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Chen Y, Zhang H, Pan Y, Zhang Y, Yang Y, Liu L, Jia Q, Wang Y, Kong Y. Association between cardiovascular health and serum vitamin D and its interaction with prediabetes and diabetes. Am J Med Sci 2024:S0002-9629(24)01414-9. [PMID: 39186977 DOI: 10.1016/j.amjms.2024.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Prediabetes and diabetes are common and serious public health problems, and high blood glucose can lead to serious cardiovascular complications. The purpose of this article was to explore the link between CVH levels and the incidence of prediabetes and diabetes in people over 20 years old, and whether serum vitamin D status could alter this relationship. MATERIALS AND METHODS Data, from six consecutive cycles of the NHANES database from 2007 to 2018 were combined, eligible participants were aged ≥20 years. After excluding missing data, a total of 19,992 subjects were enrolled in the study. Significant risk factors for prediabetes and diabetes were analyzed using univariate and multivariate logistic regression. Exploring the interaction of VD and CVH on prediabetes and diabetes based on multifactorial regression analysis. RESULTS The prevalence of prediabetes among all participants was 36.15% and the prevalence of diabetes was 16.39%. CVH and vitamin D levels are influential factors in prediabetes and diabetes, and are negatively associated with the risk of developing prediabetes and diabetes. Compared with normoglycemia, poorer CVH and vitamin D deficiency only had a synergistic multiplicative interaction on the development of diabetes, and no significant interaction was observed for the development of prediabetes. Compared with prediabetes, poorer CVH and vitamin D deficiency still had a synergistic additive interaction on the development of diabetes. CONCLUSIONS Although the cross-sectional study only determine the association and do not prove causality, the current results can be used to prompt people to improve their lifestyle and risk factors to prevent prediabetes or diabetes through higher CVH and adequate Vitamin D.
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Affiliation(s)
- Ying Chen
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Haiyu Zhang
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yanbing Pan
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yanzi Zhang
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yuxuan Yang
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Lu Liu
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Qiuting Jia
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yongle Wang
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yihui Kong
- From the Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Gul MA, Tozcu D, Tekcan A, Capraz M, Demir HD. Serum adiponectin and peroxisome proliferator-activated receptors-γ levels in obese patients with and without prediabetes. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231000. [PMID: 38655997 PMCID: PMC11045203 DOI: 10.1590/1806-9282.20231000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Obesity is an increasingly prevalent global health problem, which is generally caused by the increase in body fat mass above normal and observed in all societies. If the blood glucose level is higher than normal but not high enough to diagnose diabetes, this condition is defined as prediabetes. Adiponectin increases fatty acid oxidation and insulin sensitivity and is closely associated with obesity. One of the nuclear receptor superfamily member peroxisome proliferator-activated receptors is shown to have an important role in various metabolic reactions. This study aimed to investigate the serum levels of adiponectin and peroxisome proliferator-activated receptors-gamma parameters, which are closely related to adipose tissue, energy metabolism, and insulin sensitivity, in obese patients with and without prediabetes. METHODS For this purpose, 52 obese patients with prediabetes, 48 obese patients with non-prediabetes, and 76 healthy individuals were included in this study. Serum adiponectin and peroxisome proliferator-activated receptors-γ levels were analyzed by ELISA. RESULTS Serum adiponectin levels were significantly higher in obese patients with prediabetes (18.15±15.99) compared with the control group (15.17±15.67; p=0.42). No significant difference was observed in both adiponectin and peroxisome proliferator-activated receptors-γ levels in the obese patients with the non-prediabetes group compared with the control group. However, no significant difference was observed in the obese patients with prediabetes group and obese patients with non-prediabetes group. CONCLUSION Our results suggest that adiponectin may serve as an indicator of prediabetes. This implies that examining adiponectin levels in individuals diagnosed with prediabetes may enhance our understanding of the metabolic processes closely linked to prediabetes and related conditions.
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Affiliation(s)
- Mehmet Ali Gul
- Amasya University, Faculty of Medicine, Department of Medical
Biochemistry – Amasya, Turkey
| | - Duygu Tozcu
- Amasya University, Faculty of Medicine, Department of Physiology
– Amasya, Turkey
| | - Akın Tekcan
- Amasya University, Faculty of Medicine, Department of Medical
Biology – Amasya, Turkey
| | - Mustafa Capraz
- Amasya University, Faculty of Medicine, Department of Internal
Diseases – Amasya, Turkey
| | - Hatice Dortok Demir
- Amasya University, Faculty of Medicine, Department of Medical
Biochemistry – Amasya, Turkey
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3
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Khalil MAM, Sadagah NM, Tan J, Syed FO, Chong VH, Al-Qurashi SH. Pros and cons of live kidney donation in prediabetics: A critical review and way forward. World J Transplant 2024; 14:89822. [PMID: 38576756 PMCID: PMC10989475 DOI: 10.5500/wjt.v14.i1.89822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 03/15/2024] Open
Abstract
There is shortage of organs, including kidneys, worldwide. Along with deceased kidney transplantation, there is a significant rise in live kidney donation. The prevalence of prediabetes (PD), including impaired fasting glucose and impaired glucose tolerance, is on the rise across the globe. Transplant teams frequently come across prediabetic kidney donors for evaluation. Prediabetics are at risk of diabetes, chronic kidney disease, cardiovascular events, stroke, neuropathy, retinopathy, dementia, depression and nonalcoholic liver disease along with increased risk of all-cause mortality. Unfortunately, most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period. There is lack of prospective long-term studies to know about the real risk of complications after donation. Furthermore, there are variations in recommendations from various guidelines across the globe for donations in prediabetics, leading to more confusion among clinicians. This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients. This review focuses on pathophysiological changes of PD in kidneys, potential complications of PD, other risk factors for development of type 2 diabetes, a review of guidelines for kidney donation, the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.
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Affiliation(s)
- Muhammad Abdul Mabood Khalil
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Nihal Mohammed Sadagah
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Jackson Tan
- Department of Nephrology, RIPAS Hospital Brunei Darussalam, Brunei Muara BA1710, Brunei Darussalam
| | - Furrukh Omair Syed
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Vui Heng Chong
- Division of Gastroenterology and Hepatology, Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam
| | - Salem H Al-Qurashi
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
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Xing X, Wang Y, Shen Z, Pan F, Cai G. Association of prediabetes progression and regression with cognitive decline: Findings from the CHARLS. Diabet Med 2024; 41:e15180. [PMID: 37454341 DOI: 10.1111/dme.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
AIM The aim of the study was to describe the association of prediabetes progression and regression with change in cognitive function. METHODS Data from three waves (2011, 2015 and 2018) of the China Health and Retirement Longitudinal Study (CHARLS) were analysed. Diabetic statuses in 2011 and 2015 were ascertained using the American Diabetes Association criteria. Cognitive function was assessed and standardized at all three waves, where a total score and its two components (episodic memory and metal status) were calculated. We evaluated the association of prediabetes progression and regression (from 2011 to 2015) with changes in cognitive function from 2011 to 2015 and from 2015 to 2018. RESULTS Of 2590 participants (56% women, mean age 58.6 ± 8.4 years) with prediabetes, 12% progressed to diabetes and 41% regressed to normoglycaemia. Compared with participants who remained as prediabetes, those who progressed to diabetes showed a trend to have accelerated decline in episodic memory (β = -0.11, 95% confidence interval -0.22 to 0.003, p = 0.057). However, participants who regressed to normoglycaemia did not have less cognitive decline. Neither prediabetes progression nor regression predicted change in cognitive function from 2015 to 2018. In a separate group of participants who remained as normoglycaemia (n = 858), changes in cognitive function from 2011 to 2015 and from 2015 to 2018 were similar to those who remained as prediabetes. CONCLUSION In people with prediabetes, progression to diabetes may be associated with accelerated cognitive decline but regression to normoglycaemia does not retard cognitive decline. Prediabetes progression and regression may not be predictive of change in cognitive function.
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Affiliation(s)
- Xing Xing
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Park KY, Park JH, Han K, Yu SH, Lee CB, Kim DS, Park HK, Hwang HS, Hong S. Fatty Liver Change in Older Adults as an Important Risk Factor for Type 2 Diabetes: A Nationwide Cohort Study. Mayo Clin Proc 2023; 98:1809-1819. [PMID: 37804267 DOI: 10.1016/j.mayocp.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/16/2023] [Accepted: 02/28/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To examine the association between changes in fatty liver disease (FLD) over time and the risk of type 2 diabetes in elderly individuals with prediabetes. METHODS A total of 156,984 elderly individuals with prediabetes who underwent national health screening in 2009 and 2011 were followed up through December 31, 2019. The FLD status was defined as a change in the fatty liver index. Prediabetes was defined as impaired fasting glucose levels at baseline. Multivariable Cox proportional hazards regression was used to calculate the hazard ratio and CIs for type 2 diabetes according to the changes in FLD. RESULTS During a median of 8.35 years of follow-up, type 2 diabetes developed in 29,422 (18.7%) elderly individuals with prediabetes. Multivariable adjusted hazard ratio of type 2 diabetes according to FLD change was 2.22 (95% CI, 2.11 to 2.34) in individuals with persistent FLD compared with those who have never had FLD. Although overall weight loss of 5% or more was associated with a 7% lower risk of type 2 diabetes in total participants, fatty liver status was important. Even with weight loss, those with a history of fatty liver-resolved FLD, new FLD, or persistent FLD-had an increased risk of type 2 diabetes. The risk of type 2 diabetes did not increase in individuals with sustained FLD-free status, regardless of weight change. CONCLUSION The presence and change of FLD are important factors for the development of type 2 diabetes in elderly individuals with prediabetes.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Jung Hwan Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Sung Hoon Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, South Korea
| | - Chang Beom Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, South Korea
| | - Dong Sun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Sangmo Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, South Korea.
