Impact of daily step count on glycemic outcomes of community residents with impaired glucose tolerance / 中华健康管理学杂志

Objective:To investigate the impact of daily step count on glycemic outcomes in community residents with impaired glucose tolerance (IGT).Methods:This was a prospective cohort study, in October 2018, 204 residents who met the criteria of IGT were recruited in the Shijingshan District in Beijing. The subjects were tested for fasting blood glucose, oral glucose tolerance test 2-hour blood glucose (2hBG), glycated hemoglobin A 1c (HbA 1c), lipid profile, liver and kidney function, as well as measurements of height, weight and waist circumference. A dedicated mobile application was used to deliver prediabetes health knowledge monthly. Online guidance was provided to answer questions and daily step count was collected using the application. Three years later, a follow-up was conducted to assess the participants′ glycemic outcomes and other indexes, and a total of 142 participants completed the follow-up review. According to daily step count, the subjects were categorized into high step count group (42 cases,>7 000 steps daily), moderate step count group (54 cases, 5 000-7 000 steps daily), and low step count group (46 cases,<5 000 steps daily). Subjects were categorized into diabetes group (30 cases), prediabetes group (77 cases) and normal glucose tolerance group (35 cases) with glycemic outcomes. Independent sample t test was used to compare the differences in blood glucose, blood lipids, and step counts between the two groups. Kruskal-Wallis H test or one-way ANOVA was used to compare the differences in blood glucose, blood lipids, and step counts between multiple groups. The χ2 test was used to compare the differences in glycemic outcomes between multiple groups. Multivariate logistic regression analysis was used to assess the impact of daily step counts and body mass index on glycemic outcomes. Linear regression analysis was used to evaluate the relationship between daily step counts and 2 h BG. Results:A total of 142 participants completed the 3-year follow-up, including 43 males and 99 females, with a mean age of (60.15±5.67) years. At baseline, males had significantly higher body mass index, waist circumference, and fasting blood glucose when compared to those in females [(26.97±2.43) vs (24.89±2.93) kg/m 2, (92.68±7.75) vs (83.83±8.60) cm, (5.83±0.61) vs (5.62±0.52) mmol/L], the total cholesterol and HDL-C were also significantly lower in males than those in females [(5.10±1.16) vs (5.55±0.95) mmol/L, (1.35±0.34) vs (1.56±0.35) mmol/L] (all P<0.05). After 3-year follow-up, 21.1% (30/142) of IGT participants progressed to diabetes, with an annual conversion rate of approximately 7%. The normal glucose tolerance group showed significantly higher daily step counts when compared with the prediabetes and diabetes groups [(7 886±2 867) vs (5 981±2 655) vs (4 117±2 674) steps] ( H=31.778, P<0.001). Individuals with higher daily step counts exhibited lower body mass index, 2 h BG, and HbA 1c level when compared with those in the ones with moderate and low step counts [(24.26±3.09) vs (25.44±3.38) vs (26.26±3.59) kg/m 2, (7.50±1.71) vs (9.15±3.30) vs (11.19±3.84) mmol/L, 5.97%±0.46% vs 6.14%±0.99% vs 6.40%±0.96%] (all P<0.05). Higher step count was positively correlated with the reversal of prediabetes to normal blood glucose levels (moderate step count, OR=0.297, 95% CI: 0.109-0.804; low step count, OR=0.055, 95% CI: 0.010-0.287), lower daily step count correlated positively with prediabetes progressing to diabetes ( OR=4.857, 95% CI: 1.140-20.689) (all P<0.05). For every additional 1 000 steps per day, the 2 h BG decreased by 0.5 mmol/L. Conclusion:As daily step count increases, the glucose metabolism improves in IGT community residents. Higher daily step count is associated with reversal of IGT to normal glucose tolerance, while lower daily step count may be associated with the progression of IGT to diabetes.

A preliminary investigation study of islet function assessment / 中国糖尿病杂志

Objective To investigate doctors'knowledge and differences in islet function assessment methods in China.Methods This is a cross-sectional study that conducted by online questionnaire survey.Demographic data,examination items,blood collection point of OGTT,detection method,kit type and follow-up frequency were collected and compared among doctors in different regions,different levels of hospitals,different specialties and different titles.Results 79.2%and 85.1%of physicians believed that the levels of insulin and C-peptide should be measured at the same time to assess islet function in patients with newly diagnosed and follow-up diabetes mellitus patients.Endocrinologists preferred to access insulin and C-peptide at the same time(P<0.05).56.0%of physicians chose bread meal test for T1DM patients and 54.7%for T2DM patients.Compared with non-specialists,endocrinologists preferred to commit bread meal test to T1DM patients(61.4%vs 41.0%,P<0.05).In addition,for the islet function assessment of new-onset diabetes patients,7.6%of physicians chose the six-point method(0,30,60,90,120,180 min),27.3%selected the five-point method I(0,30,60,120,180 min),8.5%selected the five-point method II(0,30,60,90,120 min),9.8%selected the four-point method I(0,30,60,120 min),10.3%selected the four-point method II(0,60,120,180 min),13.8%chose the three-point method(0,60,120 min)and 13.4%chose the two-point method(0,120 min).At the time of follow-up assessment,the above selection rates were 5.3%,20.4%,6.4%,6.6%,9.4%,15.8%and 24.1%,respectively.In terms of the frequency of assessment,39.2%of doctors assessed islet function once a year and 24.7%once every six months.Specialists preferred to assess islet function once a year,and physicians with senior titles chose to assess islet function more variably.Conclusion At present,there are still great differences in assessment methods of islet function in China.It is of great significance for the clinical diagnosis and treatment of diabetes to understand the differences in the selection of islet function assessment methods among doctors in different regions,specialties and job titles.

