Prediabetes: Beyond the Borderline

The interplay between vitamin D status, subclinical inflammation, and prediabetes

Vitamin D's role extends beyond classical calcium and phosphate homeostasis to encompass a pivotal influence on immune modulation and metabolic health. The mechanisms by which vitamin D exerts these effects involve its conversion to hormonally active calcitriol, which binds intracellular vitamin D receptors, initiating various downstream cascades. In this review, we tease out the evidence showing the relationship between vitamin D deficiency and prediabetes within the context of subclinical inflammation, with a special focus on the novel monocyte-to-HDL ratio (MHR), a novel inflammatory marker reflecting subclinical inflammation. This was based on a thorough literature review using reputable databases covering the period from 1980 to 2024. In light of this, we discuss calcitriol's anti-inflammatory effects and consequently link vitamin D deficiency to both overt and subclinical inflammation. Additionally, the utility of several biomarkers, notably MHR, in investigating this association is also discussed. We further reviewed the role of vitamin D deficiency in precipitating prediabetes and type 2 diabetes mellitus (T2DM) via insulin resistance, decreased insulin synthesis and secretion, and subclinical inflammation. Taken together, this mini review highlights that vitamin D deficiency is significantly associated with subclinical inflammation, playing a critical role in the development of prediabetes and the progression to T2DM. Addressing vitamin D deficiency through appropriate interventions may serve as a preventative measure against the development of prediabetes and T2DM.

Association Between Prediabetes and Risk, Mortality of Hepatocellular Carcinoma: A Meta-Analysis

BACKGROUND

As the high-risk stage of diabetes, the role of prediabetes in the development of hepatocellular carcinoma (HCC) remains unclear. To address this knowledge gap, we undertook a meta-analysis to investigate the potential association between the prediabetic stage and HCC.

METHODS

In this study, two independent investigators conducted a comprehensive search for relevant articles published up until May 2023 in several databases, including PubMed, Web of Science, Medline, EMBASE, and Google Scholar. The results were then summarized using STATA 12.0 software.

RESULTS

Our analysis included a total of 6 cohort studies involving 1,490,752 participants, as well as 1 case-control study with 220 participants. The research aimed to examine the association between prediabetes and the risk of HCC. Our meta-analysis revealed that prediabetes was significantly associated with an elevated risk of HCC (odds ratio (OR)/relative risk (RR) = 1.25, 95% confidence interval (CI) 1.06 to 1.48, I2 = 57.2%, p = 0.012), using a random-effects model. Moreover, four cohort studies, encompassing 1,362,847 participants, explored the relationship between prediabetes and HCC mortality. The meta-analysis showed that prediabetes was associated with a higher mortality rate of HCC, also utilizing a random-effects model (hazard ratio (HR) = 1.36, 95% CI 1.02 to 1.81, I2 = 55.8%, p = 0.060).

CONCLUSIONS

Overall, our findings highlight a significant association between prediabetes and an increased risk of HCC and suggest that prediabetes may also contribute to higher mortality rates among HCC patients.

Combined association of abdominal obesity and depressive symptoms with risk of type 2 diabetes: A cohort study

OBJECTIVE

To explore the combined effect of abdominal obesity and depressive symptoms on the risk to type 2 diabetes, while also assessing the potential influence of various glycemic states and gender on this combined relationship.

METHODS

Data is acquired from the China Health and Retirement Longitudinal Study, and 5949 participants were included for analysis. Participants were divided into four groups: neither have abdominal obesity nor depressive symptoms (AO-/DS-), only have depressive symptoms (AO-/DS+), only have abdominal obesity (AO+/DS-), and have both abdominal obesity and depressive symptoms (AO+/DS+). Stratified analyses differentiating the glycemic statuses and sex of the participants were also carried out.

RESULTS

After adjusting for the confounders, the AO-/DS+, AO+/DS- and AO+/DS+ phenotypes were all discovered to be risk factors for type 2 diabetes (OR = 1.38, 95%CI: 1.06-1.79; OR = 2.07, 95%CI: 1.63-2.63; OR = 2.38, 95%CI: 1.83-3.11, respectively) compared with the AO-/DS- phenotype in the overall population. In further stratified analyses, we arrived at the same conclusion for normoglycemic individuals, especially in females. For prediabetes and males, the AO+/DS- and AO+/DS+ phenotypes are risk factors for type 2 diabetes compared with the AO-/DS- phenotype, but not with AO-/DS+.

CONCLUSION

Regardless of glycemic status and sex, the coexistence of abdominal obesity and depressive symptoms were associated with an increased risk of type 2 diabetes. Depressive symptoms were independent risk factors for type 2 diabetes only in normoglycemic individuals and females.

Obesity Associated with Prediabetes Increases the Risk of Breast Cancer Development and Progression-A Study on an Obese Rat Model with Impaired Glucose Tolerance