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Chen Y, Xu L, Cheng Z, Zhang D, Yang J, Yin C, Li S, Li J, Hu Y, Wang Y, Liu Y, Wang Z, Zhang L, Chen R, Dou Q, Bai Y. Progression from different blood glucose states to cardiovascular diseases: a prospective study based on multi-state model. Eur J Prev Cardiol 2023; 30:1482-1491. [PMID: 37315161 DOI: 10.1093/eurjpc/zwad196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
AIMS To quantify the trajectories from normoglycaemia to pre-diabetes, subsequently to type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and cardiovascular death, and the effects of risk factors on the rates of transition. METHODS AND RESULTS We used data from the Jinchang Cohort of 42 585 adults aged 20-88 free of coronary heart disease (CHD) and stroke at baseline. A multistate model was applied for analysing the progression of CVD and its relation to various risk factors. During a median follow-up of 7 years, 7498 participants developed pre-diabetes, 2307 developed T2DM, 2499 developed CVD, and 324 died from CVD. Among 15 postulated transitions, transition from comorbid CHD and stroke to cardiovascular death had the highest rate (157.21/1000 person-years), followed by transition from stroke alone to cardiovascular death (69.31/1000 person-years) and transition from pre-diabetes to normoglycaemia (46.51/1000 person-years). Pre-diabetes had a sojourn time of 6.77 years, and controlling weight, blood lipids, blood pressure, and uric acid within normal limits may promote reversion to normoglycaemia. Among transitions to CHD alone and stroke alone, transition from T2DM had the highest rate (12.21/1000 and 12.16/1000 person-years), followed by transition from pre-diabetes (6.81/1000 and 4.93/1000 person-years) and normoglycaemia (3.28/1000 and 2.39/1000 person-years). Age and hypertension were associated with an accelerated rate for most transitions. Overweight/obesity, smoking, dyslipidaemia, and hyperuricaemia played crucial but different roles in transitions. CONCLUSION Pre-diabetes was the optimal intervention stage in the disease trajectory. The derived transition rates, sojourn time, and influence factors could provide scientific support for the primary prevention of both T2DM and CVD.
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Affiliation(s)
- Yarong Chen
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Lulu Xu
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Zhiyuan Cheng
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 xueyuan Street, Shenzhen, Guangdong 518055, China
| | - Desheng Zhang
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 53 Beijing Road, Jinchang, Gansu 737100, China
| | - Jingli Yang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Chun Yin
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 53 Beijing Road, Jinchang, Gansu 737100, China
| | - Siyu Li
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Jing Li
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Yujia Hu
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Yufeng Wang
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, 53 Beijing Road, Jinchang, Gansu 737100, China
| | - Yanyan Liu
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Zhongge Wang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Lizhen Zhang
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Ruirui Chen
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Qian Dou
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
| | - Yana Bai
- Institution of Epidemiology and Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, Gansu 730000, China
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Davidson MB. Should Prediabetes be Treated Pharmacologically? Diabetes Ther 2023; 14:1585-1593. [PMID: 37490238 PMCID: PMC10499716 DOI: 10.1007/s13300-023-01449-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE In this commentary I will evaluate whether prediabetes should be treated pharmacologically. To consider this question, certain information concerning prediabetes is relevant. BACKGROUND INFORMATION (1) Prediabetes is not independently associated with cardiovascular disease; the other factors in the metabolic syndrome increase that risk; (2) various tests and criteria for diagnosing prediabetes are recommended, yielding prevalences varying from 6% to 38% depending on which are used; (3) one-third of patients with prediabetes revert to normal over time; (4) up to two-thirds of patients with prediabetes do not develop diabetes; (5) people with prediabetes have insulin resistance and impaired insulin secretion; (6) although pharmacological treatment of the dysglycemia temporarily lowers it, when the drugs are discontinued, incident diabetes develops similarly as that in those who received placebos; (7) when the drugs are discontinued, there are no changes in insulin resistance or impaired insulin secretion; (8) incident diabetes was similar at 10 years in people remaining on metformin in the Diabetes Prevention Program Outcome Study compared with those who did not receive the drug; (9) no current drugs will directly increase insulin secretion (except sulfonylureas and glinides which have not been used to treat prediabetes because of hypoglycemia concerns); (10) sufficient weight loss to lower insulin resistance by nutritional means is challenging and especially difficult to maintain. CONCLUSIONS Pharmacological treatment of the dysglycemia of prediabetes is not warranted. On the other hand, the ability of high doses of glucagon-like peptide (GLP)-1 receptor agonists and the combination of a GLP-1 receptor agonist and the glucose-dependent insulinotropic polypeptide (GIP) to lower weight by 15% and 20%, respectively, deserves consideration for the treatment of prediabetes. This amount of weight loss should decrease insulin resistance, allowing endogenous insulin secretion to be more effective and lower the risk for developing diabetes.
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Affiliation(s)
- Mayer B Davidson
- Charles R. Drew University, 1731 East 120th Street, Los Angeles, CA, 90059, USA.
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Golding J, Hope SV, Chakera AJ, Puttanna A. The evolving continuum of dysglycaemia: Non-diabetic hyperglycaemia in older adults. Diabet Med 2023; 40:e15177. [PMID: 37452769 DOI: 10.1111/dme.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Identifying non-diabetic hyperglycaemia (NDH) and intervening to halt the progression to type 2 diabetes has become an essential component of cardiovascular and cerebrovascular risk reduction. Diabetes prevention programs have been instigated to address the increasing prevalence of NDH and type 2 diabetes by targeting lifestyle modifications. Evidence suggests that the risk of progression from NDH to type 2 diabetes declines with age, and that a diagnosis of type 2 diabetes in older adults is not associated with the same risk of adverse consequences as it is in younger age groups. The current definition of NDH is not adjusted based on a person's age. Therefore, there is debate about the emphasis that should be placed upon a diagnosis of NDH in older adults. This article will explore the evidence and current clinical practice surrounding dysglycaemia through the spectrum of different age ranges, and the potential implications this has for older adults.
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Affiliation(s)
- J Golding
- Department of Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - S V Hope
- College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Healthcare for Older People, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - A J Chakera
- Department of Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - A Puttanna
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Chen X, Liu D, He W, Hu H, Wang W. Predictive performance of triglyceride glucose index (TyG index) to identify glucose status conversion: a 5-year longitudinal cohort study in Chinese pre-diabetes people. J Transl Med 2023; 21:624. [PMID: 37715242 PMCID: PMC10503019 DOI: 10.1186/s12967-023-04402-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/29/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE Triglyceride glucose index (TyG index) has been recommended as an alternative indicator of insulin resistance. However, the association between TyG and regression from prediabetes to normoglycemia remains to be elucidated. METHODS This retrospective cohort study involved 25,248 subjects with prediabetes at baseline conducted from 2010 to 2016. A Cox proportional hazard regression model was designed to evaluate the role of TyG in identifying people at converting from prediabetes to normoglycemia. Cox proportional hazards regression with cubic spline functions and smooth curve fitting was used to dig out the nonlinear relationship between them. Detailed evaluations for TyG were also performed using sensitivity and subgroup analyse. RESULTS Among the included prediabetes subjects (n = 25,248), the mean age was 49.27 ± 13.84 years old, and 16,701 (66.15%) were male. The mean TyG was 8.83 ± 0.60. The median follow-up time was 2.96 ± 0.90 years. 11,499 (45.54%) individuals had a final diagnosis of normoglycemia. After adjusting for covariates, TyG was negatively affecting the results of glucose status conversion in prediabetes people (HR 0.895, 95% CI 0.863, 0.928). There was a nonlinear connection between TyG and normoglycemia in prediabetes people, and the inflection point was 8.88. The effect sizes (HR) on the left and right sides of the inflection point were 0.99 (0.93, 1.05) and 0.79 (0.74, 0.85), respectively. Sensitivity analysis confirmed the robustness of these results. Subgroup analysis showed that TyG was more strongly associated with incident glucose status conversion in male, BMI ≥ 25. In contrast, there was a weaker relationship in those with female, BMI < 25. CONCLUSION Based on sample of subjects evaluated between 2010 and 2016, TyG index appears to be a promising marker for predicting normoglycemic conversion among prediabetes people in China. This study demonstrates a negative and non-linear association between TyG and glucose status conversion from prediabetes to normoglycemia. TyG is strongly related to glucose status conversion when TyG is above 8.88. From a therapeutic point of view, it is meaningful to maintain TyG levels within the inflection point to 8.88.
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Affiliation(s)
- Xiaojie Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Road, Main Building, Room 1436, Guangzhou, 510080, Guangdong, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Nephrology, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, 518000, Guangdong, China
| | - Danfeng Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Road, Main Building, Room 1436, Guangzhou, 510080, Guangdong, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
- South China University of Technology, Guangzhou, China
| | - Weiting He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Road, Main Building, Room 1436, Guangzhou, 510080, Guangdong, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haofei Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Road, Main Building, Room 1436, Guangzhou, 510080, Guangdong, China.
- Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
- Department of Nephrology, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, 518000, Guangdong, China.
| | - Wenjian Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Road, Main Building, Room 1436, Guangzhou, 510080, Guangdong, China.
- Guangdong Academy of Medical Sciences, Guangzhou, China.
- South China University of Technology, Guangzhou, China.
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Ha KH, Kim DJ, Han SJ. Associations of updated cardiovascular health metrics, including sleep health, with incident diabetes and cardiovascular events in older adults with prediabetes: A nationwide population-based cohort study. Diabetes Res Clin Pract 2023; 203:110820. [PMID: 37422164 DOI: 10.1016/j.diabres.2023.110820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
AIMS To investigate the association of updated cardiovascular health (CVH) metrics, including sleep health, with the risk of diabetes and major adverse cardiovascular events (MACE) in older adults with prediabetes. METHODS A total of 7,948 older adults with prediabetes aged ≥ 65 years were included in this study. CVH was assessed using seven baseline metrics according to the modified American Heart Association recommendations. RESULTS During a median follow-up time of 11.9 years, 2,405 (30.3%) cases of diabetes and 2,039 (25.6%) MACE were recorded. Compared with the poor composite CVH metrics group, the multivariable-adjusted hazard ratios (HRs) in the intermediate and ideal composite CVH metrics groups were respectively 0.87 (95% confidence intervals [CI] = 0.78-0.96) and 0.72 (95% CI = 0.65-0.79) for diabetes events and 0.99 (95% CI = 0.88-1.11) and 0.88 (95% CI = 0.79-0.97) for MACE. The ideal composite CVH metrics group had a lower risk of diabetes and MACE in older adults aged 65-74 years, but not in those aged ≥ 75 years. CONCLUSIONS Ideal composite CVH metrics in older adults with prediabetes were associated with a lower risk of diabetes and MACE.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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Nicolaisen SK, Pedersen L, Witte DR, Sørensen HT, Thomsen RW. HbA1c-defined prediabetes and progression to type 2 diabetes in Denmark: A population-based study based on routine clinical care laboratory data. Diabetes Res Clin Pract 2023; 203:110829. [PMID: 37451628 DOI: 10.1016/j.diabres.2023.110829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
AIMS To estimate the prevalence, incidence, mortality, and risk of progression to type 2 diabetes for individuals with HbA1c-defined prediabetes based on Danish nationwide population-based laboratory databases. METHODS We included all HbA1c measurements from general practice and hospitals during 2012 to 2018. We estimated the cumulative incidence of having at least one HbA1c measurement. The prevalence and incidence rates of prediabetes (HbA1c 42-47 mmol/mol) were examined in the adult Danish population. The 5-year cumulative incidence of progression to type 2 diabetes was estimated with death as competing event. RESULTS Among 4,979,590 adult Danes, 70.8% (95% CI 70.8-70.9) had at least one HbA1c measurement during 2012 to 2018. The prevalence of prediabetes was 7.1% (95% CI 7.1-7.1) in 2018. The incidence rate was 14.2 (95% CI 14.1-14.3) per 1,000 person-years, with median age 66.9 years (IQR 56.7-75.7) and median HbA1c 43 mmol/mol (IQR 42-44) at prediabetes diagnosis. Within five years, 17.5% (95% CI 17.3-17.7) died and the 5-year cumulative incidence of type 2 diabetes was 21.3% (95% CI 21.1-21.5). CONCLUSIONS Out of 100 Danish adults, 1.4 develop prediabetes each year and they can be identified at an early stage in laboratory databases. Within five years, one in five individuals with prediabetes progresses to diabetes and one in six dies.
