Age and glucose intolerance: effect of fitness and fatness

Do Body Composition and Values of Selected Nutritional Status Indices Influence the Glycaemic Index Values of Vegetarian Dishes? A Pilot Study in a Group of Older Women

An ageing population brings with it the need for public policy to respond to the demands and health needs of this group of people. The ageing process has been shown to be associated with changes in body composition. These mainly concern a decrease in muscle mass and an increase in body fat. Body composition and other indicators of nutritional status are important factors differentiating carbohydrate management. Glycaemic index (GI) values may be affected by differences resulting from individual metabolism. The rate of carbohydrate digestion is also influenced by a number of factors, including the degree to which the product is processed, the structure of the starch, and the presence of protein, fat and dietary fibre. Available studies do not provide information on the glycaemic response following the consumption of specific products by older people with varying BMI and body composition. Therefore, the aim of this study was to evaluate the effect of the body mass index (BMI) values of women aged 50-80 years on the glycaemic response after eating vegetarian meals and the influence of selected indices of nutritional status on their GI values. It has been shown that the areas under the glycaemic curves after the consumption of the tested foods, both traditional and modified, are higher in the group of overweight and obese women. Nevertheless, the GI of meals consumed by those with a BMI ≥ 25.0 kg/m² is lower than that of foods consumed by women with normal values of this index. In the group of women with BMI 18.5-24.9 kg/m², on the basis of an analysis of the obtained correlations, it was observed that the GI value of modified products depends on the percentage of body fat (FM%) (p = 0.0363) and the percentage of fat free mass (FFM%) (p = 0.0363), and, in the case of traditional products, also on the percentage of total body water (%) (p = 0.0133). In the group of women with a BMI ≥ 25.0 kg/m², significant correlations were only found between the GI of modified foods and the waist-to-hip ratio (WHR) (p = 0.0363) and the ratio of waist circumference to height (WHtR) (p = 0.0369) indices. The GI values of food set solely with the participation of young, healthy people should not be the basis for the nutrition planning of all groups of people.

Fasting concentrations and postprandial response of 1,2-dicarbonyl compounds 3-deoxyglucosone, glyoxal and methylglyoxal are not increased in healthy older adults

Dicarbonyl stress describes the increased formation of 1,2-dicarbonyl compounds and is associated with age-related pathologies. The role of dicarbonyl stress in healthy aging is poorly understood. In a preliminary study, we analyzed 1,2-dicarbonyl compounds, namely 3-deoxyglucosone (3-DG), glyoxal (GO), and methylglyoxal (MGO) in plasma of older (25 months, n = 11) and younger (5 months, n = 14) male C57BL/6J (B6) mice via ultra performance liquid chromatography tandem mass spectrometry. Postprandial 3-DG was higher in younger compared to older mice, whereas no differences were found for GO and MGO. Subsequently, in the main study, we analyzed fasting serum of older women (OW, 72.4 ± 6.14 years, n = 19) and younger women (YW, 27.0 ± 4.42 years, n = 19) as well as older men (OM, 74.3 ± 5.20 years, n = 15) and younger men (YM, 27.0 ± 3.34, n = 15). Serum glucose, insulin, 1,2-dicarbonyl concentrations, and markers of oxidative stress were quantified. In a subgroup of this cohort, an oral dextrose challenge was performed, and postprandial response of 1,2-dicarbonyl compounds, glucose, and insulin were measured. In women, there were no age differences regarding fasting 1,2-dicarbonyl concentrations nor the response after the oral dextrose challenge. In men, fasting MGO was significantly higher in OM compared to YM (median: 231 vs 158 nM, p = .006), whereas no age differences in fasting 3-DG and GO concentrations were found. Glucose (310 ± 71.8 vs 70.8 ± 11.9 min·mmol/L) and insulin (7 149 ± 1 249 vs 2 827 ± 493 min·µIU/mL) response were higher in OM compared to YM, which did not translate into a higher 1,2-dicarbonyl response in older individuals. Overall, aging does not necessarily result in dicarbonyl stress, indicating that strategies to cope with 1,2-dicarbonyl formation can remain intact.

