Metabolic Alteration Bridging the Prediabetic State and Colorectal Cancer.

Prediabetes and colorectal cancer (CRC) represent compelling health burdens responsible for high mortality and morbidity rates, sharing several modifiable risk factors. It has been hypothesized that metabolic abnormalities linking prediabetes and CRC are hyperglycemia, hyperinsulinemia, and adipokines imbalance. The chronic stimulation related to these metabolic signatures can favor CRC onset and development, as well as negatively influence CRC prognosis. To date, the growing burden of prediabetes and CRC has generated a global interest in defining their epidemiological and molecular relationships. Therefore, a deeper knowledge of the metabolic impairment determinants is compelling to identify the pathological mechanisms promoting the onset of prediabetes and CRC. In this scenario, this review aims to provide a comprehensive overview on the metabolic alterations of prediabetes and CRC as well as an overview of recent preventive and therapeutic approaches for both diseases, focusing on the role of the metabolic state as a pivotal contributor to consider for the development of future preventive and therapeutic strategies.

[FINDRISC as screening for detection of prediabetes and unknown type 2 diabetes]. / Evaluación del puntaje FINDRISC para detección de prediabetes y diabetes tipo 2 sin diagnóstico.

INTRODUCTION: It is fundamental to put into practice preventive and early population diagnosis actions to detect people at risk for developing Type 2 diabetes (T2D). The aim of this study was to evaluate the FINDRISC score performance as screening method to detect prediabetes and unknown T2D in municipal workers. METHODS: descriptive epidemiological and crosssectional study from 10/21 to 03/22. People suffering from a severe illness, pregnant or were already receiving drugs that modify blood glucose, were excluded. Participants completed the FINDRISC and performed an oral glucose tolerance test (OGTT). The performance of the FINDRISC was determined by calculating sensitivity, specificity, and area under the curve (AUC-ROC). The Youden's J statistic index was used to define the optimal cutoff point. RESULTS: 148 subjects between the ages of 18-65 were admitted, with a mean age of 42,9 ± 11,8, the 69% being males. The frequency of unknown T2D was of 3.3% (n = 5) and frequency of prediabetes was of 12.2% (n = 18). The mean of FINDRISC score was of 10.0 ± 4.8. The optimal cutoff point was ≥ 13 (sensitivity = 65.2%, Specificity = 74.4%) and the AUC-ROC 0.76 (IC95%: 0.66-0.86). CONCLUSION: The FINDRISC proved to be an effective method for identifying people with undiagnosed T2D and prediabetes with a cut-off point of 13 in the population, place, and study period.

Introducción: Es fundamental poner en práctica acciones preventivas y de diagnóstico poblacional precoz para detectar a las personas en riesgo de desarrollar Diabetes tipo 2 (DT2). El objetivo del trabajo fue evaluar el desempeño del score FINDRISC como método de cribado para detectar prediabetes y DT2 sin diagnostico en trabajadores municipales. Métodos: Estudio epidemiológico, descriptivo de corte transversal desde 10/21 al 3/22. Ingresaron voluntarios mayores a 18 años sin diagnóstico previo de DT2, se excluyó quienes padecían una enfermedad aguda, embarazadas o que realizaban tratamiento con medicamentos que modifiquen la glucemia. Los participantes completaron el FINDRISC y realizaron una Prueba Oral de Tolerancia a la Glucosa (POTG). El desempeño se determinó mediante el cálculo de la sensibilidad (S), especificidad (E), y el área bajo la curva (AUC-ROC). Se utilizó un índice de Youden para definir el punto de corte óptimo. Resultados: Ingresaron 148 personas, entre 18-67 años, con media de edad 42.9 ± 11.8 años, el 68.9% de sexo masculino. La frecuencia de DT2 sin diagnóstico fue del 3.3% (n = 5) y de prediabetes del 12.2% (n = 18). El promedio de puntos de FINDRISC fue de 10.0 ± 4.8. El punto de corte optimo fue ≥ 13 (S = 65.2% y E = 74.4%) y el AUC-ROC 0.76 (IC95%: 0.66-0.86). Conclusión: El FINDRISC demostró ser un método eficaz para identificar personas con DT2 y prediabetes con punto de corte 13 en la población, lugar y periodo de estudio.

Quasi-experimental evaluation of a nationwide diabetes prevention programme.

