Prediabetes Group Research Articles

The associations of glycosylated hemoglobin with grey matter volume and depression: Investigating mediating role of grey matter volume

BackgroundDepression has caused enormous health burden to human worldwide. Glycemia has been found as one important risk factor of depression. However, the biological mechanism underlying this relationship remained largely unknown. MethodsThis analysis was derived from a cohort of 33,151 participants in the UK Biobank who provided brain magnetic resonance imaging data from 2014 to 2020. Participants were classified into diabetic, prediabetic and non-diabetic groups, as well as groups aged ≥60 years and <60 years. We assessed the associations between glycosylated hemoglobin (HbA1c), grey matter volume (GMV) in 117 brain regions, and depression based on the multivariable linear and logistic regression. We further investigated the mediation effect of GMV on the relationship between HbA1c and depression. ResultsHigher HbA1c was found to be associated with reduced GMV and depression. Lower GMV was observed associated with depression. Moreover, the association was strongest in prediabetes compared to prediabetic and non-diabetic, and the association was greater in those aged ≥60 years. We further observed a significant mediation effect of GMV on the association between HbA1c and depression, and the proportions of the effect mediated by HbA1c-depression signatured regions was 7.29% (95% CI: 1.43%, 34.38%). ConclusionsThis study suggests that HbA1c is associated with cerebral grey matter abnormality especially in participants aged ≥60 years. In the context of global aging, the unhealthy blood sugar can contribute to more severe brain damage for the population and effective control of blood sugar levels among the elderly can have a positive impact on brain health and potentially reduce the risk of developing depression.

Is there an Association of Glycosylated Haemoglobin A1c and Anthropometric Measurements in Premenopausal and Postmenopausal Breast Cancer Patients?

Background: Breast cancer is the commonest malignancy among women globally. It is a leading cause of cancer death in less developed countries and the second leading cause of cancer death in developed countries. Diabetes and breast cancer are two conditions that frequently coexist, and menopause may be a metabolic watershed. The purpose of this study is to examine the relationship between glycosylated haemoglobin (HbA1c) and anthropometric measurements in premenopausal and postmenopausal breast cancer patients Methods: 100 patients diagnosed with breast cancer between December 2020 to November 2022 were evaluated and their HbA1c levels were correlated with anthropometric measurements and tumour characteristics Results: In our study mean age of the patients was 47.75 ±11.77 SD years. In patients with normal HbA1c 64% patients were pre-menopausal. In Pre-diabetic HbA1c group 70% were post-menopausal and in diabetic HbA1c group 93% were postmenopausal. Mean waist circumference was 84.56 ± 6.64 SD cms; more in pre-diabetic and diabetic patients; (p value 0.000). Most of the patients (71%) had waist to hip ratio ≥0.85 (p value 0.349). Pre-diabetic and diabetic patients were overweight (p value 0.000). 6 patients were known cases of type II diabetes mellitus and were on insulin/OHAs. T3 tumours were more common in both premenopausal and postmenopausal patients followed by T4 tumours. Stage IIB breast cancer was present in 39% of premenopausal and stage IIIA was seen in 30% of the postmenopausal patients. Grade II disease was more common in both premenopausal and postmenopausal (p value 0.858). Invasive ductal carcinoma-No special type (IDC-NST) was seen in 77% of the patients (p value 0.156). Estrogen Receptor (ER) positivity was seen in 42% of premenopausal and 33% of postmenopausal patients, negative Progesterone Receptor (PR) seen in 86% in premenopausal and 89% in postmenopausal patients and positive Her2 neu receptor was observed in 30% in premenopausal and 56% in postmenopausal patients. Conclusion: Our study demonstrated that a considerable proportion of breast cancer patients were prediabetic. Glycaemic status and HbA1c were clearly associated with measures of visceral obesity in carcinoma of breast patients. Postmenopausal patients had higher levels of HbA1c compared to premenopausal cases. However; clinicopathological and tumour characteristics in our study didn’t demonstrate any significant correlation with glycaemic status and need more research and randomized controlled trials. Collectively, findings from our study particularly emphasize the need to control hyperglycemia and identify vulnerable groups of breast cancer patients who might benefit from interventions to improve glycaemic control.

