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Wongrith P, Thirarattanasunthon P, Kaewsawat S. Glycemic control outcome in patients with type 2 diabetes mellitus: chronic care management support of family care team in Thailand. J Diabetes Metab Disord 2021; 20:1269-1279. [PMID: 34900778 DOI: 10.1007/s40200-021-00851-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/03/2021] [Indexed: 11/27/2022]
Abstract
Purpose We aimed to ascertain diabetic self-management predictors in the family care team chronic care model, and to analyze the factors associated with glycemic control. Methods A cross-sectional study was conducted with type 2 diabetes mellitus (T2DM) patients at Pak Phun Municipality Hospital, Thailand, from 2019 to 2020. The 282 participants' compraised 16 health care providers, 128 healthy volunteers, and 138 T2DM patients. Data were collected using a questionnaire. The statistics were descriptive, association and multiple regression were tested. Results Of the T2DM patients, 68.1% were female, overweight (body mass index 25.8 ± 3.99 kg/m2), had diabetic periods of 8.2 ± 4.65 y, high fasting plasma glucose (FPG) (139.3 ± 44.59 mg/dL), uncontrolled A1C (7.8 ± 1.57%), and presented with diabetic nephropathy (61.6%). Diabetic self-management was at a high level (76.8%). The factors significantly associated with A1C were income (p < 0.001), low-density lipoprotein (p < 0.05) estimated glomerular filtration rate, and FPG (p < 0.001). A1C was predicted by self-efficacy (SE) (38.0%; p < 0.001), social support (SO) (40.8%; p < 0.001), health providers evaluated by the Assessment of Chronic Illness Care (ACIC) (22.8%; p < 0.001), and patients' perception by Patient Assessment of Care for Chronic Conditions (PACIC) (17%; p < 0.01). Conclusion In order to reduce diabetes complications, the family care team played a critical role. Self-efficacy and social support were important factors in managing diabetes. The chronic care model begins with a procedure of self-management support and intervention by stakeholders such as caregivers in the community.
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Affiliation(s)
- Paleeratana Wongrith
- School of Public Health, Walailak University, 222 Thaiburi, Tha Sala, Nakhon Si Thammarat, 80161 Thailand
| | - Phiman Thirarattanasunthon
- School of Public Health, Walailak University, 222 Thaiburi, Tha Sala, Nakhon Si Thammarat, 80161 Thailand
| | - Supreecha Kaewsawat
- School of Public Health, Walailak University, 222 Thaiburi, Tha Sala, Nakhon Si Thammarat, 80161 Thailand
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Shilpasree AS, Patil VS, Revanasiddappa M, Patil VP, Ireshnavar D. Renal Dysfunction in Prediabetes: Confirmed by Glomerular Hyperfiltration and Albuminuria. J Lab Physicians 2021; 13:257-262. [PMID: 34602791 PMCID: PMC8478507 DOI: 10.1055/s-0041-1731107] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives
Prediabetes is defined as an intermediate state of hyperglycemia with glucose levels above normal but below the diagnostic cutoff of diabetes mellitus. Prediabetes is considered as an important risk factor for the development of diabetes and complications associated with diabetes. Since glomerular hyperfiltration (elevated GFR) and albuminuria represent early and reversible stages of kidney damage seen in patients with type 2 diabetes, we aim to assess the impact of hyperglycemia in prediabetic range on renal functions measured by estimated GFR and urine albumin excretion (UAE).
Materials and Methods
The study included 1,031 patients aged 30 to 70 years, attending regular health checkup. Patients were grouped as normal, prediabetes, and diabetes according to the American Diabetic Association (ADA) criteria based on fasting blood sugar and hemoglobin A1c (HbA1c). Further, the patients were grouped into multiple subgroups based on age and gender. UAE was measured by using immunoturbidimetric method, and GFR was estimated by chronic kidney disease epidemiology collaboration (CKD EPI) equation.