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Affiliation(s)
- Sia Kromann Nicolaisen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Daniel R Witte
- Steno Diabetes Center Aarhus, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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12
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Yu D, Qu B, Osuagwu UL, Pickering K, Baker J, MBChB RC, Cai Y, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Effect of onset of type 2 diabetes on risks of cardiovascular disease and heart failure among new Zealanders with impaired glucose tolerance over 25 years: tapered-matched landmark analysis. Cardiovasc Diabetol 2023; 22:163. [PMID: 37391762 PMCID: PMC10314599 DOI: 10.1186/s12933-023-01871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/29/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND This study aimed to examine the association between the incident onset of T2DM and 5- and 10-year risks of CVD and HF in people with IGT identified in primary care in South and West Auckland, New Zealand (NZ) between 1994 and 2019. METHODS We compared CVD and HF risks in patients with IGT and with/without T2D newly diagnosed within the exposure window (1-5 years). Tapered matching and landmark analysis (to account for immortal bias) were used to control for potential effects of known confounders. RESULTS Among 26,794 patients enrolled with IGT, 845 had T2D newly diagnosed within 5 years from enrolment (landmark date) and 15,452 did not have T2D diagnosed. Patients progressing to T2D (vs. those not progressing) had a similar 5-year risk for CVD (hazard ratio 1.19; 95% CI 0.61-2.32) but significantly higher 10-year risk of CVD (2.45(1.40-4.29)), 5-year risk of HF (1.94(1.20-3.12)) and 10-year risk of HF (2.84(1.83-4.39). The association between the onset of T2D and risk of 10-year risk of CVD, 5-year and 10-year risk of HF was more likely among men, the socioeconomically deprived, those currently smoking, patients with higher metabolic measures and/or those with lower renal function. Patients of NZ European ethnicity had a lower 10-year risk of CVD. CONCLUSIONS The study suggests that the diagnosis of T2D mediates the risk of CVD and HF in people with IGT. The development of risk scores to identify and better manage individuals with IGT at high risk of T2D is warranted.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - Bingjie Qu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Sydney, NSW, 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, Sydney, NSW, 2751, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield MBChB
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, the University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Sydney, NSW, 2560, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Sydney, NSW, 2751, Australia.
- Macarthur Clinical School, School of Medicine, Western Sydney University, Locked Bag 1797, Campbelltown, NSW, 2751, Australia.
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Al-Sofiani ME, Asiri A, Alajmi S, Alkeridy W. Perspectives on Prediabetes and Aging. Endocrinol Metab Clin North Am 2023; 52:377-388. [PMID: 36948785 DOI: 10.1016/j.ecl.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Diabetes prevention programs (DPPs) have been shown to effectively delay, and sometimes prevent, the progression from prediabetes to diabetes; however, labeling someone with prediabetes comes with potential negative psychological, financial, and self-perception consequences. Many older adults with prediabetes nowadays have a relatively "low-risk" form of prediabetes that rarely progresses to diabetes and may regress to normoglycemia. In this article, we review the impact of aging on glucose metabolism and provide a holistic approach to cases of prediabetes in older adults that maximizes the benefit-risk balance of interventions aimed at addressing prediabetes.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Central Region, 12372, Saudi Arabia; Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21287, USA.
| | - Alanood Asiri
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Central Region, 12372, Saudi Arabia
| | - Sarah Alajmi
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Central Region, 12372, Saudi Arabia
| | - Walid Alkeridy
- Department of Medicine, King Saud University, College of Medicine, Riyadh, Central Region, 12372, Saudi Arabia
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Wang K, Gao H, Sijbrands EJ, Kavousi M, Ahmadizar F. Associations of baseline glycemic status and its transitions with cognitive and physical functioning decline. Maturitas 2023; 171:25-32. [PMID: 36990054 DOI: 10.1016/j.maturitas.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/03/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Evidence about the decline of cognition and physical function across glycemic status (normoglycemia, prediabetes, and diabetes) is inconsistent. We evaluated longitudinal changes in cognition and physical function according to glycemic status and also different glycemic transitions. STUDY DESIGN Population-based cohort study. METHODS 9307 participants (mean age 59.7 years, 53.7 % women) were included from the China Health and Retirement Longitudinal Study (2011-2018). Global cognition (assessed by orientation, memory, and executive function) and physical function (calculated as the sum of impaired basic and instrumental activities of daily living) were assessed in each wave. The glycemic status was assessed in waves 2011 and 2015. Diabetes was defined as fasting blood glucose ≥7.0 mmol/L, HbA1c ≥6.5 %, self-reported diabetes, or glucose-lowering medication use. Prediabetes was defined as fasting blood glucose 5.6-6.9 mmol/L or an HbA1c of 5.7-6.4 %. RESULTS Compared with normoglycemia, baseline diabetes was associated with a faster decline in orientation (-0.018 SD/year, 95%CI -0.032, -0.004) and a faster increase in physical function score (0.082 /year, 95%CI 0.038, 0.126). We did not observe any effect of prediabetes on the changing rate of cognition and physical function. Progression from normoglycemia to diabetes between waves 2011 and 2015 was associated with a significantly faster decline in global cognition, memory, executive function, and physical function compared with stable normoglycemia. CONCLUSIONS Baseline diabetes was associated with accelerated decline of cognition and physical function. Associations with prediabetes were not observed, suggesting an important short diagnostic window when diabetes presents de novo.
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Lin HJ, Wang J, Tseng PY, Fu LC, Lee YC, Wu MS, Yang WS, Chiu HM. Lower-than-normal glycemic levels to achieve optimal reduction of diabetes risk among individuals with prediabetes: A prospective cohort study. Diabetes Res Clin Pract 2023; 197:110567. [PMID: 36740021 DOI: 10.1016/j.diabres.2023.110567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS To determine whether lower than currently accepted glycemic levels could lead to optimal risk reduction of incident diabetes among individuals with prediabetes. METHODS We enrolled 9903 individuals with prediabetes and 16,902 individuals with normoglycemia from a prospective cohort participating health check-ups between 2006 and 2017. While classifying fasting glucose into <5.0, 5.0-5.5, and 5.6-6.9 mmol/L and postprandial glucose into <6.7, 6.7-7.7, and 7.8-11.0 mmol/L, we grouped fasting/postprandial glucose into five categories (<5.0/<6.7, <5.0/6.7-7.7, 5.0-5.5/<6.7, 5.0-5.5/6.7-7.7 mmol/L, 5.6-6.9/7.8-11.0 mmol/L). The primary outcome was incident diabetes. RESULTS In individuals with prediabetes, the presence of a baseline fasting glucose <5.0 mmol/L or a postprandial glucose <6.7 mmol/L led to a greater risk reduction of incident diabetes with hazard ratios of 0.34 (95% confidence interval, 0.27-0.42) and 0.47 (0.41-0.54), respectively, relative to a fasting glucose 5.6-6.9 mmol/L and a postprandial glucose 7.8-11.0 mmol/L. For individuals with prediabetes having fasting/postprandial glucose <5.0/<6.7 mmol/L, the incidence of 6.4 (4.7-8.8) per 1000 person-years corresponded to that of 5.8 (4.2-8.0) per 1000 person-years for individuals with normoglycemia having 5.0-5.5/6.7-7.7 mmol/L. CONCLUSIONS/INTERPRETATION Given that lower-than-normal glycemic levels were plausible for optimal risk reduction of diabetes, stringent glycemic management could be beneficial for diabetes prevention among individuals with prediabetes.
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Affiliation(s)
- Hung-Ju Lin
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Jui Wang
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Po-Yuan Tseng
- All Vista Healthcare Center, Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taiwan.
| | - Li-Chen Fu
- Department of Electrical Engineering, Department of Computer Science and Information Engineering, and Center for Artificial Intelligence & Advanced Robotics, National Taiwan University, Taipei, Taiwan.
| | - Yi-Chia Lee
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan..