Identification of DNA methylation change in TCF7L2 gene in the blood of type 2 diabetes mellitus as a predictive biomarker in Iraq Kurdistan region by using methylation-specific PCR.

Objective. Nowadays, type 2 diabetes mellitus (T2D) is the most common chronic endocrine disorder affecting an estimated 5-10% of adults worldwide, and this disease also rapidly increased among the population in the Kurdistan region. This research aims to identify DNA methylation change in the TCF7L2 gene as a possible predictive T2D biomarker. Methods. One hundred and thirteen participants were divided into three groups: diabetic (47), prediabetic (36), and control (30). The study was carried out in patients who visited the private clinical sector between August and December 2021 in Koya city (Iraq Kurdistan region) to determine DNA methylation status using a methylation-specific PCR (MSP) with paired primers for each methylated and non-methylated region. In addition, the X2 Kruskal-Wallis statistical and Wilcoxon signed-rank tests were used, p<0.05 was considered significant. Results. The results showed hypermethylation of DNA in the promoter region in diabetic and prediabetic groups compared to the healthy controls. Different factors affected the DNA methylation level, including body max index, alcohol consumption, family history, and physical activity with the positive Coronavirus. Conclusion. The results obtained indicate that DNA methylation changes in the TCF7L2 promoter region may be used as a potential predictive biomarker of the T2D diagnosis. However, the findings obtained in this study should be supported by additional data.

DISTURBANCES IN SERUM CALCIUM AND PHOSPHATE LEVELS IN PRE-DIABETES AND TYPE 2 DIABETES MELLITUS

Objective: To evaluate serum calcium and phosphate levels in Pre-diabetic, Diabetic &amp; non-diabetic subjects. Material and Methods: This comparative cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, from July to December 2021. The study used a non-probability consecutive sample to include 300 people. Those people have been divided into three groups; diabetics, pre-diabetics and non-diabetics with a hundred people in every group. Blood specimens had been taken for the estimation of calcium, phosphate, HbA1c, plasma glucose and insulin in fasting in their respective tubes. SPSS version 24 was used to inspect the data. All descriptive variables had their means and standard deviations calculated. To examine descriptive characteristics within and between all groups, one way ANOVA and post hoc LSD were performed, and p-values 0. 05 were considered significant. Results: Calcium and Phosphorus levels were lower in Diabetic group (Ca= 1.97±0.16mmol/l, PO4 = 0.76±0.07 mmol/l) as compared to pre-diabetic group (Ca= 2.15±0.18 mmol/l, PO4 = 0.93±0.06 mmol/l) and higher in non-diabetic group (Ca= 2.33±0.10mmol/l, PO4 = 1.19±0.20 mmol/l) than both other groups. A one-way ANOVA and Post Hoc LSD revealed that the difference between and within groups was statistically significant with a p value of 0.01. Conclusion: Our research has shown that as glycemic control slowly deteriorates, blood calcium and phosphate levels fall. Keywords: Calcium, Phosphorus, Pre-diabetes, Type 2 diabetes mellitus.

Prediyabetik Gebelerde 50 gr Glukoz Yükleme Testinin Oksidatif Stres ve İnterlökin-8 Parametreleri Üzerine Etkisinin Değerlendirilmesi

