Risk Of Developing Diabetes Mellitus Research Articles

Abstract MP45: Beyond Pregnancy: Meta-Analysis of Lifestyle Intervention for Prevention of Diabetes Mellitus in Women With Prior Gestational Diabetes Mellitus

Introduction: Among parous women,1 in 3 have a pregnancy complication, increasing chances of developing Diabetes Mellitus(DM), Hypertension, or heart disease. Lifestyle intervention is recommended to reduce cardiovascular morbidity risk after complicated pregnancies. The effect of lifestyle intervention on the risk of type 2 DM in women with prior Gestational DM (GDM) is not widely studied. Our study highlights the impact of lifestyle intervention on risk of type 2 DM in women with prior GDM. Methods: We ran a systemic literature search of PubMed, EMBASE, Clinical Trials.gov, and Google Scholar from January 2000 to August 2023 for relevant articles comparing lifestyle intervention (diet and physical activity) with standard care in women with prior GDM. The relative risk (RR) of DM with 95% confidence interval (CI) and p-values were extracted with fixed effect model using RevMan v.5.4. Results: Of 3100 articles that were screened, 28 underwent full-text review, and 11 studies met the inclusion criteria. Of 11 studies, 1661 were evaluated in intervention group (IG) and 1671 in control group (CG). The mean age of participants was 26.1-39 years, with a baseline body mass index (BMI) range (R) of 23.4-31.4 kg/m2 and a follow-up duration with R of 4-36 months. On analysis, the incidence of type 2 DM was 7.6% in IG compared to CG (10.35%). IG showed a 27% reduction in DM incidence as compared to CG, RR of 0.73(CI: 0.59-0.91) (p < 0.05) (Figure 1). On meta-regression analysis, duration of lifestyle intervention (R: 4-36 months) significantly impacted the observed reduction in incident type 2 DM (p < 0.05) (positive relation) as compared to baseline BMI (p = 0.21) (Figure 1). Conclusion: Our analysis highlights that lifestyle intervention in women with prior GDM positively reduces risk of type 2 DM, and intervention duration significantly impacts the long-term risk of DM and cardiovascular diseases. Further data is warranted from larger studies for stronger evidence regarding the benefits of lifestyle intervention in prior GDM patients

Effects of war-related stress on the cardiovascular system, metabolism and the rate of ageing in women

Chronic war-related stress (WRS) due to disruption of adaptation mechanisms can affect physiological processes in the body, in particular, metabolism, neuroendocrine regulation, and the state of the cardiovascular and respiratory systems. WRS can also cause changes in the body's rate of ageing. Purpose of the Study: To investigate the effects of WRS on the cardiovascular system, metabolism and the rate of ageing in women. The study included 91 women aged from 30 to 74 years who experienced chronic WRS and 79 women examined before the Russian-Ukrainian war (control group). The biological age (BA) was determined according to the indicators of hemodynamics, heart rate variability and metabolism (cardiometabolic age) using a formula that was obtained by multiple stepwise regression. The indicators were selected, which correlate as much as possible with age and little among themselves. During the war, no statistically significant changes in heart rate, or systolic and diastolic blood pressure were observed, but a significant reduction in overall HRV in the supine position was obtained. Additionally, indices of parasympathetic nervous system activity are significantly lower during the war. In women, examined during the war, there is a statistically significant higher concentration of blood plasma glucose at fasting and 2-hour post-standard oral glucose tolerance test, they also exhibit higher plasma insulin concentration and a higher HOMA-IR index. An increased frequency of prediabetic disorders was observed. So, in the group of women examined before the war, an elevated fasting blood plasma glucose level was found in 6 %, while during the war it was observed in 19 %. Impaired glucose tolerance before the war was present in 10 % of women, and during the war, it increased to 25 %. To assess the effect of WRS on the rate of ageing, the BA of women before and during war was calculated. The formula for calculating BA was obtained on a group of healthy women before the war, and the ageing rate was calculated as the difference between BA and chronological age (CA). The average BA in the group of women before the war was 56.5±1.4 years, and in the group during the war – 64.7 ± 1.1 years. The difference between BA and CA is (0.02 ± 0.79) years in the women before the war and (10.8 ± 1.36) years during the war (p < 0.05). Chronic WRS leads to the disruption of the cardiovascular system's functioning and simultaneously triggers an imbalance in the autonomic nervous control in women. These changes indicate a state of heightened stress. Women exposed to chronic WRS experience unfavourable alterations in carbohydrate and lipid metabolism, increasing the risk of diabetes mellitus development. Chronic WRS accelerates the rate of cardiometabolic ageing in women. _________________________________________________________________________________________ Keywords: cardiovascular system; metabolism; biological age; war-related stress; woman

Risk of Diabetes Mellitus after Radiotherapy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma.

