Normal Fasting Glucose Levels Research Articles

A novel predictive model for optimizing diabetes screening in older adults.

The fasting blood glucose test is widely used for diabetes screening. However, it may fail to detect early-stage diabetes characterized by elevated postprandial glucose levels. Hence, we developed and internally validated a nomogram to predict the diabetes risk in older adults with normal fasting glucose levels. This study enrolled 2,235 older adults, dividing them into a Training Set (n = 1,564) and a Validation Set (n = 671) based on a 7:3 ratio. We employed the least absolute shrinkage and selection operator regression to identify predictors for constructing the nomogram. Calibration and discrimination were employed to assess the nomogram's performance, while its clinical utility was evaluated through decision curve analysis. Nine key variables were identified as significant factors: age, gender, body mass index, fasting blood glucose, triglycerides, alanine aminotransferase, the ratio of alanine aminotransferase to aspartate aminotransferase, blood urea nitrogen, and hemoglobin. The nomogram demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.824 in the Training Set and 0.809 in the Validation Set. Calibration curves for both sets confirmed the model's accuracy in estimating the actual diabetes risk. Decision curve analysis highlighted the model's clinical utility. We provided a dynamic nomogram for identifying older adults at risk of diabetes, potentially enhancing the efficiency of diabetes screening in primary healthcare units.

Selected Non-communicable Disease Risk Factors and Mental Health of South African Durban-based Refugees: A Cross-sectional Study

Background Non-communicable diseases (NCDs) are the leading contributor to mortality and morbidity worldwide, with refugees considered more susceptible to NCDs. Refugees often encounter difficulties in accessing healthcare, resulting in delayed diagnostic assessment and treatment of mental disorders and NCDs, leading to the deterioration of the condition. The study aimed to ascertain the prevalence of risk factors for NCDs and mental health among South African Durban-based refugees. Methods This cross-sectional study was conducted among 121 randomly selected South African Durban-based refugees. Data on the metabolic risk factors for NCDs were collected using a modified version of the World Health Organisation (WHO) STEPwise approach to (NCDs) surveillance (STEPS) instrument. Participants' mental health disorders were determined with a Global Mental Health Assessment Tool-Primary Care Version questionnaire. Results A significant 38.80% of participants had normal BMI [x2 (5, n=47) = 82.55, p<.001], 24.0% were overweight [x2 (5, n=29) = 82.55, p<.001], 25.6% were obese class l [x2 (5, n=31) = 82.55, p<.001]. A significant 77.1% [x2 (2, n=64) = 76.79, p<.001] of the participants had desirable cholesterol levels, and 62.3% [x2 (2, n=71) = 44.57, p<.001] had normal fasting glucose levels. A significant 26.1% [x2 (4, n=31) = 64.82, p<.001] and 46.2% [x2 (4, n=55) = 64.82, p<.001] were classified as having hypertension stage I and II, respectively. A non-significant 32.2% and 25.0% experienced depression and anxiety. Conclusions The prevalence of hypertension and high BMI levels combined with mental disorders underscores the importance of healthcare service delivery to this vulnerable population in SA.

Associations of normal fasting glucose levels and of insulin resistance with degenerative rotator cuff tear