Association between abnormal oral glucose tolerance test patterns in the second trimester and large for gestational age newborns / 中华妇产科杂志

Objective:To investigate the impact of abnormal patterns of 75 g oral glucose tolerance test (OGTT) in the second trimester on the risk of large for gestational age (LGA) newborn deliveries.Methods:General clinical data and OGTT results of 66 290 pregnant women who received regular prenatal care and delivered in Guangdong Maternal and Child Health Hospital from December 24, 2016 to July 26, 2022 were collected. According to the results of OGTT, the pregnant women were divided into 8 groups: normal blood glucose group (normal fasting blood glucose, 1-hour and 2-hour after oral glucose, 54 518 cases), gestational diabetes mellitus (GDM) 0 group (only abnormal fasting blood glucose, 1 430 cases), GDM 1 group (only abnormal blood glucose at 1-hour after oral glucose, 2 150 cases), GDM 2 group (only abnormal blood glucose at 2-hour after oral glucose, 3 736 cases), GDM 0+1 group (both fasting blood glucose and 1-hour after oral glucose were abnormal, 371 cases), GDM 0+2 group (both fasting blood glucose and 2-hour after oral glucose were abnormal, 280 cases), GDM 1+2 group (abnormal blood glucose at 1-hour and 2-hour after oral glucose, 2 981 cases) and GDM 0+1+2 group (abnormal fasting blood glucose, 1-hour and 2-hour after oral glucose, 824 cases). Multivariate logistic regression was used to analyze the effects of different abnormal OGTT patterns on LGA. In addition, the blood glucose measurements at the three time points of OGTT were combined and used as continuous variables in the receiver operating characteristic (ROC) curve to evaluate the predictive value of each blood glucose measurement mode for LGA and the area under the curve (AUC) was compared.Results:(1) Multivariate logistic regression analysis showed that the risks of LGA were significantly increased in GDM 0 group ( OR=1.76, 95% CI: 1.50-2.08; P<0.001), GDM 0+1 group ( OR=2.29, 95% CI: 1.72-3.04; P<0.001), and GDM 0+1+2 group ( OR=1.98, 95% CI: 1.61-2.43; P<0.001). (2) ROC curve analysis showed that fasting blood glucose, 1-hour after oral glucose, 2-hour after oral glucose, fasting+1-hour after oral glucose, fasting+2-hour after oral glucose, 1-hour+2-hour after oral glucose, and fasting+1-hour+2-hour after oral glucose had certain predictive value for LGA (all P<0.001). The AUC of fasting blood glucose measurement was higher than that of 2-hour blood glucose measurement in predicting LGA, and the difference was statistically significant ( P<0.05). There was no significant difference in the AUC between fasting blood glucose and other blood glucose measurement modes for predicting LGA (all P>0.05). Conclusions:In the abnormal OGTT patterns, pregnant women with abnormal fasting blood glucose, abnormal fasting+1-hour after oral glucose, and abnormal fasting+1-hour+2-hour after oral glucose have an increased risk of LGA. Fasting blood glucose measurement is of great significance for the prediction of LGA, and could be used as an optimal indicator to evaluate the risk of LGA in clinical practice.

Isolated polyhydramnios in the third trimester or polyhydramnios secondary to late-onset gestational diabetes: is it worth distinguishing?

SUMMARY OBJECTIVE: The aim of this study was to compare pregnancy outcomes of patients with polyhydramnios due to late-onset gestational diabetes mellitus and patients with isolated polyhydramnios. METHODS: Of the women who fully participated in prenatal examinations at Etlik Lady Zübeyde Hospital between January 1, 2018, and December 31, 2019, women with polyhydramnios of nonfetal-placental origin manifesting in the third trimester were retrospectively reviewed. Women with normal 75-g oral glucose tolerance test results between 24 and 28 weeks gestation who met the inclusion criteria were enrolled in the study and divided into two groups based on the results of rescreening with the 75-g oral glucose tolerance test for polyhydramnios in the third trimester: women with isolated polyhydramnios (group 1) and women with late-onset polyhydramnios due to gestational diabetes mellitus (group 2). RESULTS: There were a total of 295 participants, of whom 35 (11.8%) were diagnosed with polyhydramnios due to late-onset gestational diabetes mellitus. There were no differences in the main outcomes. Birthweight and gestational age at birth were identified as independent risk factors for predicting composite maternal outcome {[odds ratio (OR)=1.273, 95% confidence interval (CI) 1.063-1.524, p=0.009]} and composite neonatal outcome (OR=0.606, CI 0.494-0.744, p<0.001), respectively. CONCLUSION: Polyhydramnios in late pregnancy without evidence of pregnancy-related causes leading to polyhydramnios may be a sign of late-onset gestational diabetes mellitus in women with a normal prior oral glucose tolerance test. As pregnancy outcomes and management were indifferent, it does not seem necessary or useful to diagnose whether or not late-onset gestational diabetes mellitus is present.