Aging Reduces Insulin Clearance in Mice

Hyperinsulinemia is frequently associated with aging and may cause insulin resistance in elderly. Since insulin secretion and clearance decline with age, hyperinsulinemia seems to be maintained, primarily, due to a decrease in the insulin clearance. To investigate these aging effects, 3- and 18-month-old male C57BL/6 mice were subjected to intraperitoneal glucose and insulin tolerance tests (ipGTT and ipITT) and, during the ipGTT, plasma c-peptide and insulin were measure to evaluate in vivo insulin clearance. Glucose-stimulated insulin secretion in isolated pancreatic islets was also assessed, and liver samples were collected for molecular analyses (western blot). Although insulin sensitivity was not altered in the old mice, glucose tolerance, paradoxically, seems to be increased, accompanied by higher plasma insulin, during ipGTT. While insulin secretion did not increase, insulin clearance was reduced in the old mice, as suggested by the lower c-peptide:insulin ratio, observed during ipGTT. Carcinoembryonic antigen-related cell adhesion molecule-1 (CEACAM1) and insulin-degrading enzyme (IDE), as well as the activity of this enzyme, were reduced in the liver of old mice, justifying the decreased insulin clearance observed in these mice. Therefore, loss of hepatic CEACAM1 and IDE function may be directly related to the decline in insulin clearance during aging.

Age-related changes in clinical parameters and their associations with common complex diseases

The aim of the present study was to clarify the age-related changes in 13 clinical parameters and their associations with common complex diseases. Study subjects comprised 6,027 community-dwelling individuals who were recruited to a population-based longitudinal genetic epidemiological study. Bonferroni's correction was applied to compensate for multiple comparisons of association and P<0.0011 was considered statistically significant. Body mass index and waist circumference increased with age up to ~50 years and decreased thereafter in men, whereas the two parameters increased linearly with age in women. The prevalence of obesity was highest (41.1%) in men aged 40-49 years, after which it decreased with age. The prevalence of obesity in women increased with age to ≤32.2% in those aged ≥70 years. Systolic and mean blood pressure (BP), as well as pulse pressure, increased linearly with age in all subjects, whereas diastolic BP increased with age up to ~60 years and subsequently decreased. The prevalence of hypertension increased with age to ≤69.9 or 68.5% at age ≥70 years in men and women, respectively. The fasting plasma glucose level, blood hemoglobin A1c content and the prevalence of type 2 diabetes mellitus increased gradually with age in men and women. The serum triglyceride concentration increased with age up to ~50 years and decreased thereafter in men, whereas it increased linearly with age in women. The prevalence of hypertriglyceridemia increased to a peak of 56.8% at age 50-59 years and subsequently decreased in men, whereas in women it increased with age to ≤34.9% at ≥70 years. The serum high-density lipoprotein (HDL)-cholesterol concentration increased with age up to ~50 years and decreased thereafter in women. The prevalence of hypo-HDL-cholesterolemia increased gradually with age in women. The serum concentration of low-density lipoprotein (LDL)-cholesterol increased with age up to ~50 years and subsequently declined in men, whereas it increased linearly with age in women. The prevalence of hyper-LDL-cholesterolemia increased with age to ≤53.4% at 50-59 years in men and ≤63.9% at 60-69 years in women and it decreased thereafter in the two genders. The serum creatinine concentration and the estimated glomerular filtration rate increased or decreased linearly with age, respectively. The prevalence of chronic kidney disease (CKD) increased with age to ≤45.1 or 39.6% at ≥70 years in men and women, respectively. Therefore, these results indicate that 13 clinical parameters, as well as the prevalence of obesity, hypertension, type 2 diabetes mellitus, dyslipidemia and CKD, were significantly associated with age. They may therefore prove informative for the prevention of these diseases and contribute to the achievement of a healthy long life and successful aging.

A life course approach to cardiovascular aging

A life course approach in epidemiology investigates the biological, behavioral and social pathways that link physical and social exposures and experiences during gestation, childhood, adolescence and adult life, and across generations, to later-life health and disease risk. We illustrate how a life course approach has been applied to cardiovascular disease, highlighting the evidence in support of the early origins of disease risk. We summarize how trajectories of cardiometabolic risk factors change over the life course and suggest that understanding underlying 'normal' or 'healthy' trajectories and the characteristics that drive deviations from such trajectories offer the potential for early prevention and for identifying means of preventing future disease.

