Counterpoint: impaired fasting glucose: The case against the new American Diabetes Association guidelines

Antidiabetic and Anti-hyperlipidemic Effects of the Crude Hydromethanol Extract of Hagenia abyssinica (Rosaceae) Leaves in Streptozotocin-Induced Diabetic Mice

BACKGROUND

The leaves of Hagenia abyssinica (Rosaceae) have been used traditionally for the management of diabetes mellitus. Thus, this study aimed to evaluate the antidiabetic and anti-hyperlipidemic activity of Hagenia abyssinica leaves crude extract in streptozotocin-induced diabetic mice.

METHODS

Antidiabetic and anti-hyperlipidemic activity of the crude extract of Hagenia abyssinica was studied in streptozotocin-induced diabetic mice. The effects of the extract on fasting blood glucose level, body weight, and serum lipid profiles were analyzed. One-way ANOVA followed by Tukey's post hoc test was used for data analysis and p<0.05 was considered as statistically significant.

RESULTS

Hagenia abyssinica leaves crude extract showed significant (p<0.05-p<0.001) blood-glucose-lowering activity. Moreover, the crude extract of H. abyssinica reduced the fasting blood glucose level by 23.21%, 38.20%, 43.53%, and 58.99%, respectively, for CE100, CE 200, CE 400, and GLC 5 mg/kg on the 14th day of treatment. After diabetic mice were treated with H. abyssinica (100, 200 and 400 mg/kg) for 14 days, there was a significant decrease in serum total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and serum triglyceride and a significant increase in body weight, and HDL-cholesterol level as compared to diabetic control.

CONCLUSION

The present findings revealed that H. abyssinica leaves could be useful for the management of diabetes mellitus and other abnormalities related to this metabolic disorder. Thus, the present study may support the traditional use of H. abyssinica for diabetes mellitus treatment.

The relationship between occupational stress, health status, and temporary and permanent work disability among security guards in Serbia

Purpose. This study aimed to examine the influence of occupational stress on health status and work disability among security guards in Serbia. Methods. Three hundred and ninty nine male security guards (aged 25-65 years) were examined during regular medical preventive check-ups at the Institute of Occupational Health. Data on their health status and permanent and temporary work disability were obtained, and correlations with the levels of occupational stress (measured by occupational stress index [OSI] questionnaire) were analysed. Results. A high prevalence of health impairments, including diabetes (38.8%), dyslipidaemia (82.7%), hypertension (69.9%) and metabolic syndrome (77.7%), was found. Highly significant correlations were shown between reported levels of total stress at work (total OSI score) and measured values of glucose, lipids, blood pressure, heart rate, Framingham cardiovascular risk scale, occurrence of diabetes and impaired fasting glucose, dyslipidaemia, hypertension, metabolic syndrome, coronary heart disease, cerebrovascular insults, degenerative eye-fundus changes, and temporary and permanent work disability. All of these correlations remained significant even after adjustments for age, body mass index and smoking status. Regression analysis confirmed the independent effect of occupational stress on the analysed parameters. Conclusions. There is a significant independent impact of occupational stress on development of health impairments and work disability among security guards.

Gestational diabetes mellitus: Screening with fasting plasma glucose

Fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) has had a checkered history. During the last three decades, a few initial anecdotal reports have given way to the recent well-conducted studies. This review: (1) traces the history; (2) weighs the advantages and disadvantages; (3) addresses the significance in early pregnancy; (4) underscores the benefits after delivery; and (5) emphasizes the cost savings of using the FPG in the screening of GDM. It also highlights the utility of fasting capillary glucose and stresses the value of the FPG in circumventing the cumbersome oral glucose tolerance test. An understanding of all the caveats is crucial to be able to use the FPG for investigating glucose intolerance in pregnancy. Thus, all health professionals can use the patient-friendly FPG to simplify the onerous algorithms available for the screening and diagnosis of GDM - thereby helping each and every pregnant woman.