Background: The aim of this study is to evaluate the effect of 50 g oral glucose tolerance test (OGTT) on oxidative stress and interleukin-8 (IL-8) parameters in prediabetic pregnant women. Materials and Methods: Fasting and 1 hour blood samples were collected from 79 pregnant women who were administered 50 gr OGTT. Patients with a 1 hour blood glucose level of 140–200 mg/dl were considered as the prediabetic group. Thereafter, routine biochemical parameters and the levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA) and interleukin-8 (IL-8) parameters were measured from the serum samples taken during fasting and at 1 hour. Results: The serum GPx and SOD levels of the prediabetic group were remarkably lower than that of the control group (p&amp;lt;0.05). Whereas the serum IL-8 levels of the prediabetic group were significantly higher than that of the control group (p&amp;lt;0.05). When the fasting and 1 hour levels of the parameters were compared during OGTT, SOD levels were significantly decreased (p&amp;lt;0.001) and IL-8 levels were significantly higher (p&amp;lt;0.001). Conclusions: In conclusion, it was found that serum GPX and SOD levels decreased, while serum IL-8 levels increased in prediabetic pregnant women; however, when 50 g OGTT was administered to these patients, SOD levels decreased and IL-8 levels increased. These results we obtained suggest that oxidative stress and systemic inflammation that are already present in prediabetic pregnant women may be triggered by 50 g OGTT, posing negative risk factors for pregnant women.

Clinical, Radiographic, and Inflammatory Peri-Implant Parameters around Narrow Diameter Implant Crowns among Prediabetic and Non-Diabetic Subjects.

Background and Objectives: To compare the clinical, radiographic, and inflammatory peri-implant parameters around narrow diameter implants (NDI) supported single and splinted crowns in non-diabetics and prediabetes. Materials and Methods: The clinical and radiographic parameters and the levels of IL-6 and TNF-α in the peri-implant crevicular fluid (PICF) of narrow diameter single (NDISCs) and splinted (NDISPs) crown implants were assessed both in non-diabetics and participants with prediabetes. The glycemic state of the patient was assessed using glycated hemoglobin (HbA1c) levels. The peri-implant soft tissue indices (Plaque index (PI), bleeding on probing (BoP), probing depth (PD)) and marginal bone loss were recorded and compared between the groups. Success of the prosthesis was assessed by the frequency of technical complications and patient satisfaction. Inter-group comparison was performed using ANOVA (one-way analysis of variance) while the normal distribution of dependent variables was calculated using Shapiro-Wilk. A p-value of less than 0.05 was considered to be statistically significant. Results: Sixty participants (30 non-diabetics and 30 with prediabetes) with a total of 178 (118 NDISCs and 60 NDISPs) platform-switched NDIs were a part of the study. Of the 118 NDISCs, 56 were placed in the non-diabetic individuals and 62 were placed in the prediabetes group whereas 30 NDISPs each were placed in both the study groups. The clinical parameters of PI, BoP and PD in the single crown and splinted crown groups showed comparable results. However, a statistically significant difference (p-value of less than 0.05) in PI, BoP and PD and in the values of IL-6 and TNF-α was found when a comparison was made between the non-diabetes and prediabetes group. A total of 91% of the patients were satisfied with the esthetics of the implants while 79% of the patients showed satisfaction with function. Conclusions: All the clinical and radiographic parameters were statistically similar in both single and splinted types of narrow diameter implants. However, the bone loss, probing depth, plaque index, and levels of inflammatory markers were statistically higher in prediabetes as compared to non-diabetes implying that a slight hyperglycemic state impacts peri-implant health.

Assessment of the relationship between serum xanthine oxidase levels and type 2 diabetes: a cross-sectional study

Xanthine oxidase (XO) is an enzyme associated with purine metabolism. The relationship between XO levels and type 2 diabetes (T2D) is not clear yet or little is known so far. Therefore, we conducted a cross-sectional study to determine the association of XO levels with T2D in a Bangladeshi adult cohort. A total of 325 participants (234 males and 91 females) were enrolled in the study. The participants were divided into three groups; diabetic (n = 173), prediabetic (n = 35), and non-diabetic control (n = 117). Serum levels of XO were measured by enzyme-linked immunosorbent assay (ELISA) and other biochemical parameters including fasting blood glucose (FBG), serum uric acid (SUA), and lipid profile markers measured by colorimetric methods. Participants with T2D were confirmed according to the definition of the American Diabetic Association. The association between serum XO levels and T2D was determined by logistic regression models. The mean level of serum XO was significantly higher in females (6.0 ± 3.7 U/L) compared to male (4.0 ± 2.8 U/L) participants (p < 0.001). In contrast, males had a higher mean level of SUA (6.1 ± 1.9 mg/dL) than female (4.4 ± 1.9 mg/dL) participants (p < 0.001). The mean level of XO was significantly higher in the diabetic group (5.8 ± 3.6 U/L) compared to the prediabetic (3.7 ± 1.9 U/L) and control (2.9 ± 1.8 U/L) groups (p < 0.001). On the other hand, the mean SUA concentration was significantly lower in the diabetic group than in the other two groups (p < 0.001). A significant increasing trend was observed for FBG levels across the XO quartiles (p < 0.001). A decreasing trend was found for SUA levels in the XO quartiles (p < 0.001). Serum levels of XO and SUA showed a positive and negative correlation with FBG, respectively. In regression analysis, serum XO levels showed an independent association with T2D. In conclusion, this study reports a positive and independent association between XO levels and T2D in Bangladeshi adults. Monitoring serum levels of XO may be useful in reducing the risk of T2D. Further research is needed to determine the underlying mechanisms of the association between elevated XO levels and T2D.