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Han-Mo Chiu
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Nabila S, Kim JE, Choi J, Park J, Shin A, Lee SA, Lee JK, Kang D, Choi JY. Associations Between Modifiable Risk Factors and Changes in Glycemic Status Among Individuals With Prediabetes. Diabetes Care 2023; 46:535-543. [PMID: 36625739 DOI: 10.2337/dc22-1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 12/03/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine the associations between modifiable risk factors and glycemic status changes in individuals with prediabetes. RESEARCH DESIGN AND METHODS A total of 10,358 individuals with prediabetes defined by their fasting blood glucose and HbA1c levels from the Health Examinees-Gem study were included in the present study. Modifiable factors, including BMI, abdominal obesity, smoking status, physical activity, alcohol consumption, diet quality, hypertension, and dyslipidemia, were examined to determine their associations with changes in glycemic status during follow-up. In addition, modifiable-factor scores were calculated, and their association with changes in glycemic status was also analyzed. RESULTS The median follow-up time for this study was 4 years (range, 1-7 years). BMI ≥25 kg/m2 (adjusted odds ratio [OR] 0.71 [95% CI 0.63-0.79]), abdominal obesity (OR 0.76 [95% CI 0.68-0.86]), heavy drinking (OR 0.74 [95% CI 0.60-0.91]), hypertension (OR 0.71 [95% CI 0.64-0.79]), and dyslipidemia (OR 0.78 [95% CI 0.70-0.85]) were associated with a lower possibility of normoglycemia reversion. BMI ≥25 kg/m2 (OR 1.58 [95% CI 1.29-1.94]), abdominal obesity (OR 1.31 [95% CI 1.11-1.55]), current smoking (OR 1.43 [95% CI 1.07-1.91]), and hypertension (OR 1.26 [95% CI 1.07-1.49]) were associated with a higher probability of type 2 diabetes progression. Having more favorable modifiable factors was also associated with normoglycemia reversion (OR 1.46 [95% CI 1.30-1.64]) and type 2 diabetes progression (OR 0.62 [95% CI 0.49-0.77]). CONCLUSIONS More favorable modifiable factors were related to a higher probability of returning to normoglycemia and a lower probability of progression to type 2 diabetes.
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Affiliation(s)
- Salma Nabila
- 1Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- 2BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Eun Kim
- 1Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- 2BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaesung Choi
- 2BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- 3Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - JooYong Park
- 1Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- 2BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- 4Department of Big Data Medical Convergence, Eulji University, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Aesun Shin
- 5Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- 6Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Sang-Ah Lee
- 7Department of Preventive Medicine, Kangwon National University School of Medicine, Gangwon, Republic of Korea
| | - Jong-Koo Lee
- 8Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Daehee Kang
- 1Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- 5Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- 6Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
- 9Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Ji-Yeob Choi
- 1Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- 2BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- 3Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea
- 6Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
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Sun H, Xu L, Liu L, Zhan S, Wang S, Song Y. Predictive Efficiency of Prediabetes for Diabetes Among Chinese Middle-Aged and Older Populations: a 5-Year National Prospective Cohort Study. J Gen Intern Med 2023; 38:667-674. [PMID: 35819686 PMCID: PMC9971401 DOI: 10.1007/s11606-022-07731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Limited studies have explored the predictive efficiency of prediabetes based on two definitions for diabetes among Chinese middle-aged and older populations with prediabetes. OBJECTIVE To evaluate the predictive efficiency of prediabetes based on two definitions for diabetes and the clinical and public health benefit in Chinese middle-aged and older populations. DESIGN A 5-year cohort study from the China Health and Retirement Longitudinal Study. PARTICIPANTS A total of 5208 participants who had blood sample data at baseline in 2011. MAIN MEASURES The exposure was prediabetes based on American Diabetes Association (ADA) and World Health Organization (WHO) definition. The main outcome was incident diabetes. The ability of prediabetes for predicting diabetes was assessed by sensitivity, specificity, positive predictive value, and negative predictive value. Cox proportional hazards regression was used to explore the associations between prediabetes and the 5-year risk of diabetes and all-cause mortality. KEY RESULTS Among those with prediabetes according to the ADA definition, only 426 (15.45%) with baseline prediabetes progressed to total diabetes, while according to the WHO definition, 208 (21.89%) progressed to total diabetes. In terms of the ability of predicting the incident total diabetes in 5 years, the ADA definition has a higher sensitivity than the WHO definition (70.76% versus 34.55%, P < 0.001), while the WHO definition has a higher specificity than the ADA definition (84.09% versus 49.35%, P < 0.001). Positive predictive values based on the two definitions were low (< 24%); negative predictive values were high (> 90%). CONCLUSIONS Neither definition of prediabetes is robust for predicting diabetes development in Chineses middle-aged and older populations.
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Affiliation(s)
- Hang Sun
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Lu Xu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Siyan Zhan
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, 100191, China.
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
| | - Yongfeng Song
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China.
- Shandong Institute of Endocrine & Metabolic Diseases, Jinan, Shandong, 250000, China.
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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Kohansal K, Ahmadi N, Hadaegh F, Alizadeh Z, Azizi F, Habibi-Moeini AS, Khalili D. Determinants of the progression to type 2 diabetes and regression to normoglycemia in people with pre-diabetes: A population-based cohort study over ten years. Prim Care Diabetes 2022; 16:797-803. [PMID: 36404444 DOI: 10.1016/j.pcd.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/08/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
AIMS To determine the rates and predictors of the regression to normoglycemia and progression to diabetes among subjects with pre-diabetes. METHODS A 10-year longitudinal population-based study was conducted among 1329 participants with pre-diabetes in the Tehran Lipid and Glucose Study. Pre-diabetes was divided into isolated IFG (iIFG), isolated IGT (iIGT), and combined IFG/IGT. Univariate and stepwise multivariable Cox regression was used to evaluate predictors of glycemic conversions. RESULTS The cumulative incidences of normoglycemia and diabetes were 43.7% (95%CI 40.9-46.4) and 40.1% (37.3-42.7), respectively. Isolated IGT returned to normoglycemia more than iIFG (HR:1.26, 1.05-1.51), but there was no difference in how quickly they progressed to diabetes. Regression to normoglycemia was associated with younger age, female sex, lower BMI, no familial history of diabetes, higher HDL-C, and ex-smoking. Older age, higher BMI, diastolic blood pressure, total cholesterol, lower HDL-C, and familial history for diabetes were associated with progression to diabetes. The influence of BMI on glycemic status conversions diminished with age. At approximately above 60 years old, the hazards of BMI for any conversions faded out. CONCLUSIONS The modifiable predictors of regression to normoglycemia and progression to diabetes are roughly the same. The importance of BMI attenuates in elderly subjects.
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Affiliation(s)
- Karim Kohansal
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Ahmadi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Alizadeh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Siamak Habibi-Moeini
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Davood Khalili
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Gottwald-Hostalek U, Gwilt M. Vascular complications in prediabetes and type 2 diabetes: a continuous process arising from a common pathology. Curr Med Res Opin 2022; 38:1841-1851. [PMID: 35833523 DOI: 10.1080/03007995.2022.2101805] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The term, "prediabetes", describes a state of hyperglycaemia that is intermediate between true normoglycaemia and the diagnostic cut-offs for indices of glycaemia that are used to diagnose type 2 diabetes. The presence of prediabetes markedly increases the risk of developing type 2 diabetes. Numerous randomized, controlled evaluations of various agents have demonstrated significant prevention or delay of the onset of type 2 diabetes in subjects with prediabetes. Intensive lifestyle interventions and metformin have been studied most widely, with the lifestyle intervention being more effective in the majority of subjects. The application of therapeutic interventions at the time of prediabetes to preserve long-term outcomes has been controversial, however, due to a lack of evidence relating to the pathogenic effects of prediabetes and the effectiveness of interventions to produce a long-term clinical benefit. Recent studies have confirmed that prediabetes, however defined, is associated with a significantly increased risk of macrovascular and microvascular complications essentially identical to those of diabetes, and also with subclinical derangements of the function of microvasculature and neurons that likely signify increased risk of compilations in future. Normoglycaemia, prediabetes and type 2 diabetes appear to be part of a continuum of increased risk of adverse outcomes. Long-term (25-30 years) post-trial follow up of two major diabetes prevention trials have shown that short-term interventions to prevent diabetes lead to long-term reductions in the risk of complications. These findings support the concept of therapeutic intervention to preserve long-term health in people with prediabetes before type 2 diabetes becomes established.
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Tsai SH, Cheng HC, Liu HW. Supervised high-load resistance training for improving muscle strength and quality in prediabetic older adults: A pilot randomized controlled trial. Geriatr Nurs 2022; 48:350-355. [PMID: 36375378 DOI: 10.1016/j.gerinurse.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the effects of high- and low-load supervised, volume-matched resistance training (RT) on body composition, muscle function, and functional capacity in older adults with prediabetes. METHODS Older adults with prediabetes were recruited and randomly assigned to high-load RT (n = 13), low-load RT (n = 12), or control groups (n = 12). RESULTS No significant differences were observed in body composition at postintervention. High-load and low-load RT groups exhibited significant improvements in functional tests at postintervention compared with the control group. The high-load RT group exhibited a greater improvement in muscle strength and muscle quality at postintervention compared with the low-load RT group. CONCLUSION Supervised RT is useful in the prevention of muscle functional loss in older adults with prediabetes. High-load RT is superior for enhancing muscle strength and muscle quality, despite a similar increase in functional capacity.
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Affiliation(s)
- Shun-Hsi Tsai
- Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hao-Chien Cheng
- Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hung-Wen Liu
- Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan.
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21
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Liu Q, Zhou Q, He Y, Zou J, Guo Y, Yan Y. Predicting the 2-Year Risk of Progression from Prediabetes to Diabetes Using Machine Learning among Chinese Elderly Adults. J Pers Med 2022; 12:jpm12071055. [PMID: 35887552 PMCID: PMC9324396 DOI: 10.3390/jpm12071055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/06/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
Identifying people with a high risk of developing diabetes among those with prediabetes may facilitate the implementation of a targeted lifestyle and pharmacological interventions. We aimed to establish machine learning models based on demographic and clinical characteristics to predict the risk of incident diabetes. We used data from the free medical examination service project for elderly people who were 65 years or older to develop logistic regression (LR), decision tree (DT), random forest (RF), and extreme gradient boosting (XGBoost) machine learning models for the follow-up results of 2019 and 2020 and performed internal validation. The receiver operating characteristic (ROC), sensitivity, specificity, accuracy, and F1 score were used to select the model with better performance. The average annual progression rate to diabetes in prediabetic elderly people was 14.21%. Each model was trained using eight features and one outcome variable from 9607 prediabetic individuals, and the performance of the models was assessed in 2402 prediabetes patients. The predictive ability of four models in the first year was better than in the second year. The XGBoost model performed relatively efficiently (ROC: 0.6742 for 2019 and 0.6707 for 2020). We established and compared four machine learning models to predict the risk of progression from prediabetes to diabetes. Although there was little difference in the performance of the four models, the XGBoost model had a relatively good ROC value, which might perform well in future exploration in this field.
