Stages Of Glucose Intolerance Research Articles

Risk of Cause-Specific Mortality across Glucose Spectrum in Elderly People: A Nationwide Population-Based Cohort Study.

This study investigated the risk of cause-specific mortality according to glucose tolerance status in elderly South Koreans. A total of 1,292,264 individuals aged ≥65 years who received health examinations in 2009 were identified from the National Health Information Database. Participants were classified as normal glucose tolerance, impaired fasting glucose, newly-diagnosed diabetes, early diabetes (oral hypoglycemic agents ≤2), or advanced diabetes (oral hypoglycemic agents ≥3 or insulin). The risk of system-specific and disease-specific deaths was estimated using multivariate Cox proportional hazards analysis. During a median follow-up of 8.41 years, 257,356 deaths were recorded. Diabetes was associated with significantly higher risk of all-cause mortality (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.57 to 1.60); death due to circulatory (HR, 1.49; 95% CI, 1.46 to 1.52), respiratory (HR, 1.51; 95% CI, 1.47 to 1.55), and genitourinary systems (HR, 2.22; 95% CI, 2.10 to 2.35); and neoplasms (HR, 1.30; 95% CI, 1.28 to 1.32). Diabetes was also associated with a significantly higher risk of death due to ischemic heart disease (HR, 1.70; 95% CI, 1.63 to 1.76), cerebrovascular disease (HR, 1.46; 95% CI, 1.41 to 1.50), pneumonia (HR, 1.69; 95% CI, 1.63 to 1.76), and acute or chronic kidney disease (HR, 2.23; 95% CI, 2.09 to 2.38). There was a stepwise increase in the risk of death across the glucose spectrum (P for trend <0.0001). Stroke, heart failure, or chronic kidney disease increased the risk of all-cause mortality at every stage of glucose intolerance. A dose-dependent association between the risk of mortality from various causes and severity of glucose tolerance was noted in the elderly population.

Lipid droplet accumulation in β cells in patients with type 2 diabetes is associated with insulin resistance, hyperglycemia and β cell dysfunction involving decreased insulin granules.

Background and objectivePancreatic fat is a form of ectopic fat. Lipid droplets (LDs) are also observed in β cells; however, the pathophysiological significance, especially for β cell function, has not been elucidated. Our aim was to assess LD accumulation in β cells in various stages of glucose intolerance and to clarify its relationship with clinical and histological parameters.MethodsWe examined 42 Japanese patients who underwent pancreatectomy. The BODIPY493/503-positive (BODIPY-positive) area in β cells was measured in pancreatic sections from 32 patients. The insulin granule numbers were counted in an additional 10 patients using electron microscopy.ResultsThe BODIPY-positive area in β cells in preexisting type 2 diabetes patients was higher than that in normal glucose tolerance patients (p = 0.031). The BODIPY-positive area in β cells was positively correlated with age (r = 0.45, p = 0.0097), HbA1c (r = 0.38, p = 0.0302), fasting plasma glucose (r = 0.37, p = 0.045), and homeostasis model assessment insulin resistance (r = 0.41, p = 0.049) and negatively correlated with an increase in the C-peptide immunoreactivity level by the glucagon test (r = -0.59, p = 0.018). The ratio of mature insulin granule number to total insulin granule number was reduced in the patients with rich LD accumulation in β cells (p = 0.039).ConclusionsType 2 diabetes patients had high LD accumulation in β cells, which was associated with insulin resistance, hyperglycemia, aging and β cell dysfunction involving decreased mature insulin granules.

Knowledge of Gestational Diabetes Mellitus Among Saudi Women in a Primary Health Care Center of Almadinah Almunawarah, Kingdom of Saudi Arabia.

