Presence Of Impaired Fasting Glucose Research Articles

Risk of Coronary Heart Disease in Different Criterion of Impaired Fasting Glucose: A Meta-Analysis.

The cut-point for diagnosing impaired fasting glucose (IFG) had been dispute, as reports about the associated clinical events are inconsistent. This meta-analysis evaluated the risk of coronary heart disease (CHD) in association with different criterion of IFG according to the American Diabetes Association (ADA) or the World Health Organization (WHO) Expert Group. We included prospective cohort studies with multivariate-adjusted data on IFG and CHD for analysis. The relative risks (RRs) of CHD were calculated and reported with 95% confidence intervals (95% CIs). Seventeen prospective cohort studies, comprising 527,021 individuals were included. The risks of CHD were increased in both participants with IFG defined as the ADA or WHO criterion (RR 1.11, 95% CI 1.02-1.21; and RR 1.18, 95% CI 1.10-1.28, respectively). Subgroup analyses showed that in both definition of IFG, the risk of CHD was only increased in studies with possibility of enrolling patients with increased 2 hours plasma glucose (2-h PG), or in studies with inadequate adjustment, but not in studies excluded participants with increased 2-h PG or in those with adequate adjustment of other risk factors. Our meta-analysis demonstrates that the presence of IFG was significantly associated with future risk of CHD. The risk of CHD was increased when fasting plasma glucose was as low as 100 mg/dL according to the lower cut-point of IFG by the ADA criterion. However, the risk maybe confounded by the undetected increased 2-h PG or other cardiovascular risk factors.

Insulin Resistance Impairs Arterial Stiffness and Peripheral Vascular Resistance in Metabolic Syndrome Patients

Besides autonomic alterations, metabolic syndrome (MetS) causes changes in the vascular system directly related to cardiovascular events and death. Since insulin resistance is strongly associated with sympathetic hiperactivation, we tested the hypothesis that the presence of impaired fasting glucose (IFG) is the main cause of structural and functional worsening on large and small vessels. Never treated, newly diagnosed MetS (ATP‐III) patients were divided into: fasting glucose >100mg/dL (MetS+IFG, n=28, 49.1±1.3 yrs) and fasting glucose <100mg/dL (MetS‐IFG, n=22, 46.1±1.4 yrs). A healthy control group was also involved (C, n=17, 49.6±1.4 yrs). We measured the arterial stiffness (PWV, pulse wave velocity), muscle sympathetic nerve activity (MSNA, microneurography), forearm blood flow (plethysmography), mean blood pressure (MBP, oscillometric), and peripheral vascular resistance (VR=MBP/forearm blood flow). MetS+IFG had similar PWV vs. MetS‐IFG, but had higher PWV than C (9.6±0.3, 9.1±0.2, and 8.7±0.2, P=0.02). Similarly, MetS+IFG had no different VR vs. MetS‐IFG, albeit had higher VR vs. C group (72.1±3.9, 57.5±5.4 and 47.4±9.2, P=0.01). Further analysis showed that PWV was correlated with MSNA (R=0.47; P<0.01). In conclusion, sympathetic hyperactivation may be, at least partially, the base mechanism that increase arterial stiffness. Impaired fasting glucose appears to be the main factor to aggravate the cardiovascular risk in metabolic syndrome patients.

Diastolic Dysfunction and Left Ventricle Remodeling in Men with Impaired Fasting Glucose

Background: Early disturbances of carbohydrate metabolism are an independent risk factor of development of cardiovascular diseases. Objective: The diastolic dysfunction and left ventricle remodeling depending on presence of impaired fasting glucose were examined. Methods: The characteristics of heart remodeling and fasting glucose of capillary blood were studied in 85 men aged 30 to 63 years without coronary heart disease. Results: In male patients with impaired fasting glucose in comparison of persons with level of glucose less than 5.6 mM/l, more pronounced diastolic dysfunction and left ventricle remodeling associated with more often presence III degree of peripheral obesity. Conclusion: Impaired fasting glucose in men increases probability of development of heart remodeling.