BackgroundThe upper normoglycemic range has been proposed as a risk factor for degenerative rotator cuff tendon tear (RCT), and insulin resistance has been suggested as a risk factor for tendinopathy. However, no research has established their association with degenerative RCT in the general population. This study aimed to determine whether fasting glucose levels and insulin resistance are risk factors for degenerative RCT in the normoglycemic population and identify the risk range for fasting glucose.MethodsThis study included 418 normoglycemic participants from a rural cohort. Participants completed questionnaires, physical exams, blood tests, and MRI evaluations of both shoulders. Insulin resistance was assessed using a triglyceride/high-density-lipoprotein (TG/HDL) ≥ 3.5. Logistic regression analysis was used to determine the association between fasting glucose level, TG/HDL ≥ 3.5, and other factors and degenerative RCT. The study calculated the areas under the receiver operating characteristic curve (AUC) to determine the more appropriate predicting value between the scale and categorical values of fasting glucose levels, and compared the AUCs using the DeLong method.ResultsIn the multivariable analyses, both scale and categorical values of fasting glucose levels, and TG/HDL ≥ 3.5 were significantly associated with degenerative RCT. Fasting glucose levels ≥ 90.5 mg/dL (OR: 3.87, 95% CI: 2.10–7.06) in scale value and 90–99 mg/dL (OR: 4.13, 95% CI: 2.87–8.12) in categorical value were significantly associated with degenerative RCT (P < .001). The AUC of the scale value of fasting glucose levels ≥ 90.5 mg/dL was 0.68. The AUC of the categorical value of fasting glucose levels of 90–99 mg/dL was 0.70. Because of the significantly larger AUC of the categorical value of fasting glucose levels of 90–99 mg/dL, those fasting glucose levels were determined to be independently associated with degenerative RCT (P < .001).ConclusionsHigh fasting glucose levels within the normal range may link to increase insulin resistance and risk of degenerative RCT. Normoglycemic levels of 90–99 mg/dL and insulin resistance may be risk factors for degenerative RCT.Level of evidenceLevel III, prognostic study.

Temporal optimization of exercise to lower fasting glucose levels.

Exercise stimulates glucose uptake and increases insulin sensitivity acutely. Temporally optimizing exercise timing may minimize the nocturnal rise in glucose levels. This study examined the effect of exercise timing on evening and overnight glucose concentrations in individuals who were non-obese with normal fasting glucose levels (Non-Ob; n=18) and individuals with obesity (OB) with impaired fasting glucose levels (OB+IFG) and without (n=16 and n=18, respectively). Subjects were studied on three occasions (no exercise (NOEX)), morning exercise (AMEX; 0700h) and evening exercise (PMEX; 2000h). The evening meal was provided (1800h) and blood samples were taken from 1740 to 0700h and morning endogenous glucose production (EGP) was measured. Glucose and insulin concentrations increased with the dinner meal with peak concentrations being higher in OB+IFG than in OB and Non-Ob (P=0.04). In OB+IFG, evening glucose concentrations rose above baseline levels at about 2300h, with the glucose concentrations staying somewhat lower with AMEX and PMEX until ∼0500h than with NOEX. In OB+IFG, insulin concentrations decreased following the dinner meal and waned throughout the night, despite the rising glucose concentrations. In the OB and Non-Ob individuals following the dinner meal, no increase in glucose concentrations occurred in the evening period and insulin levels mirrored this. No difference was observed in the morning fasting glucose levels between study days or between groups. Regardless of time of day, exercise delays the evening rise in glucose concentrations in adults with OB+IFG but does not lower morning fasting glucose levels or improve the synchrony between glucose and insulin concentrations. KEY POINTS: Insulin resistance and type 2 diabetes have been linked to disturbances of the core clock, and glucose tolerance demonstrates a diurnal rhythm in healthy humans with better glucose tolerance in the morning than in the afternoon and evening. Skeletal muscle is a primary site for insulin resistance in people with impaired glucose tolerance. In individuals with obesity and impaired fasting glucose levels (OB+IFG), following a dinner meal, glucose concentrations started to rise and continues throughout the night, resulting in elevated glucose levels, while concomitantly, insulin levels are waning. Exercise, regardless of the time of day, suppressed the rise in glucose levels in OB+IFG for many hours during the night but did not lower morning fasting glucose levels. Morning exercise was not quite as effective as evening exercise.

