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Xuan Q, Hu C, Zhang Y, Wang Q, Zhao X, Liu X, Wang C, Jia W, Xu G. Serum lipidomics profiles reveal potential lipid markers for prediabetes and type 2 diabetes in patients from multiple communities. Front Endocrinol (Lausanne) 2022; 13:966823. [PMID: 36060983 PMCID: PMC9434798 DOI: 10.3389/fendo.2022.966823] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Dyslipidemia is a hallmark of diabetes mellitus (DM). However, specific lipid molecules closely associated with the initiation and progression of diabetes remain unclear. We used a pseudotargeted lipidomics approach to evaluate the complex lipid changes that occurred long before the diagnosis of type 2 diabetes mellitus (T2DM) and to identify novel lipid markers for screening prediabetes mellitus (PreDM) and T2DM in patients from multiple communities. METHODS Four hundred and eighty-one subjects consisting of T2DM, three subtypes of PreDM, and normal controls (NC) were enrolled as discovery cohort. Serum lipidomic profiles of 481 subjects were analyzed using an ultrahigh performance liquid chromatography-triple quadrupole mass spectrometry (UHPLC-QqQ-MS)-based pseudotargeted lipidomics method. The differential lipid molecules were further validated in an independent case-control study consisting of 150 PreDM, 234 T2DM and 94 NC. RESULTS Multivariate discriminative analyses show that lipidomics data have considerable potential for identifying lipidome differences among T2DM, subtypes of PreDM and NC. Statistical associations of lipid (sub)species display significant variations in 11 lipid (sub)species levels for T2DM and distinctive differences in 8 lipid (sub)species levels between prediabetic and normoglycemic individuals, with further differences in 8 lipid (sub)species levels among subtypes of PreDM. Adjusted for sex, age and BMI, only two lipid (sub)species of fatty acid (FA) and phosphatidylcholine (PC) were associated at p< 0.05 for PreDM (all) and subtypes of PreDM. The defined lipid markers not only significantly improve the diagnostic accuracy of PreDM and T2DM but also effectively evaluating the risk of developing into each subtype of PreDM and T2DM when addition of age, sex, BMI, and FPG, respectively. CONCLUSIONS Our findings improve insights into the lipid metabolic complexity and interindividual variations among subtypes of PreDM and T2DM, beyond the well-known differences in dyslipidemia in clinic.
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Affiliation(s)
- Qiuhui Xuan
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Chunxiu Hu
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yinan Zhang
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Metabolic Diseases Biobank, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qingqing Wang
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xinjie Zhao
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xinyu Liu
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Congrong Wang
- Department of Endocrinology and Metabolism, Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Guowang Xu, ; Weiping Jia, ; Congrong Wang,
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Metabolic Diseases Biobank, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Guowang Xu, ; Weiping Jia, ; Congrong Wang,
| | - Guowang Xu
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
- University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Guowang Xu, ; Weiping Jia, ; Congrong Wang,
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Jun G, Aguilar D, Evans C, Burant CF, Hanis CL. Metabolomic profiles associated with subtypes of prediabetes among Mexican Americans in Starr County, Texas, USA. Diabetologia 2020; 63:287-295. [PMID: 31802145 PMCID: PMC7771728 DOI: 10.1007/s00125-019-05031-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS To understand the complex metabolic changes that occur long before the diagnosis of type 2 diabetes, we investigated differences in metabolomic profiles in plasma between prediabetic and normoglycaemic individuals for subtypes of prediabetes defined by fasting glucose, 2 h glucose and HbA1c measures. METHODS Untargeted metabolomics data were obtained from 155 plasma samples from 127 Mexican American individuals from Starr County, TX, USA. None had type 2 diabetes at the time of sample collection and 69 had prediabetes by at least one criterion. We tested statistical associations of amino acids and other metabolites with each subtype of prediabetes. RESULTS We identified distinctive differences in amino acid profiles between prediabetic and normoglycaemic individuals, with further differences in amino acid levels among subtypes of prediabetes. When testing all named metabolites, several fatty acids were also significantly associated with 2 h glucose levels. Multivariate discriminative analyses show that untargeted metabolomic data have considerable potential for identifying metabolic differences among subtypes of prediabetes. CONCLUSIONS/INTERPRETATION People with each subtype of prediabetes have a distinctive metabolomic signature, beyond the well-known differences in branched-chain amino acids. DATA AVAILABILITY Metabolomics data are available through the NCBI database of Genotypes and Phenotypes (dbGaP, accession number phs001166; www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs001166.v1.p1).