Risk of the development of Type 2 diabetes in relation to overall obesity, abdominal obesity and the clustering of metabolic abnormalities in Japanese individuals: does metabolically healthy overweight really exist? The Niigata Wellness Study.

We investigated the risk of developing diabetes across various metabolic phenotypes by considering the presence of overall adiposity or abdominal adiposity and the number of metabolic abnormalities and aimed to clarify whether a 'healthy overweight' phenotype, that is, overweight with no metabolic abnormalities, was protective of the development of diabetes. We studied 29564 Japanese individuals without diabetes. The 5-year incidence of diabetes was assessed according to a combination of either overweight (BMI≥25.0kg/m(2) ) or abdominal obesity (waist circumference ≥90cm in men and ≥80cm in women) and the number of metabolic factors present (hypertension, elevated triglyceride concentration, low HDL cholesterol concentration and impaired fasting glucose). A total of 1188 individuals developed diabetes. Compared with normal weight individuals with none of the four metabolic abnormalities, in overweight individuals with none of the four abnormalities there was an odds ratio (OR) of 2.32 [95% confidence interval (CI) 1.50, 3.59] for diabetes; having any one metabolic abnormality increased the risk of developing diabetes among normal weight individuals [OR 3.23 (2.55, 4.10)] and overweight individuals [OR 5.00 (3.77, 6.63)]. Among overweight individuals, the presence of impaired fasting glucose alone substantially elevated the risk of diabetes by 8.98-fold (5.52, 14.6) in comparison with the absence of the four metabolic factors. Being 'healthy overweight' was associated with a higher OR of developing future diabetes among Japanese individuals than normal weight individuals with no metabolic abnormalities, and being overweight with one or more abnormalities had a further elevated OR compared with 'healthy overweight' people.

Mild fasting hyperglycemia shifts fuel reliance toward fat during exercise in adults with impaired glucose tolerance

Impaired glucose tolerance (IGT) is characterized by decreased oxidative capacity and reduced carbohydrate utilization during exercise. However, it is unclear if the presence of impaired fasting glucose (IFG) affects fuel utilization during exercise in adults with IGT. We tested the hypothesis that the presence of IFG in adults with IGT decreases reliance on carbohydrate during exercise. Middle-aged, obese, sedentary individuals (n = 6, IGT and n = 6, IFG+IGT) were compared during exercise at 60% peak O2 consumption for 45 min on a cycle ergometer. Glucose rates of appearance and disposal and muscle glycogen were assessed by stable isotope dilution methods, and fat utilization was estimated via indirect calorimetry. A 75-g oral glucose tolerance test was used to determine fasting and 2-h glucose concentrations. A glucose intolerance severity z-score was calculated from the oral glucose tolerance test. Glucose flux (i.e., rates of appearance and disposal) was not different between groups. However, individuals with IFG+IGT had lower muscle glycogen use (P < 0.05) and elevated fat oxidation (P < 0.01) during exercise compared with those with isolated IGT. Plasma nonesterified fatty acids and glucose were significantly higher during exercise in subjects with IFG+IGT vs. IGT alone (P < 0.05). Fat utilization during exercise correlated with fasting glucose (r = 0.57, P = 0.05), glucose intolerance severity z-score (r = 0.66, P = 0.01), and nonesterified fatty acids (trend; r = 0.55, P = 0.08). The presence of IFG shifts fuel selection toward increased fat oxidation and decreased muscle glycogen utilization during exercise in adults with IGT. Whether these differences in substrate use contribute to, or are the result of, movement along the continuum from prediabetes to type 2 diabetes awaits further work.

Insulin resistance, subclinical left ventricular remodeling, and the obesity paradox: MESA (Multi-Ethnic Study of Atherosclerosis).