Prevalence of non-alcoholic fatty liver disease among diabetes, prediabetes and healthy population.

Non-alcoholic fatty liver disease (NAFLD) is a global emerging health issue, which is due to extra fat deposition in the liver that poses a serious risk of liver cirrhosis. Our study assessed the glycaemic status and NAFLD in health patients coming for a regular health check-ups. This descriptive study was done on 192 healthy populations aged 30-70 years who underwent general health check-ups. History, clinical examination, heamtological and radiological workup were done and data were statistically evaluated. The age of the study population was between 30 and 70 years with an average age of 50 years and the study sample size was 190. Prevalence of prediabetes was 35.93%, diabetes at 17.18% and euglycaemics were 45.83% in our study group. Among diabetics and prediabetics, 30% and 31% were having raised transaminase. Among euglycaemics, around 19% had raised transaminase. On ultrasound scans among the diabetic group, the prevalence of fatty liver was 57.6% whereas in the prediabetic group it was 46.4%. Among the normal euglycaemic group, 22.7% had fatty liver. NAFLD is multifactorial and associated with diabetes and can progress to cirrhosis of the liver if untreated. There is a need to have more focus on screening, awareness, nutritional counselling and treatment at the primary care level.

Association between prediabetes and cognitive function in Parkinson's disease.

It remains largely unknown whether prediabetes is related to cognitive impairment in Parkinson's disease (PD). This study aimed to assess the association between prediabetes and cognitive function in PD patients. In this cross-sectional study, 262 PD patients (age, 69.8±10.3 years; Hoehn-Yahr stage, 2.3±0.8) were classified into diabetes (glycated hemoglobin [HbA1c] ≥6.5% or previously diagnosed, n=76), prediabetes (5.7%-6.4%, n=90), or diabetes free (≤5.6%, n=96) groups. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) test. Both the diabetes and prediabetes groups had significantly lower MoCA scores (17.0±6.6 and 18.0±6.1, respectively) than the diabetes free group (20.0±5.7), even after adjusting for potential confounders (p=.002 and p=.008, respectively). In the combined group of prediabetes and diabetes free patients, higher HbA1c levels significantly correlated with lower MoCA scores (p=.031). There was a significant interaction of diabetes status with age, but not with the duration of PD, on cognitive function. In addition to diabetes, prediabetes may negatively affect cognitive function in PD patients. Further prospective longitudinal studies are necessary to clarify the impact of prediabetes on the cognitive trajectory of these patients.

The assessment of neuropathic pain in patients with prediabetes

AimsNeuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated in prediabetes. This study aims to assess neuropathic pain through validated diagnostic tools in prediabetes. MethodsOne hundred and seventy-two patients with prediabetes and 170 controls were included in this cross-sectional study. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Douleur Neuropathique 4 Questions (DN4) were used to evaluate neuropathic pain. The Visual Analog Scale (VAS) was used to estimate pain intensity. ResultsTwenty-three (13.4%) and 12 (7%) patients with prediabetes were diagnosed with neuropathic pain using DN4 and LANSS questionnaires, respectively. Neuropathic pain rates of the patients were higher than controls with two pain scales (p < 0.001). VAS scores were higher in prediabetes group than in controls (p = 0.021). LANSS, DN4, and VAS scores were positively correlated with HbA1c level (r = 0.184, p = 0.016; r = 0.180, p = 0.018; r = 0.188, p = 0.014, respectively). LANNS and DN4 scores were higher in female patients than in males (p < 0.001). ConclusionsNeuropathic pain was increased in prediabetes by DN4 and LANNS questionnaires. An appropriate diagnosis of neuropathic pain in prediabetes may prevent patients from different pain-related clinical conditions.