BackgroundGestational diabetes mellitus (GDM) is a type of diabetes mellitus known as any stage of glucose intolerance with onset or first recognition during pregnancy. Awareness of GDM is the first step toward its screening in pregnancy. This study was designed to assess knowledge of GDM, its screening, and risk factors among Saudi women attending primary healthcare center in Almadinah Almunawarah, Kingdom of Saudi Arabia.MethodsThis was an observational cross-sectional study conducted on Saudi women who attended the primary healthcare centers in Almadinah Almunawarah during the study period from January 2021 to June 2021. The sampling technique used was the stratification of primary healthcare centers in Madinah. According to the Epi-Info, version 3.5.1, the minimum sample size was 292. Data collection was done using a valid, Arabic self-administered questionnaire, which was composed of two main parts: general sociodemographic data and a questionnaire to assess GDM knowledge and awareness (12 questions). Data was recorded and analyzed using SPSS version 26.ResultsIn this study, 333 women were enrolled with an age range between 18 and 60 years, with a mean of 34.31±9.21 years. Overall, more than half of the women (53.45%) had a poor level of knowledge related to GDM, whereas only 7.80% had a good level of knowledge. Results of multivariate logistic regression analysis revealed that women living in rural areas were at almost four-fold higher risk of having a poor level of knowledge (adjusted odds ratio (aOR): 3.97; 95% confidence interval (CI): 1.44-41.98, p=0.0031). With a one-year increase in women’s age, the risk of poor knowledge increased by 4% (aOR: 1.38; 95% CI: 1.08-1.48, p=0.001). In comparison to illiterate women, university-graduated and postgraduate women had a significantly lower risk of poor knowledge (aOR: 0.03; 95% CI: 0.01-0.31, p=0.001 and aOR: 0.19; 95% CI: 0.06-0.66, p = 0.011, respectively).ConclusionThe GDM knowledge of Saudi adult women was poor, particularly regarding risk factors, diagnosis, and treatment with insulin. However, their knowledge regarding treatment by lifestyle and diet modifications was quite acceptable.

Hyperglucagonemia and impaired insulin sensitivity are associated with development of prediabetes and type 2 diabetes - A study from South India

Background and aimsGlucagon levels and glucagon suppression in response to oral glucose load has not been elucidated at different stages of glucose intolerance in India. MethodsA total of 81 subjects underwent OGTT and were classified into three groups as having normal glucose tolerance (NGT) (n = 23), prediabetes (PreDM) (n = 33), newly diagnosed diabetes (NDM) (n = 25). Insulin and glucagon at fasting, 30 and 120 min was measured by ELISA. HOMA-IR, measures of insulin sensitivity, early, late and overall glucagon suppression during OGTT was calculated. ResultsPlasma glucagon levels were higher at all-time points in the PreDM and NDM groups. Fasting glucagon levels were higher than post glucose load glucagon in all groups. There was a significant difference in the fasting(p = 0.001), 30 min(p = 0.004) and 120 min(p = 0.032) glucagon between the groups. HOMA-IR increased and insulin sensitivity decreased with worsening of glucose intolerance(p < 0.0001). The groups did not differ in terms of early glucagon suppression(p = 0.094). NDM group suppressed glucagon more than NGT from 30 to 120 min after glucose intake. ConclusionThis study demonstrated higher fasting glucagon levels. Prediabetes and newly diagnosed diabetes individuals had higher glucagon levels, high insulin resistance and lower insulin sensitivity. Hyperglucagonemia may contribute to type 2 diabetes.

2025-P: Relation between Serum Uric Acid and Autonomic Function, Blood Pressure, and Visceral Obesity in Prediabetes and Type 2 Diabetes with Short Duration

Aim: The present study assesses the relation between uric acid and cardiovascular autonomic function (CAF), blood pressure (BR) and visceral obesity at early stages of glucose intolerance. Material and Methods: A total of 100 subjects - 50 males, mean age 47.4±14.2years, mean BMI 32.2±7.5kg/m2, divided into 3 groups according to glucose tolerance: 30 subjects with normal glucose tolerance (NGT), 37 with prediabetes and 33 with type 2 diabetes (T2D) with duration ≤5 years were included. Glucose tolerance was assessed by OGTT according to WHO 2006 criteria. Anthropometric indices, BP, HbA1c and plasma glucose were measured. Body fat distribution was estimated by a bioimpedance method (InBody 720, BioSpace). CAF was assessed by ANX-3.0 using frequency-domain analysis during standard clinical tests. Results: Uric acid levels were higher in prediabetes and T2D (p&amp;lt;0.0001 and p=0.004, respectively) as compared to NGT. There was a decreased parasympathetic tone at rest (p=0.026 and p=0.001, respectively), deep breathing (p=0.025 and p=0.003, respectively), Valsalva maneuver (p=0.023 and p=0.003, respectively) and standing (p=0.012 and p=0.002, respectively) test in T2D in comparison to prediabetes and NGT. Sympathetic tone was diminished at rest (p=0.004), deep breathing (p=0.040) and standing (p=0.016) test in T2D as compared to NGT. Uric acid positively correlated with waist circumference (r=44, p&amp;lt;0.0001), visceral fat area (r=24, p=0.022), diastolic BP (r=0.023) and HbA1c (r=22, p=0.030); and negatively with sympathetic activity at rest (r=-23, p=0.024), deep breathing (r=-26, p=0.010) and standing (r=-21, 0=0.039) test and with parasympathetic activity during deep breathing test (r=-21, p=0.033). Conclusions: It seems to be an increase in uric acid levels and a decline in CAF in prediabetes and T2D with short duration. Uric acid is probably associated with CAF, visceral obesity and BP at early stages of dysglycaemia. Disclosure R. Dimova: Consultant; Self; Amgen, Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; Sanofi, Wörwag Pharma. N. Chakarova: None. G. Grozeva-Damyanova: None. T. Tankova: Board Member; Self; Amgen, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Mundipharma International, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Sanofi, Servier.