Diabetes is a leading cause of morbidity, mortality and cost of illness1,2. Health behaviours, particularly those related to nutrition and physical activity, play a key role in the development of type 2 diabetes mellitus3. Whereas behaviour change programmes (also known as lifestyle interventions or similar) have been found efficacious in controlled clinical trials4,5, there remains controversy about whether targeting health behaviours at the individual level is an effective preventive strategy for type 2 diabetes mellitus6 and doubt among clinicians that lifestyle advice and counselling provided in the routine health system can achieve improvements in health7-9. Here we show that being referred to the largest behaviour change programme for prediabetes globally (the English Diabetes Prevention Programme) is effective in improving key cardiovascular risk factors, including glycated haemoglobin (HbA1c), excess body weight and serum lipid levels. We do so by using a regression discontinuity design10, which uses the eligibility threshold in HbA1c for referral to the behaviour change programme, in electronic health data from about one-fifth of all primary care practices in England. We confirm our main finding, the improvement of HbA1c, using two other quasi-experimental approaches: difference-in-differences analysis exploiting the phased roll-out of the programme and instrumental variable estimation exploiting regional variation in programme coverage. This analysis provides causal, rather than associational, evidence that lifestyle advice and counselling implemented at scale in a national health system can achieve important health improvements.

The USPSTF Recommends Earlier Screening for Prediabetes and Type 2 Diabetes.

Screening is recommended for overweight or obese adults beginning at age 35.Earlier screening should be considered in populations with a disproportionately high prevalence of diabetes.

Dietary supplementation with mung bean coat alleviates the disorders in serum glucose and lipid profile and modulates gut microbiota in high-fat diet and streptozotocin-induced prediabetic mice.

As amajor by-product of mung bean processing, mung bean coat (MBC), which is rich in polyphenols and dietary fiber, is deemed to be mainly responsible for the health benefits of mung bean. However, its beneficial effects on the hyperglycemia, hyperlipidemia, and gut microbiota composition in prediabetic mice is not fully understood. The objective of this study was to investigate the efficacy of MBC in alleviating high-fat diet and streptozotocin-induced prediabetes. Herein, compared with the model control, dietary supplementation with MBC (3%, w/w) for 12 weeks significantly decreased the fasting blood glucose (24.60%), total cholesterol (15.72%), triglyceride (14.41%), and low-density lipoprotein cholesterol (22.45%). Furthermore, the improvements in glucose tolerance were reflected in the reduction of the area under the curve (AUC) and incremental AUC by approximately 23.08% and 51.18%, respectively. 16S rRNA gene sequencing of fecal microbiota suggested that MBC promoted the enrichment of beneficial bacteria (Roseburia and Bifidobacterium) and the production of short-chain fatty acids. All of the results from this study provided a scientific reference for avoiding the functional ingredients waste of MBC and expanding its application value.

A Pilot Screening of Agro-Food Waste Products as Sources of Nutraceutical Formulations to Improve Simulated Postprandial Glycaemia and Insulinaemia in Healthy Subjects.

The control of glucose homeostasis is the main goal for both the prevention and management of diabetes and pre-diabetes. Numerous drugs are available, despite their side effects. This is constantly leading people to be inclined to natural alternative treatments. Evidence indicates antioxidant-based nutraceuticals as an optimal tool for the glycaemic control. Currently, a great interest has been focused on the valorisation of agro-food by-products as sources of bioactive compounds including polyphenols. In this sense, we tested the efficacy of novel nutraceutical products based on polyphenolic extract from nectarines (NecP), tomato peels (TP), and olive leaves (EOL) on glycaemic and insulinemic responses. The three formulations contained, respectively, 0.007 mg abscisic acid (ABA)/g, 0.5 mg carotenoids/g, and 150 mg oleuropein/g. Twenty healthy subjects consumed a regular glucose solution (RG) or a treatment beverage (TB) obtained by mixing RG with the individual formulations (TB NecP, TB EOL, and TB TP), separately, and on different days. All three formulations significantly lowered the 30 min glucose plasma peak (p < 0.05 for all); similarly, NecP and TP also significantly lowered the 30 min insulin plasma peak (p < 0.05 for all). These results may lead to the hypothesis of a formulation of a multi-component nutraceutical with a synergistic efficacy for the glycaemic control.

Mixed methods pilot study of a low-carbohydrate diabetes prevention programme among adults with pre-diabetes in the USA.

