Prediabetes Group Research Articles

Fetal and Maternal Health Implications by Pregnancy Trimesters in Gestational Diabetes

Introduction: Gestational diabetes (GD) is defined as intolerance to glucose or the presence of high levels of glycemia during pregnancy. Its incidence in Europe reaches 3-5% of all pregnancies, but in some Mediterranean countries it goes up to 7%. 1,2(This includes our country). GD usually disappears after birth.3 Its importance is not only important as a pathology of women's health but also because of the risk factors that lead to the development of the fetus. Occasionally new research and studies on the correlates of diabetes in pregnancy, glycemic values that affect maternal or fetal health, or changes in baseline parameters depending on external and internal factors affecting pregnancy. An indication of the latter is the prediabetes group or IGM. Our aim: To study intrauterine complications or fetal consequences by trimesters in diabetic pregnant women attending Regional Hospital Durres. Maternal health close observation of GD complications. Methodology: Following the primary processing of patient data, individuals at risk were separated, and categorized according to trimester of pregnancy. The data were worked out on crostabulary statistical tables, where a selected number of participants with prediabetes or gestational diabetes were associated with a risk factor to analyze the correlational correlation in our population. Results. Reported to the gynecology services, for first-trimester pathology, 1954 women, of which 1176 have had one of the diagnoses: missed abortion, blighest ovum or recurrent abortion. Reported to the Pathology Pregnancy Pathology Service about 3268 of which were monitored and resulted based in examinations in 163 cases with prediabetes and diabetes in pregnancy. We have grouped and extracted the results based on correlations of baseline glycemic index to diagnose DG and the onset of complications in the fetus and in pregnancy.
 
 Received: 19 February 2024 / Accepted: 15 March 2024 / Published: 23 March 2024

Dysglycaemia prediction using readily available clinical, anthropometric, and biochemical measurements

Background & aimsA 2-hour postprandial glucose (2-h PG) concentration greater than 140 mg/dL is associated with a greater risk of type-2 diabetes (TD2) and cardiovascular disease. An oral glucose tolerance test (OGTT) is the method most used for detecting either prediabetes or T2D; however, its use in clinical practice is limited due to the 2-h testing period. Therefore, the aim of the study was to assess dysglycaemia, through a prognostic assessment of body composition, biochemical and clinical parameters as predictors of an abnormal 2-h PG. MethodsParticipants underwent a physical examination in which their anthropometric measurements were obtained, and a blood sample was taken for biochemical and hormonal analysis. All patients underwent a 75-g OGTT after 8 h of fasting, and the levels of glucose and insulin were measured. The results were compared statistically by dividing the participants’ 2-h postprandial glucose (2-h PG) into the following groups: normoglycaemia (NGT), < 140 mg/dL; prediabetes, 140 to 199 md/dL; and T2D, ≥ 200 mg/dL. ResultsAmong 381 participants 220 belonged to the NGT group, 131 to the prediabetes group, and 30 to the diabetes group. As expected, fasting glucose, 1-h PG, 2-h PG, haemoglobin glycosylated (A1c) and QUICKI index were significantly higher as the stages of glycaemic dysregulation progressed. Interestingly, 53.4% of the NGT group had a monophasic type of curve in the OGTT and a QUICKI index of 0.32. Subsequently, associative models of 2-h PG were performed, and 4 models were obtained. The best model had a coefficient of determination of 0.747 (p = 0.001) and included the variables A1c, C-reactive protein (CRP), body fat mass, and total cholesterol. ConclusionsThe use of A1c, CRP, body fat mass, and total cholesterol in a model might associate with 2-h PG without the need for a 2-h OGTT.

Association of BMI and incidence of type 2 diabetes in Saudi population.

The study aims to identify the optimal body mass index (BMI) cut-off for obesity based on the risk of developing type 2 diabetes among the general population visiting primary health care in Saudi Arabia. A cross-sectional study was conducted in Al-Ahsa City, Saudi Arabia, from January to June 2022. The study included Saudi citizens aged 35 and older who had not previously or currently been diagnosed with type 2 diabetes. Data were collected through electronic health records from 48 primary healthcare centers. The variables derived from medical records were age, gender, HbA1c, weight, and height. The BMI mean among nondiabetic, prediabetic, and diabetic groups were 29.6 ± 6.2, 31.2 ± 6.6, and 31.7 ± 6.9 kg/m2, respectively. The BMI of the prediabetic and diabetic males were 30.1 ± 6.3 and 30.5 ± 6.5 kg/m2, respectively, and the BMI of the pre-diabetic and diabetic females were 31.9 ± 6.6 and 32.8 ± 7 kg/m2, respectively. The current study correlated the result of HbA1c levels with BMI cut-off values as a modifiable risk factor for developing type 2 diabetes among the Al-Ahsa population in Saudi Arabia. The BMI mean among nondiabetic, prediabetic, and diabetic groups were 29.6 ± 6.2, 31.2 ± 6.6, and 31.7 ± 6.9 kg/m2, respectively. This study provided a list of BMI values as cut-off points with their sensitivity and specificity measures so the policymaker could utilize them. The best cut-off point could be decided based on cost-effective analysis. Further studies in the future might help evaluate the efficacy of screening programs and the association between BMI and other types of diabetes.