Statistical Analysis
Prevalence of hyperfiltration (estimated glomerular filtration rate above the age and gender specific 95th percentile), and albuminuria in prediabetes and diabetes was compared with normal controls. Odds ratio and 95% confidence interval were calculated by using logistic regression analysis to predict the occurrence of hyperfiltration in prediabetes and diabetes. Analysis of variance followed by post hoc comparison was done to assess the significance of difference, and
p
-value < 0.05 was considered statistically significant.
Results
Prevalence of hyperfiltration was more in prediabetes and diabetes compared with normal controls, and it increased with surging HbA1c level that was shown as higher odds ratio for hyperfiltration in both the groups. UAE was more in the prediabetes and diabetes group when compared with normal controls, but the difference was significant only in diabetes.
Conclusion
Since glomerular hyperfiltration represents an early and reversible stage of renal damage manifesting before the appearance of albuminuria, elevated GFR can be used to identify asymptomatic patients with intermediate hyperglycemia having high risk of developing nephropathy in the future. Prediabetes represents a window of opportunity to initiate preventive strategies at an early stage before the occurrence of significant renal damage.
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Affiliation(s)
- Alagilawada S Shilpasree
- Department of Biochemistry, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Vidya S Patil
- Department of Biochemistry, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Manjunath Revanasiddappa
- Department of Nephrology, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Vijayetha P Patil
- Department of Biochemistry, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Deepti Ireshnavar
- Department of Biochemistry, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
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Blum MF, Surapaneni A, Stewart JD, Liao D, Yanosky JD, Whitsel EA, Power MC, Grams ME. Particulate Matter and Albuminuria, Glomerular Filtration Rate, and Incident CKD. Clin J Am Soc Nephrol 2020; 15:311-319. [PMID: 32108020 PMCID: PMC7057299 DOI: 10.2215/cjn.08350719] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Exposure to particulate matter (PM) <2.5 μm in aerodynamic diameter (PM2.5) has been linked to detrimental health effects. This study aimed to describe the relationship between long-term PM2.5 exposure and kidney disease, including eGFR, level of albuminuria, and incident CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The study included 10,997 participants from the Atherosclerosis Risk in Communities cohort who were followed from 1996-1998 through 2016. Monthly mean PM2.5 concentrations (μg/m3) were estimated at geocoded participant addresses using geographic information system-based, spatiotemporal generalized additive mixed models-including geospatial covariates such as land use-and then averaged over the 12-month period preceding participant examination. Covariate-adjusted, cross-sectional associations of PM2.5, baseline eGFR, and urinary albumin-creatinine ratio (UACR) were estimated using linear regression. PM2.5 and incident CKD (defined as follow-up eGFR <60 ml/min per 1.73 m2 with ≥25% eGFR decline relative to baseline, CKD-related hospitalization or death based on International Classification of Diseases 9/10 codes, or development of ESKD) associations were estimated using Cox proportional hazards regression. Modeling was stratified by study site, and stratum-specific estimates were combined using random-effects meta-analyses. RESULTS Baseline mean participant age was 63 (±6) years and eGFR was 86 (±16) ml/min per 1.73 m2. There was no significant PM2.5-eGFR association at baseline. Each 1-μg/m3 higher annual average PM2.5 was associated with higher UACR after adjusting for demographics, socioeconomic status, and clinical covariates (percentage difference, 6.6%; 95% confidence interval [95% CI], 2.6% to 10.7%). Each 1-μg/m3 higher annual average PM2.5 was associated with a significantly higher risk of incident CKD (hazard ratio, 1.05; 95% CI, 1.01 to 1.10). CONCLUSIONS Exposure to higher annual average PM2.5 concentrations was associated with a higher level of albuminuria and higher risk for incident CKD in a community-based cohort.