This study assessed whether impaired fasting glucose (IFG), insulin resistance, and waist-to-hip ratio (WHR) had effects on cardiac remodeling, independent of obesity, in the MESA (Multi-Ethnic Study of Atherosclerosis) trial. Recent studies have suggested that central obesity and insulin resistance may be primary mediators of obesity-related cardiac remodeling independent of body mass index (BMI). We investigated 4,364 subjects without diabetes in the MESA trial. IFG (100 to 125 mg/dl) or insulin resistance (by homeostatic model assessment of insulin resistance [HOMA-IR]) and WHR were used for cardiometabolic phenotyping. Multivariate linear regression analysis was used to determine the effects of the cardiometabolic markers on left ventricular (LV) remodeling, assessed primarily through the LV mass-to-volume ratio obtained by cine cardiac magnetic resonance imaging. Individuals with IFG were more likely to be older and hypertensive, with increased prevalence of cardiometabolic risk factors regardless of BMI. In each quartile of BMI, subjects with above-median HOMA-IR, above-median WHR, or IFG had a higher LV mass-to-volume ratio (p < 0.05 for all). HOMA-IR (p < 0.0001), WHR (p < 0.0001), and the presence of IFG (p = 0.04), but not BMI (p = 0.24), were independently associated with LV mass-to-volume ratio after adjustment for age, sex, hypertension, race, and dyslipidemia. Insulin resistance and WHR were associated with concentric LV remodeling independent of BMI. These results support the emerging hypothesis that the cardiometabolic phenotype, defined by insulin resistance and central obesity, may play a critical role in LV remodeling independently of BMI.

Association between Serum Albumin, Insulin Resistance, and Incident Diabetes in Nondiabetic Subjects

BackgroundSerum albumin has been suggested to be associated with insulin resistance. We evaluated the association between serum albumin concentration and insulin resistance. We also investigated whether serum albumin level has an independent effect on the development of diabetes.MethodsIn our study, 9,029 subjects without diabetes, who underwent comprehensive health check-ups annually for 5 years, were categorized into tertiles based on their serum albumin levels at baseline. The odds ratio (OR) for the prevalence of insulin resistance, defined as the top quartile of homeostasis model assessment of insulin resistance and the presence of impaired fasting glucose and nonalcoholic fatty liver disease, was evaluated cross-sectionally. Also, the hazard ratio (HR) for incident diabetes was estimated longitudinally, according to the baseline albumin tertiles using Cox proportional hazard analysis respectively.ResultsFrom the lowest to the highest tertile of albumin, the multivariable-adjusted ORs of insulin resistance increased significantly in both men and women. During the mean follow-up period of nearly 4 years, 556 (6.1%) subjects progressed to diabetes. The multivariable-adjusted HR (95% confidence interval [CI]) of diabetes in men were 1, 1.09 (95% CI, 0.86 to 1.40), and 1.10 (95% CI, 0.86 to 1.41), respectively, from the lowest to the highest tertiles of baseline albumin. Corresponding values for women were 1, 1.21 (95% CI, 0.66 to 2.21), and 1.06 (95% CI, 0.56 to 2.02), respectively.ConclusionOur study showed that increased serum albumin level was associated with insulin resistance. However, serum albumin did not have an independent effect on the development of diabetes.

Visceral adiposity index is highly associated with adiponectin values and glycaemic disturbances

Visceral Adiposity Index (VAI) is a gender-specific mathematical index estimated with the use of simple anthropometric (body mass index and waist circumference) and biochemical (triglycerides and high density lipoprotein cholesterol) parameters. Recent studies have shown that VAI reflects accurately the degree of visceral adiposity and insulin resistance. However, up to now, VAI has not been evaluated if it correlates with carbohydrate metabolism disorders, as well as with adipokine secretion from the fat mass. In a cohort of 308 out of 414 adult Saudi subjects screened for the study, detailed personal medical history, anthropometrics and metabolic/hormonal profiles were obtained. Additionally, the circulating concentrations of several circulating adipokines, namely adiponectin, leptin, tumour necrosis factor-α (TNF-α) and resistin, were measured. Stepwise multivariate analysis showed that VAI was the sole determinant of adiponectin levels (R(2) =0·07, beta±SE: -0·25±0·05), while BMI and female gender predicted leptin levels (R(2) =0·26, 0·10±0·01 and 0·61±0·15, respectively). Furthermore, the presence of impaired fasting glucose (IFG)/diabetes was predicted only by age and VAI. We report for the first time the direct relations of VAI with adipose tissue secretion, as well as with functional glycaemic disorders. Because VAI is estimated easily with data obtained in everyday practice, it could be used as an indirect index of adiponectin levels and the risk of impaired glucose metabolism.