Irisin as a predictor of bone metabolism in Han Chinese Young Men with pre-diabetic individuals

BackgroundIrisin is a novel myokine both in mice and humans, and it can also be secreted by adipose tissue and the liver in a small amounts. There are few studies on irisin and bone metabolism. The aim of this study was to assess the relationship between serum irisin levels and bone metabolism and analyze its related factors in Han young male with pre-diabetic individuals.MethodsThis cross-sectional study included 41 pre-diabetes and 45 normal glucose tolerance (NGT). Anthropometric measurements, including height, weight, waist circumference (WC), and bone mineral content (BMC), were performed. All patients underwent an oral glucose tolerance test (OGTT) after 8 h of fasting, and the levels of glucose, insulin, lipids, serum irisin and bone turnover markers were measured.ResultsThe levels of serum irisin (4.4 ± 1.4 vs. 6.3 ± 1.5 µg/mL), P1NP and OC were significantly lower and CTX was significantly higher in the pre-diabetes group (P < 0.05). BMC did not differ in the two groups (P > 0.05). Serum irisin levels negatively correlated with BMI (r =-0.325), FPG (r =-0.329), TG (r =-0.339) (P < 0.05) in NGT individuals. Serum irisin levels positively correlated with P1NP (r = 0.398), OC (r = 0.351), HDL-C (r = 0.432) and negatively correlated with FPG (r = -0.725), 2 h-PG (r = -0.360) (P < 0.05) in pre-diabetic individuals. Multiple regression analysis revealed that Serum irisin (β = 9.768, P = 0.025) and WC (β = -2.355, P = 0.002) were significant independent predictors for P1NP.ConclusionBone turnover markers were changed rather than bone mineral content in young men with pre-diabetes. In pre-diabetes individuals, serum irisin levels were reduced and close relationship with P1NP. Falling irisin levels may be a predictor of decreased bone formation in Han young men with pre-diabetes individuals.

Early Retinal Microvasculopathy in Prediabetic Patients and Correlated Factors

Introduction: We aimed to detect early retinal microcirculation changes in prediabetic patients and investigate their correlation with clinical examinations. Methods: Forty-seven prediabetic individuals, 29 controls, and 81 type 2 diabetic mellitus (T2DM) patients were enrolled in this study. A review of clinical data and spectral-domain optical coherence tomography angiography (SD-OCTA) parameters of macular vessel diameter (VD), foveal avascular zone (FAZ), and macular vessel area density (VAD) was performed. Results: Levels of low-density lipoprotein cholesterol and triglycerides in prediabetes and T2DM groups were significantly higher than those in the control group. The urine microalbumin-to-creatinine ratio (ACR) was mildly and moderately increased in the prediabetes and T2DM groups, respectively. The estimated glomerular filtration rate of the three groups was within the normal range. SD-OCTA showed that VAD in the superficial macular area was decreased in the prediabetes group compared to the control group (p = 0.01). The FAZ size, particularly in the deep layer, was expanded in the prediabetes group. In the deep retinal layer of the macular area, VD and FAZ size in the prediabetes group were larger than those in the control group. In the prediabetes group, the axial length was significantly correlated with macular VD and FAZ size (p < 0.05), and ACR was correlated with FAZ size (p < 0.05). Age had a negative correlation with VAD (p < 0.01). ACR had a positive correlation with FAZ size (p < 0.05). Conclusions: Enlargement and irregularity of the FAZ area, deep capillary dilation, and a decrease in VAD occur in the retina of prediabetic patients with mild kidney function impairment.