OBJECTIVES: (1) To estimate weight change from a low-carbohydrate diabetes prevention programme (LC-DPP) and (2) to evaluate the feasibility and acceptability of an LC-DPP. RESEARCH DESIGN: Single-arm, mixed methods (ie, integration of quantitative and qualitative data) pilot study. SETTING: Primary care clinic within a large academic medical centre in the USA. PARTICIPANTS: Adults with pre-diabetes and Body Mass Index of ≥25 kg/m2. INTERVENTION: We adapted the Centers for Disease Control and Prevention's National Diabetes Prevention Program (NDPP)-an evidence-based, low-fat dietary intervention-to teach participants to follow a very low-carbohydrate diet (VLCD). Participants attended 23 group-based classes over 1 year. OUTCOME MEASURES: Primary outcome measures were (1) weight change and (2) percentage of participants who achieved ≥5% wt loss. Secondary outcome measures included intervention feasibility and acceptability (eg, attendance and qualitative interview feedback). RESULTS: Our enrolment target was 22. One person dropped out before a baseline weight was obtained; data from 21 individuals were analysed. Mean weight loss in kilogram was 4.3 (SD 4.8) at 6 months and 4.9 (SD 5.8) at 12 months. Mean per cent body weight changes were 4.5 (SD 5.0) at 6 months and 5.2 (SD 6.0) at 12 months; 8/21 individuals (38%) achieved ≥5% wt loss at 12 months. Mean attendance was 10.3/16 weekly sessions and 3.4/7 biweekly or monthly sessions. Among interviewees (n=14), three factors facilitated VLCD adherence: (1) enjoyment of low-carbohydrate foods, (2) diminished hunger and cravings and (3) health benefits beyond weight loss. Three factors hindered VLCD adherence: (1) enjoyment of high-carbohydrate foods, (2) lack of social support and (3) difficulty preplanning meals. CONCLUSIONS: An LC-DPP is feasible, acceptable and may be an effective option to help individuals with pre-diabetes to lose weight. Data from this pilot will be used to plan a fully powered randomised controlled trial of weight loss among NDPP versus LC-DPP participants. TRIAL REGISTRATION NUMBER: NCT03258918.

Health education and communication needs among primary care patients with prediabetes in Singapore: A mixed methods approach.

AIMS: To assess factors associated with ever receiving prediabetes education, and to explore the health education and communication needs among primary care patients with prediabetes in Singapore. METHODS: A mixed methods study, consisting of a cross-sectional survey involving 433 patients with prediabetes aged 21-79, and in-depth interviews (IDIs) with 48. Multivariable regression was used to analyse the survey results, while thematic analysis was used to analyse the IDIs. RESULTS: The prevalence of ever receiving prediabetes education was 26.6%. This was positively associated with school education, impaired glucose tolerance, number of co-morbidities, having family or peer with diabetes, having support to reduce diabetes risk, confidence to self-manage prediabetes, and negatively associated with age. A common reason among those not receiving such education was not being referred by doctors. The preferred content of health communication messages were to focus on risk and prevention of diabetes, health and family, and to avoid the term 'prediabetes' in messages. The top 2 preferred education components were healthy eating and physical activity, and the most desired setting was the community centre. CONCLUSIONS: More efforts are needed to increase the take-up rate of prediabetes education. Polyclinic healthcare professionals could provide preliminary advice, and subsequently refer patients to community-based programmes or resources.

'I could have made those changes years earlier': experiences and characteristics associated with receiving a prediabetes diagnosis among individuals recently diagnosed with type 2 diabetes.

BACKGROUND: Prediabetes increases the risk of developing type 2 diabetes (T2D). Improving diet quality is key in preventing this progression, yet little is known about the characteristics of individuals with prediabetes or the nutrition care they receive. OBJECTIVES: This study aims to identify characteristics and experiences associated with receiving a prediabetes diagnosis prior to developing T2D. METHODS: A mixed methods study encompassed a quantitative subanalysis of participants with newly diagnosed T2D from The 3D Study, and semi-structured telephone interviews with a subsample of participants who were previously diagnosed with prediabetes. Interviews were thematically analysed and survey data synthesized using SPSS statistical software. RESULTS: Of the 225 study participants, 100 individuals were previously diagnosed with prediabetes and 120 participants were not. Those with prediabetes were less likely to be smokers (P = 0.022) and more likely to be satisfied with seeing a dietitian (P = 0.031) than those without a previous prediabetes diagnosis. A total of 20 participants completed semi-structured interviews. Thematic analysis revealed three themes: (i) experiencing a prediabetes diagnosis; (ii) receiving nutrition care during prediabetes and (iii) reflecting on the experience of receiving care for prediabetes versus T2D. CONCLUSIONS: There are gaps in the current management of prediabetes in Australia. Low rates of prediabetes diagnosis and an ambiguous experience of receiving this diagnosis suggest an area of health service improvement. With no difference in diet quality between individuals with and without a previous prediabetes diagnosis, the nutrition care during prediabetes may be more important than the diagnosis itself in delaying the onset of T2D.