Transcriptome of pancreas-specific Bmpr1a-deleted islets links to TPH1-5-HT axis

Bone morphogenetic protein (BMP) signaling is crucial for the development and function of numerous organs, but its role on the function of pancreatic islets is not completely clear. To explore this question, we applied the high throughput transcriptomic analyses on the islets isolated from mice with a pancreas-specific deletion of the gene, Bmpr1a, encoding the type 1a BMP receptor. Consistently, these pBmpr1aKO mice had impaired glucose homeostasis at 3 months, and were more severely affected at 12 months of age. These had lower fasting blood insulin concentrations, with reduced expression of several key regulators of β-cell function. Importantly, transcriptomic profiling of 3-month pBmpr1aKO islets and bioinformatic analyses revealed abnormal expression of 203 metabolic genes. Critically among these, the tryptophan hydroxylase 1 gene (Tph1), encoding the rate-limiting enzyme for the production of 5-hydroxytryptamine (5-HT) was the highest over-expressed one. 5-HT is an important regulator of insulin secretion from β cells. Treatment with excess 5-HT inhibited this secretion. Thus our transcriptomic analysis links two highly conserved molecular pathways the BMP signaling and the TPH1–5-HT axis on glucose homeostasis.

Pre-gestational vs gestational exposure to maternal obesity differentially programs the offspring in mice

AIMS/HYPOTHESIS

Maternal obesity is associated with an increased risk of obesity and impaired glucose homeostasis in offspring. However, it is not known whether a gestational or pre-gestational exposure confers similar risks, and if so, what the underlying mechanisms are.

METHODS

We used reciprocal two-cell embryo transfers between mice fed either a control or high-fat diet (HFD) starting at the time of weaning. Gene expression in placenta was assessed by microarray analyses.

RESULTS

A pre-gestational exposure to a maternal HFD (HFD/control) impaired fetal and placental growth despite a normal gestational milieu. Expression of imprinted genes and genes regulating vasculogenesis and lipid metabolism was markedly altered in placenta of HFD/control. An exposure to an HFD (control/HFD) only during gestation also resulted in fetal growth restriction and decreased placental weight. Interestingly, only a gestational exposure to an HFD (control/HFD) resulted in obesity and impaired glucose tolerance in adulthood.

CONCLUSIONS/INTERPRETATION

An HFD during pregnancy has profound consequences for the offspring later in life. Our data demonstrate that the mechanism underlying this phenomenon is not related to placental dysfunction, intrauterine growth restriction or postnatal weight gain, but rather an inability of the progeny to adapt to the abnormal gestational milieu of an HFD. Thus, the ability to adapt to an adverse intrauterine environment is conferred prior to pregnancy and it is possible that the effects of a maternal HFD may be transmitted to subsequent generations.

Effects of living at two ambient temperatures on 24-h blood pressure and neuroendocrine function among obese and non-obese humans: a pilot study

The effects of environmental temperature on blood pressure and hormones in obese subjects in Japan were compared in two seasons: summer vs winter. Five obese (BMI, 32 ± 5 kg/m(2)) and five non-obese (BMI, 23 ±3 kg/m(2)) men participated in this experiment at latitude 35°10' N and longitude 136°57.9' E. The average environmental temperature was 29 ± 1 °C in summer and 3 ± 1 °C in winter. Blood samples were analyzed for leptin, ghrelin, catecholamines, thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), total cholesterol, triglycerides, insulin and glucose. Blood pressure was measured over the course of 24 h in summer and winter. A Japanese version of the Profile of Mood States (POMS) questionnaire was also administered each season. Systolic and diastolic blood pressures in obese men were significantly higher in winter (lower environmental temperatures) than in summer (higher environmental temperatures). Noradrenaline and dopamine concentrations were also significantly higher at lower environmental temperatures in obese subjects, but ghrelin, TSH, fT3, fT4, insulin and glucose were not significantly different in summer and winter between obese and non-obese subjects. Leptin, total cholesterol and triglyceride concentrations were significantly higher in winter in obese than non-obese men. Results from the POMS questionnaire showed a significant rise in Confusion at lower environmental temperatures (winter) in obese subjects. In this pilot study, increased blood pressure may have been due to increased secretion of noradrenaline in obese men in winter, and the results suggest that blood pressure control in obese men is particularly important in winter.

