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Xu X, Wang D, Jaffar S, Alam U, Qiu S, Xie B, Zhou X, Sun Z, Garrib A. Can the postload-fasting glucose gap be used to determine risk of developing diabetes in chinese adults: A prospective cohort study. Diabetes Res Clin Pract 2024; 213:111761. [PMID: 38950783 DOI: 10.1016/j.diabres.2024.111761] [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: 03/19/2024] [Revised: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To evaluate the relationship between fasting plasma glucose (FPG) and 2-hour postload plasma glucose (2hPG) measured during an oral glucose tolerance test, and the risk of developing diabetes in Chinese adults. METHODS We followed 3,094 participants without diabetes, categorizing them based on their oral glucose tolerance test (OGTT) results into low post load (2hPG ≤ FPG) and high post load (2hPG > FPG) at baseline. We monitored the incidence of diabetes, incidence of prediabetes, disease progression from prediabetes to diabetes and disease reversal from prediabetes to normal glucose tolerance (NGT) over an average of 3.2 years of follow-up. After the Schoenfeld residual test, Cox's time-varying covariate (Cox-TVC) models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) to compare the different clinical events between low and high post load groups. RESULTS In the cohort study, of the 3,094 participants, 702 (22.7 %) had low post load (2hPG ≤ FPG, mean postload-fasting gap: -0.8 ± 0.7 mmol/L) and 2,392 (77.3 %) had high post load (2hPG > FPG, mean postload-fasting gap: 1.8 ± 1.2 mmol/L). Over 3.2 ± 0.2 years of follow-up, 282 (9.1 %) developed diabetes. In the low post load group, the incidence rates per 1,000 person-years were: diabetes was 7.9, prediabetes was 70.0, disease progression from prediabetes to diabetes was 23.4 and disease reversal to NGT was 327.2. For the high post load group, incidence rates for diabetes was 13.9, prediabetes was 124.3, disease progression was 59.5 and disease reversal was 238.6 per 1,000 person-years. Participants with high post load showed higher incidence rates of diabetes, prediabetes, and progression from prediabetes to diabetes compared to those with low post load. HRs were significantly higher for incident diabetes and prediabetes, and disease progression from prediabetes to diabetes, whereas disease reversal was lower. CONCLUSION The risk of developing prediabetes/diabetes after 3.2 years of follow-up was higher in the participants with high post load. It suggested that postload-fasting gap may be a simple tool to predict the risk of developing prediabetes, diabetes or reversal to NGT.
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Affiliation(s)
- Xiaohan Xu
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Shabbar Jaffar
- Institute for Global Health, University College London, London, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK; Department of Medicine, University Hospital Aintree, Liverpool University NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, UK
| | - Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Bo Xie
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Xiaoying Zhou
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
| | - Anupam Garrib
- Institute for Global Health, University College London, London, UK.
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Liang XY, Mu LY, Hu L, She RL, Ma CY, Feng JH, Jiang ZY, Li ZX, Qu XQ, Peng BQ, Wu KN, Kong LQ. Optimal Glycated Hemoglobin Cutoff for Diagnosis of Diabetes and Prediabetes in Chinese Breast Cancer Women. Int J Gen Med 2024; 17:1807-1822. [PMID: 38720819 PMCID: PMC11077296 DOI: 10.2147/ijgm.s457158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Purpose Glycated hemoglobin (HbA1c) is widely used in diabetes management and now recommended for diagnosis and risk assessment. Our research focused on investigating the optimal cutoff points of HbA1c for diagnosis of diabetes and prediabetes in Chinese breast cancer women, aiming to enhance early detection and tailor treatment strategies. Patients and Methods This study involved 309 breast cancer women without diabetes history in China. Patients were categorized into groups of newly diagnosed diabetes, prediabetes, and normal glucose tolerance using oral glucose tolerance test (OGTT) according to the 2010 ADA criteria. HbA1c data were collected from all patients. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the HbA1c screening. Results Among the 309 breast cancer women without diabetes history, 96 (31.0%) were identified with diabetes and 130 (42.1%) had prediabetes according to OGTT, and the incidence of normal glucose tolerance was only 26.9% (83). ROC curve analysis, using OGTT as a reference, revealed that the area under the curve of 0.903 (P<0.001, 95% CI, 0.867-0.938) for HbA1c alone, indicating high accuracy. The optimal HbA1c cutoff for identifying diabetes was determined to be 6.0%, with a sensitivity of 78.1% and specificity of 86.4%. For prediabetes, the ROC curve for HbA1c alone showed that the area under the ROC curve of 0.703 (P<0.001, 95% CI, 0.632-0.774), with an optimal cutoff of 5.5% (sensitivity of 76.9% and specificity of 51.8%). Conclusion The prevalence of undiagnosed diabetes is very high in breast cancer women without diabetes history in China. The optimal cutoff points of HbA1c for identifying diabetes and prediabetes are 6.0% and 5.5% in Chinese breast cancer women, respectively.
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Affiliation(s)
- Xin-Yu Liang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Li-yuan Mu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Lei Hu
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Rui-ling She
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Chen-yu Ma
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jun-han Feng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Zhi-yu Jiang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Zhao-xing Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Xiu-quan Qu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Bai-qing Peng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Kai-nan Wu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Ling-quan Kong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
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Elma Ö, Tümkaya Yılmaz S, Nijs J, Clarys P, Coppieters I, Mertens E, Malfliet A, Deliens T. Impaired Carbohydrate Metabolism among Women with Chronic Low Back Pain and the Role of Dietary Carbohydrates: A Randomized Controlled Cross-Over Experiment. J Clin Med 2024; 13:2155. [PMID: 38610920 PMCID: PMC11012557 DOI: 10.3390/jcm13072155] [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: 03/07/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Impaired glucose regulation is suggested to be related to chronic low back pain (CLBP), although it is not clear how they interact with each other. Thus, the primary aim of this study was to investigate differences in postprandial glycemic responses (PPGRs) (the first sign of impaired glucose metabolism) to high- (sucrose) and low-glycemic index (GI) (isomaltulose) beverages in normoglycemic women with CLBP and healthy controls (HCs) and explore whether any group that showed greater PPGRs to high-GI beverage intake would benefit when the high-GI beverage was replaced with a low-GI beverage. Secondly, this study aimed to explore the association between PPGR and pain in patients with CLBP. Methods: This study was registered at clinicaltrials.org (NCT04459104) before the start of the study. In this study, 53 CLBP patients and 53 HCs were recruited. After 11-12 h of fasting, each participant randomly received isomaltulose or sucrose. Blood glucose levels were measured during the fasting state and 15, 30, 45, 60, 90, and 120 min after the beverage intake, and each participant underwent experimental pain measures. Results: Compared to the HCs, the CLBP group showed significantly higher PPGRs to sucrose (p < 0.021). Additionally, the CLBP group showed a significantly higher decrease in PPGR (p = 0.045) when comparing PPGR to sucrose with PPGR to isomaltulose. Correlation analysis revealed a positive association between self-reported pain sensitivity and PPGR to sucrose, while there was no association found between any experimental pain measures and glycemic responses. Conclusions: Overall, these findings suggest that normoglycemic CLBP patients might have a higher risk of developing impaired glucose tolerance than the HCs and might benefit more when high-GI foods are replaced with low-GI ones.
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Affiliation(s)
- Ömer Elma
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Physiotherapy Unit, Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
| | - Sevilay Tümkaya Yılmaz
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussel, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Peter Clarys
- Movement and Nutrition for Health and Performance (MOVE) Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (P.C.); (E.M.); (T.D.)
| | - Iris Coppieters
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussel, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Evelien Mertens
- Movement and Nutrition for Health and Performance (MOVE) Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (P.C.); (E.M.); (T.D.)
- Nutrition and Dietetics Program, Department of Health Care, Design and Technology, Erasmushogeschool Brussel, 1090 Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Tom Deliens
- Movement and Nutrition for Health and Performance (MOVE) Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (P.C.); (E.M.); (T.D.)
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Martins MG, Woodside B, Kiss ACI. Effects of maternal mild hyperglycemia associated with snack intake on offspring metabolism and behavior across the lifespan. Physiol Behav 2024; 276:114483. [PMID: 38331375 DOI: 10.1016/j.physbeh.2024.114483] [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: 10/06/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
The increasing prevalence of diabetes is of particular concern in women of childbearing age because of the short and long-term consequences of maternal diabetes for the health of the offspring, such as a greater risk of developing metabolic impairments and cognitive deficits. In addition, maternal diet during pregnancy and lactation might contribute to preventing or ameliorating adverse offspring outcomes. Recently, we described that access to snacks exacerbates glucose intolerance in mildly hyperglycemic pregnant dams. Therefore, we hypothesized that these offspring would show greater impairment in metabolic and behavioral outcomes across the lifespan. Neonatal STZ treatment was employed to induce maternal mild hyperglycemia in females. After mating, normo- and hyperglycemic dams were given access either to standard chow or standard show plus snacks. Male and female offspring were evaluated on postnatal days (PND) 30, 90, and 360. Offspring behavior was assessed in the marble burying task, the open-field test, the elevated-plus maze, and sucrose preference. Glucose tolerance and morphometric analyses were also carried out. Maternal hyperglycemia increased body weight and fat deposition only on PND 30, while retroperitoneal fat deposition was reduced in the offspring of snack-fed dams. However, maternal snack intake reduced offspring body weight and length on PND 90. Fasting glucose was increased in females born to hyperglycemic, snack-fed dams on PND 90. Glucose clearance was altered by both maternal conditions in male offspring on PND 30, however, this sex difference was reversed on PND 90, with maternal hyperglycemia impairing glucose clearance only in females. In addition, maternal hyperglycemia reduced anxiety-like behavior in female offspring on PND 30, especially in the offspring of snack-fed dams, while maternal snack intake reduced sucrose preference in both males and females in adulthood. These results suggest that the effects of maternal hyperglycemia during pregnancy and lactation on offspring outcomes were not exacerbated by snack intake. Although additive effects of the two maternal conditions were hypothesized, the absence of such effects could be related to the mild maternal hyperglycemia induced by STZ treatment even when combined with snack intake. While maternal hyperglycemia alone impaired some offspring outcomes, its association with snack intake did not aggravate those impairments but rather resulted in outcomes more similar to those of offspring born to normoglycemic dams. Finally, females were found to be more susceptible to both the effects of maternal hyperglycemia and snack intake on metabolism and behavior.
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Affiliation(s)
- Marina Galleazzo Martins
- Department of Physiology, Institute of Biosciences of the University of São Paulo (IB/USP), Rua do Matão, trav. 14, 321, Cidade Universitária, São Paulo, 05508-090, Brazil; São Paulo State University (Unesp), Institute of Biosciences, Department of Structural and Functional Biology, Rua Prof. Dr. Antonio Celso Wagner Zanin, s/n, Botucatu, São Paulo, 18618-689, Brazil.
| | - Barbara Woodside
- Center for Studies in Behavioral Neurobiology, Psychology Department, Concordia University, 7141 Sherbrooke St. W., Montreal, Quebec H4B 1R6, Canada
| | - Ana Carolina Inhasz Kiss
- Department of Physiology, Institute of Biosciences of the University of São Paulo (IB/USP), Rua do Matão, trav. 14, 321, Cidade Universitária, São Paulo, 05508-090, Brazil; São Paulo State University (Unesp), Institute of Biosciences, Department of Structural and Functional Biology, Rua Prof. Dr. Antonio Celso Wagner Zanin, s/n, Botucatu, São Paulo, 18618-689, Brazil
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Feng L, Chen C, Guo Q, Chen L, Yang W. Improvement of early-phase insulin secretion is an independent factor for achieving glycaemic control: A pooled analysis of SEED and DAWN study. Diabetes Obes Metab 2024; 26:745-753. [PMID: 37985364 DOI: 10.1111/dom.15370] [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: 08/16/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
AIM To investigate the effect of improving early phase insulin secretion function for glycaemic control in patients with type 2 diabetes mellitus treated with a new class of antidiabetic drug dorzagliatin. MATERIALS AND METHODS Early insulin secretion function was studied in 726 participants of which 414 were treated with dorzagliatin in the SEED and DAWN study. The early insulinogenic index (IGI30min ) and disposition index (DI) were used to assess early-phase insulin secretion function in this study. Logistic regression analysis was performed to verify the importance of IGI30min and DI indices for achieving effective glycaemic control. RESULTS The reduction in HbA1c has a significant correlation with the improvement of IGI30min for patients that received 24 weeks of dorzagliatin treatment (p < .001), and this correlation was not observed in the placebo group (p = .364). In the dorzagliatin treatment group, the responders showed significant improvements in homeostasis model assessment 2-β, IGI30min and DI compared with the non-responders. Logistic regression analysis revealed that the odds ratio (OR) for achieving glycaemic control was 1.28 (95% CI 1.14-1.43) for baseline IGI30min , and 1.24 (95% CI 1.14-1.35) for the 24-week incremental IGI30min from baseline. The OR for baseline DI and 24-week changes in DI from baseline were 1.39 (95% CI 1.2-1.6) and 1.30 (95% CI 1.19-1.43) respectively. The timing of insulin secretion analysis showed the significant contribution of early-phase insulin secretion, rather than late-phase insulin secretion, to postprandial glucose control with the OR for the incremental IGI30min and IGI2h to postprandial glucose control were 1.3 (95% CI 1.19-1.42) and 1 (95% CI 1-1.01) respectively. CONCLUSIONS Restoring the impaired early-phase insulin secretion function in patients with type 2 diabetes mellitus is a critical factor for improving the glycaemic control by dorzagliatin treatment.