Salivary Calcium Level and Its Correlation with Salivary pH, Salivary Volume, and Calcium Intake in Hypertensive Female Patients with Different Blood Sugar Levels.

This study aimed to evaluate the salivary calcium level and its correlation with salivary pH, salivary volume, and calcium intake in hypertensive female patients with different blood sugar levels. This cross-sectional study included 49 female subjects with hypertension. Subjects were divided into three groups based on the HbA1c test: normal, prediabetes, and diabetes. Unstimulated whole saliva was collected using the spitting method. Salivary calcium levels were evaluated using an Atomic Absorption Spectrophotometer. Salivary pH was obtained using a universal indicator pH paper test. Calcium intake was assessed by a semi-quantitative food frequency questionnaire. The Kruskal-Wallis test was used to compare salivary parameters and total calcium intake within study groups. Spearman rank correlation and multiple regression analysis were used to evaluate the correlation between salivary calcium levels and all variables in the study. No significant difference in salivary calcium, volume, pH, and total calcium intake was observed within the study groups. However, a significant correlation was found between salivary calcium levels and salivary pH in hypertensive females with normal blood glucose levels. Moreover, salivary calcium levels have a significant correlation with systolic blood pressure in prediabetes and diabetes groups. This study found a decrease in all salivary parameters (calcium, pH, and volume) as well as a low calcium intake in hypertensive females, despite no significant difference found in groups with different blood glucose levels. Blood glucose levels appeared to be a confounder in the relationship between salivary calcium with salivary pH and systolic blood pressure.

The Extent of Insulin Resistance in Patients That Cleared Viral Hepatitis C Infection and the Role of Pre-Existent Type 2 Diabetes Mellitus: A Meta-Analysis

A high risk of developing insulin resistance (IR) and, eventually, type 2 diabetes mellitus (T2DM) is associated with chronic hepatitis C virus (HCV). Multiple mechanisms can account for the development of IR in chronic HCV patients, steatosis or fatty liver that can lead to metabolic syndrome, and the inflammatory process associated with the presence of HCV infection. In this article, we analyze the reported values of homoeostasis model assessment (HOMA-IR) before and after successful direct-acting agents (DAAs) treatment in the literature (23 studies) at certain intervals, respectively 12, 24, and 52 weeks depending on the presence of T2DM among patients. The meta-analysis showed improvement of IR in most cases except for three studies that presented a minimal increase in HOMA-IR value for the non-T2DM group at the 12- and 24-week check-ups possibly hinting at a prediabetes group. All other studies showed an important decrease in HOMA-IR post-DAA treatment specifically for the T2DM group. The most significant change in HOMA-IR values was noticed after 24 weeks in all categories. Our meta-analysis showed that clearance of HCV leads to improvement of IR, especially in the case of patients with T2DM.

Changes of ACE2 in different glucose metabolites and its relationship with COVID-19.

Background:To study the changes and effects of angiotensin-converting enzyme 2 (ACE2)/angiotensin 1-7 (Ang1-7) and ACE/AngII in people with different glucose metabolisms and to explore the possible mechanisms underlying the severity of COVID-19 infection in diabetic patients.Methods:A total of 88 patients with type 2 diabetes, 72 patients with prediabetes (impaired fasting glucose, 30 patients; impaired glucose regulation, 42 patients), and 50 controls were selected. Changes and correlations of ACE2, Ang1-7 and other indicators were detected among the three groups. Patients were divided into four groups according to the course of diabetes: <1 year, 1–5 years, 5–10 years, and >10 years. ACE2 and Ang1-7 levels were compared and analyzed.Results:ACE2 and Ang1-7 increased with the severity of diabetes (P0 < .05 or P < .01). The levels of ACE2 and Ang1-7 in the longer course group were lower than those in the shorter course group, whereas the levels of ACE, Ang II, and interleukin-6 (IL-6) gradually increased (P < .05). Pearson correlation analysis showed that ACE2 was positively correlated with IL-6, FBG, and 2hPBG levels in the prediabetes group. In the diabetic group, ACE2 was positively correlated with Ang1-7 and negatively correlated with ACE, AngII, IL-6, and C-reactive protein levels. Multiple linear regression analysis showed that IL-6 and ACE were the main factors influencing ACE2 in the diabetic group.Conclusion subsections:ACE2/Ang1-7 and ACE/AngII systems are activated, and inflammatory cytokine release increases in prediabetes. With the prolongation of the disease course, the effect of ACE2/Ang1-7 decreased gradually, while the effect of ACE/AngII increased significantly. Dysfunctions of ACE2/Ang1-7 may be one of the important mechanisms underlying the severity of COVID-19 infection in patients with diabetes.