Patients with comorbidities of obesity and diabetes are recognized to be at high risk of breast cancer development and face worse breast cancer outcomes. Though several reports showed the reinforced link between obesity, diabetes, and prediabetes with breast cancer, the underlying molecular mechanisms are still unknown. The present study aimed to investigate the underlying molecular link between increased risks of breast cancer due to coincident diabetes or obesity using a spontaneous obese rat model with impaired glucose tolerance (WNIN/GR-Ob rat). A single dose of solubilized DMBA suspension (40 mg/kg body weight) was orally administered to the animals at the age of 60 days to induce breast tumors. The tumor incidence, latency period, tumor frequency, and tumor volume were measured. Histology, immunohistochemistry, and immunoblotting were performed to evaluate the tumor morphology and expression levels of signal molecules. The development of mammary tumors in GR-Ob rats was characterized by early onset and shorter latency periods compared to control lean rats. While 62% of obese rats developed breast tumors, tumor development in lean rats was only 21%. Overexpression of ER, PR, Ki67, and p53 markers was observed in tumor tissues of obese rats in comparison with lean rats. The levels of the hallmarks of cell proliferation and angiogenesis involved in IGF-1/PI3K/Akt/GSK3β/β-catenin signaling pathway molecules were upregulated in obese rat breast tumors compared to lean rats. Furthermore, obesity with prediabetes is associated with changes in IGF-1 signaling and acts on PI3K/Akt/GSK3β/β-catenin signaling, which results in rapid cell proliferation and development of breast tumors in obese rats than the lean rats. These results indicate that tumor onset and development were faster in spontaneous obese rat models with impaired glucose tolerance than in their lean counterparts.

Association between METS-IR and Prediabetes or Type 2 Diabetes Mellitus among Elderly Subjects in China: A Large-Scale Population-Based Study

The metabolic score for insulin resistance (METS-IR) was recently proposed as a non-insulin-based, novel index for assessing insulin resistance (IR) in the Western population. However, evidence for the link between METS-IR and prediabetes or type 2 diabetes mellitus (T2DM) among the elderly Chinese population was still limited. We aimed to investigate the associations between METS-IR and prediabetes or T2DM based on large-scale, cross-sectional, routine physical examination data. In a total of 18,112 primary care service users, an increased METS-IR was independently associated with a higher prevalence of prediabetes (adjusted odds ratio [aOR] = 1.457, 95% confidence interval [CI]: 1.343 to 1.581, p < 0.001) and T2DM (aOR = 1.804, 95%CI: 1.720 to 1.891, p < 0.001), respectively. The aOR for prediabetes in subjects with the highest quartile of METS-IR was 3.060-fold higher than that in those with the lowest quartile of METS-IR. The aOR for T2DM in subjects with the highest quartile of METS-IR was 6.226-fold higher than that in those with the lowest quartile of METS-IR. Consistent results were obtained in subgroup analyses. Our results suggested that METS-IR was significantly associated with both prediabetes and T2DM. The monitoring of METS-IR may add value to early identification of individuals at risk for glucose metabolism disorders in primary care.

New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

This review highlights oral anomalies with major clinical impact in Addison disease (AD), including dental health and dermatologic features, through a dual perspective: pigmentation issues and AD comorbidities with oral manifestations. Affecting 92% of AD patients, cutaneomucosal hyperpigmentation is synchronous with or precedes general manifestations by up to a decade, underlying melanocytic infiltration of the basal epidermal layer; melanophages in the superficial dermis; and, rarely, acanthosis, perivascular lymphocytic infiltrate, and hyperkeratosis. Intraoral pigmentation might be the only sign of AD; thus, early recognition is mandatory, and biopsy is helpful in selected cases. The buccal area is the most affected location; other sites are palatine arches, lips, gums, and tongue. Pigmented oral lesions are patchy or diffuse; mostly asymptomatic; and occasionally accompanied by pain, itchiness, and burn-like lesions. Pigmented lingual patches are isolated or multiple, located on dorsal and lateral areas; fungiform pigmented papillae are also reported in AD individuals. Dermoscopy examination is particularly indicated for fungal etiology; yet, it is not routinely performed. AD’s comorbidity burden includes the cluster of autoimmune polyglandular syndrome (APS) type 1 underlying AIRE gene malfunction. Chronic cutaneomucosal candidiasis (CMC), including oral CMC, represents the first sign of APS1 in 70–80% of cases, displaying autoantibodies against interleukin (IL)-17A, IL-17F ± IL-22, and probably a high mucosal concentration of interferon (IFN)-γ. CMC is prone to systemic candidiasis, representing a procarcinogenic status due to Th17 cell anomalies. In APS1, the first cause of mortality is infections (24%), followed by oral and esophageal cancers (15%). Autoimmune hypoparathyroidism (HyP) is the earliest endocrine element in APS1; a combination of CMC by the age of 5 years and dental enamel hypoplasia (the most frequent dental complication of pediatric HyP) by the age of 15 is an indication for HyP assessment. Children with HyP might experience short dental roots, enamel opacities, hypodontia, and eruption dysfunctions. Copresence of APS-related type 1 diabetes mellitus (DM) enhances the risk of CMC, as well as periodontal disease (PD). Anemia-related mucosal pallor is related to DM, hypothyroidism, hypogonadism, corresponding gastroenterological diseases (Crohn’s disease also presents oral ulceration (OU), mucogingivitis, and a 2–3 times higher risk of PD; Biermer anemia might cause hyperpigmentation by itself), and rheumatologic diseases (lupus induces OU, honeycomb plaques, keratotic plaques, angular cheilitis, buccal petechial lesions, and PD). In more than half of the patients, associated vitiligo involves depigmentation of oral mucosa at different levels (palatal, gingival, alveolar, buccal mucosa, and lips). Celiac disease may manifest xerostomia, dry lips, OU, sialadenitis, recurrent aphthous stomatitis and dental enamel defects in children, a higher prevalence of caries and dentin sensitivity, and gingival bleeding. Oral pigmented lesions might provide a useful index of suspicion for AD in apparently healthy individuals, and thus an adrenocorticotropic hormone (ACTH) stimulation is useful. The spectrum of autoimmune AD comorbidities massively complicates the overall picture of oral manifestations.

