Predicting heart failure events in patients with coronary heart disease and impaired glucose tolerance: Insights from the Acarbose Cardiovascular Evaluation (ACE) trial.

AIMS: Heart failure is a fatal complication of type 2 diabetes but little is known about its incidence in people with impaired glucose tolerance (IGT). We used Acarbose Cardiovascular Evaluation (ACE) trial data to identify predictors of hospitalisation for heart failure (hHF) or cardiovascular (CV) death in patients with coronary heart disease (CHD) and IGT randomised to acarbose or placebo. METHODS: Independent hHF/CV death risk factors were determined using Cox proportional hazards models, with participants censored at first hHF event, CV death, or end of follow-up. RESULTS: During median 5-year follow-up, the composite outcome of hHF/CV death occurred in 393 (6.0%) participants. Significant hHF/CV death multivariate predictors were higher age and plasma creatinine, and prior heart failure (HF), myocardial infarction (MI), atrial fibrillation (AF) and stroke. Acarbose, compared with placebo, did not reduce hHF/CV death (hazard ratio [HR] 0.89, 95% CI 0.64-1.24, P = 0.48) or hHF (HR 0.90, 95% CI 0.74-1.10, P = 0.32). CONCLUSIONS: Patients with CHD and IGT at greater risk of hHF/CV death were older with higher plasma creatinine, prior HF, MI, AF or stroke. Addition of acarbose to optimised CV therapy to reduce post-prandial glucose excursions did not reduce the risk of hHF/CV death or hHF. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, number NCT00829660, and the International Standard Randomised Controlled Trial Number registry, number ISRCTN91899513.

Impact of Acarbose on Incident Diabetes and Regression to Normoglycemia in People With Coronary Heart Disease and Impaired Glucose Tolerance: Insights From the ACE Trial.

OBJECTIVE: We examined the impact of acarbose, an α-glucosidase inhibitor, on incident diabetes and regression to normoglycemia in 6,522 Acarbose Cardiovascular Evaluation (ACE) trial participants in China who had impaired glucose tolerance (IGT) and coronary heart disease (CHD). RESEARCH DESIGN AND METHODS: Participants were randomly assigned to acarbose or placebo and followed with four monthly fasting plasma glucose (FPG) tests and annual oral glucose tolerance tests. Incident diabetes was defined as two successive diagnostic FPG levels ≥7 mmol/L or 2-h plasma glucose (PG) levels ≥11.1 mmol/L while taking study medication or a masked adjudicated confirmation of this diagnosis. Regression to normoglycemia was defined as FPG <6.1 mmol/L and 2-h PG <7.8 mmol/L. Intention-to-treat and on-treatment analyses were conducted using Poisson regression models, overall and for subgroups (age, sex, CHD type, HbA1c, FPG, 2-h PG, BMI, estimated glomerular filtration rate, for IGT alone, for IGT + impaired fasting glucose, and for use of thiazides, ACE inhibitors [ACEis]/angiotensin receptor blockers [ARBs], ß-blockers, calcium channel blockers, or statins). RESULTS: Incident diabetes was less frequent with acarbose compared with placebo (3.2 and 3.8 per 100 person-years, respectively; rate ratio 0.82 [95% CI 0.71, 0.94], P = 0.005), with no evidence of differential effects within the predefined subgroups after accounting for multiple testing. Regression to normoglycemia occurred more frequently in those randomized to acarbose compared with placebo (16.3 and 14.1 per 100 person-years, respectively; 1.16 [1.08, 1.25], P < 0.0001). This effect was greater in participants not taking an ACEi or ARB (1.36 [1.21, 1.53], P interaction = 0.0006). The likelihood of remaining in normoglycemic regression did not differ between the acarbose and placebo groups (P = 0.41). CONCLUSIONS: Acarbose reduced the incidence of diabetes and promoted regression to normoglycemia in Chinese people with IGT and CHD.

Coffee Consumption, Genetic Polymorphisms, and the Risk of Type 2 Diabetes Mellitus: A Pooled Analysis of Four Prospective Cohort Studies.

The association between coffee consumption and the risk of type 2 diabetes may vary by genetic variants. Our study addresses the question of whether the incidence of type 2 diabetes is related to the consumption of coffee and whether this relationship is modified by polymorphisms related to type 2 diabetes. We performed a pooled analysis of four Korean prospective studies that included 71,527 participants; median follow-up periods ranged between 2 and 13 years. All participants had completed a validated food-frequency questionnaire (FFQ) at baseline. The odds ratios (ORs) and 95% confidence intervals (CIs) for type 2 diabetes were calculated using logistic regression models. The ORs were combined using a fixed or random effects model depending on the heterogeneity across the studies. Compared with 0 to <0.5 cups/day of coffee consumption, the OR for type 2 diabetes was 0.89 (95% CI: 0.80-0.98, p for trend = 0.01) for ≥3 cups/day of coffee consumption. We did not observe significant interactions by five single nucleotide polymorphisms (SNPs) related to type 2 diabetes (CDKAL1 rs7756992, CDKN2A/B rs10811661, KCNJ11 rs5215, KCNQ1 rs163184, and PEPD rs3786897) in the association between coffee and the risk of type 2 diabetes. We found that coffee consumption was inversely associated with the risk of type 2 diabetes.

Vitamin D deficiency in the aetiology of obesity-related insulin resistance.