The effects of effortless exercise on diabetic status

Treating physicians have consistently recommended exercise to either prevent diabetes or de-escalate symptomatology. Diabetic complications, however, render physical activity undesirable or unattainable. These involve: hypothyroidism leading to substantial weight gain; perpetual fatigue due to accumulation of white adipose tissue serving as fat storage, and inadequate supply of brown fat to generate energy; accumulated toxicity causing hormonal imbalance that increases hunger; chronic pain and wounds on extremities associated with diabetic neuropathy, etc. Recent research with an effortless exercise method demonstrated enhanced fitness and T3 increase, juxtaposed by decreased inflammation, an optimal relationship between leptin and ghrelin that control appetite, and a significant decrease of visceral fat along with VLDL, the very low-density lipoprotein that carries triglycerides to the tissues. We measured the fasting and postprandial glucose and insulin of 21 diabetics and 20 prediabetics respectively, pre and post twenty treatments. Both previously abnormally high fasting and postprandial (PP) glucose decreased considerably in all 21 diabetic subjects (100%). Nine of the diabetic subjects (42.85%) manifested normal fasting glucose levels after 20 treatments, while the fasting glucose of the remaining twelve diabetic subjects (57.2%) dropped down to the prediabetic level. Ten of the diabetic subjects (47.6%) manifested normal PP insulin levels, while the PP insulin of the remaining eleven diabetic subjects (52.38%) dropped to the prediabetic level after the 20 treatments. Prediabetics had more robust results as expected by their baseline healthier status. Eighteen of prediabetics (90%) manifested both normal fasting and PP insulin levels after the 20 treatments, while the fasting and PP insulin of the remaining two subjects (10%) remained within the prediabetic level. All subjects also exhibited a statistically significant increase in muscle mass, normalized T3 levels, decreased visceral and overall fat along with reduced CRP, advocating diminished inflammation. Dyslipidaemia appeared to subside as denoted by suppressed levels of triglycerides contrasted by elevated HDL.

Diet Quality and Kidney Outcomes in Adolescent and Adult American Indians: the Strong Heart Family Study.

The burden of kidney disease is exceedingly high among American Indians (AIs). We sought to examine the relationship of diet quality, a modifiable risk factor, and kidney outcomes in AI adolescents and adults, hypothesizing that healthier diets are associated with lower odds of incident albuminuria and eGFR decline. This is an analysis from the Strong Heart Family Study, a longitudinal study of cardiovascular disease and its risk factors among AIs from Arizona, North and South Dakota, and Oklahoma (n = 1720, mean age 39 + / - 16years, 16% adolescents at baseline). Participants completed two exams (baseline: 2001-2003; follow-up: 2007-2009). The primary exposure was diet quality, expressed as the Alternative Healthy Eating Index 2010 (AHEI), on a 110-point scale (assessed using a 119-item Block food frequency questionnaire). The primary outcomes were as follows: 1) incident albuminuria (albumin to creatinine ratio 30mg/g or greater); and 2) eGFR decline of 30% or greater. Generalized estimating equations were used to examine the association of AHEI (in quartiles) with outcomes. Ten percent of participants (6% of adolescents) had incident albuminuria and 2% of participants (2% of adolescents) had eGFR decline. For those with normal fasting glucose levels, the odds ratio (OR) for incident albuminuria comparing extreme quartiles of diet quality (least healthy [reference] versus healthiest quartiles) was 0.48 (95% CI 0.28, 0.81) after adjustment for demographics and comorbidities. For American Indians with normal fasting glucose, higher diet quality decreases the odds of developing albuminuria. These findings inform future efforts to prevent CKD in American Indian adolescents and young adults.

Risk of optic neuritis in type 2 diabetes mellitus: A nationwide cohort study

Background/Purpose:This study aimed to investigate the association between the time course of type 2 diabetes mellitus (DM) and the development of optic neuritis (ON) in the Korean population aged 20 years and older. MethodsA total of 10,069,044 subjects were included in this study, which utilized stratified random sampling from the national cohort. The hazard ratios (HRs) for incident ON were compared between subjects with normal fasting glucose (NFG) levels, impaired fasting glucose (IFG) levels, patients with new-onset DM, diabetes duration of fewer than 5 years (early DM), and diabetes duration of 5 years or more (late DM). In addition, the HR for incident ON was assessed and stratified into 20 fasting glucose levels. ResultsThe cumulative incidence and HR for ON demonstrated a significant increase across the time course of diabetes (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.00 to 1.10 for IFG; aHR = 1.31, 95% CI: 1.19 to 1.44 for new-onset DM; aHR = 1.46, 95% CI: 1.32 to 1.60 for early DM; and aHR = 1.92, 95% CI: 1.77 to 2.08 for late DM). Moreover, the HR for ON was 1.71-fold higher in individuals with fasting glucose levels of 132 mg/dL or more compared to those with levels below 75 mg/dL. ConclusionIn this nationwide cohort study, the risk of ON was found to increase with the time course of diabetes and elevated glucose levels. These results suggest that efforts to regulate glucose levels and prevent DM progression could reduce the risk of ON.

