Prevalence Of Abnormal Glucose Tolerance Research Articles

Abstract P289: In Africans With Abnormal Glucose Tolerance the Triglyceride-Glucose Index is a Feasible, Effective Way to Distinguish Between Beta-Cell Failure and Insulin Resistance

Background: With the prevalence of abnormal glucose tolerance (Abnl-GT) soaring in sub-Saharan Africa, there is a growing appreciation that the major etiology of Abnl-GT in Africans may be beta-cell failure rather than insulin resistance (IR). As optimal therapy depends on etiology, distinguishing between beta-cell failure and IR is critical. However, identifying IR with formulas such as the Matsuda Sensitivity Index which requires insulin to be assayed in plasma, is expensive and rarely available in medical clinics in most African countries. Therefore, our goal was to use data from the Matsuda Index as the diagnostic standard, and determine how well the widely available, low-cost Triglyceride-Glucose Index (TyG) performs in distinguishing between beta-cell failure and IR in Africans with Abnl-GT. Methods: OGTTs and fasting triglyceride (TG) levels were obtained in 589 African immigrants living in the Washington DC area (Male: 64%, Age: 39±11, (mean±SD) range 20 -69y; BMI 27.9±4.5 kg/m 2 range 19.5-41.9). Glucose tolerance status was determined by ADA criteria for the OGTT. IR was defined as the lowest quartile of the population distribution of the Matsuda Index (≤2.89). As a primary etiology, beta-cell failure was defined as Abnl-GT in the absence of IR. Insulin secretion was calculated using the insulinogenic index. The formula for TyG was: ln(fasting glucose & fasting TG)/2. IR by TyG was defined by the highest quartile of its distribution across the cohort(≥3.38). Results: Abnl-GT occurred in 39% (228/589) of the enrollees. Among participants with Abnl-GT, the prevalence of beta-cell failure and IR were: 59% (134/228) vs. 41% (94/228), P <0.001, respectively. Compared to Africans with Abnl-GT and IR, Africans with Abnl-GT and beta-cell failure had less IR & lower insulin secretion (both P<0.001). Overall, with data from the Matsuda Index as the diagnostic standard, TyG correctly identified the etiology of Abnl-GT in 90% (205/228) of the participants with Abnl-GT, specifically 93% (125/134) with beta-cell failure and 85% (80/94) of participants with IR. Conclusions: As the TyG correctly identified the etiology of Abnl-GT in 90% of Africans, it may be a feasible, economically viable alternative to the Matsuda Index in determining whether Africans with Abnl-GT have beta-cell failure or IR. With correct information about Abnl-GT etiology, therapy for can be optimized.

EPS4.04 A stitch in time saves nine – abnormal glucose tolerance in patients with cystic fibrosis: systematic review and meta-analysis

Objectives: Basic science results suggest that abnormalities of the endocrine pancreas in cystic fibrosis (CF) occur earlier than was believed so far. All stages of the spectrum of glucose metabolism disorders are associated with increased morbidity and mortality which could be reduced by early recognition and treatment. However, screening for abnormal glucose tolerance (AGT) is recommended only from the age of 10 according to the actual guidelines. We conducted a systematic review and meta-analysis on the prevalence of abnormal glucose tolerance in patients with CF with a focus on children under 10 years of age.

Abnormal glucose tolerance in children: oral glucose tolerance test is fit-for-purpose

Aim: Childhood obesity is accompanied by an increased prevalence of abnormal glucose tolerance (AGT) including the prediabetes states. This study aims to investigate and evaluate the use of oral glucose tolerance test (OGTT) for detecting AGT among overweight and obese children. Methods: A retrospective study was conducted on 895 overweight and obese Chinese children (6–18 years) with obesity assessment and analysis of demographic, anthropometric, and biochemical parameters data between January 2006 and December 2015 at Tseung Kwan O Hospital, Hong Kong Special Administrative Region. Results: The proportion of males and older age group was 63.7% and 55.9%, respectively. Girls were more in older age groups (62.7% vs. 52.0%, P = 0.002). AGT occurred in 17.1% of the cohort [impaired glucose tolerance (IGT) was the most frequent morbidity (11.3%)]. After regression analysis, female sex, low-density lipoprotein (LDL), triglyceride (TG), older age group, and homeostasis model assessment of insulin resistance (HOMA-IR) ≥ 4.1 were significantly associated with AGT. Conclusions: AGT is common in overweight and obese Chinese children. Girls, older age, higher LDL, TG and HOMA-IR ≥ 4.1 showed significant association with AGT. OGTT is essential and fit-for-purpose to detect AGT in overweight and obese children.