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Affiliation(s)
| | | | | | - Li Chen
- Hua Medicine, Shanghai, China
| | - Wenying Yang
- Japan-China Friendship Hospital, Beijing, China
- Taikang Yanyuan Rehabilitation Hospital, Beijing, China
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Sadiya A, Jakapure V, Kumar V. Ethnic Variability in Glucose and Insulin Response to Rice Among Healthy Overweight Adults: A Randomized Cross-Over Study. Diabetes Metab Syndr Obes 2023; 16:993-1002. [PMID: 37063254 PMCID: PMC10101220 DOI: 10.2147/dmso.s404212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/10/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND The influence of ethnicity on postprandial glucose and insulin responses has been reported earlier and rice is a major contributor to the overall glycaemic load of Asian and Arab diets. This study aims to compare postprandial glycaemic and insulinaemic responses to rice among healthy overweight Asian, Arab and European participants. METHODS In a randomized crossover design, 47 healthy overweight participants (23 Asian, 16 Arab, and 8 European) consumed 75 grams of glucose beverage or ate 270 grams of cooked basmati rice (75 g of available carbohydrate) on two separate occasions, separated by a one 1-week washout period. Blood glucose and insulin levels were determined at fasting 0 (fasting), 30, 60, and 120 minutes and used to determine the incremental area under the curve (iAUC). RESULTS The three groups were matched on body mass index and gender. Although no differences were noted statistically in most clinical features, a wide range of variation was noted in age, systolic, diastolic blood pressure. The fasting blood glucose and insulin levels were highest among Asians, followed by Arabs and Europeans (p < 0.01). According to the HOMA-IR test and the Matsuda index, Asians have a higher insulin resistance than Arabs or Europeans when consuming a glucose beverage (p < 0.001) and rice (p < 0.01). Postprandial glucose and insulin responses to glucose beverage did not differ between ethnic groups (p = 0.28; p = 0.10). Based on an unadjusted regression model, European participants had significantly lower iAUC-glucose (p = 0.02) and iAUC-insulin (p = 0.01) after rice consumption than Asian participants. In the adjusted model, the difference between the two groups remained for iAUC-insulin (p = 0.04) but not for iAUC-glucose (p = 0.07). CONCLUSION Our study found that ethnic differences exist among healthy overweight adults in terms of insulin resistance, glycaemic response and insulinaemic response to rice. As a result of their high insulin resistance, Asian participants had a higher postprandial insulin spike than Europeans after eating rice. These findings could have substantial implications for nutrition recommendations based on ethnicity, particularly for Asians.
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Affiliation(s)
- Amena Sadiya
- Lifestyle Clinic, Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City Ajman, Ajman, United Arab Emirates
- Correspondence: Amena Sadiya, Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City Ajman, PO Box-5166, Ajman, United Arab Emirates, Email
| | - Vidya Jakapure
- Research Department, Sheikh Khalifa Medical City Ajman, Ajman, United Arab Emirates
| | - Vijay Kumar
- Laboratory, Sheikh Khalifa Medical City Ajman, Ajman, United Arab Emirates
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Tricò D, McCollum S, Samuels S, Santoro N, Galderisi A, Groop L, Caprio S, Shabanova V. Mechanistic Insights Into the Heterogeneity of Glucose Response Classes in Youths With Obesity: A Latent Class Trajectory Approach. Diabetes Care 2022; 45:1841-1851. [PMID: 35766976 PMCID: PMC9346992 DOI: 10.2337/dc22-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In a large, multiethnic cohort of youths with obesity, we analyzed pathophysiological and genetic mechanisms underlying variations in plasma glucose responses to a 180 min oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS Latent class trajectory analysis was used to identify various glucose response profiles to a nine-point OGTT in 2,378 participants in the Yale Pathogenesis of Youth-Onset T2D study, of whom 1,190 had available TCF7L2 genotyping and 358 had multiple OGTTs over a 5 year follow-up. Insulin sensitivity, clearance, and β-cell function were estimated by glucose, insulin, and C-peptide modeling. RESULTS Four latent classes (1 to 4) were identified based on increasing areas under the curve for glucose. Participants in class 3 and 4 had the worst metabolic and genetic risk profiles, featuring impaired insulin sensitivity, clearance, and β-cell function. Model-predicted probability to be classified as class 1 and 4 increased across ages, while insulin sensitivity and clearance showed transient reductions and β-cell function progressively declined. Insulin sensitivity was the strongest determinant of class assignment at enrollment and of the longitudinal change from class 1 and 2 to higher classes. Transitions between classes 3 and 4 were explained only by changes in β-cell glucose sensitivity. CONCLUSIONS We identified four glucose response classes in youths with obesity with different genetic risk profiles and progressive impairment in insulin kinetics and action. Insulin sensitivity was the main determinant in the transition between lower and higher glucose classes across ages. In contrast, transitions between the two worst glucose classes were driven only by β-cell glucose sensitivity.
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Affiliation(s)
- Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sarah McCollum
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Stephanie Samuels
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Nicola Santoro
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT.,Department of Medicine and Health Sciences, "V. Tiberio" University of Molise, Campobasso, Italy
| | - Alfonso Galderisi
- Pediatric Endocrinology, Hôpital Necker-Enfants Malades, Paris, France
| | - Leif Groop
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Dai F, Mani H, Nurul SR, Tan KH. Risk stratification of women with gestational diabetes mellitus using mutually exclusive categories based on the International Association of Diabetes and Pregnancy Study Groups criteria for the development of postpartum dysglycaemia: a retrospective cohort study. BMJ Open 2022; 12:e055458. [PMID: 35177456 PMCID: PMC8860034 DOI: 10.1136/bmjopen-2021-055458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Women with gestational diabetes mellitus (GDM) are more predisposed to develop postpartum diabetes mellitus (DM). This study aimed to estimate the relative risk (RR) of postpartum dysglycaemia (prediabetes and DM) using mutually exclusive categories according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria cut-off points in patients with GDM, so as to establish a risk-stratification method for developing GDM management strategies. DESIGN, SETTING AND PARTICIPANTS In this retrospective cohort study, 942 women who had been diagnosed with GDM (IADPSG criteria) at 24-28 weeks of gestation from November 2016 to April 2018 underwent a 75 g oral glucose tolerance test (OGTT) at 6-12 weeks postpartum in a tertiary hospital of Singapore. Seven mutually exclusive categories (three one timepoint positive categories (fasting, 1 hour and 2 hours), three two timepoint positive categories (fasting+1 hour, fasting+2 hours and 1 hour+2 hours) and one three timepoint positive category (fasting+1 hour+2 hours)) were derived from the three timepoint antenatal OGTT according to the IADPSG criteria. To calculate the RRs of postpartum dysglyceamia of each mutually exclusive group, logistic regression was applied. RESULTS 924 mothers with GDM, whose mean age was 32.7±4.7 years, were mainly composed of Chinese (45.4%), Malay (21.7%) and Indian (14.3%) ethnicity. The total prevalence of postnatal dysglycaemia was 16.7% at 6-12 weeks postpartum. Stratifying subjects into seven mutually exclusive categories, the RRs of the one-time, two-time and three-time positive groups of the antenatal OGTT test were 1.0 (Ref.), 2.0 (95% CI=1.3 to 3.1; p=0.001) and 6.7 (95% CI=4.1 to 10.9; p<0.001), respectively, which could be used to categorise patients with GDM into low-risk, intermediate-risk and high-risk group. CONCLUSIONS Mutually exclusive categories could be useful for risk stratification and early management of patients with prenatal GDM. It is plausible and can be easily translated into clinical practice.
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Affiliation(s)
- Fei Dai
- Divsion of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Hemaavathi Mani
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Syaza Razali Nurul
- Divsion of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
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Vivek S, Carnethon MR, Prizment A, Carson AP, Bancks MP, Jacobs DR, Thyagarajan B. Association of the extent of return to fasting state 2-hours after a glucose challenge with incident prediabetes and type 2 diabetes: The CARDIA study. Diabetes Res Clin Pract 2021; 180:109004. [PMID: 34391830 PMCID: PMC8655852 DOI: 10.1016/j.diabres.2021.109004] [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: 02/10/2021] [Revised: 06/24/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
AIM To evaluate whether the extent of return to fasting state 2-hours after a glucose challenge among normoglycemic individuals is associated with lower risk of incident prediabetes/ type 2 diabetes in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. METHODS We evaluated this association among 1879 normoglycemic adults who were categorized into three groups: 'Low post load' (2hPG < FPG); 'Medium post load' (2hPG ≥ FPG and < 75th percentile of the difference); and 'High post load' (2hPG > FPG and ≥ 75th percentile of the difference). We used Cox proportional hazards regression to evaluate the association of the difference in 2hPG and FPG with incident diabetes/prediabetes after adjustment for demographic and clinical covariates. RESULTS During 20 years of follow-up, 8% developed type 2 diabetes and 35% developed prediabetes. Compared to those with 'Low post load', the risk of type 2 diabetes was higher for participants with 'High post load' [HR: 1.56, 95% CI (1.03, 2.37)] and similar for participants with 'Medium post load' [HR: 0.99, 95% CI (0.64, 1.52)]. However, HRs for incident prediabetes among participants with 'High post load' [HR = 1.2, 95 %CI = (0.98, 1.46)] was not significantly different compared to participants with 'Low post load'. CONCLUSION Among normoglycemic individuals, a difference between 2hPG and FPG concentration > 0.9 mmol/L can be used to stratify individuals at higher risk for developing type 2 diabetes.
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Affiliation(s)
- Sithara Vivek
- University of Minnesota, School of Medicine, Department of Laboratory Medicine and Pathology, United States
| | - Mercedes R Carnethon
- Northwestern University, Chicago, Department of Preventive Medicine, United States
| | - Anna Prizment
- University of Minnesota, Division of Hematology, Oncology and Transplantation, United States
| | - April P Carson
- University of Alabama at Birmingham, School of Public Health, Department of Epidemiology, United States
| | - Michael P Bancks
- Wake Forest, School of Medicine, Department of Epidemiology and Prevention, United States
| | - David R Jacobs
- University of Minnesota, Division of Epidemiology and Community Health, United States
| | - Bharat Thyagarajan
- University of Minnesota, School of Medicine, Department of Laboratory Medicine and Pathology, United States.
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10
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Alvarez-Canales MFDLL, Salazar-López SS, Farfán-Vázquez D, Martínez-López YE, González-Mena JN, Jiménez-Ceja LM, Vargas-Ortiz K, Evia-Viscarra ML, Montes de Oca-Loyola ML, Folli F, Aguilar-García A, Guardado-Mendoza R. Effect of linagliptin on glucose metabolism and pancreatic beta cell function in patients with persistent prediabetes after metformin and lifestyle. Sci Rep 2021; 11:8750. [PMID: 33888772 PMCID: PMC8062549 DOI: 10.1038/s41598-021-88108-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/31/2021] [Indexed: 01/21/2023] Open
Abstract
The goal of the study was to evaluate the effect of adding linagliptin to metformin and lifestyle on glucose levels and pancreatic β-cell function in patients with persistent impaired glucose tolerance (IGT) after 12 months of metformin and lifestyle. A single center parallel double-blind randomized clinical trial with 6 months of follow-up was performed in patients with persistent IGT after 12 months of treatment with metformin and lifestyle; patients were randomized to continue with metformin 850 mg twice daily (M group, n = 12) or linagliptin/metformin 2.5/850 mg twice daily (LM group, n = 19). Anthropometric measurements were obtained by standard methods and by bioelectrical impedance; glucose was measured by dry chemistry, insulin by chemiluminescence, and pancreatic β-cell function was calculated with the disposition index using glucose and insulin values during oral glucose tolerance test (OGTT) and adjusting by insulin sensitivity. The main outcomes were glucose levels during OGTT and pancreatic β-cell function. Patients in the LM group had a reduction in weight (-1.7 ± 0.6, p < 0.05) and body mass index (BMI, -0.67 ± 0.2, p < 0.05). Glucose levels significantly improved in LM group with a greater reduction in the area under the glucose curve during OGTT (AUCGluc0_120min) as compared to the M group (-4425 ± 871 vs -1116 ± 1104 mg/dl/120 min, p < 0.001). Pancreatic β-cell function measured with the disposition index, improved only in LM group (2.3 ± 0.23 vs 1.7 ± 0.27, p 0.001); these improvements persisted after controlling for OGTT glucose levels. The differences in pancreatic β-cell function persisted also after pairing groups for basal AUCGluc0_120min. The addition of linagliptin to patients with persistent IGT after 12 months of treatment with metformin and lifestyle, improved glucose levels during OGTT and pancreatic β-cell function after 6 months of treatment.Trial registration: Clinicaltrials.gov with the ID number NCT04088461.
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Affiliation(s)
| | | | - Diana Farfán-Vázquez
- Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico
| | | | | | | | - Katya Vargas-Ortiz
- Department of Medical Sciences, University of Guanajuato, León, Guanajuato, Mexico
| | - María Lola Evia-Viscarra
- Endocrinology Department Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, Mexico
| | | | - Franco Folli
- Endocrinology and Metabolism Dipartimento Di Scienze Della Salute, Universita' Degli Studi Di Milano, Milan, Italy.,Asst Santi Paolo E Carlo, Milan, Italy
| | - Alberto Aguilar-García
- Endocrinology Department Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, Mexico
| | - Rodolfo Guardado-Mendoza
- Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico. .,Research Department Hospital Regional de Alta Especialidad del Bajío, Col. San Carlos La Roncha, Blvd.Milenio #130, 37660, León, Guanajuato, Mexico.