Simple SummaryIn patients with gastric mucosa-associated lymphoid tissue lymphoma (GML), irradiation of the pancreas is inevitable owing to its anatomical proximity to the stomach. This is the first study to demonstrate the association between RT exposure and the risk of development of diabetes mellitus (DM) in patients with GML by measuring individual-based dose parameters of the pancreas. The findings of this study demonstrate the association between incidental pancreatic irradiation and DM. Obesity and sex were key risk factors for DM. Considering the risk of DM, the pancreas should no longer be neglected during RT planning, particularly in male patients and patients with obesity.The long-term effect of radiation on the pancreas in pediatric patients has been studied without individual radiation dosimetric data. This study investigated the effect of radiotherapy on the risk of developing diabetes mellitus (DM) in patients with gastric mucosa-associated lymphoid tissue lymphoma (GML), using individual radiation dosimetric analysis. Retrospective analysis reviewed the data of 225 patients without a history of DM receiving curative treatment for stage IE GML. Involved-site radiotherapy was delivered to the whole stomach in 83 patients. The pancreas was delineated in each patient’s computed tomography scan for dosimetric analysis. At a median follow-up of 49.0 months, the 5-year cumulative incidence of DM was 4.5%, 9.6%, and 1.6% in all patients, patients who received radiotherapy, and patients who did not receive radiotherapy, respectively (p = 0.009). Mean pancreatic dose (Dmean; p = 0.009), sex (p = 0.043), and body mass index (BMI; p = 0.008) were independently associated with DM. Using recursive partitioning analysis, patients were classified into low, intermediate, and high-risk groups, with 5-year DM incidence rates of 0.0%, 3.1%, and 15.6%, respectively (p < 0.001). Incidental irradiation of the pancreas can increase the risk of DM, which may be stratified according to patient sex and BMI.

Risk of gastrointestinal cancer in patients with metabolic syndrome. Literature review

Metabolic syndrome is known to be a combination of metabolic abnormalities, such as abdominal obesity, abnormal glucose metabolism, elevated level of triglycerides, decreased level of high-density lipoprotein cholesterol, and hypertension. The presence of these abnormalities contributes to insulin resistance and increases the risk of diabetes mellitus development. The increase in the prevalence of metabolic syndrome worldwide is a concern not only in terms of increasing overall and cardiovascular mortality, but also in the fact that it is a potential risk factor for specific types of gastrointestinal cancer. Recent investigations, in particular a large-scale prospective study of the British Biobank cohort, which included 502.656 adults, showed that metabolic syndrome, independently of diabetes prevalence, directly correlated with an overall risk of gastrointestinal cancer as a whole and its individual components in both men and women. Metabolic syndrome closely correlated with an increased risk of colorectal cancer, hepatocellular carcinoma, pancreatic cancer in women and esophageal adenocarcinoma in men. Possible mechanisms that are likely to affect gastrointestinal neoplasia include chronic inflammation associated with obesity, hyperglycemia and hyperinsulinemia associated with metabolic syndrome, production by visceral adipose tissue of large numbers of adipokines that inhibit apoptosis and stimulate mitogenesis by promoting proliferation. It is generally concluded that metabolic syndrome and its individual components present the independent factors that increase the risk of gastrointestinal cancer, and various strategies (both surgical and therapeutic), impacting the metabolic syndrome and its individual components, are of great importance in the prevention of various gastrointestinal cancers.