Association of insulin resistance and ß-cell dysfunction with incident diabetes among adults in China: a nationwide, population-based, prospective cohort study.

BACKGROUND: National investigations on the interaction of insulin resistance, ß-cell dysfunction, and obesity with the development of diabetes are scarce in China. We aimed to investigate the individual and joint associations of insulin resistance and ß-cell dysfunction with incident diabetes, and to examine the modifying effect of BMI and waist circumference on these associations among adults with normal glucose tolerance and with prediabetes. METHODS: In this nationwide, population-based, prospective cohort study, we analysed data from the China Cardiometabolic Disease and Cancer Cohort Study, which recruited adults aged 40 years or older during 2011-12 (baseline) and invited participants to attend follow-up visits in 2014-16. Patients with diabetes at baseline, missing data for baseline measures of glucose tolerance status, missing data for baseline homoeostasis model assessment (HOMA) indexes, missing data for baseline covariates, and missing data for measures of glucose tolerance status at follow-up visits were excluded. At baseline and follow-up visits, a comprehensive set of questionnaires, clinical measurements, oral glucose tolerance tests, and laboratory examinations were carried out following standardised protocols. Glucose tolerance status and prediabetes were defined according to the American Diabetes Association 2010 criteria. In the main analysis, we examined the contributions of insulin resistance (HOMA of insulin resistance [HOMA-IR]) and ß-cell dysfunction (HOMA of ß-cell function [HOMA-B]) to diabetes risk, and evaluated the impact of obesity on these associations. FINDINGS: 94 952 participants (31 517 men and 63 435 women) were included in the analysis. High HOMA-IR was associated with a greater hazard of diabetes (quartile 4 vs 1: hazard ratio [HR] 6·70, 95% CI 6·08-7·39; per unit increase in Z score: HR 2·17, 95% CI 2·10-2·24) than low HOMA-B (quartile 1 vs 4: 4·08, 3·72-4·48; per unit decrease in Z score: 1·92, 1·85-2·00). Approximately 24·4% (95% CI 23·6-25·2) of the incident diabetes could be attributed to insulin resistance and 12·4% (11·2-13·7) could be attributed to ß-cell dysfunction. The HRs for diabetes were 1·83 (95% CI 1·72-1·95) per unit increase in Z score of HOMA-IR and 2·03 (1·86-2·21) per unit decrease in Z score of HOMA-B among participants with normal weight; the corresponding HRs for diabetes were 2·02 (1·93-2·11) and 1·88 (1·79-1·98) among participants with obesity (pinteraction=0·0091). These associations and interactions were similar for participants with normal glucose tolerance or prediabetes. INTERPRETATION: Insulin resistance shows a stronger association with incident diabetes than does ß-cell dysfunction in Chinese adults, and this association pattern was more prominent among adults with obesity. Given the limitations of HOMA indexes as surrogate measures of insulin resistance and ß-cell dysfunction, these findings should be interpreted with caution. FUNDING: National Natural Science Foundation of China.

Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study.

BACKGROUND: The first episode of psychosis is a critical period in the emergence of cardiometabolic risk. AIMS: We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis. METHOD: This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months. RESULTS: Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol). CONCLUSIONS: Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.

[Possible to prevent prediabetes from progressing to manifest type 2 diabetes]. / Prediabetes ­ mål för intervention.

Different prediabetic states precede overt type 2 diabetes. Prediabetes also carries an increased cardiovascular risk per seand may be divided into fasting hyperglycemia, impaired glucose tolerance and intermediate hyperglycemia. Mixed forms of these are very common. Prediabetes develops insidiously for many years and usually produces no symptoms until very late. It is possible to prevent prediabetes from progressing to manifest type 2 diabetes and it can also be made to revert to normoglycemia. The importance of lifestyle interventions, pharmacological treatment, surgical treatment and community efforts is discussed.