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11
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Mehreen TS, Kamalesh R, Pandiyan D, Kumar DS, Anjana RM, Mohan V, Ranjani H. Incidence and Predictors of Dysglycemia and Regression to Normoglycemia in Indian Adolescents and Young Adults: 10-Year Follow-Up of the ORANGE Study. Diabetes Technol Ther 2020; 22:875-882. [PMID: 32349530 DOI: 10.1089/dia.2020.0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The prevalence of diabetes in youth is increasing worldwide in parallel with the obesity epidemic. This study aimed to determine the incidence rates of dysglycemia (diabetes or prediabetes) and evaluate the predictors of its progression or regression to normal glucose tolerance (NGT) in a cohort of children and adolescents studied in Chennai, South India. Methods: A longitudinal follow-up of the Obesity Reduction and Awareness of Noncommunicable Diseases through Group Education (ORANGE) cohort was performed after a median of 7.1 years (n = 845; 5928 person-years of follow-up). To determine their diabetes status at follow-up, participants underwent an oral glucose tolerance test (n = 811 with NGT and 34 with prediabetes at baseline), excluding those with diabetes at baseline. Incidence rates for dysglycemia were reported per 1000 person-years of follow-up. Cox proportional hazards model was used to estimate the predictors of progression and regression. Results: Out of 811 individuals with NGT at baseline, 115 developed dysglycemia giving an incidence rate of 20.2 per 1000 person-years (95% confidence interval: 16.8-24.2). Among those with prediabetes at baseline, 70.6% of the individuals converted to NGT and the remaining 29.4% either got converted to diabetes or remained as prediabetes. Higher age, body mass index, fasting plasma glucose, 2-hour plasma glucose (2-h PG), positive family history of diabetes, and systolic blood pressure (BP) were independent predictors of incident dysglycemia, whereas lower age, waist circumference, 2-h PG, systolic BP, and triglycerides predicted regression to normoglycemia. Conclusions: This study highlights the growing burden of dysglycemia in Asian Indian youth and emphasizes the need for targeted preventive actions.
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Affiliation(s)
- T S Mehreen
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
| | - R Kamalesh
- Department of Research Operations, Madras Diabetes Research Foundation, Chennai, India
| | - D Pandiyan
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
| | - D Sathish Kumar
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - H Ranjani
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
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12
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Bergman M, Abdul-Ghani M, Neves JS, Monteiro MP, Medina JL, Dorcely B, Buysschaert M. Pitfalls of HbA1c in the Diagnosis of Diabetes. J Clin Endocrinol Metab 2020; 105:dgaa372. [PMID: 32525987 PMCID: PMC7335015 DOI: 10.1210/clinem/dgaa372] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
Many health care providers screen high-risk individuals exclusively with an HbA1c despite its insensitivity for detecting dysglycemia. The 2 cases presented describe the inherent caveats of interpreting HbA1c without performing an oral glucose tolerance test (OGTT). The first case reflects the risk of overdiagnosing type 2 diabetes (T2D) in an older African American male in whom HbA1c levels, although variable, were primarily in the mid-prediabetes range (5.7-6.4% [39-46 mmol/mol]) for many years although the initial OGTT demonstrated borderline impaired fasting glucose with a fasting plasma glucose of 102 mg/dL [5.7 mmol/L]) without evidence for impaired glucose tolerance (2-hour glucose ≥140-199 mg/dl ([7.8-11.1 mmol/L]). Because subsequent HbA1c levels were diagnostic of T2D (6.5%-6.6% [48-49 mmol/mol]), a second OGTT performed was normal. The second case illustrates the risk of underdiagnosing T2D in a male with HIV having normal HbA1c levels over many years who underwent an OGTT when mild prediabetes (HbA1c = 5.7% [39 mmol/mol]) developed that was diagnostic of T2D. To avoid inadvertent mistreatment, it is therefore essential to perform an OGTT, despite its limitations, in high-risk individuals, particularly when glucose or fructosamine and HbA1c values are discordant. Innate differences in the relationship between fructosamine or fasting glucose to HbA1c are demonstrated by the glycation gap or hemoglobin glycation index.
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Affiliation(s)
- Michael Bergman
- NYU School of Medicine, Director, NYU Diabetes Prevention Program, Section Chief, Endocrinology, Diabetes, Metabolism, VA New York Harbor Healthcare System, Manhattan Campus, New York, New York
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - João Sérgio Neves
- Department of Surgery and Physiology, Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, São João University Hospital Center, Porto, Portugal
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | | | - Brenda Dorcely
- NYU Grossman School of Medicine, Division of Endocrinology, Diabetes, Metabolism, New York, New York
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University Clinic Saint-Luc, Brussels, Belgium
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13
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Colás A, Varela M, Mraz M, Novak D, Cuesta-Frau D, Vigil L, Benes M, Pelikanova T, Haluzik M, Burda V, Vargas B. Influence of glucometric 'dynamical' variables on duodenal-jejunal bypass liner (DJBL) anthropometric and metabolic outcomes. Diabetes Metab Res Rev 2020; 36:e3287. [PMID: 31916665 DOI: 10.1002/dmrr.3287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 11/19/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects. METHODS Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes. RESULTS There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control (∆BMI-∆TU6.1: rho = - 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control (∆FBG-∆AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02). CONCLUSIONS In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation.
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Affiliation(s)
- Ana Colás
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Varela
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
| | - Milos Mraz
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Daniel Novak
- Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - David Cuesta-Frau
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi, Spain
| | - Luis Vigil
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
| | - Marek Benes
- Hepatogastroenterology Department, Transplantation Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Terezie Pelikanova
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Martin Haluzik
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
- Laboratory of Experimental Diabetology, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vaclav Burda
- Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Borja Vargas
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
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14
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Lim WXJ, Chepulis L, von Hurst P, Gammon CS, Page RA. An Acute, Placebo-Controlled, Single-Blind, Crossover, Dose-Response, Exploratory Study to Assess the Effects of New Zealand Pine Bark Extract (Enzogenol ®) on Glycaemic Responses in Healthy Participants. Nutrients 2020; 12:E497. [PMID: 32075228 PMCID: PMC7071219 DOI: 10.3390/nu12020497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/29/2023] Open
Abstract
An acute, placebo-controlled, single-blind, crossover, dose-response, exploratory study was designed to investigate the hypoglycaemic effects of New Zealand pine bark extract (Enzogenol®). Twenty-five healthy participants categorised into having a monophasic or complex (biphasic or triphasic) glucose curve shape at the control visit consumed a placebo and Enzogenol® (50 and 400 mg) on three separate occasions before an oral glucose tolerance test (OGTT). In the monophasic group, 50 and 400 mg of Enzogenol® significantly reduced the mean glucose incremental area under the curve (iAUC) compared to control 241.3 ± 20.2 vs. 335.4 ± 34.0 mmol/L·min, p = 0.034 and 249.3 ± 25.4 vs. 353.6 ± 31.5 mmol/L·min, p = 0.012, respectively. The 400 mg dose further reduced the percentage increment of postprandial glucose (%PG) 31.4% ± 7.9% vs. 47.5% ± 8.6%, p = 0.010, glucose peak 7.9 ± 0.3 vs. 8.9 ± 0.3 mmol/L, p = 0.025 and 2h-OGTT postprandial glucose (2hPG) 6.1 ± 0.3 vs. 6.7 ± 0.3 mmol/L, p = 0.027. Glucose iAUC was not significantly different in the complex group, except for reductions in %PG 28.7% ± 8.2% vs. 43.4% ± 5.9%, p = 0.012 after 50 mg dose and 27.7% ± 5.4% vs. 47.3% ± 7.2%, p = 0.025 after 400 mg dose. The results suggest that Enzogenol® may have hypoglycaemic effects in healthy participants, especially those exhibiting monophasic shapes.
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Affiliation(s)
- Wen Xin Janice Lim
- School of Health Sciences, Massey University, Auckland 0632, New Zealand; (W.X.J.L.); (C.S.G.)
| | - Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton 3216, New Zealand;
| | - Pamela von Hurst
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand;
| | - Cheryl S. Gammon
- School of Health Sciences, Massey University, Auckland 0632, New Zealand; (W.X.J.L.); (C.S.G.)
| | - Rachel A. Page
- School of Health Sciences, Massey University, Wellington 6021, New Zealand
- Centre for Metabolic Health Research, Massey University, Auckland 0632, New Zealand
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15
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Tsuboi A, Kitaoka K, Yano M, Takeuchi M, Minato S, Kurata M, Yoshino G, Wu B, Kazumi T, Fukuo K. Higher circulating orosomucoid and lower early-phase insulin secretion in midlife Japanese with slower glucose disposal during oral glucose tolerance tests. Diabetol Int 2020; 11:27-32. [PMID: 31950001 DOI: 10.1007/s13340-019-00398-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/25/2019] [Indexed: 12/22/2022]
Abstract
Objective We examined whether serum orosomucoid, an acute phase protein as with C-reactive protein, in addition to insulin resistance and beta-cell dysfunction, was involved in glucose disposal during oral glucose tolerance tests. Research design and methods 124 midlife Japanese (65 women, 66% with normal glucose tolerance) received dual-energy X-ray absorptiometry and 75 g oral glucose tolerance tests with multiple postload glucose and insulin measurements. Subjects were divided based on the relationship between postload and fasting glucose. Obesity measures, insulin resistance, insulin secretion, serum orosomucoid and adiponectin were cross-sectionally analyzed by analysis of variance and then Bonferroni's multiple comparison procedure. Results In 10 subjects (group A) and 19 subjects (group B), postload glucose fell below fasting glucose at 1 h and 2 h, respectively. In the remaining 95 subjects (group C), postload glucose never fell below fasting glucose. The insulinogenic index was lower and area under the glucose curve was higher in groups B and C as compared to group A (both p<0.05), whereas the Matsuda index, the homeostasis model assessment of insulin resistance, adipose insulin resistance (the product of fasting free fatty acid and insulin) and area under the insulin curve did not differ. Although there was no difference in fat mass index, trunk/leg fat ratio and adiponectin, orosomucoid was higher in group C as compared to group A (p<0.05). Conclusions Lower early-phase insulin secretion and low-grade inflammation were associated with slower glucose disposal during an oral glucose tolerance test in midlife Japanese. The rate of glucose disposal was not related to adiposity and insulin resistance.
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Affiliation(s)
- Ayaka Tsuboi
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan.,Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Kaori Kitaoka
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan.,3Department of Nutritional Sciences for Well-Being, Faculty of Health Sciences for Welfare, Kansai University of Welfare Sciences, Kashiwara, Osaka Japan
| | - Megumu Yano
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan
| | - Mika Takeuchi
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan.,4Department of Food Sciences and Nutrition, Faculty of Human Life and Environmental Sciences, Nagoya Women's University, Nagoya, Japan
| | - Satomi Minato
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan.,5Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo Japan
| | - Miki Kurata
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan.,6Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo Japan
| | - Gen Yoshino
- Diabetes Center, Shinsuma Hospital, Kobe, Hyogo Japan
| | - Bin Wu
- 8Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women's University, Nishinomiya, Japan.,9Department of Endocrinology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan China
| | - Tsutomu Kazumi
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan.,Department of Medicine, Kohnan Kakogawa Hospital, Kakogawa, Hyogo Japan
| | - Keisuke Fukuo
- 1Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, NishinomiyaNishinomiya, 663-8558 Hyogo Japan.,6Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo Japan
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16
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González-Rodríguez M, Pazos-Couselo M, García-López JM, Rodríguez-Segade S, Rodríguez-García J, Túñez-Bastida C, Gude F. Postprandial glycemic response in a non-diabetic adult population: the effect of nutrients is different between men and women. Nutr Metab (Lond) 2019; 16:46. [PMID: 31346341 PMCID: PMC6637571 DOI: 10.1186/s12986-019-0368-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background There is a growing interest in the pathopysiological consequences of postprandial hyperglycemia. It is well known that in diabetic patients 2 h plasma glucose is a better risk predictor for coronary heart disease than fasting plasma glucose. Data on the glycemic response in healthy people are scarce. Objective To evaluate the effect of macronutrients (carbohydrates, fats, and proteins) and fiber on postprandial glycemic response in an observational study of a non-diabetic adult population. Design Cross-sectional study. 150 non-diabetic adults performed continuous glucose monitoring for 6 days. During this period they recorded food and beverage intake. The participants were instructed not to make changes in their usual diet and physical exercise. Variables analyzed included clinical parameters (age, sex, body weight, height, body mass index, blood pressure, and waist measurement), meal composition (calories, carbohydrates, fats, proteins, and fiber) and glycemic postprandial responses separated by sexes. The study period was defined from the start of dinner to 6 h later. Results A total of 148 (51% women) subjects completed all study procedures. Dinner intake was higher in males than in females (824 vs 531 kcal). Macronutrient distribution was similar in both sexes. No significant differences were found in fiber intake between men and women (5.5 g vs 4.5 g). In both sexes, the higher intake of carbohydrates corresponded to a significantly higher glycemic response (p = 0.0001 in women, p = 0.022 in men). Moreover, in women, as fat intake was higher, a flattening of the postprandial glycemic curve was observed (p = 0.003). With respect to fiber, a significantly lower glycemic response was observed in the group of women whose fiber intake at dinner was higher (p = 0.034). Conclusions Continuous glucose monitoring provides important information about glucose levels after meals. In this study, the postprandial glycemic response in women was different from that of men, and carbohydrates were the main determinant of elevated postprandial glucose levels.