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Affiliation(s)
| | - Aditya Surapaneni
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - James D. Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jeff D. Yanosky
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Morgan E. Grams
- Division of Nephrology
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Rodríguez-Poncelas A, Franch-Nadal J, Coll-de Tuero G, Mata-Cases M, Alonso-Fernández M, Mur-Marti T, Ruiz A, Giraldez-García C, Regidor E. High levels of fasting glucose and glycosylated hemoglobin values are associated with hyperfiltration in a Spanish prediabetes cohort. The PREDAPS Study. PLoS One 2019; 14:e0222848. [PMID: 31536578 PMCID: PMC6752878 DOI: 10.1371/journal.pone.0222848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/08/2019] [Indexed: 11/19/2022] Open
Abstract
AIM This study aimed to investigate whether different levels of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) in prediabetes are associated with hyperfiltration. METHODS A prospective cohort of 2,022 individuals aged 30-74 years took part in the PREDAPS Study. One cohort of 1,184 participants with prediabetes and another cohort of 838 participants with normal FPG and normal HbA1c were followed for 5 years. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile for healthy control participants, while hypofiltration was defined as an eGFR below the 5th percentile. The prevalence of hyperfiltration was compared for different levels of prediabetes: level 1 of prediabetes: FPG <100 mg/dL plus HbA1c 5.7-6.0% or FPG 100-109 mg/dL plus HbA1c < 5.7%; level 2 of prediabetes: FPG <100 mg/dL plus HbA1c 6.1-6.4% or FPG 100-109 mg/dL plus HbA1c 5.7-6.0% or FPG 110-125 mg/dL plus HbA1c <5.7% and level 3 of prediabetes: FPG 100-109 mg/dL plus HbA1c 6.1-6.4% or FPG 110-125 mg/dL plus HbA1c 5.7-6.4%. RESULTS The participants with hyperfiltration were significantly younger, had a higher percentage of active smokers, and lower levels of hemoglobin and less use of ACEIs or ARBs. Only level 3 prediabetes based on FPG 100-109 mg/dL plus HbA1c 6.1-6.4% or FPG 110-125 mg/dL plus HbA1c 5.7-6.4% had a significantly higher odds ratio (OR) of hyperfiltration (OR 1.69 (1.05-2.74); P < 0.001) compared with no prediabetes (FPG < 100 mg/dL and HbA1c < 5.7%) after adjustment for different factors. The odds ratios for different levels of HbA1c alone in prediabetes increased progressively, but not significantly. CONCLUSIONS Level 3 of prediabetes based on FPG 100-109 mg/dL plus HbA1c 6.1-6.4% or FPG 110-125 mg/dL plus HbA1c 5.7-6.4% had a significantly higher OR of hyperfiltration compared with participants without prediabetes.
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Affiliation(s)
- Antonio Rodríguez-Poncelas
- METHARISC Group, USR Girona, IDIAP Gol i Gorina, Girona, Spain
- Grup de Recerca Epidemiològica en Diabetis des de l´Atenció Primària (DAP_CAT) Jordi Gol, Barcelona, Spain
- RedGDPS Foundation, Madrid, Spain
| | - Josep Franch-Nadal
- RedGDPS Foundation, Madrid, Spain
- USR Barcelona ciutat–IDIAP Jordi Gol, Barcelona, Spain
- CIBER Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Gabriel Coll-de Tuero
- METHARISC Group, USR Girona, IDIAP Gol i Gorina, Girona, Spain
- Departamento de Ciencias Médicas, Universitat de Girona, Girona, Spain
| | - Manel Mata-Cases
- Grup de Recerca Epidemiològica en Diabetis des de l´Atenció Primària (DAP_CAT) Jordi Gol, Barcelona, Spain
- RedGDPS Foundation, Madrid, Spain
- USR Barcelona ciutat–IDIAP Jordi Gol, Barcelona, Spain
- CIBER Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Margarita Alonso-Fernández
- RedGDPS Foundation, Madrid, Spain
- Centro de Salud La Ería, Asturias, Spain
- Departamento de Medicina Preventiva y Salud Publica, Universidad de Oviedo, Asturias, Spain
| | - Teresa Mur-Marti
- RedGDPS Foundation, Madrid, Spain
- Mutua Terrassa, Barcelona, Spain
| | - Antonio Ruiz
- RedGDPS Foundation, Madrid, Spain
- Centro de Salud Universitario Pinto, Madrid, Spain
| | | | - Enrique Regidor
- RedGDPS Foundation, Madrid, Spain
- Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Rodriguez-Poncelas A, Coll-de-Tuero G, Blanch J, Comas-Cufí M, Saez M, Barceló MA. Prediabetes is associated with glomerular hyperfiltration in a European Mediterranean cohort study. J Nephrol 2018; 31:743-749. [PMID: 30151699 DOI: 10.1007/s40620-018-0524-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glomerular hyperfiltration is well recognized as an early renal alteration in subjects with diabetes mellitus. However, what is not well-known is whether hyperfiltration also occurs in the early stages of hyperglycaemia, for instance in prediabetes. Identifying subjects with glomerular hyperfiltration from among those with prediabetes might be helpful to implement preventive and therapeutic strategies. This study aimed to investigate the association of prediabetes with glomerular hyperfiltration and its associated variables. METHODS A representative sample of 9238 people aged ≥ 30 years and whose entire clinical and laboratory data were available, were included in this study. