Progression from impaired glucose tolerance to type 2 diabetes in obese children and adolescents: a 3-6-year cohort study in southern Thailand

Prevalence of different states of glucose intolerance in Sri Lankan children and adolescents with obesity and its relation to other comorbidities

BACKGROUND

South Asian adults have higher prevalence of obesity comorbidities than other ethnic groups. Whether this also is true for Sri Lankan children with obesity has rarely been investigated.

OBJECTIVE

To investigate prevalence of glucose intolerance and other comorbidities in Sri Lankan children with obesity and compare them with Swedish children. To identify risk factors associated with glucose intolerance.

SUBJECTS

A total of 357 Sri Lankan children (185 boys), aged 7 to 17 years with BMI-SDS ≥2.0 from a cross-sectional school screening in Negombo. A total of 167 subjects from this study population were matched for sex, BMI-SDS and age with 167 Swedish subjects from the ULSCO cohort for comparison.

METHODS

After a 12 hour overnight fast, blood samples were collected and oral glucose tolerance test was performed. Body fat mass was assessed by bioelectrical impedance assay. Data regarding medical history and socioeconomic status were obtained from questionnaires.

RESULTS

Based on levels of fasting glucose (FG) and 2 hours-glucose (2 hours-G), Sri Lankan subjects were divided into five groups: normal glucose tolerance (77.5%, n = 276), isolated impaired fasting glucose according to ADA criteria (9.0%, n = 32), isolated impaired glucose tolerance (8.4%, n = 30), combined impaired fasting glucose (IFG) + impaired glucose tolerance (IGT) (3.1%, n = 11) and type 2 diabetes mellitus (2.0%, n = 7). FG, 2 hours-insulin and educational status of the father independently increased the Odds ratio to have elevated 2 hours-G. Sri Lankan subjects had higher percentage of body fat, but less abdominal fat than Swedish subjects.

CONCLUSION

High prevalence in Sri Lankan children with obesity shows that screening for glucose intolerance is important even if asymptomatic.

Longitudinal 15-year follow-up of women with former early puberty: abnormal metabolic profiles not associated with earlier age at onset of puberty, but associated with obesity

BACKGROUND

In 2011, we described 104 girls who were diagnosed as early puberty (EP) during 2003-2005. In 2019-2020, the former EP women had been followed up 14 years after attaining their final height.

OBJECTIVE

To determine the reproductive function and metabolic profiles of former EP women.

STUDY DESIGN

Fifty-seven former EP women were evaluated for reproductive function and examined for health status. Blood samples were obtained for metabolic profiles of glucose, lipids and insulin, and testosterone levels.

RESULTS

In 2020, the average age of the study women was 22.9 ± 1.7 years. The average height was 156.7 ± 5.6 cm. The average weight had increased from 52.5 ± 7.8 kg in 2011 to 58.5 ± 11.1 kg in 2020 and average body mass index (BMI) from 21.4 ± 2.9 to 23.8 ± 4.0 kg/m². Obesity (BMI>25 kg/m²) was found in 8.8% (five participants) in 2011 and had increased to 22.8% (13 participants) in 2020. Most participants (79%) had regular menstrual cycle. Of the 17 married women, 4 (23.5%) had 1-2 children. Dividing the participants into obese and nonobese groups, the average fasting plasma glucose, lipid profiles, and testosterone levels were similar in both groups. However, the average systolic blood pressure and the serum insulin levels and HOMA-IR assessments were significantly higher in the obese group than in the nonobese group.

CONCLUSION

The former EP women had normal menstruation and reproductive function. The former EP women with average BMI at the follow-up had normal metabolic profiles while those who later became obese had significantly higher systolic blood pressure, serum insulin, and HOMA-IR assessments.

New Insights into Adipokines as Potential Biomarkers for Type-2 Diabetes Mellitus

A large number of studies have been focused on investigating serum biomarkers associated with risk or diagnosis of type-2 diabetes mellitus. In the last decade, promising studies have shown that circulating levels of adipokines could be used as a relevant biomarker for diabetes mellitus progression as well as therapeutic future targets. Here, we discuss the possible use of recently described adipokines, including apelin, omentin-1, resistin, FGF-21, neuregulin-4 and visfatin, as early biomarkers for diabetes. In addition, we also include recent findings of other well known adipokines such as leptin and adiponectin. In conclusion, further studies are needed to clarify the pathophysiological significance and clinical value of these biological factors as potential biomarkers in type-2 diabetes and related dysfunctions.

Postprandial Glucose Levels Are Better Associated with the Risk Factors for Diabetes Compared to Fasting Glucose and Glycosylated Hemoglobin (HbA1c) Levels in Elderly Prediabetics: Beneficial Effects of Polyherbal Supplements-A Randomized, Double-Blind, Placebo Controlled Trial

Backgrounds

Prediabetes is a condition in which a person's blood glucose levels are higher than normal physiological levels but lower compared to patients with diabetes. Up to 70% of individuals with prediabetes will eventually develop diabetes. To date, there have been no pharmaceutical drugs to treat diabetes. It is believed that early diagnosis and nonpharmacological intervention for prediabetes are critical for effective prevention of diabetes. Most individuals with prediabetes remain undiagnosed even after being evaluated using the standard tests for fasting glucose (FG) and HbA1c. We investigated if postprandial glucose levels (2h-PG) were associated with pre/diabetes and if polyherbal supplements could be beneficial for individuals with prediabetes.

Materials and Methods

100 elderly individuals with impaired 2h-PG or fasting glucose levels were recruited to receive either a 12-week supplement of GlucoVita (an antioxidative polyherbal formulation) (n=50) or placebo (n=50).

Results

No baseline differences were observed for FG, HbA1c, or 2h-PG. Individuals who received a twelve-week administration of GlucoVita supplements had significantly reduced 2h-PG (8.15±1.67 versus 7.35±2.06 mmol/l, P<0.05) levels compared to individuals in the placebo group. In addition, HbA1c levels were lower in individuals who received GlucoVita (5.81±0.49 %) compared to the individuals in the placebo group (6.00±0.51%) (P=0.08) after 12-weeks. Stratified analysis, based on impaired fasting glucose (IFG), 2h-PG, metabolic symptom, and age, demonstrated that, after the 12-week intervention, HbA1c levels were significantly lower in the GlucoVita administered group compared to the placebo group (IFG subgroup; 5.85±0.46%, n= 27 versus 6.14±0.50, n=33, P<0.05) and the metabolic symptom-free subgroup (5.73±0.45%, n=23 versus 6.04±0.52%, n=24, P<0.05). GlucoVita also reduced FG in individuals with normal 2h-PG (6.37±0.27 versus 6.08±0.38 mmol/l, P<0.05). Baseline 2h-PG levels, but not HbA1c or FG levels, were significantly correlated with body weight, waist circumference, and BMI (r=0.25, P<0.05; r=0.31, P<0.01; r=0.22, P<0.05, respectively).

Conclusion

2h-PG levels were better associated with body weight, waist circumference, and BMI risk factors compared to FG and HbA1c levels in elderly individuals with prediabetes. Polyherbal formulation GlucoVita supplements improved 2h-PG and HbA1c levels only in elderly individuals who were overweight but were symptom-free and under 65 years of age. Due to the small cohort size of this pilot study, future studies are required to validate our findings.