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Affiliation(s)
- María González-Rodríguez
- 1Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain
| | - Marcos Pazos-Couselo
- 1Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain.,2Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José M García-López
- 1Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain.,2Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Santiago Rodríguez-Segade
- 3Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Javier Rodríguez-García
- 3Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Francisco Gude
- 5Clinical Epidemiology Unit, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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17
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Tsuboi A, Minato S, Yano M, Takeuchi M, Kitaoka K, Kurata M, Yoshino G, Wu B, Kazumi T, Fukuo K. Higher circulating adiponectin and lower orosomucoid were associated with postload glucose ≤70 mg/dL, a possible inverse marker for dysglycemia, in young Japanese women. BMJ Open Diabetes Res Care 2019; 7:e000596. [PMID: 30899529 PMCID: PMC6398809 DOI: 10.1136/bmjdrc-2018-000596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/16/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine whether serum adiponectin and orosomucoid were associated with postload glucose ≤70 mg/dL during an oral glucose tolerance test (OGTT), termed as postload low glycemia, a possible inverse marker for dysglycemia. RESEARCH DESIGN AND METHODS 75 g OGTTs were performed with multiple postload glucose and insulin measurements over a 30-120 min period in 168 normal-weight Japanese women (18-24 years). Insulin resistance (IR) and β-cell function inferred from serum insulin kinetics during OGTT, fat mass and distribution by dual-energy X-ray absorptiometry (DXA), serum adiponectin and inflammatory markers were compared cross-sectionally between 39 women with and 129 women without postload low glycemia. RESULTS Of 168 women, 161 had normal glucose tolerance. Women with as compared with those without postload low glycemia had lower fasting and postload glycemia despite similar fasting and postload insulinemia. They had higher insulinogenic index (p=0.03) and lower adipose IR (a product of fasting free fatty acid and insulin, p=0.01), although DXA-derived general and central adiposity, the Matsuda Index and homeostasis model assessment-IR did not differ. In addition, they had higher adiponectin and lower orosomucoid (both p<0.001). Multivariate logistic regression analyses revealed that adiponectin (OR: 1.14, 95% CI 1.03 to 1.26, p=0.009) and orosomucoid (0.96, 0.93 to 0.97, p=0.008) were associated with postload low glycemia independently of adipose IR and insulinogenic index. CONCLUSIONS Higher adiponectin and lower orosomucoid were associated with 70 or lower mg/dL of postload glucose, a possible inverse marker for dysglycemia, in young women independently of DXA-derived fat mass and distribution, insulin secretion and IR.
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Affiliation(s)
- Ayaka Tsuboi
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Satomi Minato
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan
| | - Megumu Yano
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
| | - Mika Takeuchi
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
| | - Kaori Kitaoka
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Nutritional Sciences for Well-Being, Faculty of Health Sciences for Welfare, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Miki Kurata
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
| | - Gen Yoshino
- Diabetes Center, Shinsuma Hospital, Kobe, Hyogo, Japan
| | - Bin Wu
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women’s University Diabetes Division, Nishinomiya, Japan
- Department of Endocrinology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tsutomu Kazumi
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Medicine, Kohnan Kakogawa Hospital, Kakogawa, Hyogo, Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
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Maeta K, Nishiyama Y, Fujibayashi K, Gunji T, Sasabe N, Iijima K, Naito T. Prediction of Glucose Metabolism Disorder Risk Using a Machine Learning Algorithm: Pilot Study. JMIR Diabetes 2018; 3:e10212. [PMID: 30478026 PMCID: PMC6288596 DOI: 10.2196/10212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/16/2018] [Accepted: 10/17/2018] [Indexed: 01/10/2023] Open
Abstract
Background A 75-g oral glucose tolerance test (OGTT) provides important information about glucose metabolism, although the test is expensive and invasive. Complete OGTT information, such as 1-hour and 2-hour postloading plasma glucose and immunoreactive insulin levels, may be useful for predicting the future risk of diabetes or glucose metabolism disorders (GMD), which includes both diabetes and prediabetes. Objective We trained several classification models for predicting the risk of developing diabetes or GMD using data from thousands of OGTTs and a machine learning technique (XGBoost). The receiver operating characteristic (ROC) curves and their area under the curve (AUC) values for the trained classification models are reported, along with the sensitivity and specificity determined by the cutoff values of the Youden index. We compared the performance of the machine learning techniques with logistic regressions (LR), which are traditionally used in medical research studies. Methods Data were collected from subjects who underwent multiple OGTTs during comprehensive check-up medical examinations conducted at a single facility in Tokyo, Japan, from May 2006 to April 2017. For each examination, a subject was diagnosed with diabetes or prediabetes according to the American Diabetes Association guidelines. Given the data, 2 studies were conducted: predicting the risk of developing diabetes (study 1) or GMD (study 2). For each study, to apply supervised machine learning methods, the required label data was prepared. If a subject was diagnosed with diabetes or GMD at least once during the period, then that subject’s data obtained in previous trials were classified into the risk group (y=1). After data processing, 13,581 and 6760 OGTTs were analyzed for study 1 and study 2, respectively. For each study, a randomly chosen subset representing 80% of the data was used for training 9 classification models and the remaining 20% was used for evaluating the models. Three classification models, A to C, used XGBoost with various input variables, some including OGTT data. The other 6 classification models, D to I, used LR for comparison. Results For study 1, the AUC values ranged from 0.78 to 0.93. For study 2, the AUC values ranged from 0.63 to 0.78. The machine learning approach using XGBoost showed better performance compared with traditional LR methods. The AUC values increased when the full OGTT variables were included. In our analysis using a particular setting of input variables, XGBoost showed that the OGTT variables were more important than fasting plasma glucose or glycated hemoglobin. Conclusions A machine learning approach, XGBoost, showed better prediction accuracy compared with LR, suggesting that advanced machine learning methods are useful for detecting the early signs of diabetes or GMD. The prediction accuracy increased when all OGTT variables were added. This indicates that complete OGTT information is important for predicting the future risk of diabetes and GMD accurately.
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Affiliation(s)
- Katsutoshi Maeta
- Faculty of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Yu Nishiyama
- Faculty of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Kazutoshi Fujibayashi
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiaki Gunji
- Center for Preventive Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Noriko Sasabe
- Center for Preventive Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kimiko Iijima
- Center for Preventive Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
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Richter B, Hemmingsen B, Metzendorf M, Takwoingi Y. Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev 2018; 10:CD012661. [PMID: 30371961 PMCID: PMC6516891 DOI: 10.1002/14651858.cd012661.pub2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts. OBJECTIVES To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia. SEARCH METHODS We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining. SELECTION CRITERIA We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only. DATA COLLECTION AND ANALYSIS One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework. MAIN RESULTS We included 103 prospective cohort studies. The studies mainly defined IH by IFG5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG5.6, IFG6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG6.1 and IFG5.6. Limited data showed a higher T2DM incidence associated with HbA1c6.0 compared to HbA1c5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018. AUTHORS' CONCLUSIONS Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.
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Affiliation(s)
- Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Bianca Hemmingsen
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
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Takeuchi M, Minato S, Kitaoka K, Tsuboi A, Kurata M, Kazumi T, Fukuo K. Higher Fasting and Postprandial Free Fatty Acid Levels Are Associated With Higher Muscle Insulin Resistance and Lower Insulin Secretion in Young Non-Obese Women. J Clin Med Res 2018; 10:822-829. [PMID: 30344817 PMCID: PMC6188023 DOI: 10.14740/jocmr3534w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/20/2018] [Indexed: 12/02/2022] Open
Abstract
Background To assess the relationship of the shape of glucose concentration curve during a standardized meal test to serum free fatty acid (FFA) concentrations, insulin resistance and insulin secretion in young non-obese women. Methods Thirty-five young women had a standardized meal for breakfast with measurement of glucose, insulin and FFA concentrations at 0 (fasting), 30, 60 and 120 min; the areas under the concentration curves were calculated (AUCg, AUCi and AUCffa, respectively). Meal-induced insulin response (MIR) was calculated as the ratio between the incremental insulin and glucose concentrations during the first 30 min of meal tests. In two women (group A), post-breakfast glucose (PBG) returned to levels below fasting plasma glucose (FPG) at 30 min; in 15 and 11 women, PBG returned to levels below FPG at 60 and 120 min (groups B and C, respectively). In the remaining seven women (group D), PBG never fell below FPG. Results Despite no difference in fasting insulin and AUCi, fasting FFA, AUCg and AUCffa were the lowest in group A, increased linearly from group B to C and plateaued in group D, whereas MIR might be the highest in group A, decreased from group B to C and plateaued in group D. Conclusion Young women whose PBG returned to FPG more slowly had higher muscle insulin resistance and lower MIR associated with higher fasting and postprandial FFA levels compared with young women whose PBG returned to baseline more quickly.
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Affiliation(s)
- Mika Takeuchi
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
| | - Satomi Minato
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan
| | - Kaori Kitaoka
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Department of Welfare and Nutrition, Faculty of Health Welfare, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Ayaka Tsuboi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Miki Kurata
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
| | - Tsutomu Kazumi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Diabetes Division, Kohnan Kakogawa Hospital, Kakogawa, Hyogo, Japan
| | - Keisuke Fukuo
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
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21
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Armato JP, DeFronzo RA, Abdul-Ghani M, Ruby RJ. Successful treatment of prediabetes in clinical practice using physiological assessment (STOP DIABETES). Lancet Diabetes Endocrinol 2018; 6:781-789. [PMID: 30224284 DOI: 10.1016/s2213-8587(18)30234-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Of the 84 million American adults with prediabetes, over 5 to 7 years, about 28 million progress to type 2 diabetes. We aimed to assess whether a real-world, pathophysiology-based, therapeutic approach could prevent development of type 2 diabetes in high-risk individuals. METHODS We did a retrospective observational study of people at increased risk of type 2 diabetes from a community practice in southern California, USA. Participants had an oral glucose tolerance test and were assigned a risk stratification on the basis of presence and severity of insulin resistance, impaired β-cell function, and glycaemia (ie, 1-h plasma glucose concentration of more than 8·6 mmol/L during an oral glucose tolerance test). Treatment was recommended on the basis of risk: metformin, pioglitazone, glucagon-like peptide-1 (GLP-1) receptor agonist, and lifestyle therapy for participants at high risk of diabetes, and metformin, pioglitazone, and lifestyle therapy for those at intermediate risk. Individuals who refused pharmacological therapy were assigned to lifestyle therapy only. Participants were followed up every 6 months and oral glucose tolerance tests were repeated at 6 months and subsequently every 2 years or sooner. The primary outcome of our analysis was incidence of type 2 diabetes according to the American Diabetes Association criteria, within the study period (2009-16). This study is registered with ClinicalTrials.gov, number NCT03308773. FINDINGS Between Jan 1, 2009 and Dec 31, 2016, we assessed 1769 people at increased risk of diabetes, of which 747 (42%) were identified at high or intermediate risk and were recommended pharmacological treatment. Of 422 participants analysed, 28 (7%) progressed to type 2 diabetes (seven [5%] of 141 participants who received metformin, pioglitazone, and lifestyle therapy, none [0%] of 81 who received metformin, pioglitazone, GLP-1 receptor agonist, and lifestyle therapy, and 21 [11%] of 200 who received lifestyle therapy only) after mean follow-up of 32·09 months (SEM 1·24). Compared with participants who received lifestyle therapy only, the adjusted hazard ratio for progression to type 2 diabetes was 0·29 (95% CI 0·11-0·78, p=0·0009) in participants who received metformin and pioglitazone, and 0·12 (95% CI 0·02-0·94, p=0·04) in participants who received metformin, pioglitazone, and GLP-1 receptor agonist. Improved β-cell function was the strongest predictor of type 2 diabetes prevention. INTERPRETATION Progression to type 2 diabetes in people at high risk of diabetes can be markedly reduced with interventions designed to correct underlying pathophysiological disturbances (ie, impaired insulin secretion and resistance) in a real-world setting. FUNDING None.
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Affiliation(s)
- John P Armato
- Providence Little Company of Mary Cardiometabolic Center, Torrance, CA, USA.
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA
| | - Muhammad Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA
| | - Ron J Ruby
- Providence Little Company of Mary Cardiometabolic Center, Torrance, CA, USA.
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22
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Fiorentino TV, Marini MA, Succurro E, Andreozzi F, Perticone M, Hribal ML, Sciacqua A, Perticone F, Sesti G. One-Hour Postload Hyperglycemia: Implications for Prediction and Prevention of Type 2 Diabetes. J Clin Endocrinol Metab 2018; 103:3131-3143. [PMID: 30020454 DOI: 10.1210/jc.2018-00468] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/12/2018] [Indexed: 12/18/2022]
Abstract
CONTEXT Recently, a value of 1-hour postload glucose concentration (1-h-PG) ≥155 mg/dL (8.6 mmol/L) in individuals with normal glucose tolerance (NGT) has been found to be associated with an increased risk for future type 2 diabetes mellitus (T2DM). In this review, we analyze the implication of 1-h-PG determination in prediction of T2DM and cardiovascular disease. DESIGN A literature search was performed using MEDLINE. We included all English studies published up to February 2018 in peer-reviewed journals that examined the relationship between 1-h-PG and diabetes, cardiometabolic alterations, organ damage, and cardiovascular disease. RESULTS Several longitudinal studies have consistently shown that 1-h-PG ≥155 mg/dL can recognize individuals at increased risk for future T2DM among subjects with NGT. Additionally, we describe the pathophysiological abnormalities associated with 1-h-PG ≥155 mg/dL including impaired insulin sensitivity, β-cell dysfunction, and increased glucose intestinal absorption, which are known to be involved in T2DM pathogenesis. Importantly, numerous studies have demonstrated that a value of 1-h-PG ≥155 mg/dL in individuals with NGT is not only linked to an increased risk for future T2DM, but also able to identify those having a worse cardiovascular phenotype and an increased risk of adverse cardiovascular outcomes. CONCLUSIONS Although 1-h-PG determination is not currently recommended by the American Diabetes Association for identifying high-risk individuals, the available evidence indicates that a value of 1-h-PG ≥155 mg/dL may be a useful tool to recognize, among subjects with NGT, those at increased risk of T2DM and cardiovascular disease.