The Influence of Hormone Therapy on secondary diabetes mellitus in Breast Cancer: A Meta-analysis

BackgroundGrowing evidences have implied that patients with primary breast cancer (BC) were at increased risks of developing diabetes mellitus (DM). However, as a major adjuvant treatment, the influence of hormone therapy (HT) on secondary DM in primary BC remains controversial; we conducted a meta-analysis of existing studies to evaluate the association of hormone therapy and secondary DM. MethodsWe searched online databases (PubMed, EMBASE, the Cochrane library, Scopus, and Google Scholar) for studies exploring the influence of hormone therapy on secondary DM in BC. The summarized effect sizes (ES) and 95% confidence interval (95% CI) are calculated by STATA software utilizing fixed-effect or random-effect models, depending on the heterogeneity of the eligible studies. ResultsUltimately, 7 retrospective publications including a total of 44,524 primary BC patients are eligible in present meta-analysis. HT use significantly increased the risk of developing DM in primary BC patients, whenever compared with NON–HT BC patients (pooled adjusted HR 1.30, 95% CI: 1.19-1.43) or NORMAL participants (HR 1.19, 95% CI: 1.14-1.25). As to specific HT medications, our sub-analysis demonstrates the risk for DM in tamoxifen (TAM) users elevates by 30% than NON–TAM use BC patients (pooled HR 1.30, 95% CI: 1.20-1.40) and by 18% than NORMAL participants (pooled HR 1.18, 95% CI: 1.12-1.24). However, for aromatase inhibitors (AIs) users, the risks for DM do not elevate significantly. Funnel plots and Egger's tests are used to evaluate publication bias and no apparent bias is detected in all analysis. ConclusionThe present study is the first meta-analysis which thoroughly reveals that adjuvant HT is a risk factor of secondary DM in primary female BC patients. As to specific HT medications, TAM use significantly enhances the incidence of secondary DM, while AIs use does not influence the DM incidence significantly. Our results can help clinicians to tailor more appropriate strategies for the therapy and follow-up of primary BC patients.

MC4R polymorphism in rs17782313 influences on insulin resistance

Introduction: There are many factors responsible for the development of metabolic syndrome – mainly associated with lifestyle, but also genetic ones. MC4R (melanocortin 4 receptor) genes variants have been associated with the risk of developing obesity, type 2 diabetes mellitus and coronary artery disease. Aim of the study: To investigate the association between MC4R rs17782313 polymorphism and concentrations of glucose, insulin, HOMA-IR and QUICKI values in the whole study group. Materials and methods: Study group consisted of 294 patients (136 men and 158 women). Collected venous blood samples were stored at -700C until the study group was completed. In the laboratory of Clinical Hospital 1 in Zabrze, the DNA materials were isolated, proper concentration of the DNA (15 ng/μL) were prepared and quality and quantity were checked by spectrophotometry. Allelic discrimination was performed with the use of fluorescent-labelled TaqMan Pre-designed SNP Genotyping Assay probes. Results: No statistically significant differences in concentrations of cholesterol, HDL, LDL, TG between genotypes in women and men were observed. In the whole group of patients, glucose and insulin levels did not differ significantly between TT, CT and CC carriers. Significant differences in values of HOMA-IR and QUICKI between TT, CT and CC carriers as well as between TT carriers and CT+CC carriers were found. CC+TT carriers have a significantly lower value of HOMA-IR and higher QUICKI value than TT carriers. Conclusions: MC4R polymorphism in rs17782313 may be associated with insulin resistance. Further studies are necessary to completely assess the association between investigated polymorphism, insulin resistance and risk of diabetes mellitus development.

Work Environment-related Stress Factors are Correlated with Diabetes Development in Workers with Impaired Glucose Tolerance: A 5-year Follow-up Study Using the Brief Job Stress Questionnaire (BJSQ)

Several previous studies have investigated the effects of occupational stress on the onset of diabetes mellitus (DM), but there are few studies of occupational stress and DM using the Brief Job Stress Questionnaire (BJSQ), a standard stress check method in Japan. This study aimed to determine the relationship between occupational stress factors and the onset of DM using the BJSQ. We examined 6,620 male company workers aged 40 years and above in 2013, using the BJSQ. Overall, 2,604 subjects with impaired glucose tolerance who were free of mental disorders and DM were followed-up for 5 years and re-examined in 2017. A retrospective data analysis was conducted in 2019. We documented 241 new cases of DM in 2017 (diabetes group). Compared with the non-diabetes group, the subjects in the diabetes group had significantly decreased "skill utilization". A binomial logistic regression analysis (generalized linear model) revealed that "skill utilization" was associated with the risk of DM development in 2017 (odds ratio, 1.632; 95% confidence interval, 1.061-2.510). Our results showed that low skill utilization might increase the risk of diabetes development in Japanese male workers.