A CROSS-SECTIONAL STUDY TO FIND THE PREVALENCE OF IMPAIRED GLUCOSE TOLERANCE IN PULMONARY TUBERCULOSIS PATIENTS

Introduction: Higher prevalence of pulmonary tuberculosis in a diabetic patient is a well-known fact. The inverse relationship i.e. higher prevalence of impaired glucose tolerance in a tuberculous population is also being increasingly realized now and it becomes more relevant due to increased prevalence of DM in general population. Aim/ Objective: To nd the prevalence of abnormal glucose tolerance in pulmonary tuberculosis patients and to correlate the glycaemic parameters with the grades of sputum AFB positivity. Materials & Methods: A hospital based prospective observational comparative study was conducted at a tertiary care hospital. A total of 100 consecutive eligible patients of tuberculosis, were included after taking informed parental consent. Data was analyzed using statistical software SPSS ver. 21. Results: Mean age of the study cases was 42.59 years with 78% males to 22% females. On Oral glucose tolerance test, 56% had normal results while 44% had deranged results. Out of the total 44 cases with deranged results, 13% had IGT and 31% had diabetes. A signicant association was observed between deranged OGTT values and higher sputum grades (p<0.05). Glycemic control as measured by glycated haemoglobin was signicantly associated with grade of sputum positivity. HbA1c levels were 5.98% in cases with “scanty” grade while it was 6.18%, 6.53% and 6.99% in cases with grade +1, +2 and +3 respectively (p<0.05). Conclusion: We observed high prevalence of impaired glucose tolerance and diabetes in tuberculosis patients. Impaired results were signicantly associated with higher degree of sputum positivity. We thus recommend diabetes screening in all TB patients by either HbA1c or OGTT and glucose levels should be measured at least every 2 months after the initiation of anti-tuberculosis treatment.

English

BACKGROUND Obesity has emerged as an important risk factor in modern obstetrics and poses a major threat to pregnancy by causing complications including gestational diabetes. It also increases the risk of cardiovascular diseases and diabetes mellitus in later life. Obesity creates major technical challenges in providing maternity services too. The objective of the study was to assess the prevalence of abnormal glucose tolerance in obese pregnant women in a Government Medical College over one year. METHODS A prospective observational study was conducted among obese pregnant women, registered at the Outpatient department of Obstetrics and Gynaecology at the Government Medical College, Kottayam from January 2017 to December 2017. 450 women were considered for the study after satisfying inclusion and exclusion criteria. BMI was calculated using pre-pregnant weight. An oral glucose test was performed with 75 gm glucose at 24 to 28 weeks of pregnancy after 8 hours of fasting. International Association of Diabetes and Pregnancy Study Group cut-offs i.e., fasting blood sugar values more than 92 mg/dl, 1hr value more than 180 mg/dl, 2 hr value more than 153 mg/dl were used as the criteria. Oral glucose tolerance was considered abnormal if any of the above values were impaired. RESULTS The prevalence of abnormal glucose tolerance among the 450 pregnant women was 35.6 %. The incidence of abnormal GTT increased with increasing age and in those with a history of menstrual irregularities and infertility treatment. No relation was found between economic status, family history of diabetes, preeclampsia and abnormal GTT. CONCLUSIONS Obesity turns to be a menace in the reproductive life of women that begins by affecting the fertility, continues to cause complications in pregnancy, increases morbidity in the long-term future and reduces the quality of life. Since more than one-third of the study population was affected by gestational diabetes, active intervention to reduce the weight preconceptionally is needed. KEY WORDS Obesity, Glucose Tolerance Test, Gestational Diabetes Mellitus, Body Mass Index, Pregnancy