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Affiliation(s)
- Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | | | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Maria Perticone
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
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23
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Abildgaard J, Danielsen ER, Dorph E, Thomsen C, Juul A, Ewertsen C, Pedersen BK, Pedersen AT, Ploug T, Lindegaard B. Ectopic Lipid Deposition Is Associated With Insulin Resistance in Postmenopausal Women. J Clin Endocrinol Metab 2018; 103:3394-3404. [PMID: 29889238 DOI: 10.1210/jc.2018-00554] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022]
Abstract
CONTEXT Menopause is associated with an increased incidence of insulin resistance and diabetes. OBJECTIVE The aim of this study was to explore the lipid deposition in liver and skeletal muscle and investigate the association with insulin sensitivity in postmenopausal and premenopausal women. DESIGN AND SETTING Single-center cross-sectional study of 55 healthy women between 45 and 60 years of age. We measured lipid deposition in the liver with magnetic resonance spectroscopy, intramuscular and intra-abdominal lipid deposition with MRI, body composition with a dual-energy X-ray absorptiometry scan, and insulin sensitivity with the composite Matsuda Index. OUTCOME MEASURES We studied the association between fat distribution, ectopic lipid deposition, and insulin sensitivity in pre- and postmenopausal women. RESULTS Postmenopausal women had an increased lipid deposition in the liver [0.68% (0.44 to 0.99) vs 0.49% (0.38 to 0.64), P = 0.01] and skeletal muscle [3% (2 to 4) vs 2% (1 to 3), P = 0.001] and had a 28% lower Matsuda insulin sensitivity index during an oral glucose tolerance test (6.31 ± 3.48 vs 8.78 ± 4.67, P = 0.05) compared with premenopausal women. Total fat mass and leg fat mass were stronger predictors of ectopic lipid deposition, and visceral fat mass was a stronger predictor of both ectopic lipid deposition and insulin resistance in postmenopausal women compared with premenopausal women. CONCLUSIONS For a given subcutaneous and visceral fat depot size, postmenopausal women show increased ectopic lipid deposition and insulin resistance compared with premenopausal women. It is suggested that lipid deposition in liver and skeletal muscle may represent important mechanistic links between the changes in fat depots and the increased incidence of insulin resistance seen after menopause.
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Affiliation(s)
- Julie Abildgaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Else Rubaek Danielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emma Dorph
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Thomsen
- Department of Radiology, Sealand University Hospital, Roskilde, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anette Tønnes Pedersen
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thorkil Ploug
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
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de Andrade Mesquita L, Pavan Antoniolli L, Cittolin-Santos GF, Gerchman F. Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study. BMC Endocr Disord 2018; 18:56. [PMID: 30115058 PMCID: PMC6097323 DOI: 10.1186/s12902-018-0286-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The shapes of the plasma glucose concentration curve during the oral glucose tolerance test are related to different metabolic risk profiles and future risk of type 2 DM. We sought to further analyze the relationship between the specific shapes and hyperglycemic states, the metabolic syndrome and hormones involved in carbohydrate and lipid metabolism, and to isolate the effect of the shape by adjusting for the area under the glucose curve. METHODS One hundred twenty one adult participants underwent a 2-h oral glucose tolerance test and were assigned to either the monophasic (n = 97) or the biphasic (n = 24) group based upon the rise and fall of their plasma glucose concentration. We evaluated anthropometric measures, blood pressure, lipid profile, high-sensitivity C-reactive protein, glycated hemoglobin, insulin sensitivity, beta-cell function, C-peptide, glucagon, adiponectin and pancreatic polypeptide. RESULTS Subjects with monophasic curves had higher fasting and 2-h plasma glucose levels, while presenting lower insulin sensitivity, beta-cell function, HDL cholesterol, adiponectin and pancreatic polypeptide levels. Prediabetes and metabolic syndrome had a higher prevalence in this group. Glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein and glucagon were not significantly different between groups. After adjusting for the area under the glucose curve, only the differences in the 1-h and 2-h plasma glucose concentrations and HDL cholesterol levels between the monophasic and biphasic groups remained statistically significant. CONCLUSIONS Rates and intensity of metabolic dysfunction are higher in subjects with monophasic curves, who have lower insulin sensitivity and beta-cell function and a higher prevalence of prediabetes and metabolic syndrome. These differences, however, seem to be dependent on the area under the glucose curve.
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Affiliation(s)
- Leonardo de Andrade Mesquita
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, 90035-003 Brazil
| | - Luciana Pavan Antoniolli
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, 90035-003 Brazil
| | | | - Fernando Gerchman
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, 90035-003 Brazil
- Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, 90035-903 Brazil
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Skoradal MB, Weihe P, Patursson P, Mortensen J, Connolly L, Krustrup P, Mohr M. Football training improves metabolic and cardiovascular health status in 55- to 70-year-old women and men with prediabetes. Scand J Med Sci Sports 2018; 28 Suppl 1:42-51. [PMID: 29718556 DOI: 10.1111/sms.13081] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 01/04/2023]
Abstract
We examined the effects of 16 weeks of football training and dietary advice on blood glucose control and health status in 55- to 70-year-old women and men with prediabetes. Fifty participants with prediabetes (age; 61 ± 6 years, BMI; 29.6 ± 4.7; VO2max 22.3 ± 5.7 mL·min-1 ·kg-1 ) were randomized into a football and dietary advice group (F+D; n = 27) and a dietary advice group (D; n = 23). F+D performed football training (twice weekly 30- to 60-minutes sessions) and received dietary advice, while D only received dietary advice. An oral glucose tolerance test (OGTT) was completed pre and post the 16-week period. Body composition, blood pressure, and maximal oxygen uptake (VO2max ) were additionally measured. Both groups demonstrated a decrement (P < .05) in fasting blood glucose (-0.4 ± 0.5 mmol·L-1 ) and lowered blood glucose throughout OGTT. F+D displayed lower values than D (P < .05) after 60 minutes (9.0 ± 2.7 vs 10.6 ± 2.9 mmol·L-1 ) and 120 minutes (5.7 ± 1.6 vs 7.5 ± 2.4 mmol·L-1 ). VO2max increased by 14% in F+D, with a higher (P < .05) change score than in D (2%). Mean arterial pressure declined more (P < .05) in F+D than in D (-8 ± 9 vs -4 ± 11 mm Hg). Fat loss was greater (P < .05) in F+D than in D (-3.4 ± 2.8 vs -1.2 ± 2.0 kg), and the increase in lean body mass was also greater (P < .05) in F+D than in D (0.7 ± 1.5 vs -0.3 ± 1.6 kg). In conclusion, football training combined with dietary advice has broad-spectrum effects on metabolic and cardiovascular health profile with greater overall effects than professional dietary advice per se for 55- to 70-year-old women and men with prediabetes.
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Affiliation(s)
- M-B Skoradal
- Faculty of Health Sciences, Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - P Weihe
- Faculty of Health Sciences, Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands.,Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - P Patursson
- Faculty of Health Sciences, Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands.,Department of Medicine, The Faroese National Hospital, Tórshavn, Faroe Islands
| | - J Mortensen
- Department of Medicine, The Faroese National Hospital, Tórshavn, Faroe Islands.,Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Connolly
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - P Krustrup
- Sport and Health Sciences, University of Exeter, Exeter, UK.,Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M Mohr
- Faculty of Health Sciences, Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands.,Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Food and Nutrition, and Sport Science, Center for Health and Human Performance, University of Gothenburg, Gothenburg, Sweden
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Tran S, Kramer CK, Zinman B, Choi H, Retnakaran R. Effect of chronic liraglutide therapy and its withdrawal on time to postchallenge peak glucose in type 2 diabetes. Am J Physiol Endocrinol Metab 2018; 314:E287-E295. [PMID: 29183873 DOI: 10.1152/ajpendo.00374.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Delayed timing of peak serum glucose following an oral glucose challenge can predict declining β-cell function and worsening glucose tolerance over time. Accordingly, postchallenge peak glucose is typically delayed in patients with type 2 diabetes (T2DM). However, little is known about the capacity of antidiabetic medications to reverse this delay. Thus, we sought to evaluate the effect of the glucagon-like peptide-1 agonist liraglutide on time to peak glucose in early T2DM. In this secondary analysis of a double-blind placebo-controlled trial, 51 patients with T2DM of 2.6 ± 1.9 yr duration were randomized to daily subcutaneous liraglutide or placebo injection for 48 wk, with oral glucose tolerance test (OGTT) performed every 12 wk while on therapy and after a 2-wk washout. On each OGTT, time to peak glucose was determined from venous glucose measurements at 0, 10, 20, 30, 60, 90, and 120 min. At randomization, most patients in both arms exhibited peak glucose at 90 min postchallenge. By 12 wk, 65.4% of the liraglutide arm had shifted to an earlier peak (vs. 36% on placebo; P = 0.19), with little change thereafter at 24, 36, and 48 wk. After the 2-wk washout, however, 57.7% of those who had been on liraglutide reverted to a later peak (vs. 4.5% on placebo; P < 0.001). This shift was associated with declining β-cell function ( P = 0.001), resulting in higher 2-h blood glucose at washout in the liraglutide arm compared with placebo ( P = 0.001). Thus, although liraglutide possibly might improve the delay in peak glucose, its cessation yielded a worsening thereof and higher glycemia. The mechanisms underlying these observations and their clinical implications warrant further investigation.
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Affiliation(s)
- Susan Tran
- Department of Medicine, University of Toronto , Toronto, Ontario , Canada
| | - Caroline K Kramer
- Department of Medicine, University of Toronto , Toronto, Ontario , Canada
- Division of Endocrinology, University of Toronto , Toronto, Ontario , Canada
| | - Bernard Zinman
- Department of Medicine, University of Toronto , Toronto, Ontario , Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital , Toronto, Ontario , Canada
- Division of Endocrinology, University of Toronto , Toronto, Ontario , Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto, Ontario , Canada
| | - Haysook Choi
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital , Toronto, Ontario , Canada
| | - Ravi Retnakaran
- Department of Medicine, University of Toronto , Toronto, Ontario , Canada
- Division of Endocrinology, University of Toronto , Toronto, Ontario , Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto, Ontario , Canada
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Lin YC, Chen HS. Longer time to peak glucose during the oral glucose tolerance test increases cardiovascular risk score and diabetes prevalence. PLoS One 2017; 12:e0189047. [PMID: 29216249 PMCID: PMC5720677 DOI: 10.1371/journal.pone.0189047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/19/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The pattern of glucose levels during an oral glucose tolerance test (OGTT) may be useful for predicting diabetes or cardiovascular disease (CVD). Our aim was to determine whether the time to peak glucose during the OGTT is associated with CVD risk scores and diabetes. METHODS Individuals with impaired fasting glucose (IFG) were enrolled in this observational study. Participants were grouped by the measured time to peak glucose (30, 60, 90 and 120 min) during the 75g OGTT. The primary outcome was 10-year CVD risk scores (using the Framingham risk score calculator). Secondary outcomes evaluated effect of time to peak glucose on prevalence of diabetes and indicators of glucose homeostasis. RESULTS A total of 125 patients with IFG underwent OGTTs. Framingham 10-year risk score for the 90-min group was 1.7 times higher than for the 60-min group (6.98±6.56% vs. 4.05±4.60%, P = 0.023). Based on multivariate linear regression, time to peak glucose at 90 min was associated with a higher Framingham risk score than 60-min group (β coefficient: 2.043, 95% confidence interval: 0.067-6.008, P = 0.045). The percentages of patients with HbA1c ≥6.5%, isolated post-challenge hyperglycemia (IPH) and diabetes (combined IPH and HbA1c ≥6.5%) were significantly increased with longer times to peak glucose. Prevalence of diabetes was higher in the 90-min group than in the 60-min group (31.5% vs. 5.7%, P = 0.001). CONCLUSIONS In subjects with IFG, those with a longer time to peak glucose had a higher Framingham 10-year risk score and were associated with a greater likelihood of IPH and diabetes.
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Affiliation(s)
- Yi-Chun Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Harn-Shen Chen
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail:
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Chung ST, Ha J, Onuzuruike AU, Kasturi K, Galvan-De La Cruz M, Bingham BA, Baker RL, Utumatwishima JN, Mabundo LS, Ricks M, Sherman AS, Sumner AE. Time to glucose peak during an oral glucose tolerance test identifies prediabetes risk. Clin Endocrinol (Oxf) 2017; 87:484-491. [PMID: 28681942 PMCID: PMC5658251 DOI: 10.1111/cen.13416] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022]
Abstract
CONTEXT Morphological characteristics of the glucose curve during an oral glucose tolerance test (OGTT) (time to peak and shape) may reflect different phenotypes of insulin secretion and action, but their ability to predict diabetes risk is uncertain. OBJECTIVE To compare the ability of time to glucose peak and curve shape to detect prediabetes and β-cell function. DESIGN AND PARTICIPANTS In a cross-sectional evaluation using an OGTT, 145 adults without diabetes (age 42±9 years (mean±SD), range 24-62 years, BMI 29.2±5.3 kg/m2 , range 19.9-45.2 kg/m2 ) were characterized by peak (30 minutes vs >30 minutes) and shape (biphasic vs monophasic). MAIN OUTCOME MEASURES Prediabetes and disposition index (DI)-a marker of β-cell function. RESULTS Prediabetes was diagnosed in 36% (52/145) of participants. Peak>30 minutes, not monophasic curve, was associated with increased odds of prediabetes (OR: 4.0 vs 1.1; P<.001). Both monophasic curve and peak>30 minutes were associated with lower DI (P≤.01). Time to glucose peak and glucose area under the curves (AUC) were independent predictors of DI (adjR2 =0.45, P<.001). CONCLUSION Glucose peak >30 minutes was a stronger independent indicator of prediabetes and β-cell function than the monophasic curve. Time to glucose peak may be an important tool that could enhance prediabetes risk stratification.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Joon Ha
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Kannan Kasturi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Mirella Galvan-De La Cruz
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Brianna A Bingham
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Rafeal L Baker
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jean N Utumatwishima
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Lilian S Mabundo
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Madia Ricks
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Arthur S Sherman
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
- National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD, USA
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The monophasic pattern in oral glucose tolerance test as a predictive risk factor of type 2 diabetes in obese paediatric patients. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Płaczkowska S, Kokot I, Pawlik-Sobecka L, Piwowar A. Assessment of HOMA1-IR, Matsuda and ISSI-2 indices in relation to the metabolic syndrome features and oral glucose tolerance test in young people. ACTA ACUST UNITED AC 2017. [DOI: 10.5604/01.3001.0013.7973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<I>Background:</I> Insulin resistance and reduced ability of pancreatic beta cells to secrete insulin preside carbohydrate disorders development and this condition is one of the stages in the type 2 diabetes development. Indirect indices of insulin resistance, sensitivity and pancreatic beta cells function, are used in clinical practice. They are calculated based on glucose and insulin concentration under fasting and postprandial condition.