Associations of common genetic variants with age-related changes in fasting and postload glucose: evidence from 18 years of follow-up of the Whitehall II cohort

OBJECTIVE

In the general, nondiabetic population, fasting glucose increases only slightly over time, whereas 2-h postload glucose shows a much steeper age-related rise. The reasons underlying these different age trajectories are unknown. We investigated whether common genetic variants associated with fasting and 2-h glucose contribute to age-related changes of these traits.

RESEARCH DESIGN AND METHODS

We studied 5,196 nondiabetic participants of the Whitehall II cohort (aged 40-78 years) attending up to four 5-yearly oral glucose tolerance tests. A genetic score was calculated separately for fasting and 2-h glucose, including 16 and 5 single nucleotide polymorphisms, respectively. Longitudinal modeling with age centered at 55 years was used to study the effects of each genotype and genetic score on fasting and 2-h glucose and their interactions with age, adjusting for sex and time-varying BMI.

RESULTS

The fasting glucose genetic score was significantly associated with fasting glucose with a 0.029 mmol/L (95% CI 0.023-0.034) difference (P = 2.76 × 10(-21)) per genetic score point, an association that remained constant over time (age interaction P = 0.17). Two-hour glucose levels differed by 0.076 mmol/L (0.047-0.105) per genetic score point (P = 3.1 × 10(-7)); notably, this effect became stronger with increasing age by 0.006 mmol/L (0.003-0.009) per genetic score point per year (age interaction P = 3.0 × 10(-5)), resulting in diverging age trajectories by genetic score.

CONCLUSIONS

Common genetic variants contribute to the age-related rise of 2-h glucose levels, whereas associations of variants for fasting glucose are constant over time, in line with stable age trajectories of fasting glucose.

Is an appropriate cutoff of hypertriglyceridemic waist designated for type 2 diabetes among Chinese adults?

BACKGROUND & AIMS

We aimed to estimate appropriate cutoff of hypertriglyceridemic waist (HTGW) designated for impaired fasting glucose (IFG)/diabetes mellitus (DM) and to evaluate the association between HTGW and fasting glucose, IFG and DM, respectively.

METHODS

A cross-sectional survey in a nationally representative sample of 15,540 Chinese adults aged 35-74 years was conducted during 2000-2001.

RESULTS

Appropriate cutoffs of HTGW designated both for IFG and DM was triglyceride> or =110mg/dl and waist circumference> or =75cm both among men and women. Overall 35.4% of men as well as 33.6% of women had HTGW. Moreover 30.8%, 7.2% of men with HTGW as well as 30.0%, 9.7% of women had IFG and DM, respectively. Furthermore multivariate models revealed that adjusted odds ratios of IFG and DM were 2.7 (1.7, 2.5) and 2.6 (1.8, 3.8) for men with HTGW as well as 1.7 (1.4, 2.1) and 3.6 (2.5, 5.1) for women, respectively.

CONCLUSIONS

As the phenotype of visceral obesity HTGW was more common among Chinese adults. Global lifestyle modification should be targeted at adults with HTGW to prevent the premature incidence of DM and reduce the burden in future in China.

Diet-induced obesity is associated with hyperleptinemia, hyperinsulinemia, hepatic steatosis, and glomerulopathy in C57Bl/6J mice

Obesity and obesity-related illnesses are global epidemics impacting the health of adults and children. The purpose of the present work is to evaluate a genetically intact obese mouse model that more accurately reflects the impact of aging on diet-induced obesity and type 2 diabetes in humans. Male C57Bl/6J mice consumed either a control diet or one in which 60% kcal were due to lard beginning at 5-6 weeks of age. Body weight and fat measurements were obtained and necropsy performed at 15, 20, 30, and 40 weeks of age. Serum chemistry, histopathology, gene expression of the liver, and renal and hepatic function were also evaluated. In concert with significant increases in percent body fat and weight, mice fed the high-fat versus control diet had significantly increased levels of serum cholesterol. At ages 20 and 30 weeks, serum glucose was significantly higher in obese versus controls, while serum insulin levels were >/=4-fold higher in obese mice at ages 30 and 40 weeks. The effect of age exacerbated the effects of consuming a high-fat diet. In addition to being hyperinsulinemic and leptin resistant, older obese mice exhibited elevated hepatic PAI-1 and downregulation of GLUT4, G6PC, IGFBP-1, and leptin receptor mRNA in the liver, steatosis with subsequent inflammation, glomerular mesangial proliferation, elevated serum ALT, AST, and BUN, and increased numbers of pancreatic islets.