DIABETES SELF MANAGEMENT TERHADAP HBA1C DAN KADAR GULA DARAH PADA KELOMPOK PREDIABETES SEBELUM DAN SESUDAH INTERVENSI

Prediabetes is a condition in which a person has blood glucose levels that are higher than normal but not yet high enough to be classified as diabetes. The aim of this study was to determine the effect of diabetes self-management on blood sugar and HbA1c levels in the prediabetes group before and after intervention in the Kalumpang Community Health Center working area, Ternate. This research uses the Pre-Experimental method (one-group pre-post test design with control). Based on the data, the number of samples in this study was 25 which included control and intervention groups with a total of 50 samples. Inclusion criteria are individuals who are willing to be respondents, cooperative individuals, individuals aged 45 – 54 years, individuals who are willing to fill out a 24 hour food recall questionnaire, individuals who have HbA1c levels: ≥5.7% - &lt;6.5%, GDP : ≥100- &lt;126 mg/dl and GD2PP :≥140- &lt;200 mg/dl. Meanwhile, the exclusion criteria are individuals who are not willing to be respondents and individuals who are not cooperative. Data analysis to test the results of treatment before and after treatment used the Paired T-Test. The study's results showed a significant difference between the patient's blood sugar and HbA1c before and after the intervention. Compared with the control, there was a significant difference in blood sugar levels and HbA1c between the intervention and control groups. The main finding of this study is that diabetes self-management has an impact on HbA1c and blood sugar levels in the prediabetes group.

The correlation between stress score. Quality and duration of sleep with lipid profile and glycemic status.

Diabetes (DM) is a disease of global concern. Studies have suggested that sleep disturbance is affiliated with insulin resistance and poor lipid. Impaired glucose tolerance precedes the diabetic state and we are aware that the blood glucose levels are deranged in these patients, but not much research is done to comment on the pattern of lipid abnormalities, sleep quality and stress in these patients. Hence our study is aimed to identify abnormal patterns or similarities in the above parameters in pre diabetic and diabetic groups. This is a cross - sectional study carried out at the tertiary care hospitals.The data of 45 pre diabetic and diabetic (30 to 70 years) were collected from the files history from Medical Records Department (MRD) after taking permission. The following parameters like glucose and lipid parameters were taken for the study and standard questionnaire was given to correlate the sleep and stress levels. Data analysis were done using SPSS (Statistical Package for Social Sciences) version write the verson number). In the pre diabetic participants, sleep duration varied with stress levels (p=0.03) and their HDL was positively correlated to HbA1c (p=0.02) In the diabetic participants, TC (total cholesterol) varied with both stress (p=0.02) and sleep quality (p=0.001), LDL,& TC: HDL ratio varied only with sleep quality (p=0.04 ratio quality (p=0.01). Triglyceride levels were significantly higher in the diabetic group (p=0.04), as it is a major component of the triad of diabetic dyslipidemia. No other correlations or variations were significant. Poor sleep, abnormal lipid profiles, and stress may serve as risk factors predicting the onset of prediabetes and poor glycemic control. Confirming a direct relationship between these parameters through cohort or experimental studies could facilitate early detection of diabetes and encourage the adoption of appropriate healthy lifestyle measures.

Glucose volume of distribution affects insulin sensitivity measured by intravenous glucose tolerance test.