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS After adjustment for age, gender, body mass index, systolic blood pressure and diastolic blood pressure, cholesterol, log (triglycerides), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum uric acid, smoking status, hypertension, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, fasting plasma glucose (FPG) was found to be independently positively associated with eGFR. The hazard ratios (95% confidence interval) for hyperfiltration were 1.61 (1.28-2.03) and 2.30 (1.89-2.79) for prediabetes and diabetes, respectively, when compared with participants with normoglycemia. CONCLUSION Prediabetes was associated with glomerular hyperfiltration. Longitudinal studies are needed to investigate whether hyperfiltration in prediabetes is associated with a later decline in eGFR.
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Affiliation(s)
| | - Gabriel Coll-de-Tuero
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain.,Department of Medical Sciences, University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jordi Blanch
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain
| | - Marc Comas-Cufí
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain
| | - Marc Saez
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain.
| | - Maria Antònia Barceló
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain
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Hu W, Wu XJ, Ni YJ, Hao HR, Yu WN, Zhou HW. Metabolic syndrome is independently associated with a mildly reduced estimated glomerular filtration rate: a cross-sectional study. BMC Nephrol 2017; 18:192. [PMID: 28610620 PMCID: PMC5470228 DOI: 10.1186/s12882-017-0597-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 05/19/2017] [Indexed: 01/28/2023] Open
Abstract
Background Association between metabolic syndrome (MS) and mildly reduced estimated glomerular filtration rates (eGFRs) remains unclear. Therefore, we aimed to evaluate the association between MS and a mildly reduced eGFR in Chinese adults. Methods Anthropometric and biochemical examinations were performed in 2992 individuals. The eGFR was calculated from the creatinine level. MS was defined according to the Adult Treatment Panel III criteria as the presence of three or more risk factors. Mildly reduced eGFR was defined as a value between 60 and 90 mL/min/1.73 m2. Multiple linear regression and multiple logistic regression analysis were used to evaluate association between metabolic syndrome and estimate glomerular filtration rate. Results After adjusting for several potential confounders, the participants with MS showed a 1.29-fold increased odds ratio for a mildly reduced eGFR compared with those without MS. Additionally, the odds ratios (and 95% confidence intervals (CIs)) for mildly reduced eGFR in participants with elevated triglycerides (TG), decreased high-density lipoprotein (HDL), obesity and elevated fasting blood glucose (FPG) after multivariable adjustment were 1.25 (1.05–1.49), 1.23 (1.03–1.48), 1.22 (1.03–1.45) and 0.64 (0.52–0.78), respectively. The odds ratios (95% CIs) for hyperfiltration in participants with elevated FPG and HbA1c levels after multivariable adjustment were 1.53 (1.30–1.81) and 2.86 (2.00–4.09), respectively. Conclusions MS is associated with an increased risk of a mildly reduced eGFR in the Chinese population, and several individual components of MS have different impacts on eGFR levels. MS had dual roles on renal damage. Trial registration ChiCTR-TRC-14005029. Registered 28 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0597-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wen Hu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.,Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiao-Juan Wu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Yao-Jun Ni
- Department of Cardiothoracic Surgery, Hospital Affiliated to Nanjing Medical University and Huai'an First People's Hospital, Huai'an, 223001, China
| | - Hai-Rong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Wei-Nan Yu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Hong-Wen Zhou
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China. .,Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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7
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Kumar R, Nandhini LP, Kamalanathan S, Sahoo J, Vivekanadan M. Evidence for current diagnostic criteria of diabetes mellitus. World J Diabetes 2016; 7:396-405. [PMID: 27660696 PMCID: PMC5027003 DOI: 10.4239/wjd.v7.i17.396] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/24/2016] [Accepted: 07/18/2016] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus is a non-communicable metabolic derangement afflicting several millions of individuals globally. It is associated with several micro and macrovascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Association (ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of evidence.This review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose (FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications.