Comparison of MAFLD and NAFLD Characteristics in Children.

An international panel proposed a diagnostic framework for metabolic-associated fatty liver disease (MAFLD) in children. The aim was to compare the clinical features of MAFLD and nonalcoholic fatty liver disease (NAFLD) in children. The characteristic differences between NAFLD and MAFLD in children were compared with the National Health and Nutrition Examination Survey (NHANES) 2017-2018 in the U.S. and the Comprehensive Prevention Project for Overweight and Obese Adolescents (CPOOA) study in China. In NHANES 2017-2018, regardless of which criteria were implemented, participants with hepatic steatosis were more likely to have higher BMI z-scores, a higher prevalence of hypertension or higher metabolic indices and higher non-invasive liver fibrosis scores (all p < 0.05). The cases diagnosed by those two definitions had a similarity of over 75%. More obese children were diagnosed with MAFLD than NAFLD (p < 0.001). However, approximately 19% of children with NAFLD present with normal weight and fasting glucose levels and cannot be diagnosed with MAFLD. The CPOOA study excluded viral infected liver disease and certain kinds of congenital causes of liver steatosis patients, resulting in children with NAFLD being identical with MAFLD children. Most clinical features were similar between children with MAFLD and children with NAFLD, and more than 75% of children with NAFLD can also be diagnosed with MAFLD. However, approximately 19% of children with NAFLD cannot be categorized as MAFLD. Therefore, to gain greater benefits from renaming NAFLD to MAFLD in pediatrics, the prevalence of different causes of hepatic steatosis in children needs to be understood.

Metabolic and Genetic Markers Improve Prediction of Incident Type 2 Diabetes: A Nested Case-Control Study in Chinese.

It is essential to improve the current predictive ability for type 2 diabetes (T2D) risk. We aimed to identify novel metabolic markers for future T2D in Chinese individuals of Han ethnicity and to determine whether the combined effect of metabolic and genetic markers improves the accuracy of prediction models containing clinical factors. A nested case-control study containing 220 incident T2D patients and 220 age- and sex- matched controls from normoglycemic Chinese individuals of Han ethnicity was conducted within the Wuxi Non-Communicable Disease cohort with a 12-year follow-up. Metabolic profiling detection was performed by high-performance liquid chromatography‒mass spectrometry (HPLC-MS) by an untargeted strategy and 20 single nucleotide polymorphisms (SNPs) associated with T2D were genotyped using the Iplex Sequenom MassARRAY platform. Machine learning methods were used to identify metabolites associated with future T2D risk. We found that abnormal levels of 5 metabolites were associated with increased risk of future T2D: riboflavin, cnidioside A, 2-methoxy-5-(1H-1, 2, 4-triazol-5-yl)- 4-(trifluoromethyl) pyridine, 7-methylxanthine, and mestranol. The genetic risk score (GRS) based on 20 SNPs was significantly associated with T2D risk (OR = 1.35; 95% CI, 1.08-1.70 per SD). The area under the receiver operating characteristic curve (AUC) was greater for the model containing metabolites, GRS, and clinical traits than for the model containing clinical traits only (0.960 vs 0.798, P = 7.91 × 10-16). In individuals with normal fasting glucose levels, abnormal levels of 5 metabolites were associated with future T2D. The combination of newly discovered metabolic markers and genetic markers could improve the prediction of incident T2D.

Early-Phase Changes in Serum Free Fatty Acid Levels After Glucose Intake Are Associated With Type 2 Diabetes Incidence: The Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases.