Circulating myokine levels in different stages of glucose intolerance.

Type 2 diabetes is the fastest growing metabolic disease in the world. Recently, muscle is considered an endocrine organ which secretes various peptides that play an important role in insulin resistance and metabolic syndrome. We assessed 4 different myokines, irisin, interleukin-13 (IL-13), follistatin-related protein-1 (FSTL-1), and fractalkine, in normal, prediabetes, and diabetes patients.A total of 126 participants who visited Gangnam Severance Hospital were enrolled and divided into normal, prediabetes, and diabetes groups based on oral glucose tolerance test and hemoglobin a1c. A cross-sectional study was conducted to measure and compare serum levels of irisin, IL-13, FSTL-1, and fractalkine among the groups.Irisin level showed a tendency to increase in prediabetes group compared to normal group (P < .1) but showed a significant decrease when comparing diabetes from prediabetes group (P < .001). IL-13 decreased in diabetes group compared to prediabetes and normal group (P < .001, P < .05, respectively). FSTL-1 of diabetes group was lower than that of prediabetes group (P < .05), and fractalkine was higher in diabetes group compared to that of prediabetes and normal group (P < .01, P < .01, respectively).Irisin, IL-13, and FSTL-1 levels were reduced in diabetes group compared to normal or prediabetes group while fractalkine showed a progressive increase from normal to diabetes group. Further studies are warranted to study the roles of various myokine in diabetes through a larger prospective study.

Characterization of the Gut Microbiota of Individuals at Different T2D Stages Reveals a Complex Relationship with the Host.

In this work, we studied 217 Mexican subjects divided into six groups with different stages of glucose intolerance: 76 Controls (CO), 54 prediabetes (PRE), 14 T2D no medication (T2D−No−M), 14 T2D with Metformin (T2D−M), 22 T2D with polypharmacy (T2D−P), and 37 T2D with polypharmacy and insulin (T2D−P+I). We aimed to determine differences in the gut microbiota diversity for each condition. At the phylum level, we found that Firmicutes and Bacteroidetes outline major changes in the gut microbiota. The gut bacterial richness and diversity of individuals in the T2D−No−M group were lesser than other groups. Interestingly, we found a significant difference in the beta diversity of the gut microbiota among all groups. Higher abundance was found for Comamonadaceae in PRE, and Sutterella spp. in T2D−No−M. In addition, we found associations of specific microbial taxa with clinical parameters. Finally, we report predicted metabolic pathways of gut microbiota linked to T2D−M and PRE conditions. Collectively, these results indicate that each group has specific predicted metabolic characteristics and gut bacteria populations for each phenotype. The results of this study could be used to define strategies to modulate gut microbiota through noninvasive treatments, such as dietary intervention, probiotics or prebiotics, and to improve glucose tolerance of individuals with prediabetes or T2D.