Поширеність неалкогольної жирової хвороби печінки у хворих на предіабет

Актуальність. Цукровий діабет (ЦД) є одним із глобальних і надзвичайних викликів у галузі охорони здоров’я. Предіабет— це рання стадія в континуумі гіперглікемії, при якій організм схильний до підвищеного ризику розвитку ЦД. Неалкогольна жирова хвороба печінки (НАЖХП) становить собою низку порушень функції печінки, які характеризуються стеатозом печінки або накопиченням жиру в клітинах печінки за відсутності надмірного вживання алкоголю, вірусної етіології чи вживання наркотиків. На сьогодні проведено не так багато досліджень із метою вивчення поширеності НАЖХП в осіб із предіабетом. Дане дослідження є зусиллям у цьому напрямку. Матеріали та методи. Проведене поперечне обсерваційне дослідження. 100 пацієнтів із предіабетом були включені в дослідження протягом періоду з листопада 2017 року по березень 2019 року після отримання інформованої згоди. Дані дослідження включали визначення біохімічних показників, рівня глікемії в плазмі натще, електролітів та HbA1c, інсуліну в сироватці крові, проведення загального аналізу крові, функціональних тестів печінки та нирок, 2-годинного орального глюкозотолерантного тесту. Результати. Дослідження включало 38 чоловіків та 62 жінки, середній вік досліджуваної популяції становив 46 років. Установлено, що середній індекс маси тіла (ІМТ) становить 24,29±3,98 кг/м2, окружність талії— 81,26±8,71 см. Виявлений вірогідний зв’язок між показниками ехоструктури печінки при ультразвуковому дослідженні (УЗД) та ІМТ (р=0,003) і статтю. Установлено, що 30% обстежених мають порушену чутливість до інсуліну, у 22% виявлені ранні прояви резистентності до інсуліну, у 48%— виражена інсулінорезистентність. Показано статистично значущу кореляцію між результатами УЗД й еластографії. Виявлено статистичну кореляцію між HOMA-IR та показниками ехоструктури на УЗД, а також середньою жорсткістю печінки при еластографії. Висновки. Виявлено вірогідну кореляцію між резистентністю до інсуліну та наявністю НАЖХП. Спостерігалися вірогідні зв’язки між різними демографічними характеристиками та ступенем стеатозу. Існує необхідність провести подальші дослідження в більш широкому масштабі, щоб обґрунтувати отримані результати цього дослідження. Очікується, що це значною мірою сприятиме підвищенню обізнаності й оптимізації стратегій охорони здоров’я.

Diabetes mellitus risk among Jordanians in a dental setting: a cross-sectional study

Dental offices can be useful to screen and identify patients at risk of developing diabetes mellitus (DM) using risk prediction tools. The Finnish Diabetes Risk Score (FINDRISC) is a validated, questionnaire-based tool used to predict the 10-year risk of developing type II DM. To determine the 10-year DM risk among Jordanians using the FINDRISC questionnaire in a dental setting. Participants attending two university dental teaching centres between March 2017 and February 2018 were interviewed using an Arabic translated version of the FINDRISC questionnaire. Anthropometrics including weight, height, waist circumference (WC) and body mass index (BMI) were recorded. Random capillary blood glucose level was measured for each participant. Statistical analysis was done using Chi-square and independent t-tests. A total of 1,247 (436 males and 811 females) participants were included. As defined by BMI, 1,012 (81.2%) participants were either overweight or obese. Abdominal adiposity as determined by WC was seen in 738 (59.2%) participants. The mean (± SD) FINDRISC score for females (11.3±4.3) was significantly higher (P=0.001) than males (10.4±4.9). After age adjustment, more females were in the high-risk categories (FINDRISC ≥ 15) compared with males. This trend was seen among all age groups, but was statistically significant in the older age groups; 55-64 years (P=0.037) and ≥ 65years (P=0.004). In a developing Middle Eastern country such as Jordan, almost half of Jordanians attending university dental clinics are at a moderate to high risk of developing type II DM in 10 years. The risk of DM should be considered in dental patients, particularly older females.