Risk of Carotid Atherosclerosis in Subjects with Prediabetes Overlapping Metabolic Syndrome.

Background: While the number of individuals with prediabetes and metabolic syndrome (MetS) is increasing, only a few studies have reported differences in cardiovascular risk according to the presence or absence of MetS in individuals with prediabetes. Here, we examined differences in carotid intima-media thickness (CIMT) and carotid plaques in individuals with prediabetes with or without MetS among subjects who visited a single center in Seoul (Huh Diabetes Center). Methods: A total of 328 participants aged ≥20 years, including the group with normoglycemia, were enrolled in the analysis, of which 273 had prediabetes. Individuals with prediabetes were defined as those who met one or more of the following two criteria: fasting plasma glucose of 100-125 mg/dL and/or HbA1c level of 5.7%-6.4%. Carotid atherosclerosis was determined by mean and maximal CIMT and by the presence of carotid plaques. Results: Eighty-nine subjects (32.6% of prediabetes group) were categorized as having MetS. Those with MetS had significantly higher mean CIMT and maximal CIMT than those without (P < 0.05). Moreover, the group with MetS had a significantly higher prevalence of carotid plaques than the group without MetS [odds ratio (OR): 2.45, 95% confidence interval (CI): 1.43-4.19; P = 0.001]. After adjusting for age, sex, body mass index, and low-density lipoprotein cholesterol, individuals with MetS still had greater mean and maximal CIMT than individuals without MetS (P < 0.05), and the presence of MetS was significantly associated with a higher risk of carotid plaques (OR: 2.55, 95% CI: 1.06-6.15; P = 0.037). Conclusion: These results suggest that MetS is independently associated with increased CIMT and the presence of carotid plaques in prediabetes. Our study indicates that the risk of cardiovascular disease (CVD) is high in prediabetic individuals with MetS, and that more attention is needed on the risk of CVD in these individuals.

Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study.

To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression in T2D in PD and NGT groups. Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49-54%; protein, 19-20%; and fat, 21-26%; 2) PD remission to NGT: carbohydrate, 50-56%; protein,18-20%; fat, 21-27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54-57% and 56-60%; protein, 16-20% and 14-17%, respectively; and fat 20-24% for PD and NGT. We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.

TCF7L2 gene associated postprandial triglyceride dysmetabolism- a novel mechanism for diabetes risk among Asian Indians.

Aim TCF7L2 gene is believed to increase the risk of T2DM by its effects on insulin secretion. However, the exact mechanism of this enhanced risk is not clearly known. While TCF7L2 gene has been shown to affect lipid metabolism, these effects have remained largely unexplored in the context of diabetes risk.MethodsPostprandial lipid responses to a standardized fat challenge test were performed in 620 Asian Indian subjects (310 with NGT and 310 with T2DM/prediabetes) and compared between the risk and wild genotypes of the rs7903146 TCF7L2 gene. In 30 subjects scheduled to undergo abdominal surgery (10 each with NGT, Prediabetes and T2DM), adipocyte TCF7L2 gene expression was also performed by real time qPCR and confirmed by protein expression in western blot.ResultsT allele of rs7903146 TCF7L2 gene was confirmed as the risk allele for T2DM (OR=1.8(1.2-2.74), p=0.005). TT+CT genotypes of rs7903146 TCF7L2 gene showed significantly higher 4hrTg (p<0.01), TgAUC (p<0.01), peakTg (p<0.01) as well as higher postprandial plasma glucose (p=.006) levels and HOMA-IR (p=0.03) and significantly lower adiponectin levels (p=0.02) as compared to CC genotype. The expression of TCF7L2 gene in VAT was 11-fold higher in prediabetes group as compared to NGT (P<0.01) and 5.7-fold higher in T2DM group as compared to NGT group(P=0.003) and was significantly associated with PPTg and glucose levels.ConclusionThere is significant PPTg dysmetabolism associated with the risk allele of rs7903146 polymorphism as well as adipocyte expression of TCF7L2 gene. Significant upregulation of TCF7L2 gene expression in VAT that correlates with PPTg and glycaemia is also seen in Asian Indians with glucose intolerance. Modulation of PPTg metabolism by TCF7L2 gene and the resultant PPHTg may be a novel mechanism that contributes to its diabetes risk in them.