1446-P: A1C and Glycated Albumin Combined Improves Detection of Abnormal Glucose Tolerance in Africans

In nonwhite populations the prevalence of abnormal glucose tolerance (Abnl-GT) is increasing in the nonobese. However, the prevalence of Abnl-GT in African-born blacks is unknown. As BMI correlates positively with A1C and negatively with glycated albumin (GA) and fructosamine (FA), BMI may influence the diagnostic sensitivity of nonfasting markers of glycemia. Working with Africans, our goals were to determine: a) by BMI category the prevalence of Abnl-GT; and b) the diagnostic value of nonfasting markers of glycemia, individually and combined. In 416 African-born blacks living in America (male: 66%; age: 39±10 (mean±SD), range 20 to 65y, BMI: 27.7±4.5, range 18.2-42.4 kg/m2) OGTT were performed. A1C, GA and FA levels were measured. A1C, GA and FA levels were repeated 11±7 days later in 136 participants. Abnl-GT was defined by glucose: 0h ≥100 and/or 2h ≥140 mg/dL. Thresholds for A1C, GA and FA were defined by the cut-off at the upper quartile for the population (5.7%, 14.2%, 234 µM/L, resp). Analytic tools were κ-statistic, Spearman correlations and the McNemar test. In short, Abnl-GT occurred in 36% (152/416). Of the individuals with Abnl-GT, 68% (104/152) were nonobese. Reproducibility of A1C and GA were excellent (both κ≥0.8) but only moderate for FA (κ=0.6). For this reason, results focus on A1C and GA. BMI positively correlated with A1C (r= 0.18) and negatively with GA (r=-0.18) (both P<0.01). The diagnostic sensitivities of A1C, GA and the combined tests were: 43%, 34% and 61%, resp (P<0.01 compared to A1C alone). By test, 66 people with Abnl-GT were detected by A1C or A1C and GA; whereas 25 people were detected by GA alone. People with Abnl-GT detected by GA only had lower BMI than those detected by A1C (26.8±2.4 vs. 30.4±4, P<0.01). Overall, two-thirds of African-born blacks with Abnl-GT are nonobese. As GA detects Abnl-GT in nonobese individuals not detected by A1C, using both tests could improve screening and lead to earlier intervention. Disclosure A.E. Sumner: None. A.F. Hobabagabo: None. E.M. Shoup: None. T. Hormenu: None. N.H. Osei-Tutu: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. D.B. Sacks: Other Relationship; Self; Sebia, Trinity Biotech plc.

From the Editor’s Desk…: October 2019

From the Editor’s Desk…: October 2019

Prevalence of prediabetes and diabetes in children and adolescents with biopsy-proven non-alcoholic fatty liver disease