HbA1c, fasting plasma glucose and the prediction of diabetes: Inter99, AusDiab and D.E.S.I.R

INTRODUCTION

With diabetes defined by HbA1c≥6.5% and/or FPG≥7.0mmol/l and/or diabetes treatment, we investigated HbA1c and fasting plasma glucose (FPG) thresholds/change-points above which the incidence of diabetes increases.

METHODS

Data are Danish (Inter99), Australian (AusDiab) and French (D.E.S.I.R.), with respectively 4930, 6012 and 3784 non-diabetic participants.

RESULTS

Diabetes incidences at 5 years for Inter99 and AusDiab and at 6 years for D.E.S.I.R. were 2.3%, 3.1% and 2.4% respectively and incidences increased with baseline HbA1c and FPG. As HbA1c distributions differed between cohorts, HbA1c was standardized on D.E.S.I.R. data. Change-points where diabetes incidence increased were identified for HbA1c (%) after standardization: 5.1 (4.9-5.6) (Inter99), 5.4 (5.1-5.6) (AusDiab), 5.3 (5.1-5.7) (D.E.S.I.R.); for FPG change-points (mmol/l) were 5.1 (…-6.1) (Inter99), 5.5 (5.2-5.8) (AusDiab), no change-point for D.E.S.I.R. Using current diabetes risk criteria HbA1c≥5.7% and/or FPG≥5.6mmol/l to screen for diabetes provided high sensitivity (over 89%) and positive predictive values: 4.3%, 6.9%, and 5.9% respectively.

CONCLUSIONS

HbA1c and FPG change-points predicting incident diabetes did not always exist, differed across studies, when available were generally lower than current criteria with wide confidence intervals. Using jointly HbA1c≥5.7% and/or FPG≥5.6mmol/l as a criterion for the risk of incident diabetes is appropriate.

Cardiovascular disease and type 2 diabetes mellitus: a multifaceted symbiosis

Chronic hyperglycaemia (e.g. type 2 diabetes mellitus (T2DM) and prediabetes) in humans is associated with an increased risk of cardiovascular (CV) complications, and, vice versa, the presence of CV complications (e.g. myocardial infarction, stroke or intermittent claudication) among patients heightens the risk of T2DM or prediabetes. In both cases (i.e. chronic hyperglycaemia and CV complications), significant diagnostic and treatment challenges resulting from a broad range of factors may serve as barriers to reducing the deleterious societal impact of T2DM and prediabetes. These challenges often include clinicians: failing to intervene early and aggressively enough among patients with T2DM to achieve CV risk factor control; failing to efficaciously identify T2DM patients with already established CV complications; and failing proactively to assess individuals at high risk for T2DM. This review discusses the apparent symbiosis between CV disease and T2DM, with a focus on identifying patients with established T2DM or at risk for T2DM; traditional and novel risk factors and markers for CV disease in T2DM; challenges related to diagnosing CV disease in T2DM; and organization of T2DM care in order to prevent CV complications. These are issues that require attention because identifying patients at high risk for T2DM can halt or reduce their further glycaemic deterioration if addressed properly, and because novel markers and non-invasive tests could be applied in patients with T2DM as a means of detecting and possibly treating unrecognized CV disease in time. Furthermore, several approaches for T2DM care can be effective in controlling the CV risk factors contributing to CV complications.

Prediabetes in rural and urban children in 3 states in Mexico

The authors studied the frequency, distribution, and factors associated with prediabetes (fasting glucose, 100-125 mg/dL) in rural and urban children from San Luis Potosí, León, and Querétaro in central Mexico. Family history, somatometry, and levels of fasting insulin, glucose, and lipids were collected in 1238 children 6 to 13 years of age. The authors found no cases of type 2 diabetes and a 5.7% frequency of prediabetes. The group with prediabetes had higher homeostasis model assessment of insulin resistance scores and total cholesterol and high-density lipoprotein cholesterol levels. Prediabetes was more frequent in León, with similar distribution in rural and urban children. The frequency of insulin resistance was 24.1%, with higher figures in urban groups and in San Luis Potosí. In multivariate analysis, prediabetes was associated with insulin resistance and residence in León. The authors concluded that in central Mexico the frequency of prediabetes is significant, and it is associated with insulin resistance and a geographic location, but not with obesity or urban vs rural dwelling.