Low molecular weight NGF mimetic GK-2 normalizes the parameters of glucose and lipid metabolism and exhibits a hepatoprotective effect on a prediabetes model in obese Wistar rats

Signs of metabolic syndrome and prediabetes preceding type 2 diabetes are modelled in an experiment using a high-fat diet (HFD). The aim of this work was to study the effect of a low molecular weight systemically active nerve growth factor mimetic, compound GK-2 (hexamethylenediamide bis(N-monosuccinyl-L-glutamyl-L-lysine)), on indicators of abdominal obesity, basal blood glucose level, glucose tolerance, cholesterol and triglyceride blood levels, as well as the morphological structure of the liver in male Wistar rats fed a HFD. Rats were divided into three groups: one of them received standard food (control) and two others were fed a HFD containing 45% fat, 35% carbohydrates and 20% protein, with a total caloric value of 516 kcal/100 g, over 12 weeks. Starting from the 9th week, for the next 4 weeks, one of the HFD groups was treated orally with saline whilst the other group was treated orally with GK-2 at a dose of 5 mg/kg. GK-2 was found to reduce the basal glycemia level and improve glucose tolerance, as well as to reduce the blood level of cholesterol by 30% and that of triglycerides by 28% in comparison with the saline-treated HFD animals. GK-2 reduced the degree of abdominal obesity to the level of the healthy animals and eliminated morphological abnormalities in the liver caused by the HFD. The results of the study determine the feasibility of further GK-2 research as a potential agent for prediabetes treatment.

Influence of the Triglyceride-Glucose Index on Adverse Cardiovascular and Cerebrovascular Events in Prediabetic Patients With Acute Coronary Syndrome

BACKGROUND

Cardiovascular disease and insulin resistance are closely related. The triglyceride-glucose (TyG) index is frequently used as an indicator of insulin resistance. However, there is scant information on the TyG index in the prediabetic population, nor is the prognostic significance of the index known for prediabetes and acute coronary syndrome (ACS) patients.

METHODS

The clinical endpoint was a major adverse cardiovascular and cerebrovascular event (MACCEs), including cardiac-related death, non-fatal myocardial infarction, ischemia-driven revascularization, and stroke. The TyG index was calculated as = ln [(triglyceride level, mg/dL) × (glucose level, mg/dL)÷2] under fasting conditions.

RESULTS

The study included 2,030 prediabetic patients with ACS. Patients were followed up for 2.5 years, during which the total incidence of MACCEs was 12%. After adjustment for covariates, the TyG index was found to be predictive of prediabetes with ACS (HR 4.942, 95%CI: 3.432-6.115, P<0.001). Using propensity score matching, 574 pairs were successfully matched, and the two groups were analyzed in terms of survival. This showed that there was a significantly greater incidence of MACCEs in patients with high TyG indices (HR 3.526, 95%CI: 2.618-4.749, P<0.001), mainly due to ischemia-driven revascularization and stroke.

CONCLUSIONS

The TyG index independently predicts future MACCEs and may be an important prognostic indicator for patients with prediabetes and ACS.

Replication of Integrative Data Analysis for Adipose Tissue Dysfunction, Low-Grade Inflammation, Postprandial Responses and OMICs Signatures in Symptom-Free Adults

We previously reported preliminary characterization of adipose tissue (AT) dysfunction through the adiponectin/leptin ratio (ALR) and fasting/postprandial (F/P) gene expression in subcutaneous (SQ) adipose tissue (AT) biopsies obtained from participants in the GEMM study, a precision medicine research project. Here we present integrative data replication of previous findings from an increased number of GEMM symptom-free (SF) adults (N = 124) to improve characterization of early biomarkers for cardiovascular (CV)/immunometabolic risk in SF adults with AT dysfunction. We achieved this goal by taking advantage of the rich set of GEMM F/P 5 h time course data and three tissue samples collected at the same time and frequency on each adult participant (F/P blood, biopsies of SQAT and skeletal muscle (SKM)). We classified them with the presence/absence of AT dysfunction: low (<1) or high (>1) ALR. We also examined the presence of metabolically healthy (MH)/unhealthy (MUH) individuals through low-grade chronic subclinical inflammation (high sensitivity C-reactive protein (hsCRP)), whole body insulin sensitivity (Matsuda Index) and Metabolic Syndrome criteria in people with/without AT dysfunction. Molecular data directly measured from three tissues in a subset of participants allowed fine-scale multi-OMIC profiling of individual postprandial responses (RNA-seq in SKM and SQAT, miRNA from plasma exosomes and shotgun lipidomics in blood). Dynamic postprandial immunometabolic molecular endophenotypes were obtained to move towards a personalized, patient-defined medicine. This study offers an example of integrative translational research, which applies bench-to-bedside research to clinical medicine. Our F/P study design has the potential to characterize CV/immunometabolic early risk detection in support of precision medicine and discovery in SF individuals.

Behavioral, neuroplasticity and metabolic effects of 7,8-dihydroxy-4-methylcoumarin associated with physical activity in mice

The search for strategies to develop resilience against metabolic and neuropsychiatric disorders has motivated the clinical and experimental assessment of early life interventions such as lifestyle-based and use of unconventional pharmacological compounds. In this study, we assessed the effects of voluntary physical activity and 7,8-Dihydroxy-4-methylcoumarin (DHMC), independently or in combination, over mice physiological and behavioral parameters, adult hippocampal and hypothalamic neurogenesis, and neurotrophic factors expression in the hypothalamus. C57Bl/6J mice were submitted to a 29-day treatment with DHMC and allowed free access to a running wheel. We found that DHMC treatment alone reduced fasting blood glucose levels. Moreover, physical activity showed an anxiolytic effect in the elevated plus maze task and DHMC produced additional anxiolytic behavior, evidenced by reduced activity during the light cycle in the physical activity group. Although we did not find any differences in hypothalamic or hippocampal adult neurogenesis, DHMC increased gene expression levels of VEGF, which was correlated to the reduced fasting glucose levels. In conclusion, our data emphasize the potential of physical activity in reducing development of neuropsychiatric conditions, such as anxiety, and highlights DHMC as an attractive compound to be investigated in future studies addressing neuropsychiatric disorders associated with metabolic conditions.