Association of chronic pancreatitis with risk of diabetes mellitus development

Introduction: Pancreatogenic diabetes mellitus affects the life quality and it is an independent risk factor for mortality at chronic pancreatitis. In practice, pancreatogenic diabetes mellitus is rarely diagnosed, and patients are incorrectly diagnosed with diabetes mellitus type 1 or type 2. Objective: To determine the association of chronic pancreatitis with risk of diabetes mellitus developing. Material and methods: Case-control study design, retrospective studies. The study was conducted on the base of the Municipal hospital №1 of Karaganda. Case histories of 23 patients, their outpatient records and discharges from hospital were studied. The patients were divided into 2 groups during the study: group 1 – the patients with chronic pancreatitis; group 2 – the patients with chronic pancreatitis and diabetes mellitus type 2. Results and discussion: The study found that the number of patients under 60 years of age with chronic pancreatitis and diabetes mellitus are 4 times higher than the number of patients over 60 years of age. An increase in blood sugar among patients with chronic pancreatitis was associated with an exacerbation of the underlying disease. Predictors of diabetes mellitus in patients with chronic pancreatitis were female gender (OR=1,179) and high glucose level (OR=0,667). High body mass index did not affect an increase in glucose levels in patients with chronic pancreatitis.

Diet Control in Pregnant Women with Gestational Diabetes Mellitus

Background: The incidence of diabetes mellitus has significantly increased in the last two decades. Gestational diabetes mellitus, GDM, is a complication that affects both pregnant women and newborn babies. Pregnant women that are diagnosed with GDM are 7 times more likely to be diagnosed with type II diabetes mellitus. In addition, infants born by GDM mothers are at higher risk of developing diabetes mellitus in the future. Objective: The study aims to review the literature on the diet control in pregnant women with gestational diabetes mellitus. Results: Controlling blood sugar within the normal range during pregnancy can decrease negative pregnancy outcomes. However, most pregnant women with GDM cannot control their blood sugar within the normal range because of a lack of knowledge and skill in selecting appropriate foods. They also often experience inconsistency in their diet control behavior Most pregnant women worry about gaining too much weight, and most pregnant women with GDM have to learn how to choose their food properly in terms of both nutrients and quantity in order to control their blood sugar levels within the normal range. Conclusion: Diet control during pregnancy is one way to prevent the negative consequences of GDM for both mothers and infants. The food proportion for pregnant women with gestational diabetes is CHO: PRO: FAT = 50: 20:30 and also to consume an appropriate amount of vitamins and minerals and water each day.

Hemoglobin A1c as a Marker to Stratify Diabetes Risk Following Pancreaticoduodenectomy

Background: Pancreatic cancer has been shown to cause diabetes mellitus (DM) and DM has been shown to be a risk factor for pancreatic cancer. The effect of pancreaticoduodenectomy(PD) on risk for development of DM is unclear. This study used Hemoglobin A1c (HbA1c) to determine the incidence of DM development following PD based on preoperative risk of DM. Methods: Retrospective review of patients undergoing PD was performed with comparison of preoperative DM status and HbA1c with development of DM postoperatively. Odds ratios were calculated to determine the risk for DM development. Results: Among 90 patients who met inclusion criteria, 16.1% developed new-onset or worsening DM following PD. Of those with HbA1c <5.5%, only 3.7% of patients developed DM. Patients at risk for DM preoperatively had1.8 times greater risk for development of DM following PD. Conclusion: HbA1c levels should be used to identify patients at risk for new-onset or worsening DM following PD.

Biological and pathophysiological role of adiponectin

Adipose tissue is now recognized as an important endocrine organ that secretes numerous protein hormones, including leptin, adiponectin, and resistin. Adiponectin is a hormone that is produced by white adipose tissue. Adiponectin has been isolated independently by several groups of scientists. In humans, this protein is encoded by the ADIPOQ gene. Adiponectin receptors are widely distributed in many organs and tissues including liver, heart, pancreas, kidneys, muscles and many other cell types. A serum concentration of adipocin correlates with body mass index (BMI). Decreased level of adiponectin leads to obesity, the development of gestational complications in pregnant women, as well as a high risk of diabetes mellitus development and atherosclerosis. A high concentration of this hormone has anti-inflammatory, antiatherogenic, antiproliferative and cancer-defense mechanisms. Adiponectin strongly suppresses hepatic gluconeogenesis by inhibiting genes involved in glucose production. Obese people have lower blood levels of adiponectin than normal weight individuals. Adiponectin’s anti-inflammatory and anti-apoptotic properties result in protection of the blood vessels, heart, lungs, and colon. Adiponectin, an abundant adipocyte-secreted factor with a wide-range of biological activities, improves insulin sensitivity in insulin target tissues, modulates inflammatory responses, and plays a crucial role in the regulation of energy metabolism.