To determine whether glucose volume of distribution (VdGLUCOSE ) affects the diagnosis of impaired insulin sensitivity (IS) when using an intravenous glucose tolerance test (IVGTT). Individuals with distinct levels of IS underwent IVGTT after an overnight fast. The prediabetic group (Prediab; n = 33) differed from the healthy group (Healthy; n = 14) in their larger glycosylated hemoglobin (HbA1c of 5.9 ± 0.3 vs. 5.4 ± 0.1%; 41 ± 4 vs. 36 ± 1 mmol/mol; p < 0.001), percent body fat (37 ± 6 vs. 24 ± 3%; p < 0.001) and cardiovascular fitness level (VO2MAX 22 ± 5 vs. 44 ± 5 mL of O2 ·kg-1 ·min-1 ; p < 0.001). Ten minutes after intravenous infusion of the glucose bolus (i.e., 35 g in a 30% solution), VdGLUCOSE was assessed from the increases in plasma glucose concentration. IS was calculated during the next 50 min using the slope of glucose disappearance and the insulin time-response curve. VdGLUCOSE was higher in Healthy than in Prediab (230 ± 49 vs. 185 ± 21 mL·kg-1 ; p < 0.001). VdGLUCOSE was a strong predictor of IS (β standardized coefficient 0.362; p = 0.004). VO2MAX was associated with VdGLUCOSE and IS (Pearson r = 0.582 and 0.704, respectively; p < 0.001). However, body fat was inversely associated with VdGLUCOSE and IS (r = -0.548 and -0.555, respectively; p < 0.001). Since fat mass is inversely related to VdGLUCOSE and in turn, VdGLUCOSE affects the calculations of IS, the IV glucose bolus dose should be calculated based on fat-free mass rather than body weight for a more accurate diagnosis of impaired IS.

Hydration status in patients hospitalized with acute decompensated heart failure depending on the severity of glucose metabolism disorder

Aim. To study the hydration status according to clinical parameters and laboratory and instrumental research findings at admission and discharge in patients hospitalized with acute decompensated heart failure (ADHF), depending on the severity of glucose metabolism disorder.Materials and methods. The study included 280 patients (53% men, average age 70.1 ± 10.8 years) with ADHF. 72.5% of patients had arterial hypertension in the medical history, 60% of patients had coronary artery disease. In all patients, the level of glycated hemoglobin (HbA1c) was determined to assess the glucose metabolism status. The patients were divided into groups depending on the results obtained: at HbA1c values &lt; 5.7%, patients were included in the group without glucose metabolism disorders, at HbA1c of 5.7–6.4% – in the prediabetes group, at HbA1c ≥ 6.5% – in the type 2 diabetes group. The patients underwent a standard physical examination at admission and at discharge, as well as a clinical and comprehensive assessment of congestion (determination of N-terminal pro B-type natriuretic peptide (NT-proBNP), lung ultrasound, liver Fibroscan testing, including calculation of a controlled attenuation parameter, bioimpedance analysis of the body).Results. The frequency of glucose metabolism disorders in patients hospitalized with ADHF was 57.5% (n = 161), while prediabetes was detected in 17.1% of patients (n = 48) and type 2 diabetes – in 40.4% (n = 113) of cases. Congestion at admission was detected in all patients. A significantly higher frequency of residual (61%) and a lower frequency of subclinical congestion (10%) were revealed in patients with ADHF and type 2 diabetes, compared to patients without glucose metabolism disorders (39% for residual congestion, 27% for subclinical congestion) and prediabetes (40% for residual congestion, 25% for subclinical congestion), respectively. There were no significant differences in the frequency of euvolemia at discharge, depending on the glucose metabolism disorder.Conclusion. Тo assess congestion phenomena at discharge, it is necessary to use clinical, laboratory, and instrumental assessments for patients with ADHF and glucose metabolism disorders. However, in patients with ADHF and prediabetes, it is preferable to focus on the laboratory and instrumental assessment of congestion, while in patients with ADHF and type 2 diabetes, both clinical and laboratory and instrumental assessment of congestion should be performed.

Screening of Prediabetic Patients by using HbA1c in District Narowal Pakistan

Background: The prevalence of prediabetes is on the rise globally, with lifestyle factors and obesity being key contributors to the development of the condition. Studies have consistently shown a link between higher Body Mass Index (BMI) and an increased risk of progressing from prediabetes to type 2 diabetes mellitus (T2DM). Objective: This study aimed to determine the prevalence of prediabetes and its association with BMI and lifestyle factors in District Narowal, Pakistan. Methods: A cross-sectional study was conducted with 200 participants from District Narowal. HbA1c levels were measured to classify participants into non-diabetic (4-7%), prediabetic (7-10%), and diabetic (10-13% and 13-16%) groups. BMI was calculated for each participant to assess weight status. Lifestyle factors were evaluated using a standardized questionnaire. Statistical analyses included the independent t-test for mean comparison and standard deviation assessment, with a significance level set at P &lt; 0.05. Results: Out of 200 participants, 81 (40.5%) were non-diabetic, 60 (30%) were prediabetic, and 16 (8%) were classified as diabetic. The mean HbA1c levels for non-diabetic, prediabetic, and diabetic individuals were 5.7%, 8.5%, and 14.5%, respectively. BMI assessment revealed that higher HbA1c levels were associated with higher BMI, and lifestyle analysis indicated a high consumption of ultra-processed foods among prediabetic individuals. Conclusion: The study found a notable prevalence of prediabetes in District Narowal, with a significant association between higher BMI and poor dietary habits with elevated HbA1c levels. These findings suggest the necessity of public health strategies focusing on weight management, nutritional education, and lifestyle modification to prevent the progression of prediabetes to T2DM.

