolerance tests. We used Cox proportional hazard models to estimate hazard ratio for incident T2D across tertiles of TG/HDL and TC/HDL ratios and plotted a receiver operating characteristic (ROC) curve to assess discrimination. The highest tertile of TG/HDL and TC/HDL ratios compared with the lowest tertile was not associated with T2D in age- and gender-adjusted models (HR 0.99, 95% CI: 0.88, 1.11 for TG/HDL ratio and 1.10, 95% CI: 0.97, 1.23 for TC/HDL ratio). Further adjustment for waist circumference or body mass index, fasting plasma glucose, and low-density lipoprotein cholesterol did not appreciably alter the hazard ratio compared with the age- and gender-adjusted model. The area under the ROC curve for TG/HDL ratio was 57.7% (95% CI: 54.0, 61.5) and for TC/HDL ratio was 55.1% (95% CI: 51.2, 59.0). TG/HDL and TC/HDL ratios were not robust predictors of T2D in high-risk individuals in Iran. Copyright © 2015 John Wiley & Sons, Ltd.

Low Levels of High-Density Lipoprotein Cholesterol Do Not Predict the Incidence of Type 2 Diabetes in an Iranian High-Risk Population: The Isfahan Diabetes Prevention Study.

To evaluate the ability of low-level fasting high-density lipoprotein cholesterol (HDLC) to predict the incidence of type 2 diabetes (T2D) in an Iranian high-risk population. Seven-year follow-up data (n = 1,775) in non-diabetic first-degree relatives (FDR) of consecutive patients with T2D aged 30-70 years were analyzed. The primary outcome was the diagnosis of T2D based on repeated oral glucose tolerance test (OGTT). We used Cox proportional hazard models to estimate the hazard ratio (HR) for the incidence of T2D across quartiles of HDLC, and plotted a receiver operating characteristic (ROC) curve to assess discrimination. The highest quartile compared with the lowest quartile of HDLC was associated with T2D in age- and gender-adjusted models (HR: 0.83, 95% CI: 0.73-0.95). Further adjustment for fasting plasma glucose and cholesterol attenuated the association for T2D incidence (HR: 0.93, 95% CI: 0.80-1.08). The area under the ROC curve for HDLC was 54.1% (95% CI: 50.2-58.0). HDLC level was a weak predictor of T2D in an Iranian high-risk population, independent of age and gender.

Utility of Continuous Metabolic Syndrome Score in Assessing Risk of Type 2 Diabetes: The Isfahan Diabetes Prevention Study

Background/Aim: It is not clear whether levels of continuous metabolic syndrome (cMetS) are associated with type 2 diabetes (T2D). The aim of this study was to determine the ability of the cMetS score to predict progression to T2D in non-diabetic first-degree relatives (FDRs) of patients with T2D in Isfahan, Iran. Methods: A total of 1,869 non-diabetic FDRs 30-70 years old in 2003-2005 were followed through 2014 for the occurrence of T2D. At baseline and through follow-ups, participants underwent a standard 75 g 2-h oral glucose tolerance test. MetS was defined by the National Cholesterol Education Program-Adult Treatment Panel III. The cMetS score was calculated using age- and gender-standardized Z-score for MetS components. Receiver operating characteristic (ROC) curve was used to assess the association between cMetS and components of MetS with T2D. Results: During 13,571 person-years of follow-up, 72 men and 210 women developed diabetes. Those in the top quartile of cMetS were 8.0 times more likely to develop diabetes than those in the bottom quartile (OR 7.96; 95% CI 4.88-12.99). On ROC curve analysis, a higher area under the ROC were found for FPG (74.3%; 95% CI 70.8-77.8), than for cMetS (69.4%; 95% CI 66.0-72.8). Conclusions: The cMetS score is a robust predictor of T2D and may be more effective and efficient than the current binary definition of MetS in predicting progression to T2D in our study population.