We undertook a cross-sectional study of children/adolescents with and without non-alcoholic fatty liver disease (NAFLD) to compare the prevalence of prediabetes and diabetes, and to examine the role of abnormal glucose tolerance as a predictor of liver disease severity. We recruited a cohort of 599 Caucasian children/adolescents with biopsy-proven NAFLD, and 118 children/adolescents without NAFLD, who were selected to be similar for age, sex, body mass index and waist circumference to those with NAFLD. The diagnosis of prediabetes and diabetes was based on either hemoglobin A1c, fasting plasma glucose or 2 h post-load glucose concentrations. Children/adolescents with NAFLD had a significantly higher prevalence of abnormal glucose tolerance (prediabetes or diabetes) than those without NAFLD (20.6% vs. 11%, p = 0.02). In particular, 124 (20.6%) children/adolescents with NAFLD had abnormal glucose tolerance, with 19.8% (n = 119) satisfying the diagnostic criteria for prediabetes and 0.8% (n = 5) satisfying the criteria for diabetes. The combined presence of prediabetes and diabetes was associated with a nearly 2.2-fold increased risk of non-alcoholic steatohepatitis (NASH; unadjustedodds ratio 2.19; 95% CI 1.47-3.29; p <0.001). However, this association was attenuated (but remained significant) after adjustment for age, sex, waist circumference (adjustedodds ratio 1.69, 95% CI 1.06-2.69, p = 0.032), and the PNPLA3 rs738409 polymorphism. Both this PNPLA3 polymorphism and waist circumference were strongly associated with NASH. Abnormal glucose tolerance (especially prediabetes) is highly prevalent among children/adolescents with biopsy-proven NAFLD. These children also have a higher risk of NASH, though central adiposity is the factor that is most strongly associated with NASH. Children with biopsy-proven non-alcoholic fatty liver disease (NAFLD) have a higher prevalence of abnormal glucose tolerance (prediabetes or type 2 diabetes) than children without NAFLD. Children with biopsy-proven NAFLD and abnormal glucose tolerance also have a higher prevalence of the progressive form of disease, non-alcoholic steatohepatitis, than those with normal glucose tolerance, though central adiposity is the factor that is most strongly associated with non-alcoholic steatohepatitis.

Glucose intolerance in children with cystic fibrosis: a developing country’s perspective

Background Cystic fibrosis-related diabetes (CFRD) is a common comorbidity reported in patients with cystic fibrosis (CF). There is a dearth of data on glucose intolerance or CFRD in children with CF from developing countries. So, we planned to study the prevalence of abnormal glucose tolerance (AGT) in children with CF and its relation with the duration and severity of CF. Methods We performed an oral glucose tolerance test (OGTT) on children (2-18 years old) having CF for at least 6 months. Two-hour plasma glucose levels on OGTT were correlated with various disease-related factors. Results Out of the 25 children enrolled, there were 18 boys and seven girls. The mean age and duration of CF were 7.9±4.3 and 3.16±2.5 years, respectively. AGT was observed in 16 (64%) children with CF including three (12%) children with CFRD. Children with a duration of CF of 3 years had significantly higher prevalence (81.8%) of AGT when compared with duration ≤3 years (p-value<0.05). Twelve out of 17 (70.6%) children were colonized with Pseudomonas and 12 out of 15 (80%) children >6 years of age had AGT. There was a positive correlation of 2-h glucose value on OGTT with duration of CF and number of hospitalizations with acute pulmonary exacerbations. Conclusions The majority of children having CF for >3 years and/or age >6 years developed AGT. In our clinical setting, an annual screening with OGTT to detect AGT may be required at an early age and duration of CF.

Routine HbA1c Testing in Women Undergoing Major Gynecologic Surgery to Detect Prevalence of Glucose Intolerance [20Q

INTRODUCTION: Determine the prevalence of undiagnosed diabetes, prediabetes and overall incidence of glucose intolerance in women undergoing major surgical procedures on the gynecologic oncology service. METHODS: Retrospective review of preoperative HbA1c levels obtained at preadmission testing in women scheduled for major gynecologic surgery at NYU Winthrop Hospital by gynecologic oncologists between July 2014 and July 2016. Exclusion criteria were lack of HbA1c within 90 days of scheduled surgery and all women undergoing minor surgical procedures. Diabetes was defined either by established diagnosis or with HbA1c ≥6.5, and prediabetes if HbA1c ranged 5.7- 6.4. Value less than 5.7 was considered normal. RESULTS: 343 women underwent major procedures and had HbA1c levels obtained. Fifty-eight (16.9%) had a known diagnosis of diabetes, and 285 (83.1%) were presumed non-diabetics. Majority (182, 63.9%) had normal HbA1c, 86 (30.2%) were prediabetic and 17 (6%) met criteria for diabetes, for a 36.2% prevalence of abnormal glucose tolerance in presumed non-diabetics. When all 343 women were considered, the diagnosis of glucose intolerance was present in 161 (46.9%), 64.0% of whom were previously undiagnosed. CONCLUSION: Nearly half of the women undergoing major gynecologic surgery procedures on the oncology service had impaired glucose tolerance. The diagnosis was previously not established in 64.0%. Pre-surgical assessment of HbA1c is warranted in this high risk population.