Is extracorporeal shockwave lithotripsy a risk factor for the development of diabetes mellitus? A population-based study.

To determine if patients treated with extracorporeal shockwave lithotripsy (ESWL) are at a greater risk of developing diabetes mellitus (DM) than those treated with ureteroscopy (URS). A retrospective population-based cohort study was performed of all ESWL and URS stone treatments done in Ontario between January 1994 and March 2014, utilising linked encoded healthcare databases. The primary outcome was the development of DM >90days after treatment. TheKaplan-Meier method was used for unadjusted survivalanalysis and multivariable analysis with Cox proportional hazards regression was used to assess the risk of DM between the ESWL and URS groups whilst controlling for age, gender, region of residence, income quintile, year of treatment, and comorbidity index. A sensitivity analysis with a subset of ESWL patients treatedfor left renal or proximal ureteric stones was completed. We identified 106963 patients who underwent ESWL or URS over the study period with a median follow-up of 6.6years (ESWL 8.5years, URS 5.6years). Unadjusted survival analysis showed an increased risk of developing DM in the ESWL group compared to the URS group (P<0.001); however, multivariable analysis showed no increased risk of DM in the ESWL cohort (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.91-1.02; P=0.25). Similarly, sensitivity analysis showed no increased risk of DM in the left renal/proximal ureteric stone ESWL cohort compared to the URS cohort (HR 1.04, 95% CI 0.96-1.13; P=0.35). Our population-based cohort study demonstrated no increased risk of DM in patients undergoing ESWL compared to URS.

Increased risk for diabetes mellitus in patients with carbon monoxide poisoning.

Carbon monoxide poisoning (COP) causes hypoxic injury and inflammatory and immunological reactions in the brain and local organs including the pancreas. Therefore, it is plausible that COP may increase the risk for developing diabetes mellitus (DM), but studies on this possible association are limited. We conducted a nationwide study in Taiwan to fill the data gap. We used the Nationwide Poisoning Database and the Longitudinal Health Insurance Database 2000 to identify all COP patients diagnosed between 1999 and 2012 (the study cohort) and then construct a comparison cohort of patients without COP through matching at 1:3 by the index date and age. The risk for DM between the two cohorts was compared by following up until 2013. We also investigated the independent predictors for DM in all the patients. During the study period, 22,308 COP patients were identified, and 66,924 non-COP patients were included in the comparison cohort accordingly. Patients with COP had an increased risk for DM with an adjusted hazard ratio (AHR) of 1.92 (95% confidence interval [CI]: 1.79–2.06) after adjusting for age, sex, comorbidities, and monthly income, especially in the subgroups of age <35 years, age ≥ 65 years, female sex, and comorbidities with congestive heart failure, hyperthyroidism, and polycystic ovary syndrome. Cox proportional hazard regression analysis showed that the increased risk for DM was highest in the first month after COP (AHR= 3.38; 95% CI: 2.29–4.99) and lasted even after 4 years (AHR= 1.82; 95% CI: 1.62–2.04). We found that COP, older age, male sex, hypertension, hyperlipidemia, hyperuricemia, and low monthly income were independent predictors for DM. Intervention studies are needed to validate the results and delineate the detailed mechanisms.

Cancer patients with undiagnosed and poorly managed diabetes mellitus.