The study of association of serum ischemia-modified albumin and prediabetes in women: A case–control study

Background: Prediabetes, diabetes, and their associated complications adversely affect women’s health worldwide. Women in the reproductive age group are more prone for developing diabetes and its associated complications such as gestational diabetes and infertility. Hence, it is the need of the hour to diagnose women at risk of pre-diabetes. Oxidative stress, ischemia, and hypoxia have been suggested as important factors in developing prediabetes and its sequels. Aims and Objectives: The present study aimed to study the association of serum ischemia-modified albumin (IMA), namely, a marker of oxidative stress, ischemia, and hypoxia with prediabetes in the women of reproductive age group. Materials and Methods: The present study was carried out in 50 females in the reproductive age group of 19–45 years. The study population was further sub-divided into two groups: Group I consisted of 25 prediabetic patients and Group II consisted of 25 healthy controls. Serum samples of the subjects were analyzed for serum IMA, blood sugar profile, and other routine biochemistry tests. Results: The present study showed that mean serum IMA was raised in prediabetic group as compared to healthy controls. The serum IMA also positively correlated with blood sugar profile. Conclusion: Increased serum IMA could be used as a biomarker for predicting prediabetes in females of reproductive age group. This, in turn, would be helpful in preventing the burden of various complications known to occur in the natural course of prediabetes and diabetes.

Prediabetes and incident heart failure in hypertensive patients: Results from the Swedish Primary Care Cardiovascular Database

Backgrounds and aimsThe cardiovascular risk conferred by concomitant prediabetes in hypertension is unclear. We aimed to examine the impact of prediabetes on incident heart failure (HF) and all-cause mortality, and to describe time in therapeutic blood pressure range (TTR) in a hypertensive real-world primary care population. Methods and resultsIn this retrospective cohort study, 9628 hypertensive individuals with a fasting plasma glucose (FPG) in 2006–2010 but no diabetes, cardiovascular or renal disease were followed to 2016; median follow-up was 9 years. Prediabetes was defined as FPG 5.6–6.9 mmol/L, and in a secondary analysis as 6.1–6.9 mmol/L. Study outcomes were HF and all-cause mortality. Hazard ratios (HR) were compared for prediabetes with normoglycemia using Cox regression. All blood pressure values from 2001 to the index date (first FPG in 2006–2010) were used to calculate TTR. At baseline, 51.4% had prediabetes. The multivariable-adjusted HR (95% confidence intervals) was 0.86 (0.67–1.09) for HF and 1.06 (0.90–1.26) for all-cause mortality. For FPG defined as 6.1–6.9 mmol/L, the multivariable-adjusted HR were 1.05 (0.80–1.39) and 1.42 (1.19–1.70), respectively. The prediabetic group had a lower TTR (p < 0.05). ConclusionsPrediabetes was not independently associated with incident HF in hypertensive patients without diabetes, cardiovascular or renal disease. However, prediabetes was associated with all-cause mortality when defined as FPG 6.1–6.9 mmol/L (but not as 5.6–6.9 mmol/L). TTR was lower in the prediabetic group, suggesting room for improved blood pressure to reduce incident heart failure in prediabetes.