Prevalence of Glucose Intolerance in Women with Polycystic Ovary Syndrome: Experience from a Tertiary Care Hospital

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5-10% women of reproductive age. The prevalence of abnormal glucose tolerance (impaired fasting glucose, IFG, impaired glucose tolerance, IGT and type 2 diabetes mellitus, T2DM) in women with PCOS is substantially higher than expected when compared with age and weight-matched population of women without PCOS. The present study was conducted among women of reproductive age with PCOS to characterize the extent and nature of glucose intolerance.Methods: This observational study was conducted in Centre for Assisted Reproduction (CARE), Department of Obstetrics and Gynaecology and Biomedical Research group, BIRDEM from January 2006 to December 2008.Results: Total number of patients was 103 and their age ranged between 15 and 36 years. Fifty percent of them were overweight or obese. IGT and T2DM were present in 29.1% and 4.9% cases respectively. Body mass index (BMI) of patients with T2DM with PCOS was significantly higher than normal glucose tolerance (NGT) group (p=0.005). There was no difference of BMI between NGT, with IGT and IGT with T2DM with PCOS. Diabetic PCOS women were older than NGT and IGT group (p=0.002, p=0.009 respectively). Family history of diabetes was present in 80% diabetes PCOS compared to 63.3% in IGT and 39.7% of NGT with PCOS.Conclusions: PCOS women have significantly increased prevalence of IGT and T2DM. Obesity and age substantially increase risk of glucose intolerance but IGT and T2DM can develop independent of obesity in PCOS women.Birdem Med J 2016; 6(1): 36-39

Oral glucose tolerance test significantly impacts the prevalence of abnormal glucose tolerance among Indian women with polycystic ovary syndrome: lessons from a large database of two tertiary care centers on the Indian subcontinent

To estimate the prevalence of abnormal glucose tolerance (AGT) among Indian women with polycystic ovary syndrome (PCOS) and analyze the role of oral glucose tolerance (OGTT) test on its estimation. Cross-sectional clinical study. Tertiary care center. A total of 2,014 women with PCOS diagnosed on the basis of the Rotterdam 2003 criteria were enrolled, and the data of 1,746 subjects were analyzed. In addition to recording clinical, biochemical, and hormone parameters, a 75g OGTT was administered. Prevalence of AGT and impact of age, body mass index (BMI), family history, and OGTT on its prevalence. The mean age of subjects was 23.8 ± 5.3years, with a mean BMI of 24.9 ± 4.4kg/m(2). The overall prevalence of AGT was 36.3% (6.3% diabetes and 30% impaired fasting plasma glucose/impaired glucose tolerance) using American Diabetes Association criteria. The glucose intolerance showed a rising trend with advancing age (30.3%, 35.4%, 51%, and 58.8% in the second, third, fourth, and fifth decades, respectively) and increasing BMI. Family history of diabetes mellitus was present in 54.6% (953/1,746) subjects, and it did not correlate with any of the studied parameters except waist circumference and BMI. Sensitivity was better with 2-hour post-OGTT glucose values as compared with fasting plasma glucose, since using fasting plasma glucose alone would have missed the diagnosis in 107 (6.1%) subjects. We conclude that AGT is high among young Indian women with PCOS and that it is not predicted by family history of type 2 DM. OGTT significantly improves the detection rate of AGT among Indian women with PCOS.