Enfermedades asociadas e indicadores metabólicos en personas con esquizofrenia / Associated Diseases and Metabolic Indicators in Schizophrenic Individuals

La esquizofrenia es una enfermedad que está caracterizada por su complejidad psicopatológica agravada por una frecuente asociación de enfermedades físicas como la obesidad, la intolerancia a la glucosa, la diabetes y la dislipidemia. Además, indicadores metabólicos como la glucemia, el colesterol y los triglicéridos en sangre, así como la obesidad, tienen relevancia en estos pacientes, según lo planteado en la literatura especializada sobre el tema. Por otra parte, las enfermedades físicas asociadas como los indicadores metabólicos, tienen su impacto en el sistema nervioso central con independencia de la esquizofrenia. La suma de los trastornos mentales y físicos implica la necesidad de atender ambos problemas simultáneamente y se recomienda la intervención interdisciplinaria. El protocolo de actuación para la atención de los pacientes con esquizofrenia y psicosis relacionadas en el Hospital Clínico Quirúrgico Hermanos Ameijeiras es un ejemplo del abordaje señalado(AU)

Schizophrenia is a disease characterized by a psychopathological complexity, aggravated by frequent association of physical diseases such as obesity, glucose intolerance, diabetes and dyslipidemia. In addition, there are other metabolic indicators such as blood glucose, cholesterol and triglycerides which are relevant in these patients, and the international literature has been suggested so. On the other hand, both associated physical diseases and metabolic indicators have their impact on the central nervous system in addition to schizophrenia. The sum of mental and physical disorders implies the need to address both problems simultaneously, which is why interdisciplinary intervention is recommended. Hermanos Ameijeiras Clinical Surgical Hospital is an example of the action protocol for patients with schizophrenia and psychosis(AU)

USPSTF and ISPAD Guidelines on Screening for Prediabetes and Type 2 Diabetes in Children and Adolescents

The rising trends of obesity, metabolic syndrome and diabetes in adults are worrisome globally. The majority of antecedents to adult noncommunicable diseases begin in childhood. Type 2 diabetes is recognized as one of the major diseases that contribute to the NCD burden in childhood. Recently, the US Preventive Services Task Force (USPSTF) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) released their guidelines on diagnosis and management of prediabetes and diabetes in children targeted screening for youth-onset type 2 diabetes is suggested in at-risk children (obese, positive family history of type 2 diabetes, etc.), while the role of screening asymptomatic children is not substantiated. Obesity and insulin resistance are important risk factors for type 2 diabetes. The cutoffs of fasting plasma glucose for the diagnosis of prediabetes and diabetes are >100 to 125 and ?126 mg/dL, respectively. This update briefly summarizes the recommendations on screening for youth-onset prediabetes and type 2 diabetes.

Prevalence of Undiagnosed Diabetes and Impaired Glucose Tolerance in a Semi-urban Population from Calicut City

Though the prevalence of Diabetes is increasing worldwide, a thorough knowledge of the prevalence of undiagnosed Diabetes a pre-diabetes is lacking. This study from India is to evaluate the prevalence of asymptomatic diabetes among adults with comorbidities and without any history of Diabetes. Prevalence of asymptomatic individuals with Diabetes and impaired glucose tolerancewas 3% and 15%, respectively. The high prevalence found in the study raises concern over the health care indices and the need for urgent public health action to control the pandemic. Regular screening for Diabetes in adults is required to prevent complications of long-term diabetes

The chemical constituents and hypoglycemic activity of alcoholic extract of sea buckthorn leaves / 药学学报

The purpose of this research is to identify the chemical constituents of sea buckthorn leaves extract (SBLE) and explore its hypoglycemic biological activity. SBLE was prepared by hot reflux extraction with 65% ethanol, and its chemical composition was analyzed by ultra-high-performance liquid chromatography-photodiode array-mass spectrometry/mass spectrometry (UHPLC-PDA-MS/MS) system. The animal experiments were compliant with ethical principles for animal use and had been approved by the Animal Experiment Ethics Committee of Jinan University. Mice were injected with streptozocin (STZ) to establish a hyperglycemic animal model, and SBLE (1.5 g·kg-1) was administered by gavage for 5 weeks. The fasting blood glucose (FBG) and oral glucose tolerance were detected. Normal mice were given SBLE (1.5 g·kg-1) by intragastric administration for 10 days, and blood was collected from the tail vein to detect the changes in blood glucose within 120 min after sucrose or starch loading. The mucous membrane of the small intestine of mice was taken to detect the activity of α-glucosidase (AG), and the activity of yeast-derived AG incubated with SBLE was evaluated. The glucose uptake by Caco-2 cells treated with SBLE was detected by fluorescence microscopy and cytometry, and the gene expression of sodium-dependent glucose transporter 1 (SGLT1) and glucose transporter 2 (GLUT2) in Caco-2 cells were detected by real-time quantitative PCR (qPCR). A total of 18 compounds were identified, mainly including tannins and flavonoids. SBLE reduced FBG and increased oral glucose tolerance in STZ hyperglycemic mice. SBLE effectively inhibited the increase of blood glucose caused by starch intake in normal mice. SBLE exerted good inhibitory activity on yeast-derived AG (IC50 = 16.94 μg·mL-1) and small intestinal mucosa AG with an inhibition rate of 15.48%. SBLE (25-100 μg·mL-1) dose-dependently inhibited glucose uptake by Caco-2 cells, and SBLE significantly reduced the mRNA level of SGLT1 without changing the expression of GLUT2. In conclusion, the UHPLC characteristic fingerprint of SBLE is established with 18 chemical components identified by mass spectrometry, and SBLE exerts hypoglycemic effect by inhibiting the activity of AG and the absorption of glucose by intestinal epithelial cells.