White rice consumption and risk of type 2 diabetes

Recent studies suggest that white rice consumption increases risk of diabetes. to assess the association between white rice intake and the incidence of diabetes in a population from Southern Spain. A population-based cohort study was undertaken in Pizarra, Spain. At baseline and follow-up, participants underwent an interview and a standardized clinical examination which included an oral glucose tolerance test in those subjects without known diabetes. Incidence and odds ratio (OR) for diabetes were calculated. Multivariate analysis was performed using stepwise logistical regression. Thirty eight percent of subjects reported rice consumption 2-3 times a week, 58.5% once or less a week, and 3.6% no rice consumption. In subjects who reported rice intake 2-3 times a week, incidence of diabetes after 6 years follow-up was 12.0%, and in those who reported once or less a week, 20.2% (p=0.04, non adjusted). Subjects who ate rice frequently had lower risk to develop diabetes 6 years later (OR=0.43, p=0.04; adjusted for age, sex, obesity, and presence of impaired fasting glucose and/or impaired glucose tolerance at baseline). A negative association was found between white rice intake in the way it is consumed in Southern Spain, and the 6 years incidence of diabetes.

The Effect of Fenofibrate on Lymphocyte Release of Proinflammatory Cytokines and Systemic Inflammation in Simvastatin‐Treated Patients with Atherosclerosis and Early Glucose Metabolism Disturbances

This study was designed to investigate whether fibrates produce lymphocyte-suppressing and systemic anti-inflammatory effects in statin-treated pre-diabetic patients. The study included 47 atherosclerotic patients with the concomitant presence of impaired fasting glucose and impaired glucose tolerance already receiving simvastatin treatment (40 mg daily) who were allocated to one of two groups treated for 90 days with, respectively, fenofibrate (200 mg daily) or placebo. Plasma lipids, glucose homoeostasis markers, plasma high-sensitivity C-reactive protein as well as lymphocyte release of pro-inflammatory cytokines were determined on the allocation day and after 90 days of therapy. Compared with placebo, fenofibrate reduced lymphocyte release of interleukin-2, interferon-γ and tumour necrosis factor-α, which was accompanied by a reduction in plasma C-reactive protein levels. The results obtained indicate that fenofibrate inhibits lymphocyte secretory function and reduces low-grade inflammation in patients with both impaired fasting glucose and impaired glucose tolerance. Our findings suggest that the combined treatment with simvastatin and fenofibrate may be a better treatment option than simvastatin alone in this group of patients, particularly in those who are at high risk for cardiovascular events.

Role of peroxisome proliferator-activated receptor gamma agonist in improving hepatic steatosis: Possible molecular mechanism.

Role of peroxisome proliferator-activated receptor gamma agonist in improving hepatic steatosis: Possible molecular mechanism.

WHAT IS THE FREQUENCY OF CARBOHYDRATE METABOLISM DISORDER IN CKD?

The objective of this paper is to detect the incidence of insulin resistance (IR) in Chronic Kidney disease (CKD) patients and the presence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes mellitus (DM) in patients with/without IR. We enrolled 113 patients with CKD. Biochemical parameters were investigated. IFG was found 59.3% of patients with CKD. Age (p = 0.012), BMI (p = 0.036), TG (p = 0.008), HbA1c(p = 0.002), hs-CRP (p = 0.015) levels were higher in patients with IFG. According to the results of Oral glucose tolerance test (OGTT), 69% of patients with CKD had a detected carbohydrate metabolism disorder, 9.7% had DM, 59.3% had IGT. In patients with IFG 13.6% had DM, 31.8% IGT, in patients without IFG 4.2% had DM and 29.8% IGT. The mean HOMA-IR and insulin levels were 3.03 ± 1, 97/11.9 ± 7.13. IR was detected 23% of patients with CKD. In patients with IR; FBG (p = 0.003), serum insulin (p = 0.001), TG (p = 0.05) and HbA1c (p = 0.004) levels were elevated. 31.3% of patients with IFG were found to be IR. Carbohydrate metabolism disorder and insulin resistance are found in patients with CKD. Most patients with CKD who are elderly, obesity or overweight offer targets for additional risk factors. For these reasons, screening for DM may be recommended.