Association of Prediabetes and Recurrent Stroke in Atrial Fibrillation Patients: A Population-Based Analysis of Hospitalizations and Outcomes.

Prediabetes is a risk factor for ischemic stroke in atrial fibrillation (AF) patients, yet, its impact on recurrent stroke in AF patients remains understudied. Using the 2018 National Inpatient Sample, we investigated the link between Prediabetes and recurrent stroke in AF patients with prior stroke or transient ischemic attack (TIA). Among 18,905 non-diabetic AF patients, 480 (2.5%) had prediabetes. The prediabetic group, with a median age of 78, exhibited a two-fold higher risk of recurrent stroke compared to the non-prediabetic cohort (median age 82), as evidenced by both unadjusted (OR 2.14, 95% CI 1.72-2.66) and adjusted (adjusted for socio-demographics/comorbidities, OR 2.09, 95% CI 1.65-2.64, p < 0.001). The prediabetes cohort, comprising more male and Black patients, demonstrated associations with higher Medicaid enrollment, admissions from certain regions, and higher rates of hyperlipidemia, smoking, peripheral vascular disease, obesity, and chronic obstructive pulmonary disease (all p < 0.05). Despite higher rates of home health care and increased hospital costs in the prediabetes group, the adjusted odds of all-cause mortality were not statistically significant (OR 0.55, 95% CI 0.19-1.56, p = 0.260). The findings of this study suggest that clinicians should be vigilant in managing prediabetes in AF patients, and strategies to prevent recurrent stroke in this high-risk population should be considered.

Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients.

Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events (MACCE). However, the relationship between prediabetes and MACCE in atrial fibrillation (AF) patients has not been extensively studied. Therefore, this study aimed to establish a link between prediabetes and MACCE in AF patients. To investigate a link between prediabetes and MACCE in AF patients. We used the National Inpatient Sample (2019) and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes, excluding diabetics. The primary outcome was MACCE (all-cause inpatient mortality, cardiac arrest including ventricular fibrillation, and stroke) in AF-related hospitalizations. Of the 2965875 AF-related hospitalizations for MACCE, 47505 (1.6%) were among patients with prediabetes. The prediabetes cohort was relatively younger (median 75 vs 78 years), and often consisted of males (56.3% vs 51.4%), blacks (9.8% vs 7.9%), Hispanics (7.3% vs 4.3%), and Asians (4.7% vs 1.6%) than the non-prediabetic cohort (P < 0.001). The prediabetes group had significantly higher rates of hypertension, hyperlipidemia, smoking, obesity, drug abuse, prior myocardial infarction, peripheral vascular disease, and hyperthyroidism (all P < 0.05). The prediabetes cohort was often discharged routinely (51.1% vs 41.1%), but more frequently required home health care (23.6% vs 21.0%) and had higher costs. After adjusting for baseline characteristics or comorbidities, the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort [18.6% vs 14.7%, odds ratio (OR) 1.34, 95% confidence interval 1.26-1.42, P < 0.001]. On subgroup analyses, males had a stronger association (aOR 1.43) compared to females (aOR 1.22), whereas on the race-wise comparison, Hispanics (aOR 1.43) and Asians (aOR 1.36) had a stronger association with MACCE with prediabetes vs whites (aOR 1.33) and blacks (aOR 1.21). This population-based study found a significant association between prediabetes and MACCE in AF patients. Therefore, there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

The glycosylated hemoglobin level and the severity of cardiovascular involvement in patients with the first episode of acute coronary syndrome.

The current study was carried out aiming at investigating the relationship between glycosylated hemoglobin level and coronary atherosclerosis in patients with the first episode of acute coronary syndrome. This case-control study evaluated 450 patients with the first episode of acute coronary syndrome in Ayatollah Rouhani Hospital in Babol (Iran) from 2011 to 2018. Based on glycosylated hemoglobin, patients were divided into three groups of non-diabetic, pre-diabetic, and diabetic (n=150 in each group). Since SYNTAX score and Gensini score are employed to evaluate the extent of cardiovascular disease and predict CVD in patients with CAD over long-term follow-up, we calculated SYNTAX score and Gensini score based on angiographic results. Concerning the factors related to the severity of cardiovascular involvement, the results revealed no significant difference between the diabetic and pre-diabetic groups in terms of the frequency of patients in terms of SYNTAX score, Gensini score, and the number of vessels involved (0.142 and 87, respectively, and P=0.102). However, this difference between the diabetic and non-diabetic groups, as well as between the pre-diabetic and non-diabetic groups was statistically significant (respectively for SYNTAX score, p< 0.001 and P=0.001; for Gensini score, P=0.013 and P=0.019; and for the number of vessels involved P=0.001and p<0.001). According to the findings of the current study, since there was no significant difference between diabetic and pre-diabetic patients in terms of the components indicating the severity of cardiovascular involvement, pre-diabetes itself may be associated with the severity of cardiovascular involvement as a predisposing factor.