Adiposity and insulin sensitivity derived from intravenous glucose tolerance tests in antipsychotic-treated patients

Cardiovascular disease is more common in schizophrenia patients than in the general population, with a hypothesized contribution from increases in adiposity produced by antipsychotic medications. We sought to test the relationship between adiposity and insulin resistance using frequently sampled intravenous glucose tolerance tests (FSIVGTTs) to quantify whole-body insulin sensitivity in chronically treated patients with schizophrenia or schizoaffective disorder and untreated healthy controls. FSIVGTTs, body mass index (BMI), and waist circumference were obtained in nondiabetic patients (n=63) receiving olanzapine, risperidone, ziprasidone, or first generation antipsychotics, as well as in healthy controls (n=14). Subject groups (including untreated healthy controls) were matched for BMI and all treated patient groups were additionally matched for age. Bergman's minimal model (MinMod) was used to calculate insulin sensitivity (S(I)), as well as secondary measures of interest. BMI and waist circumference significantly predicted insulin sensitivity measured as MinMod S(I) (F(1,62)=35.11, p<0.0001 and F(1,46)=24.48, p<0.0001, respectively). In addition, BMI and waist circumference significantly predicted the acute plasma insulin response to the glucose challenge (AIR(G)), consistent with a beta cell compensatory response to insulin resistance (MinMod AIR(G) F(1,65)=22.42, p<0.0001 and F(1,49)=11.72, p=0.0013, respectively). Adiposity levels occurring during antipsychotic treatment are strongly related to insulin resistance, confirming that antipsychotic-induced weight gain can contribute to increased cardiometabolic risk in this population.

Hyperglycaemia and cardiovascular disease

Coronary artery disease and type 2 diabetes are chronic diseases of substantial and growing prevalence. Their coincidence is common, markedly enhancing mortality and morbidity. The risk for cardiovascular disease increases along a spectrum of blood glucose concentrations already apparent at levels regarded as normal. Accordingly, strategies for the early detection of glucometabolic disturbances are needed to find ways to prevent the occurrence of cardiovascular complications or to treat them already at an early stage. More specifically, abnormal glucose tolerance is almost twice as common amongst patients with a myocardial infarction as in population-based controls and a normal glucose regulation is indeed less common than abnormal glucose metabolism also amongst patients with stable coronary artery disease. Already an abnormal glucose tolerance is a strong risk factor for future cardiovascular events after an acute myocardial infarction. An oral glucose tolerance test should, therefore, be a part of the evaluation of total risk in all patients with coronary artery disease. As glucose disturbances are common and easy to detect, they may be suitable targets for novel secondary preventive efforts.

Postchallenge glucose rises with increasing age even when glucose tolerance is normal

AIMS

Ageing increases the likelihood of developing diabetes, with associated cardiovascular disease. In a cross-sectional study, we sought to determine whether age is associated with an increase in glucose concentrations 1 h after an oral glucose challenge (1-h OGTT), even when glucose tolerance is normal (NGT).

METHODS

Among subjects in the NHANES II database, 2591 subjects with NGT and documented 1-h OGTT glucose concentrations were studied. The relationship between age and 1-h OGTT glucose concentrations was assessed in a multivariable linear regression analysis.

RESULTS

In a multivariable linear regression analysis, each 10-year increase in age conferred an additional 0.20 mmol/l increase in the 1-h OGTT glucose (P < 0.0001). Moreover, an interaction between age and gender was found such that 1-h OGTT glucose concentrations rose more rapidly with increasing age in men than in women. The impact of age on 1-h OGTT glucose was independent of both fasting and 2-h OGTT glucose concentrations.

CONCLUSIONS

One-hour OGTT glucose concentrations rise significantly with age even in subjects with NGT. Further investigation is warranted to explore the pathophysiological significance of such age-related impairment of glucose handling, which might increase the risk of cardiovascular disease even when patients do not meet criteria for the diagnosis of diabetes or prediabetes.