Experimental studies suggest that excess serum free fatty acid (FFA) levels result in impaired glucose metabolism. This study investigated the relationship between changes in serum FFA levels after glucose intake and type 2 diabetes risk. This observational study included 6,800 individuals without diabetes who underwent a 75-g oral glucose tolerance test. Serum FFA levels were measured before and 30 and 60 min after glucose intake. The percentages of changes in serum FFA levels from 0 to 30 and from 30 to 60 min were compared, and a low rate of change in FFA levels was determined using the receiver operating characteristic curve analysis. Over a mean 5.3-year follow-up period, 485 participants developed type 2 diabetes. After adjusting for plasma glucose levels and indices of insulin resistance and β-cell function, low rates of change in FFA levels at 0-30 min (adjusted odds ratio [aOR] 1.91; 95% CI 1.54-2.37) and 30-60 min (aOR 1.48; 95% CI 1.15-1.90) were associated with the incidence of type 2 diabetes. Stratified analysis revealed that the low rate of change in FFA levels at 30-60 min (aOR 1.97; 95% CI 1.05-3.69) was associated with the incidence of type 2 diabetes even in participants with normal fasting glucose levels or glucose tolerance. Changes in serum FFA levels within the 1st h after glucose intake could be a primary predictor of type 2 diabetes. This change may occur prior to the onset of impaired glucose metabolism.

Preferencesfor Patients with Type 2 DiabetesMellitus for Medications in Shandong Province, China: A Discrete Choice Experiment.

PurposeTo evaluate preferences for medications among patients with type 2 diabetes mellitus (T2DM) from urban community health stations or rural village clinics in Shandong province, China.MethodsWe use a discrete choice experiment (DCE) to measure the medication preferences. Each patient completed six DCE choice sets. The attributes for the DCE questionnaire include mode of administration, out-of-pocket medication cost per month, fasting blood glucose control effect and frequency of hypoglycemia events. The conditional logit model (Clogit) and mixed logit model (MXL) were used to evaluate choice data.ResultsA total of 887 patients with T2DM completed the survey. The mean age of participants was 64 years, 36.42% experienced complications, and the mean duration of diabetes was about 8 years. Overall, patients’ ideal medication would not have hypoglycemia events, provide normal fasting glucose levels, have oral medication three times a day and lower monthly medication cost. Patients prioritized the frequency of hypoglycemia events (β=15.055, P < 0.01) and were willing to spend CNY 393.10 per month to avoid hypoglycemia events. For patients with higher educational levels and with longer diagnosis time, the effect of fasting blood glucose was more relevant than all other outcomes.ConclusionThis study provides information on T2DM patients’ preference for medications. Our results suggest that clinical doctors should present patients with a variety of pharmaceutical characteristics and include their preference into medication decision, which will improve patient adherence and health outcomes.

Evaluation of ultrasound measurements of abdominal fat for the prediction of gestational diabetes in the first and second trimesters of pregnancy

Objective To evaluate whether ultrasound abdominal fat measurements in the first and second trimesters can predict adverse gestational outcomes, particularly gestational diabetes mellitus (GDM), and identify early patients at higher risk for complications. Methods A prospective cohort study of 126 pregnant women at 11–14 and 20–24 weeks of gestation with normal fasting glucose levels during early pregnancy. From 126 participants with complete data, 13.5% were diagnosed with GDM, based on the cutoffs established for the peripherical blood glucose. Subcutaneous, visceral, and maximum preperitoneal abdominal fat were measured using ultrasound techniques. GDM status was determined by oral glucose tolerance test (OGTT) with 75 g glucose overload, and the following values were considered abnormal: fasting glucose ≥92 mg/dl and/or 1 h after overload ≥180 mg/dl and/or 2 h after overload ≥153 mg/dl. The receiver operator characteristic (ROC) curve was used to determine the optimal threshold to predict GDM. Results Maximum preperitoneal fat measurement was predictive of GDM, and subcutaneous and visceral abdominal fat measurements did not show significant differences in the prediction of GDM. According to the ROC curve, a threshold of 45.25 mm of preperitoneal fat was identified as the optimal cutoff point, with 87% sensitivity and 41% specificity to predict GDM. The raw and adjusted odds ratios for age and pre-pregnancy body mass index were 0.730 (95% confidence interval [CI], 0.561–0.900) and 0.777 (95% CI, 0.623–0.931), respectively. Conclusion The use of a 45.25 mm threshold for maximum preperitoneal fat, measured by ultrasound to predict the risk of GDM, appears to be a feasible, inexpensive, and practical alternative to incorporate into clinical practice during the first trimester of pregnancy.