Blueberry Counteracts Prediabetes in a Hypercaloric Diet-Induced Rat Model and Rescues Hepatic Mitochondrial Bioenergetics

The paramount importance of a healthy diet in the prevention of type 2 diabetes is now well recognized. Blueberries (BBs) have been described as attractive functional fruits for this purpose. This study aimed to elucidate the cellular and molecular mechanisms pertaining to the protective impact of blueberry juice (BJ) on prediabetes. Using a hypercaloric diet-induced prediabetic rat model, we evaluated the effects of BJ on glucose, insulin, and lipid profiles; gut microbiota composition; intestinal barrier integrity; and metabolic endotoxemia, as well as on hepatic metabolic surrogates, including several related to mitochondria bioenergetics. BJ supplementation for 14 weeks counteracted diet-evoked metabolic deregulation, improving glucose tolerance, insulin sensitivity, and hypertriglyceridemia, along with systemic and hepatic antioxidant properties, without a significant impact on the gut microbiota composition and related mechanisms. In addition, BJ treatment effectively alleviated hepatic steatosis and mitochondrial dysfunction observed in the prediabetic animals, as suggested by the amelioration of bioenergetics parameters and key targets of inflammation, insulin signaling, ketogenesis, and fatty acids oxidation. In conclusion, the beneficial metabolic impact of BJ in prediabetes may be mainly explained by the rescue of hepatic mitochondrial bioenergetics. These findings pave the way to support the use of BJ in prediabetes to prevent diabetes and its complications.

Hemoglobin A1c in combination with fasting plasma glucose trumps fasting plasma glucose alone as predictive indicators for diabetes mellitus: an ambidirectional cohort study of Thai people with impaired fasting glucose

INTRODUCTION

This ambidirectional cohort study aimed to assess the performance of combining hemoglobin A1c (HbA1c) to fasting plasma glucose (FPG) for estimation of progression rate to diabetes mellitus (DM) and to explore the risk factors of DM in patients with impaired fasting glucose (IFG).

RESEARCH DESIGN AND METHODS

Patients with IFG were eligible for this study. IFG was defined as FPG of 100-125 mg/dL. Progression rates to DM were estimated using Kaplan-Meier analysis. Risk factors of DM were explored by Cox regression analysis.

RESULTS

3011 patients were enrolled with median follow-up time of 8 years (range: 6 months-29 years). Progression rates to DM in patients with FPG 100-109 mg/dL and 110-125 mg/dL were 2.64 and 4.79 per 100 person-years. After adjusting covariables, compared with patients with FPG 100-109 mg/dL plus normal HbA1c (<5.7%), hazard ratios (95% CI) of patients with FPG 110-125 plus normal HbA1c, FBG 100-109 plus abnormal HbA1c (5.7%-6.49%), and FPG 110-125 plus abnormal HbA1c were 5.89 (2.37 to 14.63), 16.30 (8.59 to 30.92), and 33.84 (16.41 to 69.78), respectively. Body mass index ≥27.5 kg/m², serum triglyceride level ≥150 mg/dL, family history of DM, and low level of high-density lipoprotein-cholesterol were independently associated with risk of DM in patients with IFG.

CONCLUSIONS

Patients with both IFG and abnormal HbA1c had higher risk of DM than patients with IFG alone. Therefore, performing HbA1c in combination with FPG helps to identify subgroups of people with IFG at highest risk of DM. These patients should have the highest priority in diabetes prevention programs, especially in countries with low and limited resources.

miRNAs as biomarkers for diagnosis of type 2 diabetes: A systematic review

BACKGROUND

This systematic review summarizes results of studies that evaluated the expression of microRNAs (miRs) in prediabetes or type 2 diabetes (T2D).

METHODS

The information was obtained from PubMed, EMBL-EBI, Wanfang, Trip Database, Lilacs, CINAHL, Human microRNA Disease Database (HMDD) v3.0, and Google. A qualitative synthesis of the results was performed and miRs frequency was graphically represented. From 1893 identified studies, only 55 fulfilled the inclusion criteria. These 55 studies analyzed miRs in T2D, and of them, 13 also described data of prediabetes.

RESULTS

In diabetics, 122 miRs were reported and 35 miRs for prediabetics. However, we identified that five miRs (-122-5p, 144-3p, 210, 375, and -126b) were reported more often in diabetics and four (144-3p, -192, 29a, and -30d) in prediabetics.

CONCLUSIONS

Circulating miRs could be used as biomarkers of T2D. However, it is necessary to validate these microRNAs in prospective and multicenter studies with different population subgroups, considering age, gender, and risk factors.

Application of machine learning algorithm for predicting gestational diabetes mellitus in early pregnancy†

Objective

To study the application of a machine learning algorithm for predicting gestational diabetes mellitus (GDM) in early pregnancy.

Methods

This study identified indicators related to GDM through a literature review and expert discussion. Pregnant women who had attended medical institutions for an antenatal examination from November 2017 to August 2018 were selected for analysis, and the collected indicators were retrospectively analyzed. Based on Python, the indicators were classified and modeled using a random forest regression algorithm, and the performance of the prediction model was analyzed.