Impaired Fasting Glucose Association With Mortality in Nondiabetic Patients on Maintenance Peritoneal Dialysis

IntroductionThe aim of this study was to investigate clinical significance of impaired fasting glucose (IFG) in nondiabetic patients on maintenance peritoneal dialysis (PD). MethodsIn total, 362 maintenance PD patients were enrolled and followed up for 2-years. According to 1997 definitions, patients were divided into 3 groups: diabetic (n = 85), nondiabetic with IFG (n = 62) and nondiabetic with normal fasting glucose levels (n = 215). After basal data were collected for cross-sectional analyses, mortality and cause of death were recorded for longitudinal analyses. ResultsAfter adjusting for related variables by multivariate logistic regression analysis, IFG was found to be positively associated with age but negatively associated with normalized protein nitrogen appearance and transferrin saturation in nondiabetic maintenance PD patients. Thirty nondiabetic patients had died after the 2-year follow-up. Cox multivariate analysis showed that age (hazard ratio: 1.037; 95% confidence interval: 1.0021.073; P = 0.036) and presence of IFG (hazard ratio: 2.719; 95% confidence interval: 1.082-6.833; P = 0.033) were significant risk factors for all-cause 2-year mortality in nondiabetic maintenance PD patients. ConclusionsIFG, a preventable and treatable condition, was associated with all-cause 2-year mortality in nondiabetic maintenance PD patients.

Combined Effect of Nonalcoholic Fatty Liver Disease and Impaired Fasting Glucose on the Development of Type 2 Diabetes

OBJECTIVETo evaluate whether there is a difference in the association between nonalcoholic fatty liver disease (NAFLD) and incident diabetes based on the presence of impaired fasting glucose.RESEARCH DESIGN AND METHODSA total of 7,849 individuals (5,409 men and 2,440 women) without diabetes, who underwent comprehensive health check-ups annually for 5 years, were categorized into four groups by the presence of impaired fasting glucose and NAFLD at baseline. The association between NAFLD and incident diabetes was evaluated separately in groups with normal and impaired fasting glucose.RESULTSFor 4 years, the incidence of diabetes in the NAFLD group was 9.9% compared with 3.7% in the non-NAFLD group, with multivariable-adjusted hazard ratio of 1.33 (95% CI 1.07–1.66). However, this higher risk for diabetes only existed in the impaired fasting glucose group.CONCLUSIONSOur study suggests that NAFLD has an independent and additive effect on the development of diabetes under conditions of impaired insulin secretion.

Serum Gamma-Glutamyl Transferase within Its Normal Concentration Range Is Related to the Presence of Impaired Fasting Glucose and Diabetes among Japanese Community-Dwelling Persons

Introduction. Serum gamma-glutamyl transferase (GGT) activity changes in response to oxidative stress. Little data are available on the association between serum GGT and the prevalence of impaired fasting glucose (IFG) and diabetes among Japanese community-dwelling persons. Methods. We recruited 871 men, aged 61 ± 14 (range, 20–89) years, and 1,139 women, aged 63 ± 12 (range, 21–88) years during their annual health examination from a single community. We performed a cross-sectional study to examine whether serum GGT was associated with IFG and diabetes. Results and conclusions. The levels of most confounding characteristics varied with increasing GGT activity. The prevalence of IFG and diabetes was significantly and linearly associated with increasing quartiles of serum GGT. After adjustment for sex, age, smoking status, drinking status, low-density lipoprotein cholesterol, uric acid, estimated glomerular filtration rate, and alanine aminotransferase, the odds ratio (OR) [95% confidence interval (CI)] for IFG compared with the participants with lowest quartile of serum GGT was 1.91 (1.31–2.78) for second quartiles, 2.41 (1.63–3.57) for third quartiles, and 3.24 (2.03–5.17) for highest quartiles. The multivariate-adjusted OR (95% CI) for diabetes was 1.91 (1.18–3.09) for second quartiles, 2.15 (1.30–3.54) for third quartiles, and 3.79 (2.11–6.82) for highest quartiles. Furthermore, the multivariate-adjusted ORs for IFG were also associated with increasing levels of serum GGT within subgroups of age, body mass index, drinking status, serum high-molecular-weight adiponectin levels, insulin resistance, and the presence of antihypertensive/antilipidemic medication. These results suggested that higher serum GGT within normal concentration range was significantly associated with IFG and diabetes in the general population.