20-Year-Old Man With Elevated Liver Tests

20-Year-Old Man With Elevated Liver Tests

Level of knowledge, attitude and practice towards diabetes among nationals and long-term residents of Qatar: a cross-sectional study

ObjectivesThis study examines the levels of knowledge, attitude and practices (KAP) towards diabetes among Qatar nationals and long-term residents and its association with participants’ selected demographics.SettingA cross-sectional study conducted in...

The impact of prediabetes in the first trimester of pregnancy on the incidence of gestational diabetes

Introduction: Prediabetes (PD) outside of pregnancy is a condition reflecting a significant loss of glucose tolerance, characterized in the laboratory by fasting glucose between 100 and 125 mg/dL or 2 hour glucose in the 75 g Oral Glucose Tolerance Test (OGTT) between 140 and 199 mg/dL or by HbA1c levels between 5.7%-6.4% and is associated with an increased risk of developing type 2 diabetes. The development of gestational diabetes mellitus (GDM) during pregnancy, characterized by a fasting blood glucose between 92 and 125 mg/dL or an impaired OGTT value of 75 g between 24th and 28th weeks, is another condition that increases the risk of perinatal complications such as preeclampsia, cesarean section rate, macrosomia, and also the development of type 2 diabetes after delivery. Determining the prevalence of women diagnosed with prediabetes at the beginning of prenatal care and its association with the diagnosis of GDM is therefore of great importance for clinical, gynecological and obstetric care. Objective: the aim of the study is to determine the prevalence and association of prediabetes in the first trimester of pregnancy with the development of gestational diabetes&#x0D; Methodology: It was carried out in the Clinical Hospital of Botucatu Medical School. Retrospective cohort study involving eligible pregnant women who underwent fasting glucose test (FG) and glycated hemoglobin (HbA1c) test up to the 14 th week of gestation without previous diagnosis of diabetes mellitus, and who underwent 75 g oral glucose tolerance test (between the 24th and 28th week). We excluded cases in which FG was between 92 mg/dL and 125 mg/dL, which were considered GDM, and cases with FG ≥ 126 mg/dL and/or HbA1c ≥ 6.5 % (overt diabetes). One thousand electronic medical records from between 2013 and 2021 were reviewed and a database was created. The partial results were presented as percentage and 95 Confidence Interval (95% CI). The association between HbA1c and GDM was presented as relative risk and 95% CI. Results: Among pregnant women with normal fasting glucose levels and HbA1c &lt;5.7%, the incidence of GDM, diagnosed by OGTT, was 8.5% (6.4-11.3), while in the group with PD was 14.3% (5.8%-29.8%). The relative risk (RR) for developing GDM among the PD group was 1.7 (0.7-3.9). Discussion and conclusion: The association between prediabetes and gestational diabetes was not confirmed. However, these results are preliminary, and we need to reach the sample size calculated before starting the study to better understand these results. Furthermore, nonpregnant women with prediabetes are monitored and eventually treated, therefore, further studies are needed to evaluate the benefit of treating these pregnant women as recommended for the general population

Hyperinsulinemia and insulin resistance in the obese may develop as part of a homeostatic response to elevated free fatty acids: A mechanistic case-control and a population-based cohort study.