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Affiliation(s)
- Qing Liu
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan 430071, China; (Q.L.); (Q.Z.)
| | - Qing Zhou
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan 430071, China; (Q.L.); (Q.Z.)
| | - Yifeng He
- School of Geodesy and Geomatics, Wuhan University, Wuhan 430079, China; (Y.H.); (J.Z.)
| | - Jingui Zou
- School of Geodesy and Geomatics, Wuhan University, Wuhan 430079, China; (Y.H.); (J.Z.)
| | - Yan Guo
- Wuhan Center for Disease Control and Prevention, Wuhan 430015, China;
| | - Yaqiong Yan
- Wuhan Center for Disease Control and Prevention, Wuhan 430015, China;
- Correspondence:
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22
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Suzuki Y, Kaneko H, Okada A, Matsuoka S, Itoh H, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Yamaguchi S, Node K, Yamauchi T, Yasunaga H, Komuro I. Prediabetes in Young Adults and Its Association With Cardiovascular Health Metrics in the Progression to Diabetes. J Clin Endocrinol Metab 2022; 107:1843-1853. [PMID: 35446413 DOI: 10.1210/clinem/dgac247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The natural history of young adults with prediabetes and its association with cardiovascular health (CVH) metrics in progression to diabetes remain unknown. OBJECTIVE We examined the association between CVH metrics and the annual incidence of diabetes in young adults with prediabetes. METHODS This observational cohort study used the JMDC Claims Database. We analyzed 18 908 participants aged 18 to 44 years, with available fasting plasma glucose (FPG) data for 5 consecutive years, and who had prediabetes (FPG 100-125 mg/dL) at the initial health checkup. The ideal CVH metrics were as follows: nonsmoking, body mass index (BMI) less than 25 kg/m2, physical activity at goal, optimal dietary habits, blood pressure less than 120/80 mm Hg, and total cholesterol less than 200 mg/dL. We analyzed the association between CVH metrics and the annual incidence of diabetes. We also examined the relationship between 1-year changes in CVH metrics and the subsequent risk of diabetes. RESULTS The incidence of diabetes was 3.3% at 1 year and 9.5% at 5 years after the initial health checkup. An increasing number of nonideal CVH metrics have been associated with an increased risk of diabetes. Nonideal BMI, smoking, blood pressure, and total cholesterol level were associated with an increased risk of diabetes. This association was observed both in men and women. A one-point increase in the number of nonideal CVH metric components was associated over 1 year with an increased risk of diabetes. CONCLUSION CVH metrics can stratify the risk of diabetes in young adults with prediabetes. Improving CVH metrics may reduce the risk of developing diabetes.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Rehabilitation Science, Graduate School of Medical Sciences, Kitasato University, Kanagawa 252-0373, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Cardiology, New Tokyo Hospital, Matsudo 270-2232, Japan
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo 113-8655, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo 113-8655, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga 849-8501, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-8655, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Choi G, Yoon H, Choi HH, Ha KH, Kim DJ. Association of prediabetes with death and diabetic complications in older adults: the pros and cons of active screening for prediabetes. Age Ageing 2022; 51:6612689. [PMID: 35737599 DOI: 10.1093/ageing/afac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND active screening can improve health outcomes for people with prediabetes. However, its efficacy in older adults remains uncertain. OBJECTIVE the study aimed to analyse the progression from prediabetes to diabetes in older adults, including associated complications and mortality rates, to determine the benefits of active screening. DESIGN retrospective cohort study. SETTING Korean National Health Insurance Service claims database. SUBJECTS a total of 36,946 adults aged ≥65 years who underwent national health examinations from 2006 to 2008. METHODS follow-up was until 31 December 2015. Cox's proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for death and diabetic complications. RESULTS over a median follow-up of 8.2 years, 19.3% of older adults with prediabetes progressed to diabetes. Compared with normoglycaemic adults, the multivariable-adjusted HRs (95% CI) for major adverse cardiovascular events were 1.01 (0.95-1.07), 1.08 (0.95-1.23), 1.14 (1.05-1.23) and 1.50 (1.35-1.68) in adults with prediabetes, newly diagnosed diabetes, diabetes not on insulin and diabetes on insulin, respectively. The corresponding HRs (95% CI) for diabetic retinopathy risk were 1.28 (1.15-1.43), 3.16 (2.71-3.69), 6.58 (6.02-7.19) and 9.17 (8.21-10.24). Diabetic nephropathy risk also significantly increased. CONCLUSIONS progression from prediabetes to diabetes is an important concern among older adults. Prediabetes is associated with the risk of microvascular complications, but not cardiovascular complications and mortality. Therefore, active regular screening for prediabetes is necessary to prevent microvascular complications.
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Affiliation(s)
- Giwoong Choi
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hojun Yoon
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Ho Choi
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
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Liu H, Chen S, Li Z, Xing A, Liu Y, Yu J, Li D, Li Y, Zhou X, Yang Q, Wu S, Lei P. Long-term risks for cardiovascular disease and mortality across the glycaemic spectrum in a male-predominant Chinese cohort aged 75 years or older: the Kailuan study. Age Ageing 2022; 51:6596557. [PMID: 35647762 DOI: 10.1093/ageing/afac109] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ageing and diabetes are growing global health burdens. The current understanding of cardiovascular disease (CVD) and mortality risk across the glycaemic spectrum in older populations is limited. OBJECTIVES This study sought to characterise CVD and all-cause mortality risk across the glycaemic spectrum among Chinese adults aged 75 years or older in a community-based setting over10 years. METHODS The 3,989 adults in the Kailuan Study were aged over 75 years (median age was 79 years [interquartile range: 76-82]; 2,785 normoglycaemic, 691 prediabetic and 513 diabetic, determined by fasting blood glucose levels) at baseline, predominantly male (92.9% male) and followed until December 2019. Time-varying Cox regression and competing-risk models were used to examine the hazard ratio (HR) of incident CVD and mortality across the glycaemic exposures. RESULTS During median follow-up of 11.3 years, 433 first CVD and 2,222 deaths were recorded. Compared with normoglycaemia, multivariable-adjusted models revealed the following: (i) prediabetes was not associated with future risks for CVD (HR: 1.17; 95% CI 0.82-1.69) and all-cause mortality (HR 1.06; 95% CI 0.70-1.60); (ii) diabetes-associated enhanced risks for CVD and all-cause mortality were mainly confined to those exhibiting low-grade inflammation (high-sensitivity C-reactive protein ≥2.0 mg/L) levels. The results were consistent after multiple sensitivity analyses. CONCLUSIONS Among a male-predominant Chinese population aged 75 years or older, compared with normoglycaemic participants, prediabetes was not associated with an enhanced 10-year CVD and all-cause mortality risk, and diabetes-associated enhanced 10-year risk was mainly confined to individuals exhibiting low-grade inflammation.
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Affiliation(s)
- Hangkuan Liu
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Ziping Li
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Aijun Xing
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Yan Liu
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Jiaxin Yu
- Department of Cardiology, Tangshan Worker’s Hospital , Tangshan 063003, Hebei, China
| | - Dai Li
- Department of Geriatrics, Tianjin Medical University General Hospital; Tianjin Geriatrics Institute , Tianjin 300052, China
| | - Yongle Li
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Ping Lei
- Department of Geriatrics, Tianjin Medical University General Hospital; Tianjin Geriatrics Institute , Tianjin 300052, China
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25
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Qiu S, Cai X, Yuan Y, Xie B, Sun Z, Wang D, Wu T. Muscle strength and prediabetes progression and regression in middle-aged and older adults: a prospective cohort study. J Cachexia Sarcopenia Muscle 2022; 13:909-918. [PMID: 35068089 PMCID: PMC8978008 DOI: 10.1002/jcsm.12905] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Prediabetes progression is associated with increased mortality while its regression decreases it. It is unclear whether muscle strength is related to prediabetes progression or regression. This study investigated the associations of muscle strength, assessed by grip strength and chair-rising time, with prediabetes progression and regression based on the China Health and Retirement Longitudinal Study (CHARLS) enrolling middle-aged and older adults. METHODS We included 2623 participants with prediabetes from CHARLS, who were followed up 4 years later with blood samples collected for measuring fasting plasma glucose and haemoglobin A1c. Grip strength (normalized by body weight) and chair-rising time were assessed at baseline and categorized into tertiles (low, middle, and high groups). Prediabetes at baseline and follow-up was defined primarily using the American Diabetes Association (ADA) criteria and secondarily using the World Health Organization (WHO) and International Expert Committee (IEC) criteria. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The mean age of included participants was 59.0 ± 8.6 years, and 46.6% of them were males. During follow-up, 1646 participants remained as prediabetes, 379 progressed to diabetes, and 598 regressed to normoglycaemia based on ADA criteria. Participants who progressed to diabetes had lower normalized grip strength than those who remained as prediabetes (0.49 ± 0.15 vs. 0.53 ± 0.15, P < 0.001), but participants who regressed to normoglycaemia showed the opposite (0.55 ± 0.16 vs. 0.53 ± 0.15, P = 0.003). However, chair-rising time was comparable across different groups (Poverall = 0.17). Compared with participants in low normalized grip strength or high chair-rising time group, those in high normalized grip strength or low chair-rising time group had decreased odds of progression to diabetes (OR 0.62, 95% CI 0.44 to 0.87; and OR 0.69, 95% CI 0.51 to 0.93, respectively) after multivariable adjustment. However, both were unrelated to the odds of regression to normoglycaemia (OR 0.94, 95% CI 0.71 to 1.25; and OR 0.84, 95% CI 0.65 to 1.07, respectively). These outcomes remained generally comparable when prediabetes was defined by WHO or IEC criteria. Higher normalized grip strength but not lower chair-rising time was prospectively associated with lower blood pressure, better glycaemic condition, and lower inflammation (all P ≤ 0.04). CONCLUSIONS High muscle strength is associated with reduced odds of progression to diabetes but does not predict regression to normoglycaemia in prediabetes. Future studies are warranted to assess whether increases in muscle strength promote prediabetes regression.