Screening for people with abnormal glucose metabolism in the European DE-PLAN project

AimsThe aim of this report is to describe the application of the FINDRISC in clinical practice within the DE-PLAN project as a step to screen for Type 2 diabetes. MethodsNine out of 24 possible centers were included. Six centers used opportunistic screening methods for participant recruitment whereas three centers provided study participants of a random population sample. Men (n=1621) and women (n=2483) were evaluated separately. In order to assess the prevalence of abnormal glucose tolerance (AGT) disorders across different risk categories, the FINDRISC was used. Anthropometric measurements included blood pressure, height, weight, and waist circumference. Blood lipids and an oral glucose tolerance test were performed in all participants. The primary outcome was identified risk of AGT and type 2 diabetes. ResultsThere was no difference in the prevalence of smoking between the FINDRISC categories, people with a FINDRISC below 15 points tend to be more physically active and to eat more frequently fruits and vegetables. Men with a FINDRISC from 15 to 19 points had a prevalence of abnormal glucose tolerance of approximately 60% and women 50%. The prevalence for men and women with a FINDRISC >20 points was 80%. 30% of men and 20% of women with a FINDRISC between 15 and 19 points had Type 2 diabetes. Among people with a FINDRISC more than 20 points, 50% had previously undiagnosed Type 2 diabetes. ConclusionsThe FINDRISC may be a practical tool to be used in primary health-care systems throughout the European population.

A study on prevalence of abnormal glucose tolerance and correlation of insulin resistance with dyslipidemia in South-Indian women with polycystic ovary syndrome

Abnormal glucose tolerance, insulin resistance, obesity and dyslipidemia are all potent cardiovascular risk factors that cluster in women with polycystic ovary syndrome (PCOS). Metabolic abnormalities in PCOS women cannot be explained by presence of obesity alone. The aim of this study is to analyze the prevalence of abnormal glucose tolerance and correlation of insulin resistance with serum lipid profile in South-Indian women with PCOS. In this prospective case control study, a total of 45 PCOS women were recruited. All patients underwent oral glucose tolerance test (OGTT) with blood samples at 0 and 2nd hour. Fasting insulin and lipid profiles were also measured in each case. The prevalence of impaired glucose tolerance (IGT), impaired fasting glycemia (IFG), type 2 diabetes mellitus and normal glucose tolerance was found to be 24.44 % (11/45), 4.44 % (2/45), 2.22 % (1/45) and 68.9 % (31/45) respectively. PCOS women had significantly higher serum total cholesterol (P = 0.002), triglycerides (P < 0.001), LDL-C (P = 0.001), VLDLC (P < 0.001) and decreased HDL-C (P < 0.001) compared to control group. No significant correlation was found between HOMA-IR with total cholesterol, triglycerides and LDL-C. However, HDL-C showed negative correlation with HOMA-IR (P = 0.04). Indian women with PCOS are at increased risk of IGT and NIDDM. Also, PCOS women have significant alteration in lipid profile and hence are more prone for cardiovascular disease.

The Prevalence of Glucose Intolerance in Japanese Schizophrenic Patients With a Normal Fasting Glucose Level

The prevalence of diabetes in patients with schizophrenia is 2- to 3-fold higher than in the general population. Glucose abnormalities were detected in 11.9% of Japanese schizophrenic patients in a recent cross-sectional study that included fasting glucose monitoring. However, detailed studies of glucose intolerance using the glucose tolerance test have been limited in Japanese patients with schizophrenia. We investigated the prevalence of abnormal glucose tolerance after glucose loading among Japanese inpatients with schizophrenia, with normal fasting glucose levels. A total of 258 inpatients with schizophrenia participated in this study after giving their written informed consent. A 75-g oral glucose tolerance test was conducted in the morning after a 12-hour overnight fast. Among patients with normal fasting glucose, 81.3% had normal glucose tolerance, 17.3% had impaired glucose tolerance, and 1.3% were diagnosed with diabetes. This study showed that the frequency of impaired glucose tolerance in patients with schizophrenia with normal fasting glucose levels might be higher than in the general population. Careful monitoring and screening of patients with schizophrenia for abnormal glucose metabolism might therefore be necessary.