Results

We obtained 4806 analyzable data from 1625 pregnant women. Among these, 3265 samples with all 67 indicators were used to establish data set F1; 4806 samples with 38 identical indicators were used to establish data set F2. Each of F1 and F2 was used for training the random forest algorithm. The overall predictive accuracy of the F1 model was 93.10%, area under the receiver operating characteristic curve (AUC) was 0.66, and the predictive accuracy of GDM-positive cases was 37.10%. The corresponding values for the F2 model were 88.70%, 0.87, and 79.44%. The results thus showed that the F2 prediction model performed better than the F1 model. To explore the impact of sacrificial indicators on GDM prediction, the F3 data set was established using 3265 samples (F1) with 38 indicators (F2). After training, the overall predictive accuracy of the F3 model was 91.60%, AUC was 0.58, and the predictive accuracy of positive cases was 15.85%.

Conclusions

In this study, a model for predicting GDM with several input variables (e.g., physical examination, past history, personal history, family history, and laboratory indicators) was established using a random forest regression algorithm. The trained prediction model exhibited a good performance and is valuable as a reference for predicting GDM in women at an early stage of pregnancy. In addition, there are certain requirements for the proportions of negative and positive cases in sample data sets when the random forest algorithm is applied to the early prediction of GDM.

Occupational Noise Exposure and Incidence of High Fasting Blood Glucose: A 3-Year, Multicenter, Retrospective Study

The role of hazardous occupational noise exposure on the development of prediabetes is not well researched. We aimed to elucidate exposure to hazardous occupational noise as an independent risk factor for high fasting blood glucose (FBG). Participants exposed/non-exposed to occupational noise were recruited from the Common Data Model cohorts of 2013/2014 from two centers and were followed-up for 3 years. Multivariate time-dependent Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) and were adjusted for various covariates. Pooled HRs were calculated. Among the 43,858 participants of this retrospective cohort study, 37.64% developed high FBG. The mean (standard deviation) age in the cohort was 40.91 (9.71) years. In the fully adjusted models, the HRs of high FBG in the two centers were 1.35 (95% CI: 1.24-1.48) and 1.22 (95% CI: 1.17-1.28), and the pooled HR was 1.28 (95% CI: 1.16-1.41). A Kaplan-Meier plot of high FBG incidence by occupational noise exposure showed significant results (p < 0.001). We found that occupational noise exposure is significantly associated with high FBG. Preventing exposure to hazardous noise in the work environment may help reduce the risk for prediabetes among workers.

Association of a Self-Paid Medically Supervised Weight Management Program with Reversal of Obesity-Associated Impaired Fasting Glucose

Aims: The progression of prediabetes to T2DM can be delayed through diet modification and weight management. However, the intensive lifestyle program is often not covered by medical insurance. This retrospective analysis evaluates the association of a patient self-paid weight management program on an improvement of blood sugar in overweight and obese patients with impaired fasting glucose (IFG). Methods: The medical records of 4634 patients who participated in the self-pay UCLA Weight Management Program were reviewed and 2572 patients met the criteria for this retrospective analysis to examine whether this program was associated with the reversal of IFG over 3 months among 1396 patients with normal fasting glucose (NFG) and 1176 with IFG. Results: The patients with IFG lost comparable amounts of weight (10.5 ± 1.3 kg) at three months, as did the subjects with NFG (10.1 ± 1.3 kg). Fasting blood glucose in the IFG group decreased from 108.49 ± 6.4 to 101.8 ± 9.41 mg/dL (p < 0.0001) after three months. There were also significant reductions in triglycerides, and both systolic and diastolic blood pressure in both groups in association with weight loss. Conclusion: Our medically supervised self-pay multidisciplinary weight management program was associated with reduced fasting blood glucose levels in patients with IFG over three months with comparable weight loss to patients with NFG.

Simple risk score to screen for prediabetes: A cross-sectional study from the Qatar Biobank cohort

AIMS/INTRODUCTION

The progression from prediabetes to type 2 diabetes is preventable by lifestyle intervention and/or pharmacotherapy in a large fraction of individuals with prediabetes. Our objective was to develop a risk score to screen for prediabetes in the Middle East, where diabetes prevalence is one of the highest in the world.

MATERIALS AND METHODS

In this cross-sectional, case-control study, we used data of 4,895 controls and 2,373 prediabetic adults obtained from the Qatar Biobank cohort. Significant risk factors were identified by logistic regression and other machine learning methods. The receiver operating characteristic was used to calculate the area under curve, cut-off point, sensitivity, specificity, positive and negative predictive values. The prediabetes risk score was developed from data of Qatari citizens, as well as long-term (≥15 years) residents.

RESULTS

The significant risk factors for the Prediabetes Risk Score in Qatar were age, sex, body mass index, waist circumference and blood pressure. The risk score ranges from 0 to 45. The area under the curve of the score was 80% (95% confidence interval 78-83%), and the cut-off point of 16 yielded sensitivity and specificity of 86.2% (95% confidence interval 82.7-89.2%) and 57.9% (95% confidence interval 65.5-71.4%), respectively. Prediabetes Risk Score in Qatar performed equally in Qatari nationals and long-term residents.

CONCLUSIONS

Prediabetes Risk Score in Qatar is the first prediabetes screening score developed in a Middle Eastern population. It only uses risk factors measured non-invasively, is simple, cost-effective, and can be easily understood by the general public and health providers. Prediabetes Risk Score in Qatar is an important tool for early detection of prediabetes, and can help tremendously in curbing the diabetes epidemic in the region.