<I>Aim:</I> The aim of this study was to examine relationship between HOMA1-IR, Matsuda Index, and ISSI-2 with metabolic syndrome (MS) features and shape of glycemic curve in young, potentially healthy people.
<i>Material and method:</i> The study group consisted of 152 volunteers (108 women, 44 men) aged 19-28. Participants underwent the questionnaire, anthropometric and arterial blood pressure examination. In blood samples under fasting condition lipid profiles, glucose, and insulin were measured. Glucose and insulin were measured also in 60 and 120 minutes of Oral Glucose Tolerance Test (OGTT). Based on the results, MS features were identified and HOMA1-IR, Matsuda Index and ISSI-2 values were calculated.
<I>Results:</I> The value of HOMA1-IR was significant higher in patients with metabolic syndrome while lower values of Matsuda and ISSI-2 were observed in participants with the MS as well as with glucose concentration in 120-minute of OGTT higher than under fasting condition.
<i> Conclusions:</i> MS is associated with an increase in hepatic insulin resistance. Both MS and retardation of glucose returning to fasting values during OGTT are related to peripheral insulin resistance and reduction of pancreatic beta cell ability to insulin secretion.
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Affiliation(s)
- Sylwia Płaczkowska
- Diagnostyczne Laboratorium Naukowo-Dydaktyczne, Wydział Farmaceutyczny z Oddziałem Analityki Medycznej, Uniwersytet Medyczny we Wrocławiu
| | - Izabela Kokot
- Zakład Praktycznej Nauki Zawodu Analityka, Wydział Farmaceutyczny z Oddziałem Analityki Medycznej, Uniwersytet Medyczny we Wrocławiu
| | - Lilla Pawlik-Sobecka
- Zakład Praktycznej Nauki Zawodu Analityka, Wydział Farmaceutyczny z Oddziałem Analityki Medycznej, Uniwersytet Medyczny we Wrocławiu
| | - Agnieszka Piwowar
- Katedra i Zakład Toksykologii, Wydział Farmaceutyczny z Oddziałem Analityki Medycznej, Uniwersytet Medyczny we Wrocławiu
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Tsuboi A, Takeuchi M, Kitaoka K, Minato S, Kurata M, Kazumi T, Fukuo K. Post-Prandial Plasma Glucose Less Than or Equal to 70 mg/dL Is Not Uncommon in Young Japanese Women. J Clin Med Res 2017; 9:680-686. [PMID: 28725316 PMCID: PMC5505304 DOI: 10.14740/jocmr3069w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/10/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Post-breakfast/post-challenge plasma glucose (PG) concentrations were studied less in young normal weight Japanese women. We addressed these issues. METHODS Two separate groups of female collegiate athletes and female untrained students underwent either a standardized meal test or a standard 75-g oral glucose tolerance test, but not both. Frequency of women whose post-breakfast/post-load PG fell to 70 mg/dL or lower (termed as low glycemia) was compared between athletes and non-athletes, who also underwent measurements of serum adipokines, markers of insulin resistance and inflammation and dual-energy X-ray absorptiometry. Insulin secretion, insulin sensitivity/resistance and serum adipokines were compared between women with and without post-breakfast low glycemia. The same comparison was done between women whose post-breakfast PG returned to levels below the fasting PG and women whose post-breakfast PG never fell below the fasting PG. RESULTS There was no difference between athletes and non-athletes in frequency of post-breakfast low glycemia (47% (8/17) and 44% (8/18)) and post-challenge low glycemia (24% (12/50) and 23% (27/118)). As compared to seven women whose post-breakfast PG never fell below the fasting PG, 28 women whose post-breakfast PG returned to levels below the fasting PG had higher meal-induced insulin responses (283 ± 366 vs. 89 ± 36 µU/mg, P = 0.014). However, two groups did not differ in body composition, markers of insulin resistance and serum adiponectin. No significant difference was also observed in any of these variables between women with and without post-breakfast low glycemia. CONCLUSION Post-prandial PG ≤ 70 mg/dL is not uncommon in young normal weight Japanese women and may not be a pathological condition. The underlying mechanisms for this finding need further exploration.
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Affiliation(s)
- Ayaka Tsuboi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Mika Takeuchi
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
| | - Kaori Kitaoka
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Department of Welfare and Nutrition, Faculty of Health Welfare, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Satomi Minato
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan
| | - Miki Kurata
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
| | - Tsutomu Kazumi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Diabetes Division, Department of Medicine, Kohnan Kakogawa Hospital, Kakogawa, Hyogo, Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.,Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
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[The monophasic pattern in oral glucose tolerance test as a predictive risk factor of type 2 diabetes in obese paediatric patients]. An Pediatr (Barc) 2017; 87:211-217. [PMID: 28428013 DOI: 10.1016/j.anpedi.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The onset of obesity at young ages is strongly associated with the early development of type 2diabetes (T2D). The shape of the curves of glucose and insulin curves during an oral glucose tolerance test (OGTT) could predict the risk of developing T2D. OBJECTIVE To analyse the morphology of the OGTT and determine T2D risk factors in a mainly Caucasian population of children and adolescents. METHODS Observational retrospective study including 588 patients (309 males, 279 females) with a mean age of 11.1±2years, and of whom 90.3% were Caucasian. Risk factors for T2D were compared in patients with a monophasic or biphasic pattern during the performance of an OGTT, as well as anthropometric and biochemical variables, insulin resistance, and beta-cell function. RESULTS The shape of the glucose curve was monophasic in 50.2% of patients (50.8% male), biphasic in 48.5% (47.6% males), and indeterminate in 1.3%. The monophasic pattern showed lower insulin-sensitivity and worse beta-cell function. Patients with a biphasic pattern had a higher BMI, waist circumference, and blood pressure, although the results were not significant. Latin-American patients had significantly lower serum glucose levels with higher insulin levels during the OGTT. CONCLUSIONS The pattern of response to an OGTT reflects different metabolic phenotypes. Paediatric patients with a biphasic pattern have lower risk-profiling for T2D. The performing of an OGTT could be useful to implement early intervention strategies in children and adolescents with obesity, in order to prevent the development of pre-diabetes or T2D.
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Fasting but not casual blood glucose is associated with pancreatic cancer mortality in Japanese: EPOCH-JAPAN. Cancer Causes Control 2017; 28:625-633. [DOI: 10.1007/s10552-017-0884-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/11/2017] [Indexed: 12/20/2022]
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Long-term consumption of a green/roasted coffee blend positively affects glucose metabolism and insulin resistance in humans. Food Res Int 2016. [DOI: 10.1016/j.foodres.2015.12.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Di Pino A, Urbano F, Piro S, Purrello F, Rabuazzo AM. Update on pre-diabetes: Focus on diagnostic criteria and cardiovascular risk. World J Diabetes 2016; 7:423-432. [PMID: 27795816 PMCID: PMC5065662 DOI: 10.4239/wjd.v7.i18.423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/24/2016] [Accepted: 08/15/2016] [Indexed: 02/05/2023] Open
Abstract
Pre-diabetes, which is typically defined as blood glucose concentrations higher than normal but lower than the diabetes threshold, is a high-risk state for diabetes and cardiovascular disease development. As such, it represents three groups of individuals: Those with impaired fasting glucose (IFG), those with impaired glucose tolerance (IGT) and those with a glycated haemoglobin (HbA1c) between 39-46 mmol/mol. Several clinical trials have shown the important role of IFG, IGT and HbA1c-pre-diabetes as predictive tools for the risk of developing type 2 diabetes. Moreover, with regard to cardiovascular disease, pre-diabetes is associated with more advanced vascular damage compared with normoglycaemia, independently of confounding factors. In view of these observations, diagnosis of pre-diabetes is mandatory to prevent or delay the development of the disease and its complications; however, a number of previous studies reported that the concordance between pre-diabetes diagnoses made by IFG, IGT or HbA1c is scarce and there are conflicting data as to which of these methods best predicts cardiovascular disease. This review highlights recent studies and current controversies in the field. In consideration of the expected increased use of HbA1c as a screening tool to identify individuals with alteration of glycaemic homeostasis, we focused on the evidence regarding the ability of HbA1c as a diagnostic tool for pre-diabetes and as a useful marker in identifying patients who have an increased risk for cardiovascular disease. Finally, we reviewed the current evidence regarding non-traditional glycaemic biomarkers and their use as alternatives to or additions to traditional ones.
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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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Altin C, Sade LE, Gezmis E, Ozen N, Duzceker O, Bozbas H, Eroglu S, Muderrisoglu H. Assessment of Subclinical Atherosclerosis by Carotid Intima-Media Thickness and Epicardial Adipose Tissue Thickness in Prediabetes. Angiology 2016; 67:961-969. [PMID: 27069111 DOI: 10.1177/0003319716643669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Impaired fasting glucose (IFG) and impaired glucose intolerance (IGT) are predictors of cardiovascular disease (CVD). We tested the hypothesis that epicardial fat thickness (EFT) and carotid intima-media thickness (cIMT), as markers of early atherosclerosis, are increased in patients with prediabetes. We prospectively enrolled 246 patients (162 with prediabetes and 84 controls). Prediabetes was defined according to American Diabetes Association criteria, and patients were divided into 3 groups: group 1-IFG, group 2-IGT, and group 3-IFG + IGT. Both cIMT and EFT were significantly greater in patients with prediabetes compared with controls (0.81 ± 0.20 mm vs 0.68 ± 0.16 mm, P < .001 and 7.0 ± 2.0 mm vs 5.6 ± 1.6 mm, P < .001, respectively). This difference was mainly attributed to patients with IGT. Age, waist circumference, and 2-hour glucose independently predicted cIMT, while 2-hour glucose was the only independent predictor of EFT in multivariate analysis among other relevant parameters for cIMT and EFT. The cIMT and EFT (measured noninvasively) could be useful indicators of CVD risk in these patients. In order to prove this hypothesis, long-term prospective studies with greater patient numbers are required.
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Affiliation(s)
- Cihan Altin
- 1 Department of Cardiology, Faculty of Medicine, University of Baskent, Izmir, Turkey
| | - Leyla Elif Sade
- 2 Department of Cardiology, Faculty of Medicine, University of Baskent, Ankara, Turkey
| | - Esin Gezmis
- 3 Department of Radiology, Faculty of Medicine, University of Baskent, Izmir, Turkey
| | - Necmi Ozen
- 1 Department of Cardiology, Faculty of Medicine, University of Baskent, Izmir, Turkey
| | - Ozkan Duzceker
- 4 Department of Internal Medicine, Faculty of Medicine, University of Baskent, Izmir, Turkey
| | - Huseyin Bozbas
- 2 Department of Cardiology, Faculty of Medicine, University of Baskent, Ankara, Turkey
| | - Serpil Eroglu
- 2 Department of Cardiology, Faculty of Medicine, University of Baskent, Ankara, Turkey
| | - Haldun Muderrisoglu
- 2 Department of Cardiology, Faculty of Medicine, University of Baskent, Ankara, Turkey
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Vinoy S, Laville M, Feskens EJM. Slow-release carbohydrates: growing evidence on metabolic responses and public health interest. Summary of the symposium held at the 12th European Nutrition Conference (FENS 2015). Food Nutr Res 2016; 60:31662. [PMID: 27388153 PMCID: PMC4933791 DOI: 10.3402/fnr.v60.31662] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/15/2022] Open
Abstract
To draw attention to the necessity of considering differences in the digestibility of carbohydrates, and more specifically of starch, a symposium was held at the 12th European Nutrition Conference (FENS), which took place in Berlin from October 20 to 23, 2015. The purpose of this session was to present the consolidated knowledge and recent advances regarding the relationship between slow-release carbohydrates, metabolic responses, and public health issues. Three main topics were presented: 1) the definition of, sources of, and recognised interest in the glycaemic response to slowly digestible starch (SDS); 2) clinical evidence regarding the physiological effects of slow-release carbohydrates from cereal foods; and 3) interest in reducing the postprandial glycaemic response to help prevent metabolic diseases. Foods with the highest SDS content induce the lowest glycaemic responses, as the starch is protected from gelatinisation during processing. In humans, high-SDS food consumption induces slower glucose release, lower postprandial insulinaemia, and stimulation of gut hormones. Moreover, postprandial hyperglycaemia is an independent risk factor for type two diabetes mellitus (T2DM) and cardiovascular disease (CVD). Therefore, given the plausible aetiologic mechanisms, we argue that postprandial glucose levels are relevant for health and disease and represent a meaningful target for intervention, for example, through dietary factors. This symposium was organised by Mondelez International R&D.