578-P: Evaluation of Autonomic Function and Its Relation to Glucose Variability, Insulin Resistance, and Oxidative Stress in Prediabetes

Aim: The present study assesses the relation between cardiovascular autonomic function and some indexes of glycose variability, insulin resistance and oxidative stress in prediabetes. Material and Methods: A total of 50 subjects - 12 males, mean age 55.6±9.7 years, mean BMI 28.4±6.4 kg/m2, divided into 2 groups according to glucose tolerance: 32 subjects with prediabetes and 18 subjects with normal glucose tolerance (NG) were included. Glucose tolerance was assessed by OGTT in accordance with WHO 2006 criteria. Plasma glucose was measured by hexokinase method and immunoreactive insulin - by immuno-chemiluminescence method at fasting, 120-minute and 180-minute during the test; and also oxLDL and 5-Nitrotyrosine - by ELISA method at fasting and 120-minute during the test. Indirect indexes of insulin resistance - HOMA-IR and insulin sensitivity - OGIS were calculated. HbA1c was assessed by immuno-turbidimetric, NGSP certified method. Continuous glucose monitoring was performed with blind sensor for professional use - FreeStyle Libre Pro - for a mean period of 13.6 ± 2.3 days. Results: There was a significantly decreased parasympathetic tone during deep breathing test (p=0.009) and sympathetic tone at rest (p=0.021) and during Valsalva maneuver test (p=0.026) in prediabetes. Sympathetic activity was related to the standard deviation of glycemic excursions in prediabetes (F [1,31]=7.91, p=0.018); whilst parasympathetic activity was related to J-index and % time spent in glycemic range &amp;gt;7.8 mmol/l in prediabetes (F [1,31]=7.20, p=0.004) and with CONGA index in NGT (F [1,18]=6.75, p=0.025). No significant correlation between autonomic tone and the assessed markers of insulin resistance and oxidative stress was established. Conclusions: The autonomic tone has been found to be declined in prediabetes. Glucose variability is probably an additional risk factor for autonomic dysfunction at these early stages of glucose intolerance. Disclosure R. Dimova: None. N. Chakarova: None. G. Kirilov: None. G. Grozeva: None. T. Tankova: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp &amp; Dohme Corp., Sanofi. Speaker's Bureau; Self; Lilly Diabetes, Novo Nordisk A/S, Servier.

The Association of Irisin with the Progression of Diabetes Mellitus Irisin and Diabetes Progression

Introduction: There is an ongoing debate over the involvement of irisin in the glucose metabolism. In this study, we aimed to see the association of irisin with the markers of glucose intolerance. Materials and Methods: We analyzed the relation of irisin with metabolic markers such as Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), insulin, and glucose in 152 subjects, subdivided into normal, impaired glucose tolerance and diabetic subgroups. Results: We found that the irisin levels of individuals with different stages of glucose intolerance did not show any significant difference. There was not any correlation between irisin levels with HOMA-IR. However, we observed a positive and significant correlation between circulating irisin concentrations and 120-minute glucose, 120-minute insulin, and HbA1c levels. Conclusion: The conclusive results of this study are that irisin could be somehow associated with insulin resistance but do not show a significant difference with neither diabetes nor different stages of insulin resistance.

Prevalence of Lipid Abnormalities in Progressive Stages of Diabetes Mellitus

Prediabetes (PD) often exists in patients with coronary artery disease (CAD). This cross-sectional study aimed to uncover a link between measures of fat metabolism and lipid profiles with increasing stages of glucose intolerance which could promote premature CAD in PD. Methods: Subjects from NHANES 2005-2012 without history of DM, dyslipidemia or medication for these disorders were matched by age and gender and categorized into normal group (HbA1c&amp;lt;5.7 and fasting plasma glucose&amp;lt;100mg/dl), PD group (6.5&amp;gt;HbA1c≥5.7 or 125mg/dl&amp;gt;fasting plasma glucose≥100mg/dl) and DM group (HbA1c≥6.5 or fasting plasma glucose≥125mg/dl). Body mass measures, plasma insulin level, lipid panel and hepatic steatosis were compared among 3 groups, using Chi-square and Wilcoxon rank sum test. Results: From 29314 subjects in NHANES: 128 normal, 132 PD and 130 DM subjects were selected. Weight, BMI, waist circumference significantly increased within groups (all P&amp;lt;0.001) in parallel with hepatosteatosis, and consistent with increasing lipogenesis. LDL changes were distinctive being highest in PD group (P=0.0003). Conclusions: Insulin values and progressive dyslipidemia correlated with increasing diabetes as expected, but the disparity between hepatic steatosis and LDL suggests an imbalance between lipogenesis and lipoprotein clearance resulting in higher LDL in PD; and a mechanism for early onset of diabetic induced atherogenesis. Table 1Median and interquartile range or percentageNormal (1)PD (2)DM (3)P among groupsP (1) vs (2)P(2) vs (3)Total cholesterol204 (181-226)213 (194-249)2(182-245)0.010.0020.11LDL124 (99-141)146 (119-167)126 (100- 151)0.0003&amp;lt;0.00010.007Triglyceride104 (82 -139)117 (83-175)179 (131-243)&amp;lt;0.00010.13&amp;lt;0.0001HDL55 (42-69)49 (43-60)40 (34-48)&amp;lt;0.00010.16&amp;lt;0.0001Non-HDL-Cholesterol147 (126-170)167 (140-198)167 (135-196)&amp;lt;0.00010.00020.96Insulin7.24 (5.77-10.55)9.12 (7.28-12.59)15.22 (11.21-22.88)&amp;lt;0.00010.0002&amp;lt;0.0001Hepatic steatosis24.20%45.65%78.72%&amp;lt;0.00010.002&amp;lt;0.0001 Disclosure B. Gui: None. E. Siau: None. L.F. Amorosa: None.