Waist circumference glucose, a novel and effective predictor of type 2 diabetes: a prospective cohort study.

Waist circumference (WC) and fasting plasma glucose (FPG) have been demonstrated as risk factors for type 2 diabetes mellitus (T2DM). Evidence is limited regarding the association of the combination of WC and FPG (WyG) with the risk of T2DM. The primary aim of the study was to investigate the relationship between WyG and T2DM. The current study was a population-based cohort study using data from the NAGALA database. Participants were divided into tertiles based on WyG. Cox proportional hazard regression model was applied to identify the association of WyG with T2DM. During a median follow-up of 6.19 years in the normoglycemia group and 5.58 years in the prediabetes group, respectively, 88 and 285 individuals in the two groups received a diagnosis of T2DM. After full adjustment, risk of T2DM increased in step-wise fashion with increasing tertiles of WyG. For a per-SD increase in WyG, the hazard ratios for T2DM were 3.05 (95% CI 2.64 - 3.51) in all populations, 1.94 (95% CI 1.46 - 2.58) in the normoglycemia group and 1.63 (95% CI 1.40 - 1.90) in the prediabetes group. The interaction between WyG and fatty liver on T2DM was statistically significant in the prediabetes group (P for interaction = 0.034). Elevated WyG was independently associated with incident T2DM in Japan. Baseline WyG help identify individuals at high risk of T2DM and implement effective preventive measures.

Metabolic profiling identifies potential biomarkers associated with progression from gestational diabetes mellitus to prediabetes postpartum.

The current study aims to identify potential metabolic biomarkers that predict the progression to prediabetes in women with a history of gestational diabetes mellitus (GDM). We constructed a prediabetes group ( n = 42) and a control group ( n = 40) based on a2-hour 75 g oral glucose tolerance test for women with a history of GDM from six weeks to six months postpartum, and collected their clinical data and biochemical test results. We performed the plasma metabolomics analysis of the subjects at the fasting and 2-hour post-load time points by using ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF-MS/MS). We found that the prediabetes group was older and had higher 2-hour post-load glucose levels during pregnancy than the control group. The metabolomic analysis identified 164 differential metabolites between the groups. Compared with the control group, 15 metabolites in the prediabetes group exhibited consistent change trends at both time points, including three increased and 12 decreased metabolites. By building a prediction model of the progression from GDM to prediabetes, we found a combination of three clinical markers yielded an area under thecurve (AUC) of 0.71 (95% confidence interval [CI], 0.60-0.82). We also assessed the discriminative power of the panel of 15 metabolites for distinguishing between postpartum prediabetes and normal glucose tolerance of the subjects at the fasting (AUC, 0.98; 95% CI, 0.94-1.00) and 2-hour post-load (AUC, 0.99; 95% CI, 0.97-1.00) time points. The metabolic pathway analysis indicated that energy metabolism and branched-chain amino acids played a role in the development of prediabetes in women with a history of GDM during early postpartum. In conclusion, this study identified potential metabolic biomarkers and pathways associated with the progression from GDM to prediabetes in the early postpartum period. A panel of 15 metabolites showed promising discriminative power for distinguishing between postpartum prediabetes and normal glucose tolerance. These findings provide insights into the underlying pathophysiology of this transition and suggest the feasibility of developing a metabolic profiling test for the early identification of women at high risk of prediabetes following GDM.

Serum adiponectin and peroxisome proliferator-activated receptors-γ levels in obese patients with and without prediabetes.