Serum SHBG level in male adults with different glucose tolerance and its correlation with lipid metabolism and visceral fat area / 中国糖尿病杂志

Objective To investigate the correlation between sex hormone-binding globulin(SHBG)and lipid metabolism and visceral fat area(VFA)in male adults with different glucose tolerance.Methods A total of 473 male subjects were enrolled from the outpatient clinic and ward in PLA NO.903 Hospital from January 2018 to December 2020.All the subjects were divided into three groups according to OGTT results:normal glucose tolerance group(NGT,n=179),impaired glucose regulation group(IGR,n=90)and newly diagnosed type 2 diabetes mellitus group(T2DM,n=204).Serum SHBG level,abdominal visceral fat area(VFA)and biochemical indexes were compared among the three groups.Results Compared with NGT group,WC,WHR,BMI,HbA1c,FPG,2 hPG,2 hIns,TG and VFA were increased(P＜0.05),while SHBG was decreased(P＜0.05)in IGR group.WC,SBP,DBP,HbA1c,FPG,2 hPG,2 hIns,HOMA-IR,TG,FFA,VFA and VFA/SFA were increased,while HOMA-β,SHBG were decreased(P＜0.05)in T2DM group.Compared with IGR group,SBP,HbA1c,FPG,2 hPG,2 hIns and HOMA-IR were increased,HOMA-β was decreased in T2DM group(P＜0.05).Pearson correlation analysis showed that SHBG was positively correlated with HDL-C(P＜0.01),but was negatively correlated with WC,WHR,BMI,2 hIns,SUA,TG,VFA and SFA(P＜0.05 or P＜0.01).Multivariable linear regression analysis showed that HDL-C,TG and VFA were the influencing factors for SHBG.Conclusion Serum SHBG is closely related to abdominal obesity and lipid metabolism.Increasing the level of SHBG can reduce visceral fat accumulation and improve IR.

Characteristics of the oral glucose tolerance test in women with different pre-pregnancy body mass index and the effect of gestational diabetes mellitus on twin pregnancy outcomes

Abstract Objective This study aimed to investigate the mid-pregnancy blood glucose levels of women with singleton or twin pregnancies. Method The relationship between blood glucose levels and Gestational Diabetes Mellitus (GDM) was studied in women with different pre-pregnancy Body Mass Index (BMI), and the effect of GDM on twin pregnancy outcomes was analyzed. Women with twin (n= 1,985) and singleton (n= 1,985) pregnancies were categorized into underweight (BMI < 18.5 kg/m2, n= 597), normal weight (BMI: 18.5-23.9 kg/m2, n= 2,575), and overweight/obese (BMI ≥ 24 kg/m2, n= 798) groups. Results The incidence of GDM was 21.01% in women with twin pregnancies. Among the women with GDM in twin pregnancies, 38.37% had at least two abnormal blood glucose levels. The incidence of these parameters increased with preconception BMI, and the incidence of twin pregnancies was higher than that of singleton pregnancies (p < 0.001). In the normal weight and overweight/obese group, the oral glucose tolerance test glucose level and incidence of GDM were higher in women with twin than singleton pregnancies (p < 0.05). For twin pregnancies, the prevalence of selective fetal growth restriction was higher and anemia was lower in the GDM group than in the non-GDM group (all p < 0.05). Conclusion Therefore, a greater emphasis should be placed on BMI before conception, and well-controlled GDM does not increase adverse pregnancy outcomes for twin pregnancies.

Actualización en fibrosis quística: diabetes relacionada a fibrosis quística en la era de los moduladores del regulador de transmembrana de fibrosis quística (CFTR) / Update on cystic fibrosis/cystic fibrosis related diabete in the era of transmembrane regulator in cystic fibrosis (CFTR)

Las disglicemias, objetivadas en el test de tolerancia a la glucosa de 2 horas y en el monitoreo continuo de glicemia, son el factor de riesgo principal para el desarrollo de la diabetes relacionada a fibrosis quística (FQ) (DRFQ), la que constituiría la etapa final de un continuo de alteraciones del metabolismo de la glucosa en los pacientes con FQ. Estas disglicemias se deben tanto al daño directo de las células de los islotes pancreáticos productores de insulina, como al aumento de la resistencia a la insulina asociada al estado inflamatorio sistémico de la FQ. El uso cada vez más precoz de los moduladores del CFTR debiera contribuir a evitar el desarrollo de DRFQ y sus complicaciones. La siguiente revisión se enfoca en los efectos de los moduladores del CFTR en la tolerancia a la glucosa en pacientes con FQ.

Dysglycemia, observed in the 2-hour glucose tolerance test and in the continuous monitoring of glycemia, are the main risk factor for the development of diabetes related to cystic fibrosis (CF), which constitutes the final stage of a continuum of impaired glucose metabolism in people with CF. These dysglycemias are due both to direct damage to insulin-producing pancreatic islet cells, and to increased insulin resistance associated with the systemic inflammatory state of CF. The increasingly early use of CFTR modulators should help prevent the development of CRFD and its complications. The following review focuses on the effects of regulador de transmembrana de fibrosis quística (CFTR) modulators on glucose tolerance in people with CF.