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes, and identifies women at risk of future type 2 diabetes mellitus (T2DM). Breast-feeding may improve post partum maternal glucose tolerance. Our objective was to identify the prevalence of post partum dysglycemia after GDM, to delineate associated factors and to examine the effect of lactation on post partum glucose tolerance. We compared post partum 75 g oral glucose tolerance test (OGTT) results from 300 women with GDM and 220 controls with normal gestational glucose tolerance (NGT) in five regional centers. Breast-feeding data was collected at time of OGTT. Methods Post partum OGTT results were classified as normal (fasting plasma glucose (FPG) <5.6 mmol/l, 2 h <7.8 mmol/l) and abnormal (impaired fasting glucose (IFG), FPG 5.6-6.9 mmol/l; impaired glucose tolerance (IGT), 2 h glucose 7.8-11 mmol/l; IFG+IGT; T2DM, FPG ≥7 mmol/l±2 h glucose ≥11.1 mmol/l). Binary logistic regression was used to identify factors predictive of persistent hyperglycemia. Five hundred and twenty women were tested; six (2.7%) with NGT in pregnancy had post partum dysglycemia compared with 57 (19%) with GDM in index pregnancy (P<0.001). Non-European ethnicity (odds ratio (OR) 3.40; 95% confidence interval (CI) 1.45-8.02, P=0.005), family history of T2DM (OR 2.14; 95% CI 1.06-4.32, P=0.034), and gestational insulin use (OR 2.62; 95% CI 1.17-5.87, P=0.019) were associated with persistent dysglycemia. The prevalence of persistent hyperglycemia was significantly lower in women who breast-fed vs bottle-fed post partum (8.2 vs 18.4%, P<0.001). Non-European ethnicity, gestational insulin use, family history of T2DM, and elevated body mass index were associated with persistent dysglycemia after GDM. Breast-feeding may confer beneficial metabolic effects after GDM and should be encouraged.

Prevalence of Abnormal Glucose Tolerance and Risk Factors in Urban and Rural Malaysia

OBJECTIVETo determine the prevalence of prediabetes and diabetes among rural and urban Malaysians.RESEARCH DESIGN AND METHODSThis cross-sectional survey was conducted among 3,879 Malaysian adults (1,335 men and 2,544 women). All subjects underwent the 75-g oral glucose tolerance test (OGTT).RESULTSThe overall prevalence of prediabetes was 22.1% (30.2% in men and 69.8% in women). Isolated impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were found in 3.4 and 16.1% of the study population, respectively, whereas 2.6% of the subjects had both IFG and IGT. Based on an OGTT, the prevalence of newly diagnosed type 2 diabetes was 12.6% (31.0% in men and 69.0% in women). The prediabetic subjects also had an increased prevalence of cardiovascular disease risk factors.CONCLUSIONSThe large proportion of undiagnosed cases of prediabetes and diabetes reflects the lack of public awareness of the disease.

Prediabetes influences cardiac rehabilitation in coronary artery disease patients

An abnormal glucose tolerance (AGT) in coronary artery disease (CAD) patients could negatively influence recovery after an acute event but the question, relevant in the field of cardiac rehabilitation (CR), is still controversial. Prospective study, aiming to establish the prevalence of AGT and its possible influence on functional recovery in CAD patients without a previous diagnosis of diabetes mellitus (DM). An oral glucose tolerance test was performed on 230 CAD patients without known DM, submitted to a 2-week period of intensive exercise-based CR after a recent acute myocardial infarction or coronary artery bypass graft. Functional capacity was assessed by a cardiopulmonary exercise test (CPET) and by 6-minute walking tests (6MWT) performed both on admission and at discharge. The prevalence of AGT in our population was 53%. Exercise capacity was lower in AGT patients (maximum workload achieved at CPET 79.3 ± 29.9 vs. 91.8 ± 36.9 W, p = 0.01; peak-VO(2) 17.8 ± 4.7 vs. 19.8 ± 5.6 ml/kg/min, p = 0.01). In the subgroup of AGT patients characterized by an inferior walking capacity at baseline, the increment in the distance walked was less than in the controls (Δ6MWT: 81.9 ± 60.1 vs. 109.1 ± 72.1, p = 0.04). An independent, negative, association was observed between AGT and Δ6MWT in patients with lower baseline test, and between maximum workload and peak-VO(2) in the whole population. A high prevalence of AGT was observed in a population of CAD patients without known DM after an acute coronary event. AGT is associated to a lower functional recovery, and to a reduced exercise capacity at the end of CR.