Vitamin D in the Spectrum of Prediabetes and Cardiovascular Autonomic Dysfunction

Vitamin D is a fat-soluble secosteroid hormone with pleiotropic effects. 1,25-Dihydroxyvitamin D coordinates the biosynthesis of neurotransmitters in the central nervous system, which regulate cardiovascular autonomic function and may explain its putative role in the development of cardiovascular autonomic neuropathy (CAN). CAN is an independent risk factor for mortality in patients with diabetes and prediabetes and is associated with an increased risk of developing type 2 diabetes and cardiovascular disease. Accumulating data indicate the presence of peripheral nerve injury at these early stages of dysglycemia and its multifactorial pathogenesis. Prediabetes is associated with vitamin D insufficiency. Vitamin D is proposed to prevent the progression of glucose intolerance. The putative underlying mechanisms include maintenance of the intracellular calcium concentration, direct stimulation of insulin receptor expression, and enhancement of the insulin response to glucose transporters. Vitamin D exerts a protective effect on peripheral nerve fibers by decreasing the demyelination process and inducing axonal regeneration. The effects of vitamin D supplementation on glucose tolerance and related autonomic nerve dysfunction have been a recent focus of scientific interest. Although well-designed observational studies are available, the causative relation between vitamin D deficiency, glucose intolerance, and CAN is still debatable. One reason might be that interventional studies are unpersuasive with regard to the beneficial clinical effects of vitamin D supplementation. Because of its favorable side effect profile, vitamin D supplementation might represent an attractive therapeutic option for treating the pandemic prevalence of prediabetes and vitamin D deficiency. Vitamin D supplementation can improve glucose tolerance and cardiovascular autonomic function and can thus reduce cardiovascular mortality among subjects with different stages of glucose intolerance and autonomic dysfunction. However, more patient-centered trials on the use of vitamin D supplementation in different conditions are needed.

Insulin, Glucagon and Growth Hormone and CIMT in Glucose Intolerance

Objective: There is an increasing evidence that glucagon and growth hormone (GH)-insulin-like growth factor (IGF) axis may play an important role in glucose metabolism since early stages of glucose intolerance. Carotid intima media thickness is a marker for subclinical atherosclerosis. We aimed to evaluate glucagon, GH and IGF-1 in prediabetic states and their relationship with carotid intima media thickness. Methods: One hundred subjects underwent a 75 gr oral glucose tolerance test and were divided into 4 groups according to their state of glucose tolerance: (i) normal glucose tolerance (NGT)/Controls (n=21), (ii) impaired glucose tolerance (IGT) (n=35), (iii) impaired fasting glucose (IFG) (n=22), (iv) type 2 diabetes mellitus (n=22). Insulin, glucagon and GH were measured at 0, 60 and 120. minutes of OGTT and their area under the curve (AUC) were calculated. Fasting IGF-1 levels and carotid intima media thickness were determined in all participants. Results: AUC for Glucagon was significantly higher in subjects with IGT, IFG and type 2 diabetes mellitus compared to NGT subjects. AUC for GH was significantly higher in subjects with IFG compared to subjects with IGT, type 2 diabetes mellitus and NGT. Plasma IGF-1 levels were significantly lower in subjects with abnormal glucose tolerance. CIMT was significantly higher in IFG group and CIMT was found to be negatively correlated with IGF-1 levels in subjects with IFG. Conclusion: There are pathological alterations of glucagon, GH-IGF-1 and insulin in prediabetic stages. Among these alterations insulin resistance and IGF-1 are associated with CIMT. Further studies needed to investigate the role of treatments targeting insulin sensitivity will have an impact on the association between insulin and early atherogenesis

Post-glucose-load urinary C-peptide and glucose concentration obtained during OGTT do not affect oral minimal model-based plasma indices.