Impaired Fasting Glucose in Cystic Fibrosis

OBJECTIVEWhile glucose tolerance abnormalities are common in cystic fibrosis (CF), impaired fasting glucose (IFG) has scarcely been explored. No studies have examined the relation between IFG and clinical status.RESEARCH DESIGN AND METHODSData were retrieved from the University of Minnesota CF database on oral glucose tolerance tests (OGTTs) performed in 1996–2005. Subjects were identified as normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or CF–related diabetes without fasting hyperglycemia (CFRD FH−). Patients with fasting hyperglycemia were excluded. The presence of IFG was assessed within each category. In a separate case-control cohort study, subjects with IFG were matched to CF control subjects by age, sex, and OGTT class to explore outcomes.RESULTSFor the total population (n = 310), the prevalence of IFG was 22%, and by OGTT class was NGT 14%, IGT 31%, CFRD FH− 53%. Within the cohort study, mortality was significantly reduced in IFG (two vs. nine deaths, odds ratio [OR] = 0.2 [95% CI 0.04–0.9]). IFG did not confer increased risk of progression to diabetes (OR 0.66 [0.29–1.48]). Lung function was better in pediatric IFG subjects with IGT and not significantly worse in adults with IGT or adults and children with NGT and CFRD FH−. BMI was not significantly different in IFG subjects versus control subjects.CONCLUSIONSContrary to expectations in patients with CF, IFG appeared to be associated with improved survival and was not associated with worse nutritional or pulmonary status or increased progression to fasting hyperglycemia.

Prediabetes: The Importance of Early Identification and Intervention

Prediabetes is a state of abnormal glucose homeostasis characterized by the presence of impaired fasting glucose, impaired glucose tolerance, or both. Individuals with prediabetes are at increased risk for type 2 diabetes, compared with individuals with normal glucose values (normal fasting plasma glucose, < 100 mg/dL [5.6 mmol/L]). The increased risk for cardiovascular disease in prediabetes is multifactorial, with etiologies including insulin resistance, hyperglycemia, dyslipidemia, hypertension, systemic inflammation, and oxidative stress. The preferred treatment is intensive lifestyle management and aggressive pharmacologic therapies directed toward individual coronary heart disease risk factors. The use of antihyperglycemic agents in this setting is a topic of intense debate. This review discusses the pathophysiology of prediabetes and its clinical implications, highlighting the importance of early identification and intervention.

Impaired fasting glucose and metabolic syndrome in an indigenous siberian population

Objectives. This study investigated the lifestyle and anthropometric correlates of impaired fastingglucose and the presence of metabolic syndrome (MetS) among an Indigenous high-latitude herdingpopulation from north-eastern Siberia.Study Design. Cross-sectional study of Yakut (Sakha) adult volunteers.Methods. We collected health, lifestyle and anthropometric data among 166 Yakut adults (≥18years old; 101 females, 65 males) from the rural village of Tyungyulyu (62°N, 130°E; population2,500), Sakha Republic (Yakutia), Russia. Measurements of fasting glucose, triglycerides, HDLcholesterol, blood pressure and waist circumference were used to document the presence of MetSbased on the updated Adult Treatment Panel (ATP) III definition.Results. Metabolic syndrome was relatively uncommon among study participants, with only 10%of participants classified as having MetS, including 8% of females and 12% of males. Elevatedblood pressure and low HDL cholesterol were the most common features of MetS in Yakut men andwomen, while elevated fasting glucose and high triglycerides were uncommon in both sexes. Relativelylow mean fasting glucose concentrations were documented among Yakut women (4.46±0.65mmol/L) and men (4.41±0.76 mmol/L); no participants were classified as diabetic.Conclusions. Fasting glucose and MetS are at relatively low levels in this population; however, rising rates of obesity are likely to lead to future increases in MetS and impaired fasting glucose inthis population. Further, increasing consumption of market foods, many high in refined sugars, islikely to contribute to an increased presence of impaired fasting glucose and MetS.