Obesity is an increasingly prevalent global health problem, which is generally caused by the increase in body fat mass above normal and observed in all societies. If the blood glucose level is higher than normal but not high enough to diagnose diabetes, this condition is defined as prediabetes. Adiponectin increases fatty acid oxidation and insulin sensitivity and is closely associated with obesity. One of the nuclear receptor superfamily member peroxisome proliferator-activated receptors is shown to have an important role in various metabolic reactions. This study aimed to investigate the serum levels of adiponectin and peroxisome proliferator-activated receptors-gamma parameters, which are closely related to adipose tissue, energy metabolism, and insulin sensitivity, in obese patients with and without prediabetes. For this purpose, 52 obese patients with prediabetes, 48 obese patients with non-prediabetes, and 76 healthy individuals were included in this study. Serum adiponectin and peroxisome proliferator-activated receptors-γ levels were analyzed by ELISA. Serum adiponectin levels were significantly higher in obese patients with prediabetes (18.15±15.99) compared with the control group (15.17±15.67; p=0.42). No significant difference was observed in both adiponectin and peroxisome proliferator-activated receptors-γ levels in the obese patients with the non-prediabetes group compared with the control group. However, no significant difference was observed in the obese patients with prediabetes group and obese patients with non-prediabetes group. Our results suggest that adiponectin may serve as an indicator of prediabetes. This implies that examining adiponectin levels in individuals diagnosed with prediabetes may enhance our understanding of the metabolic processes closely linked to prediabetes and related conditions.

The use of colour and rapid flicker sensitivity tests for early detection and monitoring of vision changes in diabetes

Aims/Purpose: There is increasing evidence of impaired visual function prior to the presence of diabetic retinopathy (DR), yet current diagnostic criteria and treatment onset rely mostly on retinal vascular changes. In this study we measured changes in chromatic and rapid flicker sensitivity in subjects with prediabetes and diabetes to establish the value of such tests as a potential biomarker in the detecting early diabetes.Methods: Three groups of subjects were recruited: 1) normal controls, 2) subjects with prediabetes (HbA1c between 42‐47 mmol/mol), and 3) diabetics (with or without DR). Monocular cone‐ and rod‐enhanced flicker modulation thresholds (FMTs) were measured at the point of regard and in four parafoveal (5°) locations using the Flicker‐Plus test. Monocular red/green (RG) and yellow/blue (YB) colour thresholds were also measured at the fovea using the Colour Assessment and Diagnosis (CAD) test.Results: Both the RG and YB thresholds, as well as rod‐ and cone‐mediated flicker thresholds were significantly higher in both diabetic and prediabetic groups (when compared with healthy controls). When examined individually, ~50% and ~ 63% of the prediabetics and ~ 58% and ~ 70% of the diabetics revealed abnormal RG and YB thresholds, respectively (when compared with the upper normal limits for the corresponding age). HBA1c levels also revealed a positive trend with increasing RG and YB thresholds in the prediabetic group.Conclusions: In agreement with previous findings, both colour and FMTs are affected in patients diagnosed with diabetes. Unexpectedly, those deemed prediabetic that do not meet the clinical criteria for diabetes exhibit considerable loss of both colour and flicker sensitivity. The results suggest that colour and rapid flicker tests can provide useful information when screening for diabetes.

Low-grade inflammation and inflammatory mediators in individuals with prediabetes

Background/Aim. Prediabetes is a condition that refers to the state of hyperglycemia not sufficiently high to reach the diagnostic values for type 2 diabetes mellitus (T2DM). This condition often precedes the appearance of T2DM. The association between the development of early glycoregulation disorders and the state of low-grade chronic inflammation is still not sufficiently well understood. The aim of the study was to assess the values of different inflammatory mediators and biomarkers in individuals with prediabetes. Methods. This cross-sectional, observational study included 60 respondents divided into two groups: the prediabetes group (PDG) with 31 patients and the healthy control group (HCG) with 29 respondents. Serum values of seven selected cytokines/biomarkers were compared between the two groups. Examined biomarkers were: interleukin (IL)-1?, IL- 6, IL-8, IL-18, tumor necrosis factor (TNF)-?, E-selectin, and vascular endothelial growth factor (VEGF)-A. In addition, the values of body mass index (BMI), waist circumference (WC), blood pressure (BP), serum triglyceride (TG), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were also compared between the two groups. Results. PDG patients had statistically significantly higher TNF-? values compared to the HCG patients (73 pg/mL vs. 55 pg/mL, p = 0.024). A trend towards higher levels of IL-8 and IL-1? and lower levels of E-selectin, VEGF-A, and IL-18 was registered in PDG patients but without statistical significance. Furthermore, PDG patients had higher values of BMI, WC, systolic BP, serum TG, FPG, and HbA1c when compared to HCG. Conclusion. The results of our study suggest the importance of inflammation and some inflammatory mediators in the pathogenesis of early glycoregulation disorder. We believe that the main goal of future studies should focus on anti-inflammatory therapy in prediabetes.

Serum-based ATR-FTIR spectroscopy combined with multivariate analysis for the diagnosis of pre-diabetes and diabetes.