Diet-induced rodent models of obesity-related metabolic disorders-A guide to a translational perspective

Diet is a critical element determining human health and diseases, and unbalanced food habits are major risk factors for the development of obesity and related metabolic disorders. Despite technological and pharmacological advances, as well as intensification of awareness campaigns, the prevalence of metabolic disorders worldwide is still increasing. Thus, novel therapeutic approaches with increased efficacy are urgently required, which often depends on cellular and molecular investigations using robust animal models. In the absence of perfect rodent models, those induced by excessive consumption of fat and sugars better replicate the key aspects that are the root causes of human metabolic diseases. However, the results obtained using these models cannot be directly compared, particularly because of the use of different dietary protocols, and animal species and strains, among other confounding factors. This review article revisits diet-induced models of obesity and related metabolic disorders, namely, metabolic syndrome, prediabetes, diabetes and nonalcoholic fatty liver disease. A critical analysis focused on the main pathophysiological features of rodent models, as opposed to the criteria defined for humans, is provided as a practical guide with a translational perspective for the establishment of animal models of obesity-related metabolic diseases.

Dietary Patterns and the Risk of Prediabetes in Taiwan: A Cross-Sectional Study

Background: prediabetes prevention and management are the main methods used to combat the prevalence of diabetes. Exploratory factor analysis is an upcoming method that is successful in identifying dietary patterns that correlate with healthy or unhealthy outcomes. Aim: this study aims to identify dietary patterns in Taiwan that are associated with the risk of prediabetes. Methods: anthropometric, blood glucose, 3 d/24 h dietary records, and food frequency questionnaire data were collected from subjects recruited at Taipei Tzu-Chi Hospital. The following five dietary patterns were identified using factor analysis: Western, prudent, convenience, Asian traditional, and continental. This cross-sectional study compares tertiles of dietary patterns and analyzes the significance of the characteristics. Results: the Western and the prudent patterns are the major dietary patterns found in other studies. A higher factor loading in the Western pattern is significantly related to a higher risk of prediabetes. A higher factor loading in the continental pattern is significantly related to a lower risk of prediabetes. Conclusion: decreasing meat and seafood consumption while increasing egg, coffee, and milk consumption may be associated with a decreased risk for prediabetes.

Efficacy of metformin in preventing progression to diabetes in a Chinese population with impaired glucose regulation: Protocol for a multicentre, open-label, randomized controlled clinical study

AIM

To investigate the effectiveness of metformin in delaying or preventing progression to diabetes in a Chinese population with impaired glucose regulation (IGR).

MATERIALS AND METHODS

This multicentre, randomized, open-label, controlled study (NCT03441750) will assess the efficacy of metformin in preventing diabetes over ≥2 years. Eligible participants will be randomly assigned (1:1) to lifestyle intervention (LSI) or metformin plus LSI, with stratification based on blood pressure, anti-hypertensive medication use and isolated/non-isolated impaired fasting glucose. All participants will receive LSI advice. Participants in the metformin plus LSI group will receive metformin 850 mg once daily for the first 2 weeks, and twice daily thereafter, according to tolerability.

RESULTS

The primary objective is to compare rates of newly diagnosed diabetes in the two intervention groups. Changes in glycaemia, blood pressure, body weight, insulin resistance, and safety outcomes will also be evaluated.

CONCLUSIONS

This large clinical trial in a Chinese population with IGR aims to provide critical information to guide clinical decision-making in order to alleviate the current diabetes epidemic.

Obstructive Sleep Apnea Exacerbates Glucose Dysmetabolism and Pancreatic β-Cell Dysfunction in Overweight and Obese Nondiabetic Young Adults

PURPOSE

This study aimed to investigate the effects of obstructive sleep apnea (OSA) on the pancreatic β-cells dysfunction and their implications in the glucose dysmetabolism of overweight and obese nondiabetic young adults.

MATERIALS AND METHODS

The cross-sectional analysis included 422 subjects (261 males/161 females) with the mean age of 27.77 ± 7.51 years and average body mass index (BMI) of 34.84 ± 5.69 kg/m². All subjects underwent polysomnography (PSG), oral glucose tolerance-insulin releasing test (OGTT-IRT) and serum glycosylated hemoglobin A1 (HbA1c) measurement. The glucose metabolism and pancreatic β-cell function in relation to measures of OSA were determined adjustment for important confounders such as age and sex.

RESULTS

OSA subjects accounted for 54.91% in the normal glucose tolerance (NGT) group and 72.11% in the prediabetes (preDM) group (P =0.001). HbA1c was the highest in the preDM subjects with severe OSA. In the NGT subjects, the 1-h glucose level significantly elevated with the OSA severity, and the homeostasis model assessment-β (HOMA-β) was negatively related to nocturnal mean SpO₂ (P <0.05). In the preDM subjects, HOMA-β, early phase insulinogenic index (∆I₃₀/∆G₃₀), total area under the curve of insulin in 180 min (AUC-I₁₈₀), and the oral disposition index (DI_O) were the lowest in the severe OSA group. DI_O was associated with higher oxygen desaturation index (ODI) and lower nocturnal mean SpO₂, and AUC-I₁₈₀ was negatively related to TS90 (P <0.05).

CONCLUSION

Our study indicated higher prevalence of OSA in overweight and obese nondiabetic young adults, especially preDM subjects. The impaired glucose tolerance was observed early after glucose intake in the NGT subjects. OSA induces compensatory increase in the pancreatic β-cell function in the NGT subjects, while pancreatic β-cell dysfunction is present in the preDM subjects with severe OSA.