Closing the gap - Is type 2 diabetes awareness enough to prevent the growing epidemic?

BACKGROUND: Diabetes mellitus is a public health burden requiring a multi-sectorial approach including adequate population awareness to tackle this epidemic. The study was aimed to determine the level of diabetes awareness among a high-risk dysglycaemic population in relation to socio-demographic, lifestyle and family history of diabetes as well as to body mass index (BMI) and blood pressure measurements. Furthermore, the authors strived to explore any relationships between diabetes awareness and an oral glucose tolerance test dysglycaemia diagnosis. METHOD: Participants obtaining impaired fasting blood glucose in a representative health examination survey were invited to undergo an oral glucose tolerance test (OGTT). During the OGTT session, participants were invited to take part in a diabetes awareness questionnaire as well as have their weight, height and blood pressure measured. Association between awareness scores and different parameters (age, gender, education, residential district, smoking, alcohol habit, family history, BMI and blood pressure) were explored. RESULTS: Being a female, ageing, non-smoker and having a family history of diabetes had a positive association with adequate diabetes awareness. Even though generally good awareness was present, the majority of the participants were obese, with an elevated blood pressure and obtained a dysglycaemic status post OGTT. CONCLUSION: Diabetes awareness solely does not appear to engage individuals in preventive initiatives. Behavioural changes are required but these are only established after the motivational action gap has been overcome. Empowering community diabetes mellitus screening programs targeting the environment, social gradients and cultural norms while engaging in preventive interventions are recommended.

The Association of Prediabetes and Diabetes Risk Perception With Leisure-Time Physical Activity and Weight Loss.

PURPOSE: To examine the association of perceived risk of prediabetes and diabetes with leisure-time physical activity (LTPA) and weight loss, and determine whether the association of risk perception with LTPA and weight loss varies by race/ethnicity. DESIGN: Cross-sectional. SETTING: National Health and Nutrition Examination Survey (NHANES) 2011-2014. SUBJECTS: Non-Latino white, non-Latino black, and Latino nondiabetic and nonprediabetic NHANES participants ≥18 years of age who were not underweight (n = 9550). MEASURES: Demographic characteristics, LTPA, attempted weight loss, and perceived risk of prediabetes or diabetes. ANALYSIS: Log-binomial regression models were fit to assess the association of perceived risk with meeting LTPA recommendations and having attempted to lose weight, overall and by race/ethnicity. RESULTS: Individuals reporting that they perceived they could be at risk for diabetes/prediabetes were less likely to meet LTPA recommendations (adjusted prevalence ratio [aPR]: 0.87; 95% confidence interval [CI]: 0.79-0.95), but significantly more likely to report attempting weight loss in the past year (aPR: 1.14; 95%CI: 1.04-1.25), compared with those reporting no risk perception. Latino and non-Latino blacks who perceived they could be at risk for diabetes/prediabetes were 25% and 35% more likely to report trying to lose weight in the past year (aPR: 1.25; 95% CI: 1.08-1.44 and aPR: 1.35; 95% CI: 1.19-1.54, respectively), compared with Latino and non-Latino blacks that did not perceive being at risk. In contrast, non-Latino whites who perceived they were at risk were 20% less likely to report meeting LTPA recommendations (aPR: 0.80; 95% CI: 0.72-0.89), compared with non-Latino whites reporting no risk perception. CONCLUSION: Findings highlight the role of perceived risk for prediabetes and diabetes in LTPA and weight loss, with findings varying by race/ethnicity. Awareness of prediabetes and diabetes risk could contribute to efforts aimed at improving LTPA and weight loss.