The purpose of this study was to investigate how renal loss of both C-peptide and glucose during oral glucose tolerance test (OGTT) relate to and affect plasma-derived oral minimal model (OMM) indices. All individuals were recruited during family screening between August 2007 and January 2011 and underwent a 3.5-h OGTT, collecting nine plasma samples and urine during OGTT. We obtained the following three subgroups: normoglycemic, at risk, and T2D. We recruited South Asian and Caucasian families, and we report separate analyses if differences occurred. Plasma glucose, insulin, and C-peptide concentrations were analyzed as AUCs during OGTT, OMM estimate of renal C-peptide secretion, and OMM beta-cell and insulin sensitivity indices were calculated to obtain disposition indices. Post-glucose load glucose and C-peptide in urine were measured and related to plasma-based indices. Urinary glucose corresponded well with plasma glucose AUC (Cau r = 0.64, P < 0.01; SA r = 0.69, P < 0.01), SI (Cau r = −0.51, P < 0.01; SA r = −0.41, P < 0.01), Φdynamic (Cau r = −0.41, P < 0.01; SA r = −0.57, P < 0.01), and Φoral (Cau r = −0.61, P < 0.01; SA r = −0.73, P < 0.01). Urinary C-peptide corresponded well to plasma C-peptide AUC (Cau r = 0.45, P < 0.01; SA r = 0.33, P < 0.05) and OMM estimate of renal C-peptide secretion (r = 0.42, P < 0.01). In general, glucose excretion plasma threshold for the presence of glucose in urine was ~10–10.5 mmol L−1 in non-T2D individuals, but not measurable in T2D individuals. Renal glucose secretion during OGTT did not influence OMM indices in general nor in T2D patients (renal clearance range 0–2.1 %, with median 0.2 % of plasma glucose AUC). C-indices of urinary glucose to detect various stages of glucose intolerance were excellent (Cau 0.83–0.98; SA 0.75–0.89). The limited role of renal glucose secretion validates the neglecting of urinary glucose secretion in kinetic models of glucose homeostasis using plasma glucose concentrations. Both C-peptide and glucose in urine collected during OGTT might be used as non-invasive measures for endogenous insulin secretion and glucose tolerance state.

Visceral Adiposity Index and pattern of dyslipidaemia at different stages of glucose intolerance—A study from India

AimTo see the pattern of dyslipidaemia and Visceral Adiposity Index (VAI) at different stages of glucose intolerance in Indian population. MethodsData of 600 subjects were considered for this analysis. Waist circumference and BMI were recorded. OGTT and lipid profile were done. Subjects were divided into three groups; Group 1 (Normoglycaemic), Group 2 (Prediabetes) and Group 3 (new DM). Subjects having one or more lipid parameters outside the targets recommended by ADA were considered to have dyslipidaemia. VAI, a sex-specific index, was calculated. ResultsLDL-C was the most common isolated single abnormality (84.5%), followed by HDL-C (58.7%) and triglycerides (49.7%) among the total subjects. 73% had high LDL-C and 56% had low HDL-C even in normoglycaemic subjects. LDL-C abnormality was similar in prediabetes and diabetes. Commonest combination of two abnormalities was seen mainly with LDL-C and HDL-C. Mean VAI increased at different stages of glucose intolerance and VAI≥2.3 gave sensitivity of 61.2% and specificity of 59.7% to detect glucose intolerance. ConclusionsThe most common single lipid abnormality was high LDL-C. Combination of two abnormalities was seen with LDL-C and HDL-C. VAI increased at different stages of glucose intolerance. These findings may be useful for targeting high-risk population.