Ghrelin and glucagon-like peptide-1 according to body adiposity and glucose homeostasis

ABSTRACT Objective: We investigated the biological behavior of ghrelin and glucagon-like peptide-1 (GLP-1) after a standard liquid meal according to body adiposity and glucose homeostasis. Subjects and methods: This cross-sectional study included 41 individuals (92.7% women; aged 38.3 ± 7.8 years; BMI 32.2 ± 5.5 kg/m²) allocated into three groups according to body adiposity and glucose homeostasis, as follows: normoglycemic eutrophic controls (CON, n = 11), normoglycemic with obesity (NOB, n = 15), and dysglycemic with obesity (DOB, n = 15). They were tested at fasting and 30 and 60 min after the ingestion of a standard liquid meal in which we measured active ghrelin, active GLP-1, insulin, and plasma glucose levels. Results: As expected, DOB exhibited the worst metabolic status (glucose, insulin, HOMA-IR, HbA1c) and an inflammatory status (TNF-α) at fasting, besides a more significant increase in glucose than postprandial NOB (p ≤ 0.05). At fasting, no differences between groups were detected in lipid profile, ghrelin, and GLP-1 (p ≥ 0.06). After the standard meal, all groups exhibited a reduction in ghrelin levels between fasting vs. 60 min (p ≤ 0.02). Additionally, we noticed that GLP-1 and insulin increased equally in all groups after the standard meal (fasting vs. 30 and 60 min). Although glucose levels increased in all groups after meal intake, these changes were significantly more significant in DOB vs. CON and NOB at 30 and 60 min post-meal (p ≤ 0.05). Conclusions: Time course of ghrelin and GLP-1 levels during the postprandial period was not influenced by body adiposity or glucose homeostasis. Similar behaviors occurred in controls and patients with obesity, independently of glucose homeostasis.

Prevalencia de hiperinsulinismo patológico post carga de glucosa y su relación con factores de riesgo cardiovascular, en adultos no diabéticos con insulinemia basal normal / Prevalence of pathologic hyperinsulinism after a glucose load charge: its relation to cardiovascular risk factors

Introducción: 25% de personas con hiperinsulinismo desarrolla diabetes 3-5 años luego del primer diagnóstico y 70% lo hará en el resto de la vida. Intervenir los niveles de glicemia desde que se detecta hiperinsulinemia evita la progresión a diabetes y restaura el metabolismo glicémico. Objetivos: Determinar la prevalencia de hiperinsulinismo patológico post-carga de glucosa (HPPG) y su relación con factores de riesgo cardiovascular en adultos 100 UI/ml a las 2 horas), sexo, hipertensión arterial, dislipidemia, malnutrición por exceso, sedentarismo, tabaquismo, ateromatosis e infarto miocárdico documentado. Con STATA 17 se calculó la prevalencia de variables en población general y según categoría de HPPG y se evaluó la significancia con prueba exacta de Fisher. Se compararon medias con ANOVA y t-test con nivel de significancia <0,05. Se usó regresión binomial para estimar Razón de Prevalencia e intervalos de confianza en variables cuantitativas y cualitativas. Resultados: la prevalencia de HPPG fue 41%. La edad promedio 37,5 años, el sexo masculino 52,9%, la hipertensión-arterial 40,5% y la dislipidemia 74,4%. Al comparar las poblaciones con y sin HPPG existieron diferencia estadísticamente significativa en las variables dislipidemia, hipertensión-arterial, malnutrición por exceso y sexo-masculino. La razón de prevalencia alcanzó a un 62%, 37%, 59% y 20% respectivamente. Conclusión: Se encontró una alta prevalencia de HPPG. Los factores de riesgo asociados a ella fueron dislipidemia, hipertensión arterial, malnutrición por exceso y sexo masculino. Esto sugiere que encontrar HPPG puede ser de utilidad para detectar precozmente a la población con un mayor riesgo de enfermedad cardiovascular.

Introduction: 25% of people with hyperinsulinism develop diabetes 3-5 years after the first diagnosis and 70% will do so in the rest of their lives. To control glycemia levels as soon as hyperinsulinemia is detected, progression to diabetes is prevented and glycemic metabolism is restored. Aim: To determine the prevalence of post-glucose load pathological hyperinsulinism (HPPG) and its relationship with cardiovascular risk factors in adults 100 uIU/ ml at 2 hours), sex, hypertension, dyslipidemia, excess malnutrition due to, sedentary lifestyle, smoking, documented atheromatosis and myocardial infarction. The prevalence of variables in the general population was calculated and, in relation to the HPPG category, significance is evaluated with Fisher's exact test. Finally means are compared with ANOVA and t-test. With significance level <0.05. Binomial regression was used to estimate the prevalence ratio and confidence intervals in quantitative and qualitative variables. Statistical analysis was performed with the STATA 17 software. Results: HPPG prevalence was 41%, mean age 37.5 years, male sex 52.9%, arterial hypertension 40.5% and dyslipidemia 74.4%. Un relation to the presence of HPPG a statistically significant difference in the variables dyslipidemia, arterial hypertension, malnutrition due to excess and male sex was found. The prevalence ratios were 62%, 37%, 59% and 20%, respectively. Conclusion: A high prevalence of HPPG was found. Risk factors associated to HPPG were dyslipidemia, arterial hypertension, malnutrition due to excess and male sex. Thus, HPPG can play a role in the early detection of a higher risk of cardiovascular disease in the general population.