Risk of diabetes in combined metabolic abnormalities and body mass index categories

AimThe present study was designed to estimate the progression rates from combination of normal weight, overweight, obesity, and number of metabolic abnormalities (MA) to type 2 diabetes (T2D) in a non-diabetic high risk population in Isfahan, Iran. MethodsA total of 1869 non-diabetic first-degree relatives (FDR) of patients with T2D 30–70 years old were examined and followed for a mean (SD) of 7.3 (2.2) years for T2D incidence. At baseline and through follow-up, participants underwent a standard 75-g 2-h oral glucose tolerance test. ResultsThe metabolically healthy overweight and obese at baseline were associated with incidence of T2D, independently of age and gender. Any one MA increased the risk of developing T2D among normal weight, overweight and obese individuals. Those with normal weight and ≥3 MA were over 20 times (odds ratios (OR) 20.21; 95% confidence intervals (CI) 2.4, 170.4) and those with overweight and ≥3 MA 22.5 times (OR 22.5; 95% CI 3.0, 167.0) and obese with ≥3 MA were 25.4 times (OR 25.4; 95% CI 3.4, 187) more likely to develop T2D than those with normal weight and without MA. Compared with participants without MA, obese individuals with concomitant MA were not significantly more likely to progress to T2D. ConclusionOur data provide further evidence that normal weight, overweight and obese individuals with MA had a higher risk of incident T2D than normal weight individuals without MA.

Progression from optimal blood glucose and pre-diabetes to type 2 diabetes in a high risk population with or without hypertension in Isfahan, Iran

AimTo estimate the progression rates from normal glucose tolerance (NGT), isolated impaired glucose tolerance (IGT), isolated impaired fasting glucose (IFG) and combined IFG/IGT to type 2 diabetes (T2D) in a high risk population with and without hypertension (HTN) in Isfahan, Iran. MethodsDuring a mean (SD) follow-up period of 6.8 (1.7) years, 1489 non-diabetic first-degree relatives of patients with T2D with or without HTN were followed for the occurrence of T2D. At baseline and through follow-ups, participants underwent a standard 75g 2-h oral glucose tolerance test. Blood pressure was measured by standardised protocols and HTN was defined according to the criteria of the JNC7. ResultsThe progression rate (95% confidence interval) from NGT, isolated IFG, isolated IGT, and combined IFG/IGT to T2D was 10.0 (4.3, 19.6), 21.7 (9.5, 42.3), 28.2 (12.3, 54.7) and 64.7 (41.0, 96.4) per 1000 person-years in participants with HTN and 3.1 (1.5, 4.7), 16.3 (10.3, 24.2), 25.9 (17.0, 37.7) and 57.9 (46.1, 71.7) per 1000 person-years in participants without HTN based on 10,134 person-years of follow-up. Compared with individuals with NGT and without HTN, individuals with NGT and HTN, isolated IFG, isolated IGT, and combined IFG/IGT with or without HTN at baseline were more likely to progress to T2D. Compared with participants without HTN, individuals with concomitant HTN were not significantly more likely to progress to T2D. ConclusionsCompared with individuals without HTN, the presence of NGT, isolated IFG, isolated IGT, and combined IFG/IGT with concomitant HTN was not associated with higher likelihood of progression to T2D in high-risk individuals in Iran.

The product of triglycerides and glucose in comparison with fasting plasma glucose did not improve diabetes prediction.

Previous study has reported that triglycerides-glucose (TyG) index, a product of triglycerides and fasting plasma glucose (FPG), might be useful in the prediction of incident type 2 diabetes (T2D). We evaluated the ability of the TyG index compared to FPG and OGTT as possible diabetes predictor in nondiabetic first-degree relatives (FDRs) of patients with T2D. A total of 1,488 FDRs without diabetes of consecutive patients with T2D 30-70 years old (361 men and 1,127 women) were examined and followed for a mean (SD) of 6.9 (1.7) years for diabetes incidence. We examined the incidence of diabetes across quartiles of the TyG index and plotted a receiver operating characteristic (ROC) curve to assess discrimination. At baseline and through follow-up, participants underwent a standard 75-g two-hour oral glucose tolerance test. During 10,124 person-years of follow-up, 41 men and 154 women developed T2D. Those in the top quartile of TyG index were 3.4 times more likely to develop T2D than those in the bottom quartile (odds ratio 3.36; 95 % CI 1.83, 6.19). On ROC curve analysis, a higher area under the ROC was found for FPG (76.2; 95 % CI 71.9, 80.6), 1-hPG (81.0, 95 % CI 77.2, 84.9) and 2-hPG (76.5; 95 % CI 72.3, 80.8) than for TyG index (65.1; 95 % CI 60.5, 69.7). TyG index is predicted T2D in high-risk individuals in Iran but FPG, 1-hPG and 2-hPG appeared to be more robust predictor of T2D in our study population.