Combined Pharmacologic/Nonpharmacologic Intervention in Individuals at High Risk of Developing Type 2 Diabetes

The prevalence of type 2 diabetes continues to grow, and it is predicted that, unless effective prevention and control measures are implemented, the global prevalence of the disease will exceed 366 million by 2030 (1). Type 2 diabetes is associated with considerable morbidity, excess mortality, and substantial costs (2–4). A recent statement issued by the American Diabetes Association estimates that in the U.S., the cost of diabetes in 2007 was $174 million. However, the actual national burden is likely to exceed this figure because it does not include the social costs of intangibles such as care provided by nonpaid caregivers. Overall costs are expected to increase further because of the projected rise in the proportion of the population over the age of 65 years. Therefore, if successful, early intervention to delay or prevent the development of diabetes offers enormous potential benefit to individuals, health care systems, and society. Current diagnostic criteria for overt diabetes include a fasting plasma glucose concentration of ≥126 mg/dl or a 2-h postchallenge plasma glucose concentration of ≥200 mg/dl during a 75-g oral glucose tolerance test (5). The term “pre-diabetes” has recently been adopted to describe conditions in which blood glucose levels are elevated, but not above the American Diabetes Association–defined level for diabetes; it includes the presence of impaired fasting glucose (fasting plasma glucose concentration of 100–125 mg/dl) and/or impaired glucose tolerance (a 2-h post-challenge plasma glucose concentration of 140–199 mg/dl) (6). Most individuals with pre-diabetes will eventually develop overt diabetes. In the American Diabetes Prevention Program (DPP), the annual rate of development of diabetes in subjects who had impaired glucose tolerance or impaired fasting glucose was ∼10% (7). There is evidence that microvascular disease typically associated with diabetes is also observed in individuals with impaired glucose tolerance (8). A recent analysis …

Influência da adiposidade sobre o risco inflamatório em pacientes com glicemia de jejum alterada

OBJETIVO: Investigar as alterações dos marcadores inflamatórios em obesos com glicemia de jejum alterada. MÉTODOS: Foram avaliados 125 indivíduos adultos tendo sido pesquisados: Índice de Massa Corporal, circunferência da cintura, glicemia de jejum, proteína C reativa ultra-sensível, ácido úrico e homocisteína. Os grupos apresentando glicemia de jejum normal (grupo 1) e glicemia de jejum alterada (grupo 2) foram comparados entre si e em associação aos subgrupos de obesos, sobrepesos e eutróficos. RESULTADOS: O grupo 2 apresentou maiores valores de circunferência da cintura (p&lt;0,05), principalmente quando associados ao excesso de peso. Adicionalmente, o grupo 2 mostrou valores de proteína C reativa e ácido úrico superiores, sendo os dos obesos maiores que os com sobrepeso e os eutróficos, enquanto a homocisteína foi semelhante entre obesos, com sobrepeso e eutróficos. O Índice de Massa Corporal correlacionou-se positivamente com ambos ácido úrico (r=0,39, p&lt;0,01) e proteína C reativa (r=0,37; p&lt;0,01). A circunferência da cintura apresentou correlação apenas com o ácido úrico (r=0,53, p&lt;0,01). Porém, a correlação entre Índice de Massa Corporal e proteína C reativa foi significante no grupo 2 (r=0,66, p&lt;0,01), mas não no grupo 1 (r=0,25, p&gt;0,05). O mesmo resultado foi encontrado em relação à circunferência da cintura e à proteína C reativa, que se correlacionaram significantemente somente na presença de glicemia de jejum alterada (r=0,40, p&lt;0,05). Na regressão logística, a circunferência da cintura foi a variável explicativa (11%, p&lt;0,01) da alteração da glicemia de jejum. CONCLUSÃO: Os estados pró-oxidativo e pró-inflamatório estiveram significantemente associados à glicemia de jejum alterada na presença de adiposidade corporal.