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Affiliation(s)
- Goo Jun
- Human Genetics Center, University of Texas Health Science Center at Houston, P. O. Box 20186, Houston, TX, 77225, USA
| | - David Aguilar
- Human Genetics Center, University of Texas Health Science Center at Houston, P. O. Box 20186, Houston, TX, 77225, USA
| | - Charles Evans
- Michigan Regional Comprehensive Metabolomics Resource Core, University of Michigan, Ann Arbor, MI, USA
| | - Charles F Burant
- Michigan Regional Comprehensive Metabolomics Resource Core, University of Michigan, Ann Arbor, MI, USA
| | - Craig L Hanis
- Human Genetics Center, University of Texas Health Science Center at Houston, P. O. Box 20186, Houston, TX, 77225, USA.
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Alatrach M, Agyin C, Mehta R, Adams J, DeFronzo RA, Abdul-Ghani M. Glucose-Mediated Glucose Disposal at Baseline Insulin Is Impaired in IFG. J Clin Endocrinol Metab 2019; 104:163-171. [PMID: 30371795 PMCID: PMC6286408 DOI: 10.1210/jc.2017-01866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/23/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify glucose-mediated glucose disposal with and without basal insulin replacement and insulin-mediated glucose disposal in subjects with impaired fasting glucose (IFG). RESEARCH DESIGN AND METHODS We used the hyperglycemic/pancreatic clamp and stepped euglycemic clamp techniques to quantify glucose disposal and suppression of endogenous glucose production (EGP) in those with normal glucose tolerance (NGT; n = 14) and those with IFG (n = 14). RESULTS Total body glucose-mediated glucose uptake, measured with the hyperglycemic/pancreatic clamp, was not significantly affected by the basal plasma insulin levels in subjects with IFG and those with NGT. Compared with subjects with NGT, those with IFG had significantly lower glucose-mediated glucose uptake (by 15%) during the hyperglycemic clamp performed with and without basal insulin replacement. In contrast, insulin-mediated glucose disposal was comparable in both groups. The suppression of EGP by hyperglycemia was similar in both groups. However, the suppression of EGP by insulin was attenuated in those with IFG compared with those with NGT. CONCLUSIONS The results of the present study have demonstrated that (i) glucose-mediated glucose disposal is impaired in those with IFG; (ii) insulin-mediated glucose uptake in IFG is normal; and (iii) insulin action to suppress EGP is impaired.
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Affiliation(s)
- Mariam Alatrach
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Christina Agyin
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rucha Mehta
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - John Adams
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Muhammad Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Correspondence and Reprint Requests: Muhammad Abdul-Ghani, MD, PhD, Diabetes Division, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229. E-mail:
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Wijesuriya M, Fountoulakis N, Guess N, Banneheka S, Vasantharajah L, Gulliford M, Viberti G, Gnudi L, Karalliedde J. A pragmatic lifestyle modification programme reduces the incidence of predictors of cardio-metabolic disease and dysglycaemia in a young healthy urban South Asian population: a randomised controlled trial. BMC Med 2017; 15:146. [PMID: 28851373 PMCID: PMC5576225 DOI: 10.1186/s12916-017-0905-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/29/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is an increasing incidence of type 2 diabetes mellitus (T2DM) in young urban South-Asians. We tested the effect of a pragmatic trimonthly lifestyle modification (LSM) programme (P-LSM) versus a less-intensive 12-monthly control LSM (C-LSM) intervention on a primary composite endpoint of predictors of cardio-metabolic disease (new onset T2DM, hypertension, impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG) and markers of cardio-renal disease) in participants aged 5-40 years with risk factors for T2DM. METHODS This was a randomised controlled trial performed at the National Diabetes Centre, Sri-Lanka. We individually randomised 4672 participants at risk of T2DM, of whom 3539 (mean age 22.5 (range 6-40 years, 48% males) received either trimonthly (P-LSM n = 1726) or 12-monthly (C-LSM n = 1813) peer educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. RESULTS During a median follow-up of 3 years, the cumulative incidence of the primary endpoint was n = 479 in P-LSM (74 per 1000 person years) vs. 561 in C-LSM (96 per 1000 person years), with an incident rate ratio (IRR) of 0.89 (95% CI 0.83-0.96, P = 0.02). In post hoc analyses, new onset dysglycaemia (T2DM, IFG and IGT), was the major contributor to the composite and was significantly reduced by P-LSM (IRR 0.9, 95% CI 0.83-0.97, P = 0.01). A significant impact of P-LSM on the incidence of the composite endpoint was noted in 1725 participants (P-LSM n = 850, C-LSM n = 875) aged below 18; P-LSM n = 140 (48 per 1000 person years) versus C-LSM n = 174 (55.4 per 1000 person years), with an IRR of 0.83 (95% CI 0.73-0.94, P = 0.004). CONCLUSIONS In a young at-risk South-Asian population, a pragmatic LSM programme significantly reduces the incidence of predictors of cardio-metabolic disease. Our results highlight the importance of early intervention in young at-risk subjects. TRIAL REGISTRATION World Health Organization international clinical trial registry platform ( SLCTR/2008/003 ). Registration Date: March 28, 2008. Retrospectively registered.