The Natural Course of Impaired Fasting Glucose

Impaired glucose regulation, including diabetes and prediabetes, poses a huge global problem not only in health but also in the epidemiological and economic areas. These disorders are often detected too late or remain unrecognized. The article aims to provide a review of the prevalence, etiology, and natural history of impaired fasting glucose (IFG). We focus on the progression of isolated IFG to full-fledged type 2 diabetes and the factors conducive to the development of diabetes. The knowledge about it could help design an optimal management program for the prevention of diabetes in patients with IFG; a program that would be patient-tailored and based on the underlying pathophysiology.

Obesity- and Lipid-Related Parameters in the Identification of Older Adults with a High Risk of Prediabetes According to the American Diabetes Association: An Analysis of the 2015 Health, Well-Being, and Aging Study

This study evaluated the predictive ability of 11 obesity- and lipid-related parameters, including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), body roundness index (BRI), "A" body-shape index (ABSI), conicity index (CI), visceral adiposity index (VAI), triglyceride-to-glucose fasting index (TyG), triglyceride-to-glucose fasting related to BMI (TyG-BMI), triglyceride-to-glucose fasting related to WC (TyG-WC), and triglyceride-to-glucose fasting related to WtHR (TyG-WtHR), to identify patients from an elderly Colombian population with a high risk of prediabetes according to the 2016 American Diabetes Association criteria. The data were obtained from the 2015 Colombian Health and Wellbeing and Aging Survey. A total of 3307 elderly Colombian individuals (aged over 60 years) were included. Anthropometric data, fasting plasma glucose, blood lipid profiles, family history, and health-related behaviors were assessed, and prediabetes was defined as a fasting plasma glucose of 100 to 125 mg/dL. The areas under the receiver operating characteristic (ROC) curves (AUCs) were calculated for each anthropometric indicator, using the prediabetes classification to identify their sensitivity and specificity, and these indicated that the prevalence of prediabetes was 25.3% in this population. After adjusting for potential confounding factors, the TyG index was strongly associated with the odds of having prediabetes in both sexes, and multivariate logistic regression analysis showed that the ORs for prediabetes increased across quartiles (p < 0.001). The TyG index was best able to identify prediabetes in either sex (AUC and optimal cut-off = 0.700 and 8.72, and 0.695 and 8.92 for men and women, respectively), suggesting that compared to the other parameters, the TyG index has the best discriminative power to predict prediabetes in the whole population. Thus, we propose the TyG index be used as a complementary marker for assessing prediabetes in older adults.

Metabolic effects of α-lipoic acid supplementation in pre-diabetics: a randomized, placebo-controlled pilot study

Supplementation of health promoting nutraceuticals may be an effective adjunct strategy with other lifestyle and drug approaches to impede disease progression in prediabetic subjects. α-Lipoic acid, a naturally occurring short-chain fatty acid, has been extensively evaluated for its antioxidant and glycemic control properties but has rarely been investigated as a lipid-lowering strategy. We conducted a pilot study to examine the effects of α-lipoic acid supplementation on glycemic control and lipid profile in pre-diabetic, overweight/obese adults. The study was designed as a free-living, randomized, two-phase, placebo-controlled cross-over study with 12 pre-diabetic, dyslipidemic subjects. Eligible subjects completed two thirty-day phases (in random order) consisting of a placebo (600 mg cellulose per day) and α-lipoic acid treatment (600 mg day^-1). Although no change (p < 0.05) in serum glucose was observed, α-lipoic acid-supplemented subjects demonstrated reduced fasting serum insulin (p = 0.04) and HOMA-IR (p = 0.07) compared with the placebo group. However, no change (p > 0.05) in serum lipids (including total cholesterol, LDL-C, HDL-C, triglycerides, LDL-C/HDL-C, and TC/HDL-C) were observed. Study results suggest that α-lipoic acid supplementation may be a useful strategy to improve insulin sensitivity in pre-diabetic subjects but is not effective in modulating serum lipids.

Clinical characteristics of patients under 40 years old with early-onset hyperuricaemia: a retrospective monocentric study in China

OBJECTIVE

To investigate the clinical characteristics of patients with early-onset hyperuricaemia (HUC).

METHODS

A retrospective study using data from the Second Affiliated Hospital of Soochow University was conducted. 623 patients with HUC were divided into early-onset group and late-onset group. Another 201 healthy subjects ≤40 years old were regarded as control group. The data of physical measurements and biochemistry test were collected. Clinical data of early-onset group were compared with late-onset group and control group by analysis of variance (ANOVA) and χ² test. Principal component analysis (PCA) was applied. Logistic regression was used to identify the clinical factors correlated with patients with early-onset HUC.

RESULTS

The patients of early-onset group had different body mass index (BMI), serum albumin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), gamma-glutamyltransferase (GGT), creatinine (Cr), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), TG/high density lipoprotein (HDL) ratio, HDL and percentage of males, hypertension (HBP) as well as fatty liver compared with healthy people in the control group. Early-onset group patients had different albumin, ALT, fasting blood glucose, Cr, percentage of males and HBP compared with late-onset group patients. PCA identified four significant patterns including PC1 (labelled 'TG and HDL'), PC2 (labelled 'fatty liver and liver enzymes'), PC3 (labelled 'TC and LDL') and PC4 (labelled 'AKP'). The results of univariate and multivariate logistic regression analysis showed that BMI, HBP and albumin were correlative factors for early onset of HUC when the patients with early-onset and late-onset HUC were involved, while gender, BMI, PC1, PC2 and PC4 were correlative factors for early-onset HUC when the early-onset and control groups were involved.