Validity and reliability of simple surrogate indexes to evaluate beta-cell function and insulin sensitivity

BACKGROUND: Simple surrogate indexes (SSI) to assess beta-cell function, insulin sensitivity (IS) and insulin resistance (IR) are an easy and economic tool used in clinical practice to identify glucose metabolism disturbances. AIM: To evaluate the validity and reliability of SSI that estimate beta-cell function, IS and IR using as a reference the parameters obtained from the frequently sampled intravenous glucose tolerance test (FSIVGTT). MATERIAL AND METHODS: We included 62 subjects aged 20-45 years, with a normal body mass index and without diabetes or prediabetes. SSI were compared with the acute insulin response to glucose (AIRg), insulin sensitivity index (Si) and disposition index (DI) obtained from the FSIVGTT using the minimal model approach. Half of the participants (n = 31) were randomly selected for a second visit two weeks later to evaluate the reliability of all the variables. RESULTS: HOMA1-%B and HOMA2-%B had a significant correlation with AIRg (Spearman Rho (rs) = 0.33 and 0.37 respectively, p 0.50) with Si were fasting insulin, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI, and the McAuley index. The parameters that showed good reliability with an intraclass correlation coefficient (ICC) > 0.75 were AIRg, HOMA1-%S, HOMA2-%S, and QUICKI. Conclusions: Our results suggest that most of the SSI are useful and reliable.

ANTECEDENTES: Los índices simples subrogados (ISS) que evalúan la función de célula beta, sensibilidad a la insulina (SI) y resistencia a la insulina (RI) son herramientas sencillas y económicas que se usan en la práctica clínica para identificar alteraciones del metabolismo de la glucosa. OBJETIVO: Evaluar la validez y confiabilidad de ISS para estimar la función de célula beta, SI y RI usando como referencia los parámetros de la prueba de tolerancia a la glucosa intravenosa con muestreo frecuente (FSIVGTT). MATERIAL Y MÉTODOS: Se incluyeron 62 sujetos de 20-45 años, con índice de masa corporal normal y sin diabetes mellitus o prediabetes. Los ISS se compararon con la respuesta aguda de la insulina a la glucosa (AIRg), índice de sensibilidad a la insulina (Si) e índice de disposición (DI) obtenidos de la FSIVGTT en base al modelo mínimo. La mitad de los participantes (n = 31) se seleccionaron aleatoriamente para acudir dos semanas después y evaluar la confiabilidad de todas las variables. RESULTADOS: HOMA1-%B y HOMA2-%B presentaron una correlación significativa con AIRg (Rho de Spearman (rs) = 0,33 and 0,37, respectivamente, p 0,50) con Si fueron insulina en ayuno, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI y el índice de McAuley. Los parámetros que tuvieron buena confiabilidad (coeficiente de correlación intraclase > 0,75) fueron AIRg, HOMA1-%S, HOMA2-%S y QUICKI. Conclusiones: La mayoría de los ISS son instrumentos útiles y confiables.

Evaluation of high levels of sports activity and the beneficial effect on postprandial blood glucose profiles / Avaliação dos altos níveis de atividade esportiva e o efeito benéfico nos perfis de glicemia pós-prandial / Evaluación de los niveles elevados de actividad deportiva y el efecto positivo en los perfiles de glucemia postprandial