Diabetes mellitus (DM) is a metabolic disease with an increasing prevalence that is causing worldwide concern. The pre-diabetes stage is the only reversible stage in the patho-physiological process towards DM. Due to the limitations of traditional methods, the diagnosis and detection of DM and pre-diabetes are complicated, expensive, and time-consuming. Therefore, it would be of great benefit to develop a simple, rapid and inexpensive diagnostic test. Herein, the infrared (IR) spectra of serum samples from 111 DM patients, 111 pre-diabetes patients and 333 healthy volunteers were collected using attenuated total reflection Fourier-transform IR (ATR-FTIR) spectroscopy and this was combined with the multivariate analysis of principal component analysis linear discriminant analysis (PCA-LDA) to develop a discriminant model to verify the diagnostic potential of this approach. The study found that the accuracy of the test model established by ATR-FTIR spectroscopy combined with PCA-LDA was 97%, and the sensitivity and specificity were 100% and 100% in the control group, 94% and 98% in the pre-diabetes group, and 91% and 98% in the DM group, respectively. This indicates that this method can effectively diagnose DM and pre-diabetes, which has far-reaching clinical significance.

Potential synergistic antihyperglycemic effects of co-supplemental Amla and Olive extracts in hyperlipidemic adults with prediabetes and type 2 diabetes: results from a real-life clinical study.

Hyperglycemia and type 2 diabetes mellitus (T2DM) pose a significant risk for cardiovascular diseases and associated complications in individuals with hyperlipidemia. Statin therapy, effective in reducing cholesterol and cardiovascular risks, paradoxically increases incident T2DM risk due to its adverse impact on glucose homeostasis. Therefore, there is a pressing need for safe, and effective adjunctive or alternative therapies to manage hyperglycemia in hyperlipidemic individuals. There is growing body of pharmacological evidence suggesting that Amla and Olive extract supplementation can be beneficial in managing hyperglycemia in individuals with hyperlipidemia. The present study aimed to assess for the first time the potential synergistic antihyperglycemic effects of a daily co-supplementation of 1,000 mg Amla fruit and 50 mg Olive fruit standardized extracts (Cholesfytol NG®) over a 2-months period in hyperlipidemic adults with T2DM or prediabetes. This retrospective cross-sectional observational study analyzed treatment outcomes in 191 hyperlipidemic adults under the care of their physicians at 57 General Practitioner clinics in Belgium during real-life clinical practice between March 19, 2020, and January 31, 2022. These participants received Cholesfytol NG® as supplementary therapy to improve their metabolic health. The supplement was prescribed in an open-label, non-randomized manner, tailored to each participant's need. After 2-months of Cholesfytol NG® supplementation, participants showed significant reductions in glycemia levels: in the T2DM group, levels decreased by 42.7 ± 17.9 mg/dL (27.9%, p < 0.0001), and in the prediabetic group, by 2.26 ± 11.5 mg/dL (4.7%, p = 0.0020). Conversely, no significant change was observed in participants with normal baseline glycemia (1.55 ± 10.3 mg/dL, p = 0.088). Overall, glycemia levels decreased from 96.4 ± 18.2 mg/dL to 94.0 ± 13.5 mg/dL (mean decrease of 2.4 ± 14.5 mg/dL, p < 0.0001). The supplement was well tolerated and no side-effects, serious adverse events, or treatment-emergent effects were reported. The findings of this real-life clinical study highlight the potential synergistic antihyperglycemic effects of co-supplementation with Amla and Olive fruit extracts in managing hyperglycemia, particularly in individuals with hyperlipidemia. These results suggest that this botanical combination may help mitigate risks associated with hyperglycemia and cardiovascular disease in hyperlipidemic population. ClinicalTrials.gov, NCT06187298.

Insulin-like growth factor-1 and cognition in normoglycemia, prediabetes, and type 2 diabetes mellitus