Risco de desenvolvimento do diabetes tipo 2 em enfermeiras e sua relação com alterações metabólicas / Detection of risk for type 2 diabetes and its relationship with metabolic alterations in nurses / Detección de riesgo de diabetes tipo 2 y su relación con alteraciones metabólicas en enfermeras

Objetivo: identificar o risco de desenvolvimento de diabetes tipo 2 em enfermeiras e sua relação com as alterações metabólicas. Método: estudo transversal, com 155 enfermeiras. As variáveis investigadas foram: sociodemográficas, índice de massa corporal, a circunferência da cintura, índice cintura-quadril, perfil lipídico, a glicemia basal e a curva oral de tolerância à glicose. Para a coleta de dados utilizou-se o Finnish Diabetes Risk Score. Resultados: Das 155 (100%) enfermeiras, a média de idade foi de 44 anos e 85% apresentavam sobrepeso ou obesidade; 52% tinham história familiar de diabetes e 21%, hiperglicemia ocasional. Em relação ao risco, 59% foram identificados com risco moderado e muito alto de diabetes tipo 2. A glicose, a insulina, a hemoglobina glicosilada A1c e a resistência à insulina aumentaram paralelamente ao aumento do risco de diabetes tipo 2, embora os lipídios não tenham aumentado. 27% das participantes apresentaram glicemia em jejum alterada, 15%, intolerância à glicose e 5%, diabetes tipo 2. Conclusão: houve uma elevada taxa de detecção de risco de diabetes tipo 2 (59%) e a pontuação de risco alto e muito alto foi associado com níveis elevados de hemoglobina glicosilada A1c, glicose, insulina e resistência à insulina, mas não com lipídios.

Objective: to detect the risk of development of type 2 diabetes in nurses and its relationship with metabolic alterations. Method: cross-sectional study, with 155 nurses. The variables investigated were: sociodemographic, body mass index, waist circumference, waist-hip index, lipid profile, basal glycemia and oral glucose tolerance curve. The Finnish Diabetes Risk Score was used to collect data. Results: 155 nurses were included, with an average age of 44 years and 85% were overweight or obese. 52% had a family history of diabetes and 21% had occasional hyperglycemia. With respect to the risk, 59% were identified with moderate and very high risk for type 2 diabetes. Glucose, insulin, glycosylated hemoglobin A1c and insulin resistance increased in parallel to the increased risk for type 2 diabetes, although lipids did not increase. 27% of the sample had impaired fasting glycemia. 15% had glucose intolerance and 5% had type 2 diabetes. Conclusion: there was a high detection rate of people at risk for type 2 diabetes (59%) and the high and very high risk score was associated with high levels of glycosylated hemoglobin A1c, glucose, insulin and insulin resistance, but not with lipids.

Objetivo: identificar el riesgo de desarrollo de diabetes tipo 2 en enfermeras y su relación con alteraciones metabólicas. Método: estudio transversal, con 155 enfermeras. Las variables investigadas fueron: sociodemográficas, el índice de masa corporal, circunferencia de cintura, índice cintura-cadera, perfil de lípidos, glucemia basal y curva de tolerancia oral a la glucosa. Para la recolección de datos se utilizó el Finnish Diabetes Risk Score. Resultados: De las 155 enfermeras, la edad promedio fue 44 años y 85% tenía sobrepeso u obesidad. El 52% tenía antecedentes familiares de diabetes de primera línea, el 21% hiperglucemia ocasional. Con relación al riesgo, se identificaron 59% con riesgo de diabetes tipo 2 moderado y muy alto. Glucosa, insulina, hemoglobina glucosa A1c y la resistencia a la insulina incrementaron paralelos al aumento del riesgo de diabetes tipo 2, aunque los lípidos no. El 27% de las enfermeras presentó glucemia basal alterada. El 15% tuvo intolerancia a la glucosa y 5% diabetes tipo 2. Conclusión: la detección de riesgo de diabetes tipo 2 fue elevada (59%) y el puntaje de riesgo alto y muy alto se relacionó con valores mayores de hemoglobina glucosa A1c, glucosa, insulina y resistencia a la insulina pero no con lípidos.

Evidence for the Prevention of Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is a common chronic metabolic condition. Before receiving this diagnosis, persons typically have a long period of prediabetes. There is good evidence that T2DM can often be prevented or delayed by means of lifestyle interventions (39%-71%), medications (28%-79%), or metabolic surgery (75%). However, despite consistent data demonstrating their efficacy, these tools are underused, and knowledge about them among primary care physicians is limited. In an effort to engage physicians in addressing this public health crisis more effectively, the authors reviewed the evidence that T2DM can be prevented or delayed in persons at risk.

The Impact of a Novel Structured Health Intervention for Truckers (SHIFT) on Physical Activity and Cardiometabolic Risk Factors.