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Affiliation(s)
- Shanhu Qiu
- Department of General Practice, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.,Department of Endocrinology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University), Shenzhen, China
| | - Xue Cai
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Yuan
- Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.,Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bo Xie
- Department of General Practice, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Zilin Sun
- Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.,Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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26
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Davidson MB. Historical review of the diagnosis of prediabetes/intermediate hyperglycemia: Case for the international criteria. Diabetes Res Clin Pract 2022; 185:109219. [PMID: 35134465 DOI: 10.1016/j.diabres.2022.109219] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
In 1997, the ADA recommended an IFG criterion for diagnosing prediabetes/intermediate hyperglycemia of FPG concentrations of 6.1-6.9 mmol/L (110-125 mg/dL). In 2003, they lowered it to 5.6-6.9 mmol/L (100-125 mg/dL) to equalize developing diabetes between IGT and IFG. International organizations accepted the first IFG criterion but not the second. The ADA subsequently recommended HbA1c levels for diagnosing prediabetes/intermediate hyperglycemia of 39-47 mmol/mol (5.7-6.4%) based on a model that utilized the composite risk of developing diabetes and CVD. However, the evidence that the intermediate hyperglycemia that defines prediabetes is independently associated with CVD is weak. Rather, the other risk factors for CVD in the metabolic syndrome are responsible. The WHO opined that prediabetes/intermediate hyperglycemia could not be diagnosed by HbA1c levels but the Canadians and Europeans recommended its diagnosis by values of 42-47 mmol/mol (6.0-6.4%). With the ADA criteria, approximately one-half of people are normal on re-testing, one-third spontaneously revert to normal over time and two-thirds never develop diabetes in their lifetimes. The international criteria for prediabetes/intermediate hyperglycemia increase the risk of developing diabetes and might motivate these individuals to more seriously undertake lifestyle interventions as a preventive measure.
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Affiliation(s)
- Mayer B Davidson
- Charles R. Drew University, 1731 East 120(th) Street, Los Angeles, CA 90059, United States.
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27
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Veronese N, Noale M, Sinclair A, Barbagallo M, Dominguez LJ, Smith L, Pizzol D, Maggi S. Risk of progression to diabetes and mortality in older people with prediabetes: The English longitudinal study on ageing. Age Ageing 2022; 51:afab222. [PMID: 35134845 PMCID: PMC8824760 DOI: 10.1093/ageing/afab222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Indexed: 02/04/2023] Open
Abstract
AIMS Prediabetes is used to identify people at increased risk for diabetes. However, the importance of prediabetes in older populations is still poorly explored. Therefore, we aimed to investigate the prevalence of prediabetes, based on either glycated haemoglobin (HbA1c) levels or fasting glucose (FG) levels, or both and the progression of prediabetes to diabetes or to mortality in older participants of the English Longitudinal Study on Ageing. MATERIALS AND METHODS Prediabetes was categorized based on HbA1c levels (5.7%-6.4%) and/or FG levels (5.6-7.0 mmol/L). Information regarding mortality and incident diabetes were recorded during follow-up period of 10 years. RESULTS In 2027 participants (mean age: 70.6 years, 55.2% females), the prevalence of prediabetes ranged between 5.9% and 31.1%. Over 8 years of follow-up, 189 participants (5.4% of the initial population) developed diabetes and 606 (17.4%) died. Among 1,403 people with HbA1c at the baseline <5.7%, 33 developed diabetes and 138 died; in contrast, among 479 participants with a diagnosis of prediabetes using a value of HbA1c between 5.7% and 6.4%, 62 developed diabetes and 56 died. Similarly, among 1,657 people with normal values of FG at baseline 60 had a diagnosis of diabetes during follow-up and 163 died, compared to 225 with FG between 5.6 mmol/L and 7.0 mmol/L in which 35 developed diabetes and 31 died. CONCLUSION The prevalence of prediabetes in older adults is high, but the progression from prediabetes to diabetes is uncommon, whereas the regression to normoglycemia or the progression to death was more frequent.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Marianna Noale
- Aging Branch, Neuroscience Institute, National Research Council, Padua, Italy
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People (fDROP) and King's College London, London, UK
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Ligia J Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
- Faculty of Medicine and Surgery, University of Enna ``Kore'', Enna, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum, Sudan
| | - Stefania Maggi
- Aging Branch, Neuroscience Institute, National Research Council, Padua, Italy
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Prevalence of Diabetes Among Community-Living Older Persons in the Philippines: The FITforFrail Study. J ASEAN Fed Endocr Soc 2022; 37:23-27. [PMID: 36578887 PMCID: PMC9758548 DOI: 10.15605/jafes.037.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To estimate the prevalence of diabetes among Filipino older persons living in the community. Methodology A cross-sectional analysis was done on a random sample of persons 60 years and older from the Focused Interventions for Frail Older Adults Research and Development Program (2018-2019). A diagnosis of diabetes was established by self-reported physician's diagnosis or if the person was on any antihyperglycemic drugs. Results The prevalence of self-reported diabetes was 20.5%, with no difference in age, sex, education, or body mass index between older persons with and without diabetes. The presence of 2 or more comorbidities was significantly more common among older persons with diabetes (p<0.001). Visual impairment (p<0.01), hypertension (p<0.001) and hyperlipidemia (p<0.001) were more frequent among those with diabetes. Conclusion Diabetes is prevalent among community-living older Filipinos. Therefore, effective public health measures for diabetes prevention and management are needed for the ever-growing older population, who are at the highest risk for morbidity and mortality.
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29
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Burch P, Holm S. Pre-diabetes in the elderly and the see-saw model of paternalism. JOURNAL OF MEDICAL ETHICS 2021; 47:719-721. [PMID: 33148775 PMCID: PMC8562306 DOI: 10.1136/medethics-2020-106573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. While ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a 'see-saw' model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes.
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Affiliation(s)
- Patrick Burch
- Centre for Primary Care, The University of Manchester, Manchester, UK
| | - Soren Holm
- Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK
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30
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Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nat Rev Endocrinol 2021; 17:534-548. [PMID: 34172940 DOI: 10.1038/s41574-021-00512-2] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 02/06/2023]
Abstract
The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.
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Affiliation(s)
- Srikanth Bellary
- School of Life and Health Sciences, Aston University, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK.
| | - Ioannis Kyrou
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, UK
| | - James E Brown
- School of Life and Health Sciences, Aston University, Birmingham, UK
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK
| | - Clifford J Bailey
- School of Life and Health Sciences, Aston University, Birmingham, UK
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK
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Diabetes and impaired fasting glucose in a population-based sample of individuals aged 75 + years: associations with cognition, major depressive disorder, functionality and quality of life-the Pietà study. Neurol Sci 2021; 42:3663-3671. [PMID: 33439392 DOI: 10.1007/s10072-020-05008-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate the rates of diabetes mellitus (DM) and impaired fasting glucose (IFG) in a population-based sample of individuals aged 75 + years old and their associations with cognitive performance, depression, functionality, and quality of life (QoL). STUDY DESIGN Overall, 350 people participated in the study. Assessments of cognition, mood, functionality and QoL were performed using the mini-mental state examination (MMSE), clock-drawing, category fluency tests, the Mini-International Neuropsychiatric Interview, Pfeffer's Functional Activities Questionnaire, and the WHO Quality of Life-Old (WHOQOL-OLD). RESULTS IFG (ADA criteria) was identified in 42.1% of the sample, while the DM rate was 24.1%. Lack of knowledge of the DM diagnosis and lack of treatment occurred in 27% and 39% of the sample, respectively. Rates of dementia and depression, MMSE, category fluency scores, and previous cardiovascular events did not differ between the glycaemic groups. Individuals with DM performed worse on the clock-drawing test, functionality, and WHOQOL-OLD than the other participants. Individuals with IFG presented similar QoL and functionality when compared with the group without DM. CONCLUSIONS IFG and DM were common in this population-based sample aged 75 + years old, as were inadequate diagnoses and treatments of DM. DM individuals presented poor performance in the executive function test, functionality, and QoL. Further studies are recommended to investigate the value of an IFG diagnosis among the most elderly population.
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Regidor E, Cea-Soriano L, Ruiz A, Goday A, Carabantes D, Díez-Espino J, Artola S, Franch-Nadal J. Classifying and communicating risks in prediabetes according to fasting glucose and/or glycated hemoglobin: PREDAPS cohort study. Scand J Prim Health Care 2021; 39:355-363. [PMID: 34348071 PMCID: PMC8475112 DOI: 10.1080/02813432.2021.1958497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Information about prognostic outcomes can be of great help for people with prediabetes and for physicians in the face of scientific controversy about the cutoff point for defining prediabetes. We aimed to estimate different prognostic outcomes in people with prediabetes. DESIGN Prospective cohort of subjects with prediabetes according to American Diabetes Association guidelines. MAIN OUTCOME MEASURES The probabilities of diabetes onset versus non-onset, the odds against diabetes onset, and the probability of reverting to normoglycemia according to different prediabetes categories were calculated. RESULTS The odds against diabetes onset ranged from 29:1 in individuals with isolated FPG of 100-109 mg/dL to 1:1 in individuals with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. The probability of reversion to normoglycemia was 31.2% (95% CI 24.0-39.6) in those with isolated FPG 100-109 mg/dL and 6.2% (95% CI 1.4-10.0) in those with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. Of every 100 participants in the first group, 97 did not develop diabetes and 31 reverted to normoglycemia, while in the second group those figures were 52 and 6. CONCLUSIONS Using odds of probabilities and absolute numbers might be useful for people with prediabetes and physicians to share decisions on potential interventions.Key pointsCommunicating knowledge on the course of the disease to make clinical decisions is not always done appropriately.Prediabetes is an example where risk communication is important because the prognosis of subjects with prediabetes is very heterogeneous.Depending on fasting plasma glucose and HbA1c levels, the odds of probabilities against diabetes onset ranged from 29: 1 to 1: 1.Depending on fasting plasma glucose and HbA1c levels, the number of subjects in 100 who revert to normoglycemia ranged from 31 to 6.Using probabilities and number absolutes on the prognosis of prediabetes may be useful for people with prediabetes and physicians to share decisions on potential interventions.