FP45-TH-02 Hypothesis for the stages of glucose intolerance in myotonic dystrophy: evaluation by glucose tolerance test

FP45-TH-02 Hypothesis for the stages of glucose intolerance in myotonic dystrophy: evaluation by glucose tolerance test

A cross-sectional study of the association between persistent organic pollutants and glucose intolerance among Greenland Inuit

Some evidence supports the hypothesis that persistent organic pollutants (POPs) may increase the risk of type 2 diabetes. The Inuit population in Greenland, which is highly exposed to POPs due to a high intake of marine mammals, has experienced a rapid increase in diabetes prevalence over the last 30 years. Thus the aim was to study the association between POPs and glucose intolerance and markers of insulin resistance and insulin secretion using a population-based design. From 1999 to 2002 the Greenland population study was carried out among adult Inuit living in Greenland. The examination included a 75 g OGTT, anthropometric measurements, a structured interview, and blood tests. Plasma glucose and serum insulin were analysed, and three defined subclasses of POPs were analysed in a subgroup. Associations were adjusted for age, sex, waist circumference, Inuit heritage, cigarette smoking, alcohol consumption and educational level. Data on POPs were available on 692 individuals, 305 men (mean age 50 years) and 387 women (mean age 49 years). The prevalence of diabetes was 10.3%, and 10.5% had impaired glucose tolerance. The concentrations of several POPs were exceptionally high. While no associations were found between POPs and stages of glucose intolerance or markers of insulin resistance, POPs were significantly inversely associated with stimulated insulin concentrations and homeostasis model assessment of beta cell function. The study indicates that POPs may affect insulin secretion rather than being involved in the pathogenesis of insulin resistance. No association was seen between POPs and glucose intolerance or markers of insulin resistance.

Vascular Reactivity Changes in Glucose-intolerant Rat

The vascular effects of glucose-intolerance were investigated using the neonatal streptozotocin-treated (nSTZ) rat model. Glucose-intolerance was initiated by administration of STZ (90 mg/kg, IP) into 2-day-old male rats. Aortic reactivity was assessed in vitro at 3 and 6 months of age. Both the 3- and 6-month-old nSTZ rats displayed higher blood glucose levels in response to a glucose challenge. At 3 months of age, aortic responsiveness to both norepinephrine and acetylcholine was not altered. However, at 6 months of age, the responses of endothelium-denuded aortas from nSTZ rats to norepinephrine and serotonin were enhanced compared to controls. Endothelium-mediated relaxation of aortas from these animals to acetylcholine was also augmented, and this effect was linked to NO release. Although norepinephrine did not elicit enhancement of aortic contraction in calcium-free medium in 6-month-old nSTZ rats, the responses to both maximum and submaximum concentrations of the agonist after readdition of calcium were greater in these tissues than in control preparations. Pretreatment of aortas with calphostin C eliminated the difference in NE-induced contraction between the control and experimental groups. Although the concentration-response curves for phorbol 12,13-dibutyrate were not different between the 2 groups, the responses of the aortas from 6-month-old nSTZ rats to a submaximum concentration of the phorbol ester were enhanced relative to controls, and this enhancement was normalized with calphostin C. Overall, the data suggest that glucose-intolerance of sufficient duration causes increases in vascular reactivity to agonists. While these findings warrant further investigations, such vascular alterations during the prediabetes stage of glucose intolerance can be a predisposing factor for the eventual development of cardiovascular complications.

Impact of glucagon response on postprandial hyperglycemia in men with impaired glucose tolerance and type 2 diabetes mellitus