High risk of cardiovascular mortality in individuals with impaired fasting glucose is explained by conversion to diabetes: the Hoorn study

OBJECTIVE

To optimize identification of future diabetic patients, the American Diabetes Association (ADA) introduced criteria for impaired fasting glucose (IFG) in 1997 (IFG 6.1 mmol/l [IFG6.1]) and lowered the threshold from 6.1 to 5.6 mmol/l (IFG5.6) in 2003. Our aim was to assess the consequences of lowering the IFG cutoff on the risk of cardiovascular disease (CVD) mortality and to evaluate whether this risk is explained by a conversion to type 2 diabetes within 6.4 years.

RESEARCH DESIGN AND METHODS

In a population-based cohort, the Hoorn Study, plasma glucose was determined in 1989 and 1996 (n = 1,428). Subjects were classified in 1989 according to 1997 and 2003 ADA criteria. Subjects with IFG in 1989 were further classified according to diabetes status in 1996. Hazard ratios for CVD mortality (n = 81) in the period 1996-2005 were adjusted for age and sex.

RESULTS

Subjects with IFG6.1, but not IFG5.6, had a significantly higher CVD mortality risk than normal fasting glucose (NFG) subjects. Subjects who converted from IFG to diabetes (IFG6.1: 42%; IFG5.6: 21%) had a more than twofold risk of CVD mortality (IFG6.1: 2.47 [1.17-5.19]; IFG5.6: 2.14 [1.12-4.10]) than subjects with NFG. IFG subjects who did not develop diabetes did not have significantly higher CVD mortality risks (IFG6.1: 1.50 [0.72-3.15]; IFG5.6: 1.15 [0.69-1.93]).

CONCLUSIONS

The lower cutoff for IFG (ADA 2003 criteria) results in a category of IFG that no longer represents a high-risk state of CVD. Furthermore, only subjects who convert from IFG to diabetes have a high risk of CVD mortality.

Cardiometabolic risk in impaired fasting glucose and impaired glucose tolerance: the Atherosclerosis Risk in Communities Study

OBJECTIVE

We compared and contrasted cardiovascular disease (CVD) risk factors, subclinical manifestations of CVD, incident coronary heart disease (CHD), and all-cause mortality by categories of impaired glucose regulation in nondiabetic individuals.

RESEARCH DESIGN AND METHODS

The study included 6,888 participants aged 52-75 years who had no history of diabetes or CVD. All-cause mortality and incident CHD were ascertained over a median of 6.3 years of follow-up.

RESULTS

Agreement between fasting and postchallenge glucose impairment was poor: 3,048 subjects (44%) had neither impaired fasting glucose (IFG) nor impaired glucose tolerance (IGT), 1,690 (25%) had isolated IFG, 1,000 (14%) had isolated IGT, and 1,149 (17%) had both IFG and IGT. After adjustment for age, sex, race, and center, subjects with isolated IFG were more likely to smoke, consume alcohol, and had higher mean BMI, waist circumference, LDL cholesterol, and fasting insulin and lower HDL cholesterol than those with isolated IGT, while subjects with isolated IGT had higher mean triglycerides, systolic blood pressure, and white cell counts. Measures of subclinical CVD and rates of all-cause mortality and incident CHD were similar in isolated IFG and isolated IGT.

CONCLUSIONS

Neither isolated IFG nor isolated IGT was associated with a more adverse CVD risk profile.