Profile of metabolic abnormalities seen in patients with type 2 diabetes mellitus and their first degree relatives with metabolic syndrome seen in Benin City, Edo state Nigeria.

BackgroundTo determine the profile of metabolic abnormalities in T2DM persons with metabolic syndrome and their non-diabetic first-degree relatives who also had metabolic syndrome in Benin City.MethodologyThis was a cross sectional case controlled study in which convenience sampling technique was used to recruit 106 persons with T2DM, 96 people who are first degree relatives of type 2 diabetic persons and 96 controls using a interviewer administered questionnaire technique. The following were assessed: anthropometric indices, blood pressure, serum lipid profile, fasting blood sugar, proteinuria, and microalbuminuria. The data obtained were analyzed using the statistical software-Statistical package for social sciences [SPSS] version 16. A p-value of less than 0.05 was taken as statistically significant.ResultsThe mean age (SD) of the study groups were: persons living with T2DM: 58.6 ± 11.2 years, control: 57.69 ± 60.8 years and FDR: 57.4 ± 10.6 years. No significant age and sex differences were observed in these groups. There were more females (59.7%) than males (40.3%) with T2DM. The prevalence of MS was 13.5%, 16.7%, and 87.1% in the control, FDR and T2DM patients respectively. For the T2DM group of subjects, impaired fasting glycaemia was the commonest metabolic abnormality followed by microalbuminuria, low HDL cholesterol, high LDL cholesterol, hypercholesterolaemia and hypertriglyceridaemia in decreasing frequency. For the FDR group, low HDL cholesterol was the commonest metabolic abnormality followed by hypertriglyceridaemia, impaired fasting glucose, high LDL cholesterol, hypertriglyceridaemia and microalbuminuria in decreasing frequency. Hypercholesterolemia and low HDL cholesterol were the commonest metabolic abnormalities in the control group.ConclusionThe prevalence of the MS in persons with T2DM in Nigeria appears to be high. Secondly, there is a high prevalence of lipid abnormalities in all the study groups.

"Es como uno bomba de tiempo [It's like a time bomb]": A Qualitative Analysis of Perceptions of Diabetes Among First-Degree Relatives of Latino Patients With Diabetes.

Background. The South Bronx, a largely Latino community, has become an epicenter of the diabetes epidemic in New York City. In this community, nondiabetic first-degree relatives of people with diabetes are prime targets for intervention. Therefore, the objective of this study was to explore the knowledge of diabetes and attitudes toward health behavior modification of Latino adults who are first-degree relatives of people with diabetes. Methods. Participants were recruited from three settings in the South Bronx (a community-based organization, a faith-based organization, and a taxi station). The Common Sense Model was used to develop focus-group items. This model provides a framework for exploring illness representations along five domains: identity, cause, consequences, timeline, and perceptions of curability. Responses were transcribed verbatim, and data analysis proceeded in the following order: data immersion, assignment of codes, grouping of key concepts to form categories, and construction of higher-order themes. Results. Of the 115 potential participants identified, 53 were found to be eligible, and 23 of these participated in the focus group. Of these, 20 were Dominicans, 2 were Puerto Ricans, and 1 was Salvadorian. The mean age was 46.39 years, 35% were women, 61% were married, and 26% had less than a high school education. Qualitative analyses resulted in 547 codes that were grouped into 52 concepts, from which 9 categories and 4 overarching themes emerged. The dominant themes were 1) family, genetics, and culture play a major role in the etiology of diabetes; 2) being Latino and having a first-degree relative with diabetes makes getting diabetes inevitable, and, like a time bomb exploding, it is destined to happen; 3) once one develops diabetes, the physical and emotional consequences are devastating and destructive; and 4) diabetes can be "cured" through healthy eating and with insulin. Conclusions.In this study, first-degree relatives of patients with diabetes were knowledgeable about the risks and consequences of diabetes. However, some participants felt that being Latino and having a first-degree relative with diabetes made one destined to have diabetes. Addressing this misperception through culturally tailored interventions has implications for diabetes prevention and may help to stem the diabetes epidemic in Latino communities.