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Affiliation(s)
| | - Nikolaos Fountoulakis
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Nicola Guess
- Diabetes and Nutritional Sciences Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | | | | | - Martin Gulliford
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Giancarlo Viberti
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Luigi Gnudi
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Janaka Karalliedde
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK.
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Kitaoka K, Takeuchi M, Tsuboi A, Minato S, Kurata M, Tanaka S, Kazumi T, Fukuo K. Increased Adipose and Muscle Insulin Sensitivity Without Changes in Serum Adiponectin in Young Female Collegiate Athletes. Metab Syndr Relat Disord 2017; 15:246-251. [PMID: 28318384 PMCID: PMC5485219 DOI: 10.1089/met.2017.0011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Effects of endurance training on adipose insulin sensitivity in association with body composition, circulating adipokines, and markers of inflammation have been studied less in young Asian subjects. METHODS Adipose insulin sensitivity/resistance was compared between 170 female Japanese collegiate athletes and 311 nonathletes (18-24 years), who underwent measurements of serum adipokines, markers of insulin sensitivity, inflammation, and dual-energy X-ray absorptiometry. Two separate subsamples of two groups of women underwent either a 75-gram oral glucose tolerance test or a standardized meal test, but not both. RESULTS As compared with nonathletes, athletes, characterized by higher skeletal muscle mass and lower percentage of body fat (both P < 0.001), had lower adipose insulin resistance (IR) (a product of fasting insulin and nonesterified fatty acid (NEFA) and lower leptin/adiponectin ratio (both P < 0.001). Although athletes had lower postmeal/postglucose insulinemia (P = 0.009 and 0.01, respectively), the two groups did not differ in postmeal percentage NEFA suppression and postmeal/postglucose glycemia, suggesting increased insulin sensitivity in adipose tissue and skeletal muscle, respectively. Serum leptin (P < 0.001) and tumor necrosis factor-α (P = 0.01) were lower in athletes, whereas adiponectin and homeostasis model assessment IR did not differ. CONCLUSIONS Endurance training was associated with increased insulin sensitivity in adipose tissue as well as skeletal muscle without changes in circulating adiponectin even in young, normal-weight Japanese women.
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Affiliation(s)
- Kaori Kitaoka
- 1 Research Institute for Nutrition Sciences, Mukogawa Women's University , Nishinomiya, Japan .,2 Department of Welfare and Nutrition, Faculty of Health Welfare, Kansai University of Welfare Sciences , Osaka, Japan
| | - Mika Takeuchi
- 3 Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Japan
| | - Ayaka Tsuboi
- 1 Research Institute for Nutrition Sciences, Mukogawa Women's University , Nishinomiya, Japan
| | - Satomi Minato
- 1 Research Institute for Nutrition Sciences, Mukogawa Women's University , Nishinomiya, Japan .,4 Graduate School of Human Science and Environment, University of Hyogo , Himeji, Japan
| | - Miki Kurata
- 1 Research Institute for Nutrition Sciences, Mukogawa Women's University , Nishinomiya, Japan .,3 Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Japan
| | - Shigehiro Tanaka
- 5 Department of Health and Sports Sciences, Mukogawa Women's University , Nishinomiya, Japan
| | - Tsutomu Kazumi
- 1 Research Institute for Nutrition Sciences, Mukogawa Women's University , Nishinomiya, Japan .,6 Division of Diabetes, Department of Medicine, Kohnan Kakogawa Hospital , Kakogawa, Japan
| | - Keisuke Fukuo
- 1 Research Institute for Nutrition Sciences, Mukogawa Women's University , Nishinomiya, Japan .,3 Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Japan