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Affiliation(s)
- Enrique Regidor
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- redGDPS Foundation, Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- CONTACT Lucía Cea-Soriano Department of Public Health and Maternal and Child Health, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n. Ciudad Universitaria, Madrid28040, Spain
| | - Antonio Ruiz
- redGDPS Foundation, Madrid, Spain
- Centro de Salud Universitario Pinto, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Albert Goday
- Servicio de Endocrinología, Hospital del Mar, IMIM, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - David Carabantes
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Díez-Espino
- redGDPS Foundation, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
- Tafalla Health Center, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IDiSNA), Pamplona, Spain
| | - Sara Artola
- redGDPS Foundation, Madrid, Spain
- Centro de Salud José Marvá, Madrid, Spain
| | - Josep Franch-Nadal
- redGDPS Foundation, Madrid, Spain
- Barcelona City Research Support Unit, University Institute for Research in Primary Care Jordi Gol, Barcelona, Spain
- CIBER Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
- Department of Medicine, Universidad de Barcelona, Barcelona, Spain
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Tsai SH, Cheng HC, Liu HW. Effects of volume-matched resistance training with different loads on glycemic control, inflammation, and body composition in prediabetic older adults. Appl Physiol Nutr Metab 2021; 46:1400-1406. [PMID: 34265211 DOI: 10.1139/apnm-2021-0355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of the investigation was to examine the influence of resistance training (RT) with equal volume and varying load on glycemic control, inflammation, and body composition in non-obese prediabetic older adults. Non-obese older adults with prediabetes were randomized into two groups - high-load (80% 1RM) and low-load (40% of 1RM) RT (n=12/group), both with the same training volume. Oral glucose tolerance test (OGTT) and blood samples were collected at baseline and again after 10 weeks of RT. Fasting plasma glucose (103.8 vs. 99.9 mg/dL) and the area under the curve (AUC) of OGTT (0-30min) decreased significantly in older adults with prediabetes after 10-weeks of volume-matched RT (p < 0.05). Serum levels of MCP-1 (138.7 vs. 98.5 pg/mL) and TNF-α (1.8 vs. 1.3 pg/mL) showed significant decrease after 10-weeks of high-load RT (p < 0.05). There were no changes in IL-10, IL-6, and CRP levels in both groups. Leptin showed significant decrease after 10-weeks of low-load RT (p < 0.05). Changes in fasting glucose and AUC of OGTT (0-120 min) were positively correlated with changes in MCP-1 and TNF-α (p < 0.05). Lean body mass (39.6 vs. 40.3 kg) increased significantly after 10-weeks of volume-matched RT (p < 0.05). Results indicate that equal-volume RT at different loads is beneficial to glycemic control and muscle growth, and high-load RT shows more prominent anti-inflammatory effects. Novelty: ●Short-term high-load resistance training can help older adults bring their blood sugar level back to normal. ●High-load resistance training attenuates aging-associated chronic inflammation.
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Affiliation(s)
- Shun-Hsi Tsai
- National Taiwan Normal University, 34879, Department of Physical Education, Taipei, Taiwan;
| | - Hao-Chien Cheng
- National Taiwan Normal University, 34879, Department of Physical Education, Taipei, Taiwan;
| | - Hung-Wen Liu
- National Taiwan Normal University, 34879, Department of Physical Education, Taipei, Taiwan, 106;
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34
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Grottenthaler JM, Füger JK, Mahling M, Königsrainer A, Malek NP, Birkenfeld AL, Nadalin S, Berg CP, Heyne N, Guthoff M. Dynamics of glucose metabolism after liver transplantation: Prediabetes as a window of opportunity for patient survival and long-term kidney function. Transpl Int 2021; 34:1959-1970. [PMID: 34214208 DOI: 10.1111/tri.13967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/30/2021] [Accepted: 06/28/2021] [Indexed: 12/01/2022]
Abstract
Posttransplantation diabetes mellitus (PTDM) is a relevant complication following liver transplantation with profound impact on morbidity and mortality. To date, little is known about the evolution and dynamics of glucose metabolism and the impact of prediabetes in long-term follow-up. To address this issue, all consecutive adult liver transplant recipients (n=429) from a European university hospital transplant center between 2007 and 2017 were analyzed retrospectively. In patients without pre-existing diabetes (n=327), we conducted a longitudinal characterization of glucose metabolism. Median follow-up was 37 [9-64, IQR] months. Median prevalence of prediabetes was 39 [37-39]% and of PTDM 21 [17-22]%. Throughout follow-up, intra-individual glucose regulation of patients was highly variable, continuously fluctuating between different states of glucose metabolism (normal glucose tolerance, prediabetes, PTDM). Whereas overall survival and long-term kidney function of patients with PTDM were significantly lower than that of patients with normal glucose metabolism, prediabetes was not associated with adverse outcome. This study provides new insight into the dynamics and impact of glucose metabolism after liver transplantation. Unlike PTDM, prediabetes is not associated with adverse outcome, providing a window of opportunity for targeted intervention. The results underline the need for constant screening and intervention in post-transplant care of liver allograft recipients.
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Affiliation(s)
- Julia M Grottenthaler
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University of Tuebingen, Tuebingen, Germany
| | - Judith K Füger
- Department of Diabetology, Endocrinology, Nephrology, University of Tuebingen, Tuebingen, Germany
| | - Moritz Mahling
- Department of Diabetology, Endocrinology, Nephrology, University of Tuebingen, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Alfred Königsrainer
- Department of General-, Visceral- and Transplant Surgery, University of Tuebingen, Tuebingen, Germany
| | - Nisar P Malek
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University of Tuebingen, Tuebingen, Germany
| | - Andreas L Birkenfeld
- Department of Diabetology, Endocrinology, Nephrology, University of Tuebingen, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Silvio Nadalin
- Department of General-, Visceral- and Transplant Surgery, University of Tuebingen, Tuebingen, Germany
| | - Christoph P Berg
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University of Tuebingen, Tuebingen, Germany
| | - Nils Heyne
- Department of Diabetology, Endocrinology, Nephrology, University of Tuebingen, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, University of Tuebingen, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tuebingen, Tuebingen, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
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Sinha A, Ning H, Ahmad FS, Bancks MP, Carnethon MR, O'Brien MJ, Allen NB, Wilkins JT, Lloyd-Jones DM, Khan SS. Association of fasting glucose with lifetime risk of incident heart failure: the Lifetime Risk Pooling Project. Cardiovasc Diabetol 2021; 20:66. [PMID: 33752676 PMCID: PMC7983294 DOI: 10.1186/s12933-021-01265-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Given the rising prevalence of dysglycemia and disparities in heart failure (HF) burden, we determined race- and sex-specific lifetime risk of HF across the spectrum of fasting plasma glucose (FPG). METHODS Individual-level data from adults without baseline HF was pooled from 6 population-based cohorts. Modified Kaplan-Meier analysis, Cox models adjusted for the competing risk of death, and Irwin's restricted mean were used to estimate the lifetime risk, adjusted hazard ratio (aHR), and years lived free from HF in middle-aged (40-59 years) and older (60-79 years) adults with FPG < 100 mg/dL, prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) across race-sex groups. RESULTS In 40,117 participants with 638,910 person-years of follow-up, 4846 cases of incident HF occurred. The lifetime risk of HF was significantly higher among middle-aged White adults and Black women with prediabetes (range: 6.1% [95% CI 4.8%, 7.4%] to 10.8% [95% CI 8.3%, 13.4%]) compared with normoglycemic adults (range: 3.5% [95% CI 3.0%, 4.1%] to 6.5% [95% CI 4.9%, 8.1%]). Middle-aged Black women with diabetes had the highest lifetime risk (32.4% [95% CI 26.0%, 38.7%]) and aHR (4.0 [95% CI 3.0, 5.4]) for HF across race-sex groups. Middle-aged adults with prediabetes and diabetes lived on average 0.9-1.6 and 4.1-6.0 fewer years free from HF, respectively. Findings were similar in older adults except older Black women with prediabetes did not have a higher lifetime risk of HF. CONCLUSIONS Prediabetes was associated with higher lifetime risk of HF in middle-aged White adults and Black women, with the association attenuating in older Black women. Black women with diabetes had the highest lifetime risk of HF compared with other race-sex groups.
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Affiliation(s)
- Arjun Sinha
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John T Wilkins
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA. .,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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36
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Shang Y, Fratiglioni L, Vetrano DL, Dove A, Welmer AK, Xu W. Not Only Diabetes but Also Prediabetes Leads to Functional Decline and Disability in Older Adults. Diabetes Care 2021; 44:690-698. [PMID: 33446522 PMCID: PMC7896268 DOI: 10.2337/dc20-2232] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is linked to functional decline, but the impact of prediabetes on physical function is unknown. We aimed to examine and compare the impact of prediabetes and diabetes on physical function and disability progression and to explore whether cardiovascular diseases (CVDs) mediate these associations. RESEARCH DESIGN AND METHODS A cohort of 2,013 participants aged ≥60 from the Swedish National Study on Aging and Care in Kungsholmen, an ongoing population-based longitudinal study, was monitored for up to 12 years. Physical function was measured with chair stand (s) and walking speed (m/s) tests, and disability was measured by summing the numbers of impaired basic and instrumental activities of daily living. Diabetes was identified through medical examinations or clinical records, medication use, or glycated hemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7-6.4% in participants free of diabetes. CVDs were ascertained through clinical examinations and the National Patient Register. Data were analyzed using mixed-effect models and mediation models. RESULTS At baseline, 650 (32.3%) had prediabetes and 151 had diabetes (7.5%). In multiadjusted mixed-effect models, prediabetes was associated with an increased chair stand time (β 0.33, 95% CI 0.05-0.61), a decreased walking speed (β -0.006, 95% CI -0.010 to -0.002), and an accelerated disability progression (β 0.05, 95% CI 0.01-0.08), even after controlling for the future development of diabetes. Diabetes led to faster functional decline than prediabetes. In mediation analyses, CVDs mediated 7.1%, 7.8%, and 20.9% of the associations between prediabetes and chair stand, walking speed, and disability progression, respectively. CONCLUSIONS Prediabetes, in addition to diabetes, is associated with faster functional decline and disability, independent of the future development of diabetes. This association may be in part mediated by CVDs.