CONCLUSION

This study described a group of patients with early-onset HUC with distinct clinical features. Gender, BMI, 'TG and HDL', 'fatty liver and liver enzymes' and 'AKP' have higher values than HBP, type 2 diabetes mellitus and 'TC and LDL' in patients under 40 years old with early-onset HUC.

Increased Arterial Stiffness in Prediabetic Subjects Recognized by Hemoglobin A1c with Postprandial Glucose but Not Fasting Glucose Levels

Previous studies exploring the association between arterial stiffness and prediabetes remain controversial. This study aimed to investigate the association of the different domains of prediabetes categorized by glycated hemoglobin A1c (A1c) 5.7–6.4%, impaired fasting glucose (IFG), fasting plasma glucose of 5.6–6.9 mmol/L, and impaired glucose tolerance (IGT), two-hour post-load glucose of 7.8–11.0 mmol/L, on arterial stiffness. These were measured by brachial–ankle pulse-wave velocity (baPWV). We enrolled 4938 eligible subjects and divided them into the following nine groups: (1) normoglycemic; (2) isolated A1c 5.7–6.4%; (3) isolated IFG; (4) IFG with A1c 5.7–6.4%; (5) isolated IGT; (6) combined IGT and IFG with A1c <5.7%; (7) IGT with A1c 5.7–6.4%; (8) combined IGT and IFG with A1c 5.7–6.4%; and (9) newly diagnosed diabetes (NDD). The baPWV values were significantly high in subjects with NDD (β = 47.69, 95% confidence interval (CI) = 29.02–66.37, p < 0.001), those with IGT with A1c 5.7–6.4% (β = 36.02, 95% CI = 19.08–52.95, p < 0.001), and those with combined IGT and IFG with A1c 5.7–6.4% (β = 27.72, 95% CI = 0.68–54.76, p = 0.044), but not in the other subgroups. These findings suggest that increased arterial stiffness was found in prediabetes individuals having an A1c 5.7–6.4% with IGT, but not IFG. Isolated A1c 5.7–6.4% and isolated IGT were not associated with elevated arterial stiffness.

Associations of adiposity and parental diabetes with prediabetes among adolescents in Kuwait: A cross-sectional study

BACKGROUND

Prediabetes, a high-risk state for developing diabetes, has become more prevalent among children and adolescents in recent decades. This study sought to estimate the prevalence of prediabetes and assess its association with adiposity among adolescents in Kuwait. Also, to determine whether maternal and paternal history of diabetes associate with offspring prediabetes in a sex-specific manner.

METHODS

A cross-sectional study was conducted by enrolling students (n = 1959; aged 14-19 years) attending high schools across Kuwait. Body mass index-for-age z-scores were estimated using the World Health Organization growth reference. Glycated hemoglobin A1c (HbA1c) was measured in capillary blood using point-of-care testing. Prediabetes was defined according to the diagnostic criteria of the American Diabetes Association (ADA; 5.7 ≤ HbA1c% ≤ 6.4) and the International Expert Committee (IEC; 6.0 ≤ HbA1c% ≤ 6.4). Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using Poisson regression with robust variance estimation.

RESULTS

According to the ADA criteria, 33.3% (620/1845) of participants had prediabetes; whereas, 8.5% (157/1845) met the IEC definition for prediabetes. Subjects classified as obese had higher prevalence of prediabetes compared to children in the thinness/normal group (aPR = 1.68, 95% CI: 1.44-1.95). Analysis stratified by offspring sex showed that maternal history of diabetes is associated with prediabetes among male offspring (aPR = 1.29, 95% CI: 1.02-1.63). In contrast, paternal history of diabetes showed an association with prediabetes among female offspring (aPR = 1.22, 95% CI: 1.01-1.48).

CONCLUSIONS

Prediabetes affects a substantial proportion of adolescents in Kuwait and adiposity and parental diabetes being the main associated factors with prediabetes.

PREVALENCE AND RISK FACTORS OF IMPAIRED FASTING GLUCOSE AMONG ADULTS IN NORTHEAST CHINA: A CROSS-SECTIONAL STUDY

OBJECTIVE

To investigate the prevalence and risk factors of impaired fasting glucose (IFG) among adults in northeast China.

METHODS

A cross-sectional study was conducted in Jilin Province in 2012. Questionnaires were used to collect information about demographic characteristics, lifestyle factors, and health status from 15,540 residents. Fasting blood glucose (FBG) was measured in the morning after at least 12 hours of fasting, and χ² tests were performed to compare differences between subjects with and without IFG. Logistic regression was carried out to identify factors influencing IFG occurrence.

RESULTS

There were significant differences in demographic characteristics (age, sex, education, and marriage status), lifestyle factors (smoking, drinking, physical activity, and average sleep duration), and health status (hyperlipidemia, hypertension, and BMI category) between subjects with IFG and without IFG ( P<.05). IFG risk was significantly associated with sex, age, education (senior high school and college), marriage status (single), drinking, hyperlipidemia, hypertension, and BMI category (all P<.05).

CONCLUSION

In adults in northeast China, risk factors of IFG are sex, age, education (senior high school and college), drinking, hyperlipidemia, hypertension, and BMI category; however, the protective factor of IFG is marriage status (single).

ABBREVIATIONS

BMI = body mass index; CI = confidence interval; FBG = fasting blood glucose; IFG = impaired fasting glucose; OR = odds ratio; T2DM = type 2 diabetes.