Post-Transplant Diabetes Mellitus

New-onset diabetes mellitus in a previously non-diabetic transplant recipient is a serious adverse event that confers significant morbidity and mortality. The most significant consequences of post-transplant diabetes mellitus (PTDM) in solid organ transplant recipients include decreased patient and graft survival, an increased risk of infectious complications, and morbid cardiovascular events. The development of PTDM in the elderly is of particular concern because this group is already at increased risk of progression of cardiovascular disease. Because the elderly, especially those aged >65 years, are the fastest-growing segment of the renal transplant population, attention needs to be given to PTDM risk reduction and post-transplant management. PTDM develops as a consequence of both impaired insulin production and enhanced peripheral insulin resistance. A number of non-modifiable factors such as age, race, family history, hepatitis C, polycystic kidney disease and emerging genetic causes have been identified as risk factors for PTDM. However, a number of modifiable factors can be targets for intervention in high-risk patients, including bodyweight (through dietary restriction and exercise), hypertension, hyperlipidaemia and the effects of certain immunosuppressive agents. The two agents most responsible for PTDM are tacrolimus and corticosteroids, especially when used in combination. Attempts to modify doses and regimens designed to eliminate or avoid these drugs should be considered. Use of HMG-CoA reductase inhibitors ('statins') and ACE inhibitors is particularly helpful in controlling hypertension and hyperlipidaemia in the elderly because these agents confer protection against future adverse cardiovascular events. Bisphosphonates are also advantageous in controlling the progression of osteoporosis and possible increased risk of bone fractures. Future trials in the elderly should focus on such endpoints as PTDM, post-transplant neoplasia, cardiovascular events and bone fracture events in order to identify the safest regimens that provide the optimal control of rejection while limiting the morbidity from these secondary events.

Diabetes mellitus in the elderly: Diagnostic features

The new diagnostic criteria of the diabetes do not consider the age of the subjects. It has been demonstrated that the fasting glucose values as well as the glycemia levels after oral glucose load increase with age. Therefore, it is necessary to evaluate whether the new diagnostic criteria are valid for the elderly subjects also. In spite of the findings that among the subjects with fasting glycemia of 126-140 mg/ml subsequent controls after long times often revealed the presence of impaired fasting glucose (IFG) and numerous cases with IFG displayed values <110 mg/dl after longer times, the present authors accept the new diagnostic criteria even for the elderly subjects. However, they emphasize the importance of distinguishing diabetes in the elderly in subclasses, such as clinically manifest diabetes, mild diabetes and diabetic glucose tolerance (DGT) type, in order to establish the early diagnosis of diabetes, and therefore, to prevent the chronic vascular complications.

The insulin sensitivity, glucose sensitivity, and acute insulin response to glucose load in adolescent type 2 diabetes in Taiwanese

BACKGROUND

Insulin sensitivity (SI), glucose sensitivity (SG), acute insulin response to glucose load (AIR), and obesity in adolescent type 2 diabetes patients (young diabetes, YDM) in Taiwan were studied.

METHODS

Forty patients diagnosed at <22 years of age were enrolled and divided into non-obese (NOYDM, BMI < 27 kg/m(2)) and obese groups (OBYDM BMI > 27 kg/m(2)). Adult-onset type 2 diabetes patients (ADM) >40 years old (n = 41) and nondiabetic young adults (N) (n = 23) served as controls. Fasting plasma lipids, insulin, and glucose were measured. Homeostasis model assessment was calculated to estimate insulin sensitivity and beta-cell function. A frequent-sampled intravenous glucose tolerance test was performed to evaluate SI, SG, and AIR.

RESULTS

SI and AIR were significantly lower in YDM and ADM than in N (0.92 +/- 0.13, 0.8 +/- 0.15 and 3.24 +/- 0.47 x 10(-4)/U/mL for SI; 40.3 +/- 20.3, 107.3 +/- 50.2, 1208 +/- 306.3 uU/min for AIR). SG of YDM and ADM were lower compared with N (0.014 +/- 0.00138, 0.0292 +/- 0.0058 vs 0.034 +/- 0.0086 min(-1) respectively). No difference was noted between YDM and ADM. SI and SG were not different in NOYDM and OBYDM. AIR was higher in OBYDM (83.6 +/- 34.3 vs -7.6 +/- 13.66 uU/min).

CONCLUSIONS

YDM had defects in SI, SG, and AIR compared to N, which was similar to the pathophysiology of ADM. The results imply that YDM may be either a different subtype of diabetes or the same type of diabetes as ADM, with severe defects associated with earlier age of onset. OBYDM had higher AIR than NOYDM.