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Affiliation(s)
- Ying Shang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Fondazione Policlinico "A. Gemelli" IRCCS and Catholic University of Rome, Rome, Italy
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden .,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Kowall B, Rathmann W, Kuss O, Herder C, Roden M, Stang A, Huth C, Thorand B, Meisinger C, Peters A. Reversion from prediabetes to normoglycaemia after weight change in older persons: The KORA F4/FF4 study. Nutr Metab Cardiovasc Dis 2021; 31:429-438. [PMID: 33594985 DOI: 10.1016/j.numecd.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS In a non-interventional study of older persons, we assessed the impact of changes in BMI and waist circumference (WC) on reversion from glucose- and HbA1c-defined prediabetes to normoglycaemia (in short: reversion) and on persistence of normoglycaemia. Moreover, we studied whether reversion reduced cardiovascular risk. METHODS AND RESULTS From the population-based KORA S4/F4/FF4 cohort study conducted in Southern Germany, we utilized data from the second and third visit to the study center (median follow-up 6.5 years). We used two overlapping data sets, one with 563 persons with HbA1c<6.5% (mean age 69 years, 51.5% men), one with 510 persons with glucose-based prediabetes or normal glucose tolerance. We calculated proportions of reversion, and estimated adjusted relative risks for the association between initial BMI/WC and change of BMI/WC, respectively, and reversion (and persistence of normoglycaemia, respectively). We estimated 10-year cardiovascular risks using the Framingham 2008 score. Overall, 27.3% of persons with HbA1c-defined prediabetes and 9.2% of persons with glucose-based prediabetes returned to normoglycaemia during follow-up. Lower initial BMI/WC and reduction of BMI/WC were associated with larger probabilities of returning to normoglycaemia (e.g., for HbA1c 5.7-6.4%, RR = 1.24 (95% CI: 1.09-1.41) per 1 kg/m2 decline of BMI). Moreover, reduction of BMI/WC increased probabilities of maintaining normoglycaemia (e.g., for glucose-based prediabetes, RR = 1.09 (1.02-1.16) per 1 kg/m2 decline of BMI). 10-year cardiovascular risk was 5.6 (1.7-9.6) percentage points lower after reversion from glucose-based prediabetes to normoglycaemia. CONCLUSION In older adults, even moderate weight reduction contributes to reversion from prediabetes to normoglycaemia and to maintaining normoglycaemia.
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Affiliation(s)
- Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Cornelia Huth
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Thorand
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilian-Universität München, UNIKA-T Augsburg, Augsburg, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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38
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van Herpt TTW, Ligthart S, Leening MJG, van Hoek M, Lieverse AG, Ikram MA, Sijbrands EJG, Dehghan A, Kavousi M. Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria. BMJ Open Diabetes Res Care 2020; 8:8/2/e001529. [PMID: 33214188 PMCID: PMC7678236 DOI: 10.1136/bmjdrc-2020-001529] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Pre-diabetes, a status conferring high risk of overt diabetes, is defined differently by the American Diabetes Association (ADA) and the WHO. We investigated the impact of applying definitions of pre-diabetes on lifetime risk of diabetes in women and men from the general population. RESEARCH DESIGN AND METHODS We used data from 8844 women without diabetes and men aged ≥45 years from the prospective population-based Rotterdam Study in the Netherlands. In both gender groups, we calculated pre-diabetes prevalence according to ADA and WHO criteria and estimated the 10-year and lifetime risk to progress to overt diabetes with adjustment for competing risk of death. RESULTS Out of 8844 individuals, pre-diabetes was identified in 3492 individuals (prevalence 40%, 95% CI 38% to 41%) according to ADA and 1382 individuals (prevalence 16%, 95% CI 15% to 16%) according to WHO criteria. In both women and men and each age category, ADA prevalence estimates doubled WHO-defined pre-diabetes. For women and men aged 45 years having ADA-defined pre-diabetes, the 10-year risk of diabetes was 14.2% (95% CI 6.0% to 22.5%) and 9.2% (95% CI 3.4% to 15.0%) compared with 23.2% (95% CI 6.8% to 39.6%) and 24.6% (95% CI 8.4% to 40.8%) in women and men with WHO-defined pre-diabetes. At age 45 years, the remaining lifetime risk to progress to overt diabetes was 57.5% (95% CI 51.8% to 63.2%) vs 80.2% (95% CI 74.1% to 86.3%) in women and 46.1% (95% CI 40.8% to 51.4%) vs 68.4% (95% CI 58.3% to 78.5%) in men with pre-diabetes according to ADA and WHO definitions, respectively. CONCLUSION Prevalence of pre-diabetes differed considerably in both women and men when applying ADA and WHO pre-diabetes definitions. Women with pre-diabetes had higher lifetime risk to progress to diabetes. The lifetime risk of diabetes was lower in women and men with ADA-defined pre-diabetes as compared with WHO. Improvement of pre-diabetes definition considering appropriate sex-specific and age-specific glycemic thresholds may lead to better identification of individuals at high risk of diabetes.
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Affiliation(s)
- Thijs T W van Herpt
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Symen Ligthart
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Aloysius G Lieverse
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Davidson MB. Metformin Should Not Be Used to Treat Prediabetes. Diabetes Care 2020; 43:1983-1987. [PMID: 32936780 DOI: 10.2337/dc19-2221] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
Abstract
Based on the results of the Diabetes Prevention Program Outcomes Study (DPPOS), in which metformin significantly decreased the development of diabetes in individuals with baseline fasting plasma glucose (FPG) concentrations of 110-125 vs. 100-109 mg/dL (6.1-6.9 vs. 5.6-6.0 mmol/L) and A1C levels 6.0-6.4% (42-46 mmol/mol) vs. <6.0% and in women with a history of gestational diabetes mellitus, it has been suggested that metformin should be used to treat people with prediabetes. Since the association between prediabetes and cardiovascular disease is due to the associated nonglycemic risk factors in people with prediabetes, not to the slightly increased glycemia, the only reason to treat with metformin is to delay or prevent the development of diabetes. There are three reasons not to do so. First, approximately two-thirds of people with prediabetes do not develop diabetes, even after many years. Second, approximately one-third of people with prediabetes return to normal glucose regulation. Third, people who meet the glycemic criteria for prediabetes are not at risk for the microvascular complications of diabetes and thus metformin treatment will not affect this important outcome. Why put people who are not at risk for the microvascular complications of diabetes on a drug (possibly for the rest of their lives) that has no immediate advantage except to lower subdiabetes glycemia to even lower levels? Rather, individuals at the highest risk for developing diabetes-i.e., those with FPG concentrations of 110-125 mg/dL (6.1-6.9 mmol/L) or A1C levels of 6.0-6.4% (42-46 mmol/mol) or women with a history of gestational diabetes mellitus-should be followed closely and metformin immediately introduced only when they are diagnosed with diabetes.
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Shang Y, Fratiglioni L, Marseglia A, Plym A, Welmer AK, Wang HX, Wang R, Xu W. Association of diabetes with stroke and post-stroke dementia: A population-based cohort study. Alzheimers Dement 2020; 16:1003-1012. [PMID: 32489021 DOI: 10.1002/alz.12101] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/06/2019] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The impact of prediabetes and diabetes on stroke and the development of dementia after a stroke remain unclear. METHODS A total of 2655 dementia-free participants (including a stroke-free cohort and a prevalent stroke cohort) were followed-up for 12 years. Dementia and post-stroke dementia were determined by clinical examinations and national registry data. Diabetes was ascertained via medical examination, medication use, medical records, or glycated hemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7% in diabetes-free participants. RESULTS In the stroke-free cohort, 236 participants developed ischemic stroke, and 47 developed post-stroke dementia. Diabetes was associated with ischemic stroke (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.16 to 2.67) and post-stroke dementia (HR 2.56, 95% CI 1.04 to 6.25). In the prevalent stroke cohort, diabetes was also related to dementia risk. Prediabetes was not significantly related to stroke or post-stroke dementia. DISCUSSION Diabetes, but not prediabetes, is associated with an increased risk of ischemic stroke and post-stroke dementia.
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Affiliation(s)
- Ying Shang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna Plym
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Hui-Xin Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,The Swedish School of Sport and Health Science, GIH, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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41
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Jolobe OMP. Methodology of blood pressure measurements casts doubt on the validity of the conclusions. J Intern Med 2019; 286:726-727. [PMID: 31373062 DOI: 10.1111/joim.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- O M P Jolobe
- From the, Manchester Medical Society, Manchester, UK
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Shang Y, Xu W. Clarifications on blood pressure measurements and the validity of the conclusions. J Intern Med 2019; 286:728-729. [PMID: 31602687 DOI: 10.1111/joim.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y Shang
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - W Xu
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Shang Y, Marseglia A, Fratiglioni L, Welmer A, Wang R, Wang H, Xu W. Natural history of prediabetes in older adults from a population-based longitudinal study. J Intern Med 2019; 286:326-340. [PMID: 31165572 PMCID: PMC6851857 DOI: 10.1111/joim.12920] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The natural history of prediabetes in older adults remains unknown. OBJECTIVES To assess the rate at which prediabetes progresses to diabetes, leads to death or reverts to normoglycaemia in older adults and to identify prognostic factors related to different outcomes of prediabetes. METHODS In the Swedish National Study on Aging and Care-Kungsholmen, 2575 diabetes-free participants aged ≥60 years were examined at baseline and followed for up to 12 years. At each wave, diabetes was diagnosed via medical examination, antidiabetic drug use, medical records or glycated haemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7% and normoglycaemia as HbA1c <5.7% in diabetes-free participants. Data were analysed with multinomial logistic regression. RESULTS At baseline, 918 (36%) individuals had prediabetes. Of them, 204 (22%) reverted to normoglycaemia (3.4/100 person-years, 95% CI 5.6-12.3), 119 (13%) developed diabetes (2.0/100 person-years, 95% CI 1.7-2.4) and 215 (23%) died (13.0/100 person-years, 95% CI 11.4-14.9) during the 12-year follow-up. The rates of reversion, progression and mortality were higher in the first 6-year than in the second 6-year follow-up, albeit not statistically significant. Lower systolic blood pressure (SBP), absence of heart diseases and weight loss promoted the reversion from prediabetes to normoglycaemia, whilst obesity accelerated its progression to diabetes. CONCLUSIONS During a 12-year follow-up, most of older adults with prediabetes remained stable or reverted to normoglycaemia, whereas only one-third developed diabetes or died. Lower SBP, no heart diseases and weight management may promote reversion to normoglycaemia, suggesting possible strategies for achieving normoglycaemia in older adults with prediabetes.
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Affiliation(s)
- Y. Shang
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
| | - A. Marseglia
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
| | - L. Fratiglioni
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - A.‐K. Welmer
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Functional Area Occupational Therapy & PhysiotherapyKarolinska University HospitalStockholmSweden
| | - R. Wang
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
| | - H.‐X. Wang
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Stress Research InstituteStockholm UniversityStockholmSweden
| | - W. Xu
- Aging Research Center, Department of NeurobiologyCare Sciences and Society, Karolinska Institutet, Stockholm UniversityStockholmSweden
- Department of Epidemiology and BiostatisticsSchool of Public HealthTianjin Medical UniversityTianjinChina
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Mayor S. Clinical News. Br J Hosp Med (Lond) 2019; 80:370-371. [PMID: 31283391 DOI: 10.12968/hmed.2019.80.7.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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