OBJECTIVE: The aim of this study was to examine the effects of implementing a lifestyle health behavior intervention on cardiovascular risk markers in a sample of lorry drivers. METHODS: Fifty-seven males participated in the pre-post evaluation of a multicomponent 12-week intervention. RESULTS: Favorable changes in several cardiovascular health indicators were observed, including fasting blood glucose (-0.6 mmol/L), LDL-Cholesterol (-0.7 mmol/L), total cholesterol (-0.7 mmol/L), waist-hip ratio (-0.10), and waist circumference (-2.5 cm) (P < 0.01). The proportion of participants with a more than 10% risk of a cardiovascular event in the next 10 years was reduced by 12% (P < 0.05). A 21%, 12%, and 7.5% reduction in drivers with pre-diabetes (P < 0.001), undiagnosed diabetes (P < 0.05), and the metabolic syndrome (P < 0.05), respectively, was observed. CONCLUSION: This study highlights the feasibility of implementing a multicomponent health intervention within the transport setting and provides preliminary evidence of its beneficial effects on some markers of health.

Bone: Another potential target to treat, prevent and predict diabetes.

Type 2 diabetes mellitus is now a worldwide health problem with increasing prevalence. Mounting efforts have been made to treat, prevent and predict this chronic disease. In recent years, increasing evidence from mice and clinical studies suggests that bone-derived molecules modulate glucose metabolism. This review aims to summarize our current understanding of the interplay between bone and glucose metabolism and to highlight potential new means of therapeutic intervention. The first molecule recognized as a link between bone and glucose metabolism is osteocalcin (OCN), which functions in its active form, that is, undercarboxylated OCN (ucOC). ucOC acts in promoting insulin expression and secretion, facilitating insulin sensitivity, and favouring glucose and fatty acid uptake and utilization. A second bone-derived molecule, lipocalin2, functions in suppressing appetite in mice through its action on the hypothalamus. Osteocytes, the most abundant cells in bone matrix, are suggested to act on the browning of white adipose tissue and energy expenditure through secretion of bone morphogenetic protein 7 and sclerostin. The involvement of bone resorption in glucose homeostasis has also been examined. However, there is evidence indicating the implication of the receptor activator of nuclear factor κ-B ligand, neuropeptide Y, and other known and unidentified bone-derived factors that function in glucose homeostasis. We summarize recent advances and the rationale for treating, preventing and predicting diabetes by skeleton intervention.

N-Acetyl-l-Cysteine treatment efficiently prevented pre-diabetes and inflamed-dysmetabolic liver development in hypothalamic obese rats.

AIM: Hypothalamic obese rats are characterized by pre-diabetes, dyslipidemia, hyperadiposity, inflammation and, liver dysmetabolism with oxidative stress (OS), among others. We studied endocrine-metabolic dysfunctions and, liver OS and inflammation in both monosodium l-glutamate (MSG)-neonatally damaged and control litter-mate (C) adult male rats, either chronically treated with N-Acetyl-l-Cysteine since weaned (C-NAC and MSG-NAC) or not. METHODOLOGY: We evaluated circulating TBARS, glucose, insulin, triglycerides, uric acid (UA) and, aspartate and alanine amino-transferase; insulin sensitivity markers (HOMA indexes, Liver Index of Insulin Sensitivity -LISI-) were calculated and liver steps of the insulin-signaling pathway were investigated. Additionally, we monitored liver OS (protein carbonyl groups, GSH and iNOS level) and inflammation-related markers (COX-2 and TNFα protein content; gene expression level of Il1b, Tnfα and Pai-1); and carbohydrate and lipid metabolic functions (glucokinase/fructokinase activities and, mRNA levels of Srebp1c, Fas and Gpat). KEY FINDINGS: Chronic NAC treatment in MSG rats efficiently decreased the high circulating levels of triglycerides, UA, transaminases and TBARS, as well as peripheral (high insulinemia and HOMA indexes) and liver (LISI and the P-AKT:AKT and P-eNOS:eNOS protein ratio values) insulin-resistance. Moreover, NAC therapy in MSG rats prevented liver dysmetabolism by decreasing local levels of OS and inflammation markers. Finally, NAC-treated MSG rats retained normal liver glucokinase and fructokinase activities, and Srebp1c, Fas and Gpat (lipogenic genes) expression levels. SIGNIFICANCE: Our study strongly supports that chronic oral antioxidant therapy (NAC administration) prevented the development of pre-diabetes, dyslipidemia, and inflamed-dysmetabolic liver in hypothalamic obese rats by efficiently decreasing high endogenous OS.