BackgroundIt is commonly accepted that in obesity free fatty acids (FFA) cause insulin resistance and hyperglycemia, which drives hyperinsulinemia. However, hyperinsulinemia is observed in subjects with normoglycaemia and thus the paradigm above should be reevaluated.MethodsWe describe two studies: MD-Lipolysis, a case control study investigating the mechanisms of obesity-driven insulin resistance by a systemic metabolic analysis, measurements of adipose tissue lipolysis by microdialysis, and adipose tissue genomics; and POEM, a cohort study used for validating differences in circulating metabolites in relation to adiposity and insulin resistance observed in the MD-Lipolysis study.FindingsIn insulin-resistant obese with normal glycaemia from the MD-Lipolysis study, hyperinsulinemia was associated with elevated FFA. Lipolysis, assessed by glycerol release per adipose tissue mass or adipocyte surface, was similar between obese and lean individuals. Adipose tissue from obese subjects showed reduced expression of genes mediating catecholamine-driven lipolysis, lipid storage, and increased expression of genes driving hyperplastic growth. In the POEM study, FFA levels were specifically elevated in obese-overweight subjects with normal fasting glucose and high fasting levels of insulin and C-peptide.InterpretationIn obese subjects with normal glycaemia elevated circulating levels of FFA at fasting are the major metabolic derangement candidate driving fasting hyperinsulinemia. Elevated FFA in obese with normal glycaemia were better explained by increased fat mass rather than by adipose tissue insulin resistance. These results support the idea that hyperinsulinemia and insulin resistance may develop as part of a homeostatic adaptive response to increased adiposity and FFA.FundingSwedish-Research-Council (2016-02660); Diabetesfonden (DIA2017-250; DIA2018-384; DIA2020-564); Novo-Nordisk-Foundation (NNF17OC0027458; NNF19OC0057174); Cancerfonden (CAN2017/472; 200840PjF); Swedish-ALF-agreement (2018-74560).

Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation.

Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield, and post-TPIAT glucose management data to further understand their relationship. Islet yield, glucose level, and insulin requirement for 72 hours postoperatively were collected for a total of 13 TPIAT recipients between 9-2013 and 9-2018. In addition, their glucose control and basal insulin requirements at 3, 6, and 12 months post-TPIAT were analyzed. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median postoperative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin, or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour postoperatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6, and 12 months showed a positive correlation. Despite the finding of inverse correlation of islet yield with long-term basal insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies. The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long-term insulin management following TPIAT. This observation may identify a high-risk group of patients in need of more intensive diabetes education and insulin treatment prior to hospital discharge.

GK-rats respond to gastric bypass surgery with improved glycemia despite unaffected insulin secretion and beta cell mass

Roux-en-Y gastric bypass (RYGB) is the most effective treatment for morbid obesity and results in rapid remission of type 2 diabetes (T2D), before significant weight loss occurs. The underlying mechanisms for T2D remission are not fully understood. To gain insight into these mechanisms we used RYGB-operated diabetic GK-rats and Wistar control rats. Twelve adult male Wistar- and twelve adult male GK-rats were subjected to RYGB- or sham-operation. Oral glucose tolerance tests (OGTT) were performed six weeks after surgery. RYGB normalized fasting glucose levels in GK-rats, without affecting fasting insulin levels. In both rat strains, RYGB caused increased postprandial responses in glucose, GLP-1, and GIP. RYGB caused elevated postprandial insulin secretion in Wistar-rats, but had no effect on insulin secretion in GK-rats. In agreement with this, RYGB improved HOMA-IR in GK-rats, but had no effect on HOMA-β. RYGB-operated GK-rats had an increased number of GIP receptor and GLP-1 receptor immunoreactive islet cells, but RYGB had no major effect on beta or alpha cell mass. Furthermore, in RYGB-operated GK-rats, increased Slc5a1, Pck2 and Pfkfb1 and reduced Fasn hepatic mRNA expression was observed. In summary, our data shows that RYGB induces T2D remission and enhanced postprandial incretin hormone secretion in GK-rats, without affecting insulin secretion or beta cell mass. Thus our data question the dogmatic view of how T2D remission is achieved and instead point at improved insulin sensitivity as the main mechanism of remission.