e18232 Background: Cancer patients are at increased risk of developing diabetes mellitus (DM) or having worsening control of their pre-existent DM. The causes of this are multifactorial but the use of steroids, either in the palliative setting or short-term whilst on chemotherapy, is a significant contributor. An audit carried out at a district general hospital demonstrated that 5% of all oncology admissions were secondary to DM complications. A study was conducted to evaluate the prevalence of impaired blood glucose (BG) control and to assess the value of routine HbA1c testing in this population. Methods: Patients having routine chemotherapy blood tests were also tested for HbA1c over a 10 day period in December 2016. HbA1c diagnostic criteria was used as per NICE guidelines. Information on previous diabetic status, primary tumour type, chemotherapy status (number of cycles and treatment intent) was recorded. Results: 134 patients were tested for HbA1c; 28 (21%) had a HbA1c diagnostic of DM and 32 (24%) were at high risk of DM. The mean HbA1c of those in the DM group was 67.3 mmol/mol (range 48-120). Of the 28 with a HbA1C diagnostic of DM, 13 (46%) were already known to have DM with 15 (54%) being newly diagnosed from this study. 11 (73%) of those with a new diagnosis of DM were receiving a short course of steroids with chemotherapy. 12 patients in the DM group were having chemotherapy with curative intent; 6 of whom were newly diagnosed. Conclusions: 11% of the study cohort met criteria for a new diagnosis of DM with 73% of this group receiving steroids. NICE advises on monitoring of BG for all diabetics receiving steroids. Monitoring of BG and using anti-diabetic medications could prevent DM related complications. This highlights the need to involve local diabetic services and primary care providers for diabetic management. 43% of patients in DM group were receiving chemotherapy with curative intent. This has large implications on cancer survivorship and it is vital that these patients receive appropriate DM treatment. This will not only improve quality of care and patient satisfaction but also lead to significant cost savings from reduced admissions and length of stay in hospital. We therefore recommend a routine HbA1c test for all cancer patients having chemotherapy.

Triglyceride/HDL ratio and its impact on the risk of diabetes mellitus development during ART.

Our primary aim was to study diabetes mellitus (DM) arising during combination ART (cART) and to attempt to identify associations between these cases and triglycerides (TRG) and the TRG to HDL-cholesterol (TRG/HDL) ratio. Our secondary aim was to analyse the association between DM development and hepatic fibrosis. This was a retrospective cohort study. Patients from the Icona Foundation study initiating first-line cART between 1997 and 2013 were selected and observed until new-onset DM or most recent clinical follow-up. The predictive value of TRG and TRG/HDL ratio levels on DM was evaluated using multivariable Poisson regression models. Three-thousand, five-hundred and forty-six patients (males, 73.7%; median age, 38 years; median BMI, 23.1 kg/m(2); and hepatitis C virus antibody positive, 22.1%) were included. Of these, 80 developed DM over 13 911 person-years of follow-up (PYFU), corresponding to 5.7 cases per 1000 PYFU (95% CI = 4.6-7.1). At multivariable analysis, latest TRG/HDL ratio, when high, was associated with significant increases in DM risk [relative risk (RR) = 1.63; 95% CI = 1.32-2.01 per 10 points higher], while current TRG, in contrast, was associated with new-onset DM only at crude analysis. Advanced liver fibrosis (defined as fibrosis-4 index >3.25) was also shown to be an independent risk factor for DM (RR = 2.91; 95% CI = 1.10-7.72). High TRG/HDL ratio predicted risk of new-onset DM, independently of other traditional risk factors. Furthermore, our findings suggest that advanced hepatic fibrosis, estimated using the fibrosis-4 score, could provide an additional predictor for DM.

Obstructive Sleep Apnea Increases Visceral Fat Deposition but Not Total Body Fat Percentage

Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder in which obesity is a risk factor. Despite this relationship, OSA increases the risk for developing diabetes mellitus (DM) independent of total body adiposity. The mechanisms linking OSA and DM are complex and not well understood. Visceral fat is a well-established risk factor for DM due to its increased metabolic properties, and may be a contributing factor in the link between OSA and DM. PURPOSE: To examine the differences in total body and visceral fat in OSA vs. non-OSA controls. METHODS: Ten OSA and 21 control subjects were grouped by an at-home, sleep-screening device. All OSA subjects were classified as having moderate-severe OSA. Total body and visceral fat was assessed by DEXA. Physical activity was measured in each subject by hip-worn accelerometry. RESULTS: OSA subjects were significantly older (39.5 + 14.0 vs. 28.1 + 11.5 years; P = 0.02) and had a higher BMI (32.96 + 7.13 vs. 28.5 + 3.2; P = 0.02) than controls. There was no difference between groups in mean steps per day. Total percent body fat did not differ between groups before or after adjustment for age and BMI (35.31 + 7.4 vs. 34.51 + 8.7 for OSA and control subjects, respectively). Visceral fat percentage was significantly higher in OSA before adjusting for age and BMI (5.2 + 3.2 lbs vs. 1.8 + 1.6 lbs; P = 0.014). This difference remained significant after adjustment (P < 0.01). Further, the apnea-hypopnea index (AHI), the measure to quantify OSA severity, was highly correlated with visceral fat (r = 0.74; P < 0.01). CONCLUSION: Results suggest that, despite no difference in total body adiposity, visceral fat is increased in those with OSA. Visceral fat has been associated with decreased insulin sensitivity and glucose intolerance. This may be one of the many contributory mechanisms involved in the increased risk and prevalence of DM in OSA.