RELATIONSHIP BETWEEN GLUCOSE METABOLISM AND MICROALBUMINURIA IN WOMEN WITH PRIOR GESTATIONAL DIABETES: PP.17.158

Aims: Relationship between glucose abnormalities and microalbuminuria in women with pGDM.W. Methods: We prospectively studied 215 women with pGDM. According to OGTT, we divided into two groups: pGDM with normal glucose tolerance post-partum (NG) (66,8%) and pGDM with abnormal glucose tolerance post-partum (AG) (33,2%). Insulin sensitivity was derived using HOMA. Metabolic syndrome (MS) was defined by ATP-III We collected obstetric history, personal history of pGDM and personal and family history of cardiovascular risk factors. Microalbuminuria and glomerular filtration by MDRD were measured. Results: Mean age was 33,45 ± 4,5 yrs.; 26,25% smoking, 15,6% history of dyslipemia, 30% had history of previous abortions. 62,34% of women had first-degree relatives with type 2 DM and 59,25% had family history of hypertension The prevalence of MS was higher (32,3%) in AG group than in NG (14,7 %); p < 0.005. In addition, AG group had higher values of BMI and WC vs. NG group (28,86 ± 4,5 vs 22,70 ± 3,1 Kg/m2; p < 0.005 and 93,76 ± 6,1 vs 80,34 ± 4,6; p < 0.05, respectively). Fasting glucose and 2h-glucose levels were higher in AG group than NG (98,85 ± 7,7 vs 80,2 ± 5,6 mg/dl, p < 0.005 and 166,57 ± 23 vs 119,4 ± 20 mg/dl). Fasting insulin and HOMA values were significantly higher in AG than NG; p < 0.005. Microalbuminuria levels in AG group were greater (29.4 ± 13 mg/24 h) vs NT (11.67 ± 4,7 mg/24 h; p < 0.05). No differences in renal function. In addition, AG group presented a higher prevalence of family history of type 2 DM (68,7% vs 48%, p < 0.01). Conclusion: Women with pGDM have a high prevalence of abnormal glucose tolerance and MS and lower values of adiponectin, particularly those with AG (and with higher levels of microalbuminuria). Thus women with pGDM and family history of type 2 DM may be especially suitable interventions aimed at preventing or reducing type 2 DM and probably cardiovascular events.

Characteristics of abnormal glucose tolerance in patients with polycystic ovary syndrome

To analyze the characteristics of abnormal glucose tolerance in patients with polycystic ovary syndrome (PCOS). A 75 g oral glucose tolerance test (OGTT) with plasma glucose and serum insulin (INS) levels was performed in 257 PCOS patients. The states of glucose tolerance were classified by fasting plasma glucose (FPG) and plasma glucose at 120 minutes according to the Word Health Organization (WHO) criterion. According to the WHO criteria, 69.3% were classified as normal glucose tolerance (NGT) and 30.7% as with abnormal glucose metabolism, with 26.1% of them presenting impaired glucose tolerance (IGT) and 4.7% diabetes mellitus (DM). Age, BMI, fasting glucose or 2 h glucose concentration, fasting insulin or 2 h glucose concentration and homeostasis model assessment-insulin resistance (HOMA-IR) increased gradually among NGT, IGT and 2DM. QUICKI and the ratio of fasting glucose/ fasting insulin decreased gradually. The prevalence of abnormal glucose tolerance was significantly higher after 30 years old. There was significant correlation between abnormal glucose tolerance and age or BMI. A positive correlation was found between BMI and fasting glucose or 2-h glucose concentration. Abnormal glucose tolerance was correlated with age and BMI in PCOS patients. Insulin resistance is the mechanistic basis of abnormal glucose tolerance. Thus PCOS patients should be screened by glucose tolerance at an early time and a regular interval.