Utility of in-hospital post-delivery fasting plasma glucose to predict postpartum glucose status in women with hyperglycaemia first detected in pregnancy: A prospective cohort study.

BackgroundWomen with hyperglycaemia first detected in pregnancy (HFDP), including those with gestational diabetes mellitus (GDM), should undergo a glucose evaluation 4–12 weeks after delivery. Globally, suboptimal postpartum return rates limit the opportunity to intervene in women with sustained hyperglycaemia and pragmatic solutions should be sought to bridge this gap.ObjectiveTo assess the utility of postpartum in-hospital glucose evaluation to predict the outcome of the oral glucose tolerance test (OGTT) performed 4–12 weeks after delivery.MethodsThe study was performed prospectively at Tygerberg Hospital, Cape Town, South Africa. Women with HFDP, classified as GDM based on the modified National Institute for Health and Care Excellence criteria, who delivered between November 2018 and June 2019 were included in the study. Fasting plasma glucose (FPG) was performed 24–72 hours after delivery (t1) in the postnatal ward, provided glucose lowering medication was discontinued at delivery. An OGTT 4–12 weeks postpartum (t2) was scheduled for the total cohort. We compared glucose values and glucose categories at t1 and t2 and evaluated antenatal characteristics of women who returned, compared to the group that was lost to follow-up.ResultsIn-hospital post-delivery glucose assessment (t1) was performed in 115 women. Glucose levels were significantly lower at t1 compared to antenatal diagnostic values (t0) and assessment at t2. Of the fourteen women with hyperglycaemia at t2, none had abnormal fasting glucose concentrations at t1. Women with HFDP who fulfilled criteria for overt diabetes at t0, all (24/115) had normal fasting glucose levels at t1 except for IFG in one (1/24). The antenatal characteristics of women with HFDP who returned at t2, were similar to the women who did not return.ConclusionBased on this study, in-hospital fasting glucose 24–72 hours postpartum cannot replace the OGTT 4–12 weeks postpartum. Pragmatic solutions for low postpartum return rates in women with HFDP should be pursued.

Predictors of normalized HbA1c after gastric bypass surgery in subjects with abnormal glucose levels, a 2-year follow-up study

Clinical biomarkers can predict normalization of HbA1c after Roux-en-Y gastric bypass (RYGB) surgery, but it is unclear which are the most predictive.The aim of this study was to compare biomarkers for insulin sensitivity and other clinical parameters in the prediction of normalization of HbA1c after RYGB surgery. This study included 99 (23 men) obese subjects (BMI > 35 kg/m2) undergoing a laparoscopic RYGB. Clinical and biochemical examinations were performed pre-operatively and up to 2 years after surgery. Pre-operatively, normal fasting glucose levels were found in 25 individuals (NG), prediabetes in 46 and type 2 diabetes (T2DM) in 28. At baseline IGF-I (SD), IGFBP-1 and adiponectin levels were low while leptin was high. Weight loss was observed in all three groups, most in the prediabetes group. After 2 years HbA1c was decreased in prediabetes and T2DM. In all three groups insulin, HOMA-IR, lipids and blood pressure improved, IGFBP-1 and adiponectin increased and leptin decreased. IGF-I (SD) increased only in T2DM. In those with prediabetes or T2DM (n = 74), HbA1c at 2 years correlated to baseline BMI (r = -0.27, p = 0.028), age (r = 0.43, p < 0.001), HbA1c (r = 0.37, p = 0.001) and IGFBP-1 (r = 0.25, p = 0.038), and was normalized in 45/74 (61%) at 1 year and in 36 subjects (49%) at 2 years. These responders were younger, had higher BMI, larger waist circumference, lower HbA1c and lower IGFBP-1 levels at baseline. In a multiple regression model age (negative, p = 0.021) and waist circumference (positive, p = 0.047) were the only predictors for normalized HbA1c. RYGB normalized HbA1c in 49% at two years follow-up, which was predicted by low baseline IGFBP-1 level, a marker of hepatic insulin sensitivty and insulin secretion. However,. younger age and larger waist circumference were the only predictors of normalized HbA1c in multivariate analysis.