Soluble interleukin-2 receptor alpha in preclinical type 1 diabetes

To the Editor of ‘‘Acta Diabetologica’’. The interleukin-2 receptor alpha (IL-2RA or CD25) plays an essential role in IL-2 signaling and regulation of immune responses [1]. Soluble IL-2RA (sIL-2RA) is produced by proteolytic cleavage of membrane-bound IL-2RA after the induction of cell division and can inhibit IL-2 signaling, but paradoxically enhance T cell proliferation [2]. Serum sIL-2RA concentration is therefore considered a biomarker for T cell activation and can be increased in the context of autoimmune disease, inflammation, or infection [3]. Serum sIL-2RA concentration is also influenced by age and single nucleotide polymorphisms (SNPs) in the IL2RA gene region that are associated with susceptibility for type 1 diabetes and other autoimmune diseases [3, 4]. We here report sIL-2RA concentration in nondiabetic islet autoantibody-positive subjects at risk for type 1 diabetes. We conducted a case–control study using sera from 634 nondiabetic first-degree relatives of patients with type 1 diabetes who participated in prospective cohort studies at our institute [5]. Cases included 317 relatives (158 female) with persistent islet autoantibodies to insulin, GAD, insulinoma-associated antigen-2, and/or zinc transporter 8 [138 with one, 179 with at least two autoantibodies; median age 11.2 years; interquartile range (IQR) 7.3–16.0 years]. Controls were 317 islet autoantibody-negative relatives (169 female) who were matched for age (median age 11.2 years; IQR 7.3–16.0 years). sIL-2RA concentration was measured in a serum sample prior to type 1 diabetes onset or the last available follow-up sample for cases who had not progressed to diabetes, and the respective sample of controls. Sera were stored at -20 C prior to testing. All measurements of sIL-2RA were carried out using the same batch of a commercial ELISA kit (Opt EIA Human IL2sRa [sCD25]; BD Biosciences, San Diego, CA, USA). If DNA was available, IL2RA genotyping was obtained at SNP rs11594656 (n = 413, 247 cases) using the MassARRAY system with iPLEX chemistry (Sequenom, San Diego, CA, USA), and at rs2104286 (n = 383; 233 cases) and rs12722495 (n = 382; 236 cases) using the TaqMan 50 nuclease assay (Applied Biosystems, Warrington, UK). The study was approved by the ethics committees of Bavaria, Germany, and Ludwig-Maximilian University, Munich, Germany. All study participants gave informed consent, and investigations were carried out in accordance with the Declaration of Helsinki. sIL-2RA serum concentrations were minimally increased in islet autoantibody-positive cases (mean ± SD, Communicated by Massimo Porta.

β-Cells, Autoimmunity, and the Innate Immune System: “un Ménage á Trois”?

Type 1 diabetes is generally believed to result from an autoimmune attack selectively destroying β-cells in the pancreatic islets of Langerhans. Indeed, with the recent discovery of cytotoxic T cells specifically recognizing β-cells infiltrating insulitic lesions in the pancreas, the ultimate proof of an autoimmune nature in human type 1 diabetes seems to be framed (1). This could imply that one of the last pieces of the puzzle of the pathogenesis of type 1 diabetes has been laid. But is this all there is to it? In this issue of Diabetes , Valle et al. (2) present their perhaps surprising observation that slightly reduced circulating neutrophil counts associate with type 1 diabetes. The authors demonstrate that this phenomenon is not necessarily a consequence of impaired glycemic control because similarly reduced frequencies of neutrophils could also be found in nondiabetic first-degree relatives of type 1 diabetic patients with increased risk to disease but with normoglycemia, whereas type 2 diabetic patients showed neutrophils in the blood at normal counts. In contrast, the authors could demonstrate mild neutrophil infiltrates in exocrine pancreas tissue in some type 1 diabetic organ donors …