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8
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Yang P, Hu W, Fu Z, Sun L, Zhou Y, Gong Y, Yang T, Zhou H. The positive association of branched-chain amino acids and metabolic dyslipidemia in Chinese Han population. Lipids Health Dis 2016; 15:120. [PMID: 27457614 PMCID: PMC4960685 DOI: 10.1186/s12944-016-0291-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/14/2016] [Indexed: 12/19/2022] Open
Abstract
Background It has been suggested that serum branched-chain amino acids (BCAAs) are associated with the incident, progression and prognostic of type 2 diabetes. However, the role of BCAAs in metabolic dyslipidemia (raised triglycerides (TG) and reduced high-density lipoprotein cholesterol (HDL-C)) remains poorly understood. This study aims to investigate 1) the association of serum BCAAs with total cholesterol (TC), TG, HDL-C and low-density lipoprotein cholesterol (LDL-C) and 2) the association between serum BCAAs levels and risk of metabolic dyslipidemia in a community population with different glucose homeostasis. Methods Demographics data and blood samples were collected from 2251 Chinese subjects from the Huaian Diabetes Protective Program (HADPP) study. After exclusion for cardiovascular disease (CVD), serious hepatic or nephritic diseases and others, 1320 subjects remained for analysis (789 subjects with hemoglobin A1c (HbA1c) > 5.7, 521 with HbA1c ≤ 5.7). Serum BCAAs level was measured by liquid chromatography-tandem mass spectrometry (LC MS/MS). The association of BCAAs with lipids or with the risk of metabolic dyslipidemia was analyzed. Results Elevated serum BCAAs (both total and individual BCAA) were positively associated with TG and inversely associated with HDL-C in the whole population. These correlations were still significant even after adjustment for confounding factors (r = 0.165, p < 0.001 for TG; and r = -0.126, p < 0.001 for HDL-C). For reduced HDL-C, we found higher odds risk (OR) of Valine (Val) in high HbA1c group than in the low one (OR = 1.055, p < 0.001 vs OR = 1.032, p = 0.059). Compared with that in the first quartile, the multivariable-adjusted OR (95 % CI) of the 4th quartile of serum total BCAAs level for reduced HDL-C was 3.689 (2.325, 5.854) in high HbA1c group and 2.329 (1.284, 4.227) in low group, for raised TG was 3.305 (2.120, 5.152) and 2.972 (1.706, 5.176), and for metabolic dyslipidemia was 3.703 (2.261, 6.065) and 3.702 (1.877, 7.304), respectively (all p < 0.01). Conclusion Elevated serum BCAAs level are positively associated with incident metabolic dyslipidemia. In addition, glucose homeostasis could play a certain role in BCAAs-related dyslipidemia.
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Affiliation(s)
- Panpan Yang
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Wen Hu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.,Department of Endocrinology and Metabolism, Huaian Hospital Affiliated to Xuzhou Medical College and Huaian Second People's Hospital, Huaian, 223002, China
| | - Zhenzhen Fu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Luning Sun
- Research Division of Clinical Pharmacology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Ying Zhou
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Yingyun Gong
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Tao Yang
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Hongwen Zhou
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.
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