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Abdul-Ghani M, DeFronzo RA, Jayyousi A. Prediabetes and risk of diabetes and associated complications: impaired fasting glucose versus impaired glucose tolerance: does it matter? Curr Opin Clin Nutr Metab Care 2016; 19:394-399. [PMID: 27389083 DOI: 10.1097/mco.0000000000000307] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the distinct metabolic and pathophysiologic phenotype of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and the subsequent clinical implications with regard to future type 2 diabetes mellitus (T2DM) and cardiovascular risk. RECENT FINDINGS Both IFG and IGT manifest the two core defects of T2DM, that is, insulin resistance and β-cell dysfunction. However, the site of insulin resistance and shape of β-cell dysfunction differ. These distinct metabolic and pathophysiologic phenotypes explain the greater cardiovascular disease (CVD) risk associated with an increase in the 2-h plasma glucose concentration, that is, IGT compared with an increase in the fasting plasma glucose (FPG) concentration, that is, IFG. Moreover, the increase in future T2DM risk in IFG study participants is, at least in part, explained by the strong correlation between the increase in FPG and the increase in 2-h plasma glucose concentration. SUMMARY Last, recent studies have reported the presence of diabetic microvascular complications, that is, retinopathy and neuropathy, at the IGT stage.Thus, a glucose load (e.g. oral glucose tolerance test) is required in study participants with elevated FPG concentration to accurately assess their future risk for T2DM, as well as their risk for CVD to identify the subgroup of IFG who are at greater risk and subject them to an intervention program to decrease their future T2DM and CVD risk.
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Affiliation(s)
- Muhammad Abdul-Ghani
- aDivision of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA bDepartment of Medicine, Diabetes and Obesity Clinical Research Center, Hamad General Hospital, Doha, Qatar
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Mondal D, Mathur A, Chandra PK. Tripping on TRIB3 at the junction of health, metabolic dysfunction and cancer. Biochimie 2016; 124:34-52. [DOI: 10.1016/j.biochi.2016.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
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Priya MM, Amutha A, Pramodkumar TA, Ranjani H, Jebarani S, Gokulakrishnan K, Pradeepa R, Unnikrishnan R, Anjana RM, Mohan V. β-Cell Function and Insulin Sensitivity in Normal Glucose-Tolerant Subjects Stratified by 1-Hour Plasma Glucose Values. Diabetes Technol Ther 2016; 18:29-33. [PMID: 26492404 DOI: 10.1089/dia.2015.0065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM This study was designed to assess β-cell function and insulin sensitivity indices among normal glucose tolerance (NGT) subjects stratified by 1-h plasma glucose (1hPG) values during an oral glucose tolerance test (OGTT). MATERIALS AND METHODS One hundred sixty-six NGT subjects underwent a five-point OGTT, and glucose and insulin levels were estimated. We calculated the following indices: (a) β-cell function (homeostasis assessment model-β-cell function [HOMA-β] and Insulinogenic Index [IGI]) and (b) insulin sensitivity (homeostasis assessment model-insulin resistance [HOMA-IR], Matsuda Index, and Insulin Sensitivity Index [ISI]). RESULTS NGT subgroups with elevated 1hPG values (i.e., 1hPG ≥143 to <155 mg/dL and 1hPG ≥155 mg/dL) did not differ from those with 1hPG <143 mg/dL by HOMA-β (P = 0.236) but had significantly lower IGIs (367 ± 239 vs. 257 ± 243 vs. 246 ± 239; P = 0.019). With respect to ISIs, HOMA-IR was not significantly different among the groups (P = 0.103). However, the Matsuda Index (11.2 ± 5.0 vs. 7.4 ± 4.8 vs. 5.5 ± 4.9; P < 0.001) and ISI (0.015 ± 0.010 vs. 0.012 ± 0.006 vs. 0.011 ± 0.011; P = 0.028) were significantly lower in subjects with elevated 1hPG values. CONCLUSIONS NGT subjects with elevated 1hPG levels have alterations in β-cell function and insulin sensitivity compared with those with normal 1hPG levels.
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Affiliation(s)
- Miranda M Priya
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Anandakumar Amutha
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - T A Pramodkumar
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Harish Ranjani
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Saravanan Jebarani
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Kuppan Gokulakrishnan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Rajendra Pradeepa
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Ranjit Unnikrishnan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
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