BackgroundThe relationship between insulin-like growth factor-1 (IGF-1) and cognition has been studied in healthy individuals, but not extensively with regards to insulin resistance and type 2 diabetes mellitus (T2DM). In this retrospective observational study, we investigated relationships of IGF-1 with memory and executive function across people with normoglycemia, prediabetes, and T2DM. MethodsData from the Midlife in the United States (MIDUS) study were used. Episodic memory and executive function were assessed using the Brief Test of Adult Cognition by Telephone approximately 21.42 ± 12.10 months prior to measuring IGF-1 levels from a fasting blood sample. Normoglycemia was identified as individuals without a physician diagnosis of diabetes and glycated hemoglobin (HbA1c) ≤5.6%. Prediabetes was identified as those without a physician diagnosis of diabetes and HbA1c between 5.7%−6.4%. T2DM was identified as anyone with a physician diagnosis of diabetes, or HbA1c ≥6.5%, or anyone using an oral hypoglycemic medication. The associations were assessed using linear regressions controlling for age, sex, education, body mass index, C-reactive protein, HbA1c or homeostatic model of insulin resistance, MIDUS wave, exercise, smoking status, sleep quality, alcohol intake, oral hypoglycemic use, and insulin use. ResultsThe study included 1400 participants, which consisted of 583 normoglycemic (48.4% female, mean age 51.0 ± 12.2 years), 512 prediabetes (58.4% female, mean age 57.3 ± 11.8 years), and 305 T2DM participants (53.8% female, mean age 57.6 ± 11.5 years). Peripheral IGF-1 concentrations were lower (F2,1397 = 28.29, p < 0.001) in people with prediabetes or T2DM, vs. normoglycemia. Participants with prediabetes or T2DM had lower episodic memory (F2,1397 = 9.21, p < 0.001) and executive function (F2,1397 = 20.29, p < 0.001) composite z-scores than people with normoglycemia. Higher IGF-1 concentrations were associated with better executive performance in individuals with prediabetes (β = 0.115 [0.028, 0.202], p = 0.010), but not in individuals with normoglycemia or T2DM. An interaction between IGF-1 and sex in predicting executive function was observed in the prediabetes group (β = −0.344, p = 0.042), where the relationship was weaker in females (β = 0.106 [−0.012, 0.224], p = 0.077) than males (β = 0.251 [0.123, 0.380], p < 0.001). No associations were seen between IGF-1 and memory. ConclusionThe results suggest that peripheral IGF-1 concentrations may be related to executive function, and that the relationship may be sex-specific and dependent on diabetes status.

Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis.

Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucose levels by preventing glucose reabsorption and facilitating its elimination; in the process, researchers took notice of how SGLT2 inhibitors also seemed to have beneficial cardiovascular effects in patients with both diabetes and cardiovascular disease. Our single-center prospective study assesses outcomes of post-coronary artery bypass grafting (CABG) rehabilitation and SLGT2 inhibition in CABG patients with/without T2DM and with/without CKD. One hundred twenty consecutive patients undergoing CABG were included in the analysis. Patients were divided into four subgroups: diabetes patients with chronic kidney disease (T2DM + CKD), diabetes patients without chronic kidney disease (T2DM-CKD), prediabetes patients with chronic kidney disease (PreD+CKD), and prediabetes patients without chronic kidney disease (PreD-CKD). Echocardiographic and laboratory investigations post-surgery (phase I) and 6 months later (phase II) included markers for cardiac ischemia, glycemic status, and renal function, and metabolic equivalents were investigated. One hundred twenty patients participated, mostly men, overweight/obese, hypertensive, smokers; 65 had T2DM (18 with CKD), and 55 were prediabetic (17 with CKD). The mean ejection fraction increased by 8.43% overall but significantly more in the prediabetes group compared to the T2DM group (10.14% vs. 6.98%, p < 0.05). Overall, mean heart-type fatty-acid-binding protein (H-FABP) levels returned to normal levels, dropping from 68.40 ng/mL to 4.82 ng/mL (p = 0.000), and troponin data were more nuanced relative to an overall, strongly significant decrease of 44,458 ng/L (p = 0.000). Troponin levels in patients with CKD dropped more, both in the presence of T2DM (by 82,500 ng/L, p = 0.000) and in patients without T2DM (by 73,294 ng/L, p = 0.047). As expected, the overall glycated hemoglobin (HbA1c) levels improved significantly in those with prediabetes (from 6.54% to 5.55%, p = 0.000); on the other hand, the mean HbA1c changed from 7.06% to 6.06% (p = 0.000) in T2DM, and the presence or absence of CKD did not seem to make any difference: T2DM+CKD 7.01-6.08% (p = 0.000), T2DM-CKD 7.08-6.04% (p = 0.000), PreD+CKD 5.66-4.98% (p = 0.014), and PreD-CKD 6.03-4.94% (p = 0.00). Compared to an overall gain of 11.51, the GFRs of patients with CKD improved by 18.93 (68.15-87.07%, p = 0.000) in the presence of established diabetes and 14.89 (64.75-79.64%, p = 0.000) in the prediabetes group. Regarding the patients' cardiac statuses, the results from our single-center analysis revealed a significant decrease in ischemic risk (H-FABP and hs-cTnI levels) with improvements in mean ejection fraction, glycemic status, and renal function in patients post-CABG with/without T2DM, with/without CKD, and with SGLT2 inhibitor dapagliflozin treatment while undergoing cardiac rehabilitation.