Glucagon is the physiological antagonist of insulin. Postprandial (pp) hyperglycemia in impaired glucose tolerance (IGT) and in type 2 diabetes mellitus (T2DM) may also depend on irregularities in glucagon secretion. This study investigated the glucagon excursion after a lipid-glucose-protein tolerance test in subjects with different stages of glucose intolerance. We also analyzed the relationship between pp glucagon secretion and hyperglycemias. A total of 64 men (27 healthy subjects with normal glucose tolerance [NGT], 15 with IGT, and 22 with T2DM) were examined. Plasma glucose (PG), insulin, proinsulin, free fatty acids, and triglycerides were measured in the fasting state and at 30 minutes and 2, 3, 4, and 6 hours after the intake of the test meal, which contained 126 g carbohydrates, 92 g fat, and 17 g protein. Postprandial concentrations of metabolic parameters were calculated as area under the curve (AUC). Glucagon was measured in the fasting state and at 30 minutes and 2 and 4 hours pp. Early glucagon increment was defined as glucagon at 30 minutes minus fasting glucagon. The insulin response was quantified as insulin increment divided by PG increment in the corresponding time. Insulin resistance was calculated using lomeostasis model assessment (HOMA). Fasting glucagon was significantly increased in IGT vs NGT ( P < .05), and early glucagon increment was significantly higher in T2DM vs NGT and IGT ( P < .05). The 2-hour glucagon concentration after the load (AUC) was increased in IGT and T2DM vs NGT ( P < .05). Early glucagon increment and the 2-hour AUC of glucagon were strongly correlated to pp glycemia ( r = 0.494 and P = .001, and r = 0.439 and P = .003, respectively). An inverse correlation was observed between early glucagon increment and insulin response at 30 minutes and 2 hours after the meal load ( r = −0.287 and P = .026, and r = −0.435 and P = .001, respectively). The 2-hour AUC of glucagon was significantly associated with insulin resistance ( r = 0.354, P = .020). Multivariate analysis revealed 2-hour insulin response and early glucagon increment as significant independent determinants of the AUC of PG in IGT ( R = 0.787). In T2DM, 2-hour insulin response, insulin resistance, and early glucagon increment were significant determinants of the AUC of PG ( R = 0.867). Our study suggests an important role for the irregularities in glucagon response in the pp glucose excursion after a standardized oral mixed meal in IGT and in T2DM. According to our data, a bihormonal imbalance starts before diabetes is diagnosed. Prospective studies are needed to evaluate the impact of glucagon on the progression of glucose intolerance and the possible effects of medicinal suppression of glucagon increment to prevent the progression of glucose tolerance.

Increasing prevalence of Type 2 diabetes mellitus in all ethnic groups in Mauritius

To describe the prevalence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. Population-based surveys were undertaken in the multiethnic nation of Mauritius in 1987, 1992 and 1998, with 5083, 6616, and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Subjects aged between 25 and 75 years with classifiable data were identified; 4991, 6463 and 5392 from 1987, 1992 and 1998, respectively. Glucose tolerance was classified according to WHO 1999 criteria. The prevalence of Type 2 diabetes increased significantly during the period studied, from 12.8% in 1987, to 15.2% in 1992, and 17.9% in 1998. The increasing prevalence was seen in both men and women, and in all age groups. The prevalence of known diabetes (KDM) increased progressively, and more markedly than the increase in newly diagnosed diabetes (NDM). A diagnosis of impaired glucose tolerance (IGT) was more prevalent amongst women whereas impaired fasting glucose (IFG) was more common amongst men. The prevalences of IGT and IFG did not change markedly during the period. The prevalence of diabetes and IGT was similar for participants of Indian, Creole and Chinese background in each survey, and the increasing prevalence of diabetes was seen in all ethnic groups. In this study, we report an increasing prevalence of diabetes over an 11-year period in Mauritius. This increase was seen in both sexes, and in all age and ethnic groups, and was mainly due to an increase in the numbers of those with known diabetes.

High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius.

To describe the incidence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. RESEARCH DESIGN, METHODS AND SUBJECTS: Population-based surveys were undertaken in the multi-ethnic nation of Mauritius in 1987, 1992 and 1998 with 5083, 6616 and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Three cohorts aged between 25 and 79 years with classifiable glucose tolerance data were identified; 3680 between 1987 and 1992, 4178 between 1992 and 1998, and 2631 between 1987 and 1998. Glucose tolerance was classified according to WHO 1999 criteria. The incidence rate of type 2 diabetes was higher between 1992 and 1998 than between 1987 and 1992. In men, the incidence was similar between cohorts (24.5 and 25.4 per 1000 person-years) whereas the incidence increased in women (23.3 and 16.4 per 1000 person-years). The incidence of diabetes peaked in the 45-54 year age group and then plateaued or fell. The incidences of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) decreased in both men and women. Of normoglycaemic subjects at baseline, more women than men developed IGT and more men than women developed IFG. Of those labelled as IFG in 1987, 38% developed diabetes after 11 years. The corresponding figure for IGT was 46%. In this study, we report changes in incidence rates of glucose intolerance over a 11-year period. In particular, differences between men and women were observed. The increased incidence of IGT in women compared with men, and increased incidence of IFG in men compared with women was consistent with, and explains the sex biases seen in the prevalences of these states.