Abstract 9692: Lower Achieved Systolic Pressure (≤130 mm Hg) is Associated With a Decreased Risk of New Diabetes Mellitus in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study

Background: There is a well-established association between higher blood pressure (BP) and insulin resistance and hypertensive patients are at increased risk of developing diabetes mellitus (DM). Although lower achieved systolic BP (SBP) was not associated with reduced mortality or cardiovascular outcomes in diabetic hypertensives or in hypertensive patients with ECG left ventricular hypertrophy (LVH) in the LIFE study, whether more aggressive reduction of SBP is associated with a lower incidence of DM has not been examined. Methods: Risk of new-onset DM was examined in relation to last in-treatment SBP prior to DM diagnosis or last in-study measurement in the absence of new DM in 7485 hypertensive patients with ECG LVH with no history of DM randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141, were compared with patients with in-treatment SBP ≥142 (median SBP at last measurement). Results: During 4.6±1.2 years follow-up, new-onset DM was diagnosed in 520 patients (6.9%). In univariate analyses, compared with in-treatment SBP ≥142, in-treatment SBP ≤130 entered as a time-varying covariate was associated with a 57% lower risk (95% CI 39-69%) of new DM and in-treatment SBP between 131 and 141 with a 30% lower risk (95% CI 14-42%) of developing DM. After adjusting for randomized treatment, age, sex, race, prior antihypertensive therapy, baseline body mass index (BMI), uric acid, serum glucose and baseline HDL cholesterol entered as standard covariates, and for in-treatment Cornell product LVH, diastolic BP, BMI, HDL, hydrochlorothiazide and statin use treated as time-varying covariates, achievement of a SBP ≤130 remained associated with a 38% lower incidence (95% CI 12-57%) of new DM whereas an in-treatment SBP between 131 and 141 was no longer predictive of a reduced risk of new DM. Conclusions: Achieved SBP ≤130 is associated with a significantly lower risk of developing new-onset DM in hypertensive patients with ECG LVH, independent of other known and possible risk factors for DM. Further study will be needed to determine whether targeting hypertensive patients without DM to lower SBP goals can reduce the burden of new DM in this high-risk population.

The value of hemoglobin A1c for diagnosis of diabetes mellitus and other changes in carbohydrate metabolism in women with recent gestational diabetes mellitus

Abstract Introduction Women with gestational diabetes mellitus (GDM) have an increased risk for developing diabetes mellitus (DM). Their postpartum metabolic classification using a 75 g oral glucose tolerance test (75 g OGTT) is recommended. The purpose of this study was to assess the value of hemoglobin A1c for postpartum evaluation in women with recent GDM. Patients and methods Fifty-six women with recent GDM underwent a 75 g OGTT at our center to assess postpartum changes in carbohydrate metabolism and were classified using diagnostic criteria of the American Diabetes Association (ADA). Receiver operating characteristic (ROC) curves analysis was used to assess the diagnostic performance of hemoglobin A1c, and kappa index was used to evaluate diagnostic agreement between hemoglobin A1c and 75 g OGTT. Results DM was diagnosed in 7 women, and other categories of increased risk for DM in 25 women. Kappa index for diagnosis agreement was 0.22. Hemoglobin A1c ≥ 5.7% had 47% sensitivity and 71% specificity for identifying any change in carbohydrate metabolism. A hemoglobin A1c value ≥ 6.5 had 29% sensitivity and 100% specificity for diagnosis of DM. Area under the ROC curve was 0.57 for identifying any change in carbohydrate metabolism and 0.81 for diagnosis of DM. Conclusion Using ADA cutoff values, hemoglobin A1c is not appropriate for postpartum glucose tolerance evaluation in women with recent GDM.