ABSTRACT Introduction: Hyperglycemia is the principal characteristic component of type 2 diabetes. High blood glucose concentrations for long periods can be countered with postprandial exercise by increasing glucose retention involuntary muscles. However, no research is present on the relationship between exercise time and glucose levels. Objective: This study evaluates the relationship between sports activity and postprandial glycemia levels. Methodology: Forty-five individuals were included in the study, 10 males and 35 females with an age of 27.11±2.8 years; a body fat percentage of 25.02% ±5.04%; and a body mass index of 22.74±4.55 kg/m2. Participants were included via WhatsApp for daily information on postprandial activity levels. WhatsApp messages were forwarded to a total of 2,500 people at different colleges and universities. Out of the total 60 active people (2.40%) who responded, 45 individuals participated in the study. They were divided into three categories based on self-reported postprandial activity: not very active (15), quite active (15), highly active (15). All active individuals completed an oral glucose intake test with blood samples obtained for evaluation at 15, 30, 45, 60, 90, and 120 minutes post-rest. On a gender basis, the groups could not be associated (P =.057). Results: All active groups showed a remarkable effect on blood glucose level at one hour (P =.031). A mean increase in blood glucose level in the first hour of 1.50 mmol/L was observed for every extra 1.0 mmol/L of standard glycemic amount, on average, women had a higher blood glucose amount of 1.35 mmol/L than men. Conclusion: It can be concluded that a high amount of postprandial activity generates a good outcome on glycemic parameters. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução: A hiperglicemia é o principal componente característico na diabetes tipo 2. Altas concentrações de glicose por longos períodos podem ser combatidas com o exercício pós-prandial, aumentando a retenção de glicose nos músculos voluntários. Porém, ainda não há estudos sobre a relação entre o tempo de exercício e os níveis de glicose. Objetivo: Este estudo tem como objetivo avaliar a relação entre a atividade esportiva e os dados temporais de glicemia pós-prandial. Metodologia: Foram incluídos 45 indivíduos no estudo, sendo 10 do sexo masculino e 35 do sexo feminino com idade de 27,11± 2,8 anos; percentual de gordura corporal de 25,02% ±5,04%; e índice de massa corporal de 22,74±4,55 kg/m2. Os participantes foram incluídos via WhatsApp para obter informações diárias sobre os níveis de atividade pós-prandial. As mensagens de WhatsApp foram encaminhadas para um total de 2.500 pessoas em diferentes faculdades e universidades. No total de 60 pessoas ativas (2,40%) que responderam, participaram do estudo 45 indivíduos. Eles foram divididos em três categorias com base na atividade pós-prandial autorrelatada: pouco ativos (15), bastante ativos (15), altamente ativos (15). Todos os indivíduos ativos finalizaram um teste de ingestão de glicose oral com amostras de sangue obtidas para avaliação em 15, 30, 45, 60, 90 e 120 minutos pós-repouso. Na base de gênero, os grupos não puderam ser associados (P =.057). Resultados: Todos os grupos ativos revelaram um efeito notável do nível de glicose no sangue em uma hora (P =.031). Foi observado um aumento médio no nível de glicemia na primeira hora de 1,50 mmol/L para cada 1,0 mmol/L extra de quantidade glicêmica padrão, em média, as mulheres tiveram uma quantidade glicêmica no sangue de 1,35 mmol/L superior aos homens. Conclusão: Conclui-se que a alta quantidade de atividade pós-prandial gera um bom desfecho nos parâmetros glicêmicos. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: La hiperglucemia es el principal componente característico de la diabetes de tipo 2. Las concentraciones elevadas de glucosa durante largos periodos pueden combatirse con el ejercicio postprandial, aumentando la retención de glucosa en los músculos voluntarios. Sin embargo, todavía no hay estudios sobre la relación entre el tiempo de ejercicio y los niveles de glucosa. Objetivo: Este estudio pretende evaluar la relación entre la actividad deportiva y los datos de glicemia postprandial. Metodología: Se incluyeron 45 individuos en el estudio, siendo 10 hombres y 35 mujeres con una edad de 27,11±2,8 años; un porcentaje de grasa corporal de 25,02% ±5,04%; y un índice de masa corporal de 22,74±4,55 kg/m2. Se inscribió a los participantes a través de WhatsApp para obtener información diaria sobre los niveles de actividad postprandial. Se enviaron mensajes de WhatsApp a un total de 2.500 personas de diferentes colegios y universidades. Del total de 60 personas activas (2,40%) que respondieron, 45 individuos participaron en el estudio. Fueron divididos en tres categorías basadas en la actividad postprandial auto declarada: poco activos (15), bastante activos (15), muy activos (15). Todos los individuos activos completaron una prueba de ingesta de glucosa oral con muestras de sangre obtenidas para su evaluación a los 15, 30, 45, 60, 90 y 120 minutos después del reposo. En lo que respecta al género, los grupos no pudieron asociarse (P = 0,057). Resultados: Todos los grupos activos revelaron un efecto notable del nivel de glucosa en la sangre a una hora (P = 0,031). Se observó un aumento medio del nivel de glucosa en la sangre en la primera hora de 1,50 mmol/L por cada 1,0 mmol/L adicional de la cantidad de glucemia estándar; por término medio, las mujeres tuvieron una cantidad de glucosa en la sangre más alta de 1,35 mmol/L que los hombres. Conclusión: Se concluye que la elevada actividad postprandial genera un buen resultado en los parámetros glucémicos. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

COMPARISION OF DIAGNOSTIC ACCURACY OF NON – FASTING DIPSI AND HBAIC WITH FASTING WHO CRITERIA FOR DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS

Background Gestational Diabetes Mellitus [GDM] is de?ned as Carbohydrate intolerance with recognition or onset during pregnancy and resolves postpartum. Prevalence of GDM in India varies from 3.8 - 21% with different demography and diagnostic methods used. As early diagnosis and control of maternal hyperglycaemia plays a vital role in prevention of adverse outcomes, universal screening is almost mandatory due to high prevalence, we need a simple economical, feasible test with higher sensitivity to diagnose GDM. To compare diagnostic accuracy of two non- Aim fasting tests DIPSI & HBAIC and fasting WHO criteria for diagnosis of GDM. To compare DIPSI with WHO criteria as Objectives standard. To compare HBA1C with WHO criteria as standard This study was done on 100 ANC cases to compare Results: diagnostic accuracy of DIPSI & HBAIC with fasting World Health Organization Glucose Tolerance Test. Mean age of participants was 27.18±4.60 years. 39% patients were in age group of 21 to 25 years and 34% patients were in age group of 26 to 30 years. Majority (45%) of the patients were in gestational age of 26 to 30 weeks. In this study, gestational diabetes mellitus was diagnosed in 47 (47%) patients according to WHO GTT, in 48 (48%) patients according to DIPSI and in 34 (34%) patients according to Glycated Haemoglobin. Mean gestational age of patients during diagnosis of gestational diabetes mellitus was 29.21±2.84 weeks by DIPSI, 28.83±2.82 weeks by WHO GTT and 29.29±3.15 weeks by Glycated Haemoglobin. Mean blood sugar parameters of gestational diabetes mellitus women were 174.96±16.58 mg/dl by DIPSI, 173.21±17.58 mg/dl by WHO GTT and 9.41±1.91 gm% by Glycated Haemoglobin. The sensitivity of DIPSI with regard to WHO GTT was 89.36%, speci?city 88.68%, positive predictive value 87.50%, negative predictive value 90.38%, diagnostic accuracy 89.00% and chi square value of 60.78. These values convey that DIPSI is as good as gold standard WHO GTT criteria. The sensitivity of Glycated Haemoglobin with regard to WHO GTT was 51.06%, speci?city 81.13%, positive predictive value 70.59%, negative predictive value 65.15%, diagnostic accuracy 67.00% and chi square value of 11.51. These values convey that Glycated Haemoglobin is not as good as gold standard WHO GTT. Based on ?ndings from this study it can be concluded that DIPSI is Conclusions: equally as good as World Health Organization Glucose Tolerance Test criteria in diagnosing gestational diabetes mellitus in antenatal women of south India. Since DIPSI does not require fasting it is more feasible than World Health Organization criteria. Glycated haemoglobin estimation is another test to detect diabetes mellitus which does not require fasting however its results are not close to gold standard WHO criteria unlike DIPSI