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Affiliation(s)
- Sophie Vinoy
- Nutrition Department, Mondelez Int R&D, Saclay, France;
| | - Martine Laville
- Department of Nutrition, CRNH-RA, Lyon 1 University, Hospices civils de Lyon, Chemin du grand revoyet Pierre bénite, France
| | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Li L, Shelton RC, Chassan RA, Hammond JC, Gower BA, Garvey TW. Impact of Major Depressive Disorder on Prediabetes by Impairing Insulin Sensitivity. ACTA ACUST UNITED AC 2016; 7. [PMID: 27274905 PMCID: PMC4892179 DOI: 10.4172/2155-6156.1000664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reports regarding the associations between major depressive disorder (MDD) and diabetes remain heterogeneous. Our aim was to investigate whether glucose homeostasis and insulin sensitivity were impaired in the MDD patients and its mechanisms. A total of 30 patients with MDD and 30 matched controls were recruited. The oral glucose tolerance test and dual-energy X-ray absorptiometry scan were performed in each participant. Insulin signaling in postmortem brain tissues from other depressive patients and controls (obtained from Alabama brain bank) was examined. Insulin sensitivity was reduced substantially in the MDD patients, however, the fasting and 2-h glucose concentrations remained within the normal range through compensatory insulin secretion. Despite increased insulin secretion, 1-h glucose concentrations in the MDD patients were significantly elevated compared with the controls. MDD patients had greater visceral fat mass but lower adiponectin levels compared with the controls. Furthermore, phosphorylated-AKT levels in insulin signaling were decreased in postmortem brain tissues in patients with MDD. These results suggest that MDD patients are at a greater risk for diabetes due to decreased insulin sensitivity, reduced disposition index, and impaired glucose tolerance as manifested by elevated 1-h glucose concentrations following an oral glucose challenge. Mechanistic studies reveal that decreased insulin sensitivity is associated with increased visceral fat mass, lower adiponectin levels and impaired insulin action in postmortem brain tissues in the MDD patients. Our findings emphasize the importance of screening depressive patients to identify susceptible individuals for developing future diabetes with the hope of improving their health outcomes.
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Affiliation(s)
- Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd, Birmingham AL, 35294, USA
| | - Richard Charles Shelton
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd, Birmingham AL, 35294, USA
| | - Rachel Ann Chassan
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd, Birmingham AL, 35294, USA
| | - John Charles Hammond
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd, Birmingham AL, 35294, USA
| | - Barbara Ann Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham AL, 35294, USA
| | - Timothy W Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham AL, 35294, USA; Department of Nutrition Sciences, University of Alabama at Birmingham, and the Birmingham VA Medical Center, Birmingham AL, 35294, USA
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Williams IM, Otero YF, Bracy DP, Wasserman DH, Biaggioni I, Arnold AC. Chronic Angiotensin-(1-7) Improves Insulin Sensitivity in High-Fat Fed Mice Independent of Blood Pressure. Hypertension 2016; 67:983-91. [PMID: 26975707 DOI: 10.1161/hypertensionaha.115.06935] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/12/2016] [Indexed: 12/25/2022]
Abstract
Angiotensin-(1-7) improves glycemic control in animal models of cardiometabolic syndrome. The tissue-specific sites of action and blood pressure dependence of these metabolic effects, however, remain unclear. We hypothesized that Ang-(1-7) improves insulin sensitivity by enhancing peripheral glucose delivery. Adult male C57BL/6J mice were placed on standard chow or 60% high-fat diet for 11 weeks. Ang-(1-7) (400 ng/kg per minute) or saline was infused subcutaneously during the last 3 weeks of diet, and hyperinsulinemic-euglycemic clamps were performed at the end of treatment. High-fat fed mice exhibited modest hypertension (systolic blood pressure: 137 ± 3 high fat versus 123 ± 5 mm Hg chow;P=0.001), which was not altered by Ang-(1-7) (141 ± 4 mm Hg;P=0.574). Ang-(1-7) did not alter body weight or fasting glucose and insulin in chow or high-fat fed mice. Ang-(1-7) increased the steady-state glucose infusion rate needed to maintain euglycemia in high-fat fed mice (31 ± 5 Ang-(1-7) versus 16 ± 1 mg/kg per minute vehicle;P=0.017) reflecting increased whole-body insulin sensitivity, with no effect in chow-fed mice. The improved insulin sensitivity in high-fat fed mice was because of an enhanced rate of glucose disappearance (34 ± 5 Ang-(1-7) versus 20 ± 2 mg/kg per minute vehicle;P=0.049). Ang-(1-7) enhanced glucose uptake specifically into skeletal muscle by increasing translocation of glucose transporter 4 to the sarcolemma. Our data suggest that Ang-(1-7) has direct insulin-sensitizing effects on skeletal muscle, independent of changes in blood pressure. These findings provide new insight into mechanisms by which Ang-(1-7) improves insulin action, and provide further support for targeting this peptide in cardiometabolic disease.
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Affiliation(s)
- Ian M Williams
- From the Department of Molecular Physiology and Biophysics (I.M.W., Y.F.O., D.P.B., D.H.W.) and Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (I.B., A.C.A.)
| | - Yolanda F Otero
- From the Department of Molecular Physiology and Biophysics (I.M.W., Y.F.O., D.P.B., D.H.W.) and Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (I.B., A.C.A.)
| | - Deanna P Bracy
- From the Department of Molecular Physiology and Biophysics (I.M.W., Y.F.O., D.P.B., D.H.W.) and Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (I.B., A.C.A.)
| | - David H Wasserman
- From the Department of Molecular Physiology and Biophysics (I.M.W., Y.F.O., D.P.B., D.H.W.) and Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (I.B., A.C.A.)
| | - Italo Biaggioni
- From the Department of Molecular Physiology and Biophysics (I.M.W., Y.F.O., D.P.B., D.H.W.) and Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (I.B., A.C.A.)
| | - Amy C Arnold
- From the Department of Molecular Physiology and Biophysics (I.M.W., Y.F.O., D.P.B., D.H.W.) and Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (I.B., A.C.A.).
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Raskin P, Cincotta AH. Bromocriptine-QR therapy for the management of type 2 diabetes mellitus: developmental basis and therapeutic profile summary. Expert Rev Endocrinol Metab 2016; 11:113-148. [PMID: 30058874 DOI: 10.1586/17446651.2016.1131119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An extended series of studies indicate that endogenous phase shifts in circadian neuronal input signaling to the biological clock system centered within the hypothalamic suprachiasmatic nucleus (SCN) facilitates shifts in metabolic status. In particular, a diminution of the circadian peak in dopaminergic input to the peri-SCN facilitates the onset of fattening, insulin resistance and glucose intolerance while reversal of low circadian peak dopaminergic activity to the peri-SCN via direct timed dopamine administration to this area normalizes the obese, insulin resistant, glucose intolerant state in high fat fed animals. Systemic circadian-timed daily administration of a potent dopamine D2 receptor agonist, bromocriptine, to increase diminished circadian peak dopaminergic hypothalamic activity across a wide variety of animal models of metabolic syndrome and type 2 diabetes mellitus (T2DM) results in improvements in the obese, insulin resistant, glucose intolerant condition by improving hypothalamic fuel sensing and reducing insulin resistance, elevated sympathetic tone, and leptin resistance. A circadian-timed (within 2 hours of waking in the morning) once daily administration of a quick release formulation of bromocriptine (bromocriptine-QR) has been approved for the treatment of T2DM by the U.S. Food and Drug Administration. Clinical studies with such bromocriptine-QR therapy (1.6 to 4.8 mg/day) indicate that it improves glycemic control by reducing postprandial glucose levels without raising plasma insulin. Across studies of various T2DM populations, bromocriptine-QR has been demonstrated to reduce HbA1c by -0.5 to -1.7. The drug has a good safety profile with transient mild to moderate nausea, headache and dizziness as the most frequent adverse events noted with the medication. In a large randomized clinical study of T2DM subjects, bromocriptine-QR exposure was associated with a 42% hazard ratio reduction of a pre-specified adverse cardiovascular endpoint including myocardial infarction, stroke, hospitalization for congestive heart failure, revascularization surgery, or unstable angina. Bromocriptine-QR represents a novel method of treating T2DM that may have benefits for cardiovascular disease as well.
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Affiliation(s)
- Philip Raskin
- a Southwestern Medical Center , University of Texas , Dallas , TX , USA
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Holwerda SW, Reynolds LJ, Restaino RM, Credeur DP, Leidy HJ, Thyfault JP, Fadel PJ. The influence of reduced insulin sensitivity via short-term reductions in physical activity on cardiac baroreflex sensitivity during acute hyperglycemia. J Appl Physiol (1985) 2015; 119:1383-92. [PMID: 26472870 DOI: 10.1152/japplphysiol.00584.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/08/2015] [Indexed: 11/22/2022] Open
Abstract
Reduced insulin sensitivity and impaired glycemic control are among the consequences of physical inactivity and have been associated with reduced cardiac baroreflex sensitivity (BRS). However, the effect of reduced insulin sensitivity and acute hyperglycemia following glucose consumption on cardiac BRS in young, healthy subjects has not been well characterized. We hypothesized that a reduction in insulin sensitivity via reductions in physical activity would reduce cardiac BRS at rest and following an oral glucose tolerance test (OGTT). Nine recreationally active men (23 ± 1 yr; >10,000 steps/day) underwent 5 days of reduced daily physical activity (RA5) by refraining from planned exercise and reducing daily steps (<5,000 steps/day). Spontaneous cardiac BRS (sequence technique) was compared at rest and for 120 min following an OGTT at baseline and after RA5. A substudy (n = 8) was also performed to independently investigate the influence of elevated insulin alone on cardiac BRS using a 120-min hyperinsulinemic-euglycemic clamp. Insulin sensitivity (Matsuda index) was significantly reduced following RA5 (BL 9.2 ± 1.3 vs. RA5 6.4 ± 1.1, P < 0.001). Resting cardiac BRS was unaffected by RA5 and significantly reduced during the OGTT similarly at baseline and RA5 (baseline 0 min, 28 ± 4 vs. 120 min, 18 ± 4; RA5 0 min, 28 ± 4 vs. 120 min, 21 ± 3 ms/mmHg). Spontaneous cardiac BRS was also reduced during the hyperinsulinemic-euglycemic clamp (P < 0.05). Collectively, these data demonstrate that acute elevations in plasma glucose and insulin can impair spontaneous cardiac BRS in young, healthy subjects, and that reductions in cardiac BRS following acute hyperglycemia are unaffected by reduced insulin sensitivity via short-term reductions in physical activity.
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Affiliation(s)
- S W Holwerda
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - L J Reynolds
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - R M Restaino
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - D P Credeur
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, Mississippi; and
| | - H J Leidy
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - J P Thyfault
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - P J Fadel
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri;
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Kanat M, DeFronzo RA, Abdul-Ghani MA. Treatment of prediabetes. World J Diabetes 2015; 6:1207-1222. [PMID: 26464759 PMCID: PMC4598604 DOI: 10.4239/wjd.v6.i12.1207] [Citation(s) in RCA: 43] [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: 12/23/2014] [Revised: 03/12/2015] [Accepted: 09/08/2015] [Indexed: 02/05/2023] Open
Abstract
Progression of normal glucose tolerance (NGT) to overt diabetes is mediated by a transition state called impaired glucose tolerance (IGT). Beta cell dysfunction and insulin resistance are the main defects in type 2 diabetes mellitus (type 2 DM) and even normoglycemic IGT patients manifest these defects. Beta cell dysfunction and insulin resistance also contribute to the progression of IGT to type 2 DM. Improving insulin sensitivity and/or preserving functions of beta-cells can be a rational way to normalize the GT and to control transition of IGT to type 2 DM. Loosing weight, for example, improves whole body insulin sensitivity and preserves beta-cell function and its inhibitory effect on progression of IGT to type 2 DM had been proven. But interventions aiming weight loss usually not applicable in real life. Pharmacotherapy is another option to gain better insulin sensitivity and to maintain beta-cell function. In this review, two potential treatment options (lifestyle modification and pharmacologic agents) that limits the IGT-type 2 DM conversion in prediabetic subjects are discussed.
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Kramer CK, Ye C, Hanley AJG, Connelly PW, Sermer M, Zinman B, Retnakaran R. Delayed timing of post-challenge peak blood glucose predicts declining beta cell function and worsening glucose tolerance over time: insight from the first year postpartum. Diabetologia 2015; 58:1354-62. [PMID: 25762205 DOI: 10.1007/s00125-015-3551-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/12/2015] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS On cross-sectional assessment, a delayed timing of the peak blood glucose level at ≥60 min post-challenge on an OGTT is associated with beta cell dysfunction. In this context, we hypothesised that longitudinal changes in the timing of this peak might predict changes in glucose metabolism. We thus sought to evaluate the longitudinal associations of changes in the timing of the peak glucose level with changes over time in insulin sensitivity, beta cell function and glucose tolerance. METHODS A total of 532 women underwent an OGTT at both 3 months and 12 months postpartum. The participants were stratified into four groups according to the change in timing of their glucose peak between the two visits: women with no change in timing of the glucose peak at 30 min (n = 217), those whose glucose peak shifted to an earlier time point (n = 120), those whose peak shifted to a later time point (n = 87) and women with an unchanged glucose peak at ≥60 min (n = 108). Beta cell function was measured using the Insulin Secretion-Sensitivity Index-2 (ISSI-2). RESULTS Compared with an unchanged glucose peak at 30 min, both the shift of the glucose peak to a later time point and a peak that was unchanged at ≥60 min were independently associated with declining ISSI-2 scores (β = -127.5, p < 0.001 and β = -98.8, p = 0.006, respectively) and increased 2 h post-challenge glucose levels (β = 1.28, p < 0.001 and β = 0.91, p < 0.001, respectively) between the two visits. Furthermore, both these patterns of change in peak were independently associated with worsening glucose tolerance (from normal to prediabetes [defined as impaired fasting glucose or impaired glucose tolerance]/diabetes or from prediabetes to diabetes) (OR 8.1, 95% CI 3.0, 22.1 and OR 3.7, 95% CI 1.2, 11.7, respectively). CONCLUSIONS/INTERPRETATION A delayed timing of the post-challenge peak glucose level is associated with declining beta cell function and worsening glucose tolerance over time.