Identification of Glucose and Insulin Patterns during A 5-H Glucose Tolerance Test and Association with Cardiometabolic Risk Factors

ABSTRACT Background: Insulin resistance is key in the pathogenesis of the metabolic syndrome and cardiovascular disease. Objective: We aimed to identify glucose and insulin patterns after a 5-h oral glucose tolerance test (OGTT) in individuals without diabetes and to explore cardiometabolic risk factors, beta-cell function, and insulin sensitivity in each pattern. Methods: We analyzed the 5-h OGTT in a tertiary healthcare center. We identified classes using latent class trajectory analysis and evaluated their association with cardiometabolic risk factors, beta-cell function, and insulin sensitivity surrogates by multinomial logistic regression analysis. Results: We included 1088 5-h OGTT performed between 2013 and 2020 and identified four classes. Class one was associated with normal insulin sensitivity and secretion. Class two showed hyperglycemia, dysinsulinism, and a high-risk cardiometabolic profile (obesity, hypertriglyceridemia, and low high-density lipoprotein [HDL] cholesterol). Class three included older individuals, a higher proportion of males, and a greater prevalence of hypertension, hyperglycemia, hyperinsulinemia, and postprandial hypoglycemia. Finally, class four showed hyperglycemia, dysinsulinism, and hyperinsulinemia; this class had the worst cardiometabolic profile (a high proportion of males, greater age, hypertension, obesity, hypertriglyceridemia, and low HDL cholesterol, p < 0.001 vs. other classes). Conclusions: The latent class analysis approach allows the identification of groups with an adverse cardiometabolic risk factor, and who might benefit from frequent follow-ups and timely multidisciplinary interventions.

The effects of macronutrients composition on hormones and substrates during a meal tolerance test in drug-naive and sitagliptin-treated individuals with type 2 diabetes: a randomized crossover study

ABSTRACT Objectives: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Materials and methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543

Association of low total testosterone levels and impaired blood glucose levels in middle aged men – A cross-sectional study

Background: Recent studies have shown that men with impaired glucose levels (pre-diabetes)/diabetes have lower serum total testosterone (TT) levels as compared to normoglycemic men. India has a high incidence and prevalence of diabetes mellitus (DM)/pre-diabetes in the middle aged population too. Most studies have researched about the serum TT levels in elderly pre-diabetic/diabetic men, but there is lack of information about such association in middle aged men. Aims and Objectives: These objectives of this study are to study the levels of serum TT in middle aged men with DM/pre-diabetes; to compare the serum TT levels in men with DM/ pre-diabetes with normoglycemic men; and to observe the correlation between fasting blood glucose (FBG) and serum TT, body mass index (BMI), and waist circumference (WC). Materials and Methods: It is a cross-sectional, observational study. The study subjects were 150 nonsmoking, nontobacco addict, and nonalcoholic men aged between 31 and 60 years. Anthropometric measurements, serum FBG levels, and serum TT were measured. Results: The pre-diabetic and diabetic men had significantly low levels of serum TT as compared to non-diabetic men. Furthermore, serum TT levels correlated negatively with WC, BMI and blood sugar levels, but significant correlation was found only in the case of WC. Conclusion: Low serum TT levels are associated with pre-diabetes as well as diabetes. Whether the association is casual or not requires prospective study.

Impaired glucose tolerance in dengue fever: A case-control study

Background: Studies on dengue fever demonstrated that the dengue viral infection of pancreas is often associated with disease morbidity and complication. Aims and Objectives: The pancreas-pathogen interactions in dengue-infected persons were evaluated using endocrine deregulation as an investigation marker of complication. Materials and Methods: A prospective observational study was conducted in a tertiary care medical college and hospital of West Bengal, over 1 year and 4 months. Blood samples from 286 cases and 258 controls were collected on day 2. After plasma glucose determination, 44 cases and 39 controls were excluded as frank cases of diabetes mellitus. On day 6, fasting and 2 h postprandial plasma glucose estimation were done in 73 cases and 61 controls by glucose oxidase-peroxidase method using autoanalyzer. Data were analyzed using the Statistical Package for the Social Sciences version 20.0. Results: The prevalence of impaired glucose tolerance was higher in cases on day 2 than on follow-up on day 6 (12.3% vs. 8%). There existed no statistical difference in terms of fasting plasma glucose between cases and control on day 2 and day 6 and postprandial (PP) plasma glucose on day 2. However, the PP values on day 6 in cases were significantly higher in cases in comparison to controls (P = 0.006). Among cases, day 6 values were higher than day 2 values (0.016). Conclusion: Dengue viral infection correlates with the involvement of the pancreas in terms of impaired tolerance to glucose which has implications for understanding disease pathogenesis in terms of developing chronic complications.