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Affiliation(s)
- Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, Ontario, Canada, M5T 3L9
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Kolka CM, Castro AVB, Kirkman EL, Bergman RN. Modest hyperglycemia prevents interstitial dispersion of insulin in skeletal muscle. Metabolism 2015; 64:330-7. [PMID: 25468139 PMCID: PMC4277905 DOI: 10.1016/j.metabol.2014.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/22/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Insulin injected directly into skeletal muscle diffuses rapidly through the interstitial space to cause glucose uptake, but this is blocked in insulin resistance. As glucotoxicity is associated with endothelial dysfunction, the observed hyperglycemia in diet-induced obese dogs may inhibit insulin access to muscle cells, and exacerbate insulin resistance. Here we asked whether interstitial insulin diffusion is reduced in modest hyperglycemia, similar to that induced by a high fat diet. METHODS During normoglycemic (100 mg/dl) and moderately hyperglycemic (120 mg/dl) clamps in anesthetized canines, sequential doses of insulin were injected into the vastus medialis of one hindlimb; the contra-lateral limb served as a control. Plasma samples were collected and analyzed for insulin content. Lymph vessels of the hind leg were also catheterized, and lymph samples were analyzed as an indicator of interstitial insulin concentration. RESULTS Insulin injection increased lymph insulin in normoglycemic animals, but not in hyperglycemic animals. Muscle glucose uptake was elevated in response to hyperglycemia, however the insulin-mediated glucose uptake in normoglycemic controls was not observed in hyperglycemia. Modest hyperglycemia prevented intra-muscularly injected insulin from diffusing through the interstitial space reduced insulin-mediated glucose uptake. CONCLUSION Hyperglycemia prevents the appearance of injected insulin in the interstitial space, thus reducing insulin action on skeletal muscle cells.
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MESH Headings
- Absorption, Physiological
- Animals
- Biological Transport/drug effects
- Diffusion
- Dogs
- Dose-Response Relationship, Drug
- Extracellular Space/chemistry
- Glucose/metabolism
- Glucose Clamp Technique
- Hindlimb
- Hyperglycemia/blood
- Hyperglycemia/drug therapy
- Hyperglycemia/metabolism
- Hyperglycemia/physiopathology
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/metabolism
- Hypoglycemic Agents/pharmacokinetics
- Hypoglycemic Agents/therapeutic use
- Injections, Intramuscular
- Insulin Resistance
- Insulin, Regular, Pork/administration & dosage
- Insulin, Regular, Pork/analysis
- Insulin, Regular, Pork/pharmacokinetics
- Insulin, Regular, Pork/therapeutic use
- Lymph/chemistry
- Lymph/drug effects
- Male
- Quadriceps Muscle/chemistry
- Quadriceps Muscle/drug effects
- Quadriceps Muscle/metabolism
- Severity of Illness Index
- Tissue Distribution
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Affiliation(s)
- Cathryn M Kolka
- Department of Physiology and Biophysics, University of Southern California, Los Angeles, CA.
| | - Ana Valeria B Castro
- Department of Physiology and Biophysics, University of Southern California, Los Angeles, CA
| | - Erlinda L Kirkman
- Department of Physiology and Biophysics, University of Southern California, Los Angeles, CA
| | - Richard N Bergman
- Department of Physiology and Biophysics, University of Southern California, Los Angeles, CA
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Carnevale Schianca GP, Fra GP, Bigliocca M, Mella R, Rossi L, Bartoli E. Oral glucose tolerance test-based calculation identifies different glucose intolerance phenotypes within the impaired fasting glucose range. J Diabetes Investig 2014; 5:533-8. [PMID: 25411621 PMCID: PMC4188111 DOI: 10.1111/jdi.12185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/01/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction The conventional oral glucose tolerance test (OGTT) cannot detect future diabetics among isolated impaired fasting glucose (is‐IFG) nor normal glucose tolerant (NGT) groups. By analyzing the relationship between fasting (FPG) and 2‐h plasma glucose (2hPG), the present study identifies is‐IFG subjects liable to worsening glucose homeostasis. Materials and Methods Oral glucose tolerance test was carried out in 619 patients suffering from obesity, hypertension or dyslipidemia, whose FPG was in the 100–125 mg/dL range. We calculated the percentage increment of 2hPG with respect to FPG (PG%) in these patients using the formula: ([2hPG − FPG] / FPG) × 100. Differences in β‐cell function within is‐IFG patients were assessed by estimated insulin sensitivity index (EISI), first‐phase insulin release (1stPH) and 1stPH/1/EISI (1stPHcorrected). Results Diabetes was diagnosed in 69 patients (11.2%), combined IFG/impaired glucose tolerance (IGT) in 185 patients (29.9%) and is‐IFG in 365 patients (58.9%). Is‐IFG was subdivided into PG% tertile groups: the percentage of females increased from 25% in the lowest to 45.2% in the highest tertile (χ2 = 18.7, P < 0.001). Moving from the lowest to the highest PG% tertile group, insulin and 2hPG concentrations rose, whereas FPG, EISI, and 1stPHcorrected decreased progressively and significantly. Furthemore, PG% correlated inversely with EISI (r = −0.44, P < 0.0001) and 1stPHcorrected (r = −0.38, P < 0.0001). Conclusions Oral glucose tolerance test does differentiate the great heterogeneity in metabolic disorders of patients with FPG 100–125 mg/dL. Furthermore, PG% can expand the diagnostic power of OGTT in the is‐IFG range by distinguishing metabolic phenotypes very likely to herald different clinical risks.
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Affiliation(s)
| | - Gian Paolo Fra
- Internal Medicine University Hospital "Maggiore della carità" Novara Italy
| | - Marcello Bigliocca
- Internal Medicine University Hospital "Maggiore della carità" Novara Italy ; Department of Clinical and Experimental Medicine Eastern Piedmont University "A. Avogadro" Novara Italy
| | - Roberto Mella
- Internal Medicine University Hospital "Maggiore della carità" Novara Italy ; Department of Clinical and Experimental Medicine Eastern Piedmont University "A. Avogadro" Novara Italy
| | - Luca Rossi
- Internal Medicine University Hospital "Maggiore della carità" Novara Italy ; Department of Clinical and Experimental Medicine Eastern Piedmont University "A. Avogadro" Novara Italy
| | - Ettore Bartoli
- Internal Medicine University Hospital "Maggiore della carità" Novara Italy ; Department of Clinical and Experimental Medicine Eastern Piedmont University "A. Avogadro" Novara Italy
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Fu SN, Luk W, Wong CKH, Cheung KL. Progression from impaired fasting glucose to type 2 diabetes mellitus among Chinese subjects with and without hypertension in a primary care setting. J Diabetes 2014; 6:438-46. [PMID: 24393475 DOI: 10.1111/1753-0407.12120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 12/17/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The progression from impaired fasting glucose (IFG) to type 2 diabetes mellitus (T2DM) in Chinese subjects, with and without hypertension, in a primary care setting was unknown. METHODS The present retrospective multicenter 5-year (2002-2007) cohort study was performed on IFG subjects attending 23 general outpatient clinics who were identified by their elevated fasting blood glucose laboratory results. Development of T2DM was determined by physician diagnosis of T2DM or starting of oral antidiabetic drugs within 5 years. The relationship between the time of T2DM diagnosis and subject characteristics was assessed by adjusted hazard ratios (aHR) from Cox hazards model. RESULTS Of the 9161 IFG subjects, 4080 (45%) were men and 5081 (55%) were women. There were 1998 subjects who developed T2DM. The 5-year cumulative incidence was 0.218, whereas the overall annual incidence rate was 5.981/100 person-years. Subjects were more likely to develop T2DM if they were hypertensive (aHR = 1.44; 95% confidence interval [CI] 1.28-1.62; P < 0.001), aged <60 years (aHR = 1.36, 95% CI 1.24-1.49; P < 0.001), female (aHR = 1.18, 95% CI 1.08-1.29; P < 0.001), and had higher fasting glucose levels (6.39 ± 0.49 vs 6.24 ± 0.43 mmol/L in the group that developed T2DM vs the group without T2DM, respectively; aHR = 2.01, 95% CI 1.83-2.20; P < 0.001). CONCLUSION Overall, more than one-fifth of IFG subjects in the primary care setting developed T2DM within 5 years. Health care professionals can target interventions to patients with risk factors for disease progression.
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Affiliation(s)
- Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, Kowloon
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Kramer CK, Vuksan V, Choi H, Zinman B, Retnakaran R. Emerging parameters of the insulin and glucose response on the oral glucose tolerance test: reproducibility and implications for glucose homeostasis in individuals with and without diabetes. Diabetes Res Clin Pract 2014; 105:88-95. [PMID: 24842248 DOI: 10.1016/j.diabres.2014.04.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/19/2014] [Accepted: 04/19/2014] [Indexed: 12/25/2022]
Abstract
AIMS Recent studies have suggested that novel parameters of the insulin and glucose response on the oral glucose tolerance test (OGTT) can provide metabolic insight beyond glucose tolerance, but have not evaluated their reproducibility. Thus, our aim was to evaluate the reproducibility of these parameters and, if confirmed, characterize their clinical/pathophysiologic relevance in healthy and diabetic individuals. METHODS Thirty healthy adults each underwent 3 replicate OGTTs, enabling assessment of the reproducibility of the following 5 parameters: time to insulin peak, shape of the glucose curve, glucose nadir below baseline, 1-h post-challenge glucose, and time to glucose peak. The only reproducible parameter was then further evaluated in 63 patients with early type 2 diabetes (T2DM) before and after 4-weeks of intensive insulin therapy (IIT) designed to improve beta-cell function (measured by Insulin Secretion-Sensitivity-Index-2 (ISSI-2)). RESULTS Of the five parameters, only time to glucose peak displayed reliable reproducibility on replicate testing (κ=0.76). Over 80% of controls had their glucose peak at 30-min post-load, whereas all but one of the diabetic patients had their peak at 60-min or later. ISSI-2 was lower in T2DM patients with peak at ≥90-min than in those with peak at ≤60-min (P=0.012). In patients in whom IIT improved beta-cell function by ≥20% from baseline, 39.1% had glucose peak on the post-therapy OGTT shift to an earlier timepoint, as compared to 15.4% with similar shift in those without such improvement(P=0.03). CONCLUSION Time to glucose peak is a reproducible characteristic on the OGTT and associated with beta-cell function in early T2DM.
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Affiliation(s)
- Caroline Kaercher Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada; Division of Endocrinology, University of Toronto, Toronto, Canada
| | - Vladimir Vuksan
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Division of Endocrinology, Li Ka Shing Knowledge Institute and Keenan Research Centre, St. Michael's Hospital, Toronto, Canada
| | - Haysook Choi
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada; Division of Endocrinology, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada; Division of Endocrinology, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
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49
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Su JB, Chen T, Xu F, Wang XQ, Chen JF, Wu G, Jin Y, Wang XH. Glycemic variability in normal glucose regulation subjects with elevated 1-h postload plasma glucose levels. Endocrine 2014; 46:241-8. [PMID: 24030695 DOI: 10.1007/s12020-013-0047-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 08/24/2013] [Indexed: 12/15/2022]
Abstract
Subjects with normal glucose regulation (NGR), whose 1-h postload plasma glucose is ≥8.6 mmol/L (155 mg/dL, NGR 1 h ≥ 8.6) during 75-g oral glucose tolerance test (OGTT), have an increased risk of type 2 diabetes and subclinical organ damage. And, the deficiency in islet β cell function is responsible for glycemic disorders. The purpose of this study is to investigate glycemic variability in NGR subjects with elevated 1-h postload plasma glucose levels and its association with islet β cell function. The 29 NGR subjects with 1-h postload plasma glucose ≥8.6 mmol/L (NGR 1 h ≥ 8.6) and 29 age- and sex-matched NGR subjects with 1-h postload plasma glucose <8.6 mmol/L (NGR 1 h < 8.6) were recruited in the study. Insulin sensitivity (Matsuda index, ISI), insulin secretion (insulinogenic index ΔI30/ΔG30), and integrated β cell function measured by the oral disposition index (ΔI30/ΔG30 multiplied by the ISI) were derived from OGTT. All subjects were monitored using the continuous glucose monitoring system for consecutive 72 h. The multiple parameters of glycemic variability included the standard deviation of blood glucose (SDBG), mean blood glucose (MBG), mean of daily differences (MODD), and mean amplitude of glycemic excursions (MAGE). MAGE is considered as a gold standard of glycemic variability. Glycemic variability parameters SDBG, MBG, MODD, and MAGE in NGR 1 h ≥ 8.6 group were higher than those in NGR 1 h < 8.6 group (p < 0.05), and oral disposition index in NGR 1 h ≥ 8.6 group was lower than that in NGR 1 h < 8.6 group (p < 0.05). SDBG, MBG, MODD, MAGE, and 1-h postload plasma glucose all negatively associated with oral disposition index in the separate group (p < 0.05) and in the whole subjects (p < 0.05). After multivariate regression analysis, oral disposition index was the strongest independent contributor to MAGE and 1-h postload plasma glucose in the separate group (p < 0.05) and in the whole subjects (p < 0.05). It is concluded that NGR 1 h ≥ 8.6 group had higher glycemic variability and lower oral disposition index, compared with NGR 1 h < 8.6 group. Increased glycemic variability parameters and elevated 1-h postload plasma glucose consistently associated with declined oral disposition index in subjects from NGR 1 h < 8.6 to NGR 1 h ≥ 8.6 group.
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Affiliation(s)
- Jian-Bin Su
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, Nantong, 226001, China,
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50
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Hellgren MI, Daka B, Jansson PA, Lindblad U, Larsson CA. Insulin resistance predicts early cardiovascular morbidity in men without diabetes mellitus, with effect modification by physical activity. Eur J Prev Cardiol 2014; 22:940-9. [DOI: 10.1177/2047487314537917] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/11/2014] [Indexed: 01/24/2023]
Affiliation(s)
- Margareta I Hellgren
- Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Bledar Daka
- Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Per-Anders Jansson
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, the Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Ulf Lindblad
- Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Charlotte A Larsson
- Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden
- Social Medicine and Global Health, Department of Clinical Science, Malmö, Lund University, Sweden
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