The obese insulin-resistant state is often associated with low circulating concentration of vitamin D 25-hydroxyvitamin D3 [25(OH)D3 ]. Fat sequestration of vitamin D in the expanded obese adipose tissue mass has been pointed out as a plausible explanation for this circulating vitamin D deficiency. However, the putative mechanisms behind this hypovitaminosis D remain to be elucidated. The presence of vitamin D receptor and vitamin D-metabolizing enzymes in insulin-sensitive organs suggests that vitamin D may be involved in glucose and lipid metabolism and may be related to insulin sensitivity. Indeed, mainly in vitro studies support a role of vitamin D in regulating glucose and lipid metabolism in several insulin-sensitive tissues including adipose tissue, skeletal muscle, liver, as well as pancreatic insulin secretion. A potential role of vitamin D in gut barrier function and metabolism has also been suggested. This review summarizes recent knowledge on vitamin D deficiency in the aetiology of obesity-related insulin resistance and discusses potential underlying mechanisms. Finally, the role of vitamin D supplementation on insulin sensitivity and glycaemic control is discussed.

Prevalence of vitamin B12 deficiency in South Indians with different grades of glucose tolerance.

AIMS: To determine the prevalence of vitamin B12 deficiency in an urban south Indian population in individuals with different grades of glucose tolerance. METHODS: A total of 1500 individuals [900 normal glucose tolerance (NGT), 300 prediabetes and 300 type 2 diabetes (T2DM)] who were not on vitamin B12 supplementation were randomly selected from the Chennai Urban Rural Epidemiological Study (CURES) follow-up study. Anthropometric, clinical and biochemical investigations, which included vitamin B12, insulin, homocysteine, HbA1c and serum lipids, were measured. Vitamin B12 ≤ 191 pg/ml was defined as absolute vitamin B12 deficiency and vitamin B12 > 191 pg/ml and ≤ 350 pg/ml as borderline deficiency. RESULTS: The mean levels of vitamin B12 significantly decreased with increasing degrees of glucose tolerance (NGT 444 ± 368; prediabetes 409 ± 246; T2DM 389 ± 211 pg/ml, p = 0.021). The prevalence of absolute vitamin B12 deficiency was 14.9% while 37.6% had borderline deficiency. The prevalence of absolute vitamin B12 deficiency was significantly higher among individuals with T2DM (18.7%) followed by prediabetes (15%) and NGT(13.7%) [p for trend = 0.05]. The prevalence of vitamin B12 significantly increased with age (p < 0.05) and in those with abdominal obesity (p < 0.001). Men and vegetarians had twice the risk of vitamin B12 deficiency compared to women and non-vegetarians, respectively. Among individuals with NGT, prediabetes and T2DM, vitamin B12 negatively correlated with homocysteine. CONCLUSION: This study reports that the levels of vitamin B12 decreased with increasing severity of glucose tolerance.

The effect of different forms of dysglycemia during pregnancy on maternal and fetal outcomes in treated women and comparison with large cohort studies.

AIMS OF THE STUDY: We describe the impact of different forms of dysglycemia on maternal and neonatal health. This research is a part of the PEARL-Peristat Maternal and newborn registry, funded by Qatar National Research Fund (QNRF) Doha, Qatar. METHODS: A population-based retrospective data analysis of 12,255 women with singleton pregnancies screened during the year 2016-2017, of which 3,027 women were identified with gestation diabetes mellitus (GDM) during pregnancy and 233 were diabetic before pregnancy. Data on maternal outcome was collected from the PEARL-Peristat Maternal and newborn registry. RESULTS: The prevalence of GDM and diabetes mellitus (DM) was 24.7 % and 1.9%, respectively. 55% of DM, 38% of GDM and 25.6% of controls were obese (p<0.001). 71% of pregnant women with DM and 57.8% of those with GDM were older than 30 years versus 44.2% of controls. Pregnant women with DM or GDM had higher prevalence of hypertension versus normal controls (9.9%, 5.5% and 3.5%, respectively; p<0.001). Among women with vaginal deliveries, the proportion of women with induction of labor was significantly higher in the DM and GDM compared to control subjects (33.9%, 26.5% and 12.4%, respectively; p<0.001). The number of women who underwent Cesarean section was significantly higher in the DM and GDM groups versus normal controls (51.9%, 36.8%, and 28.5%, respectively; p<0.001).  Preterm delivery was significantly higher in women with DM and GDM (13.7% and 9%, respectively versus normal women (6.4%); p<0.001). Babies of DM and GDM had significantly higher occurrence of respiratory distress (RDS) or transient tachypnea (TTS): 9% and 5.8 % versus normal controls (4.8%). Macrosomia was more prevalent in babies of DM (6.4%) and GDM (6.8%) compared to controls (5%) (p: <0.001). Significant hypoglycemic episodes occurred more frequently in babies of DM and GDM women (11.2% and 3%, respectively) versus controls (0.6%) (p: <0.001. Infants of DM and GDM mothers required more treatments of phototherapy (9.4% and 8.9%, respectively) versus those born to normal women (7.2%) (p: 0.006). The prevalence of congenital anomalies and neonatal death did not differ between the groups. CONCLUSIONS: Despite the improvement in the prenatal diagnosis and management of dysglycemia, there is still a higher prevalence of prematurity, macrosomia, and hypoglycemia in infants of mothers with DM and GDM. Measurements to reduce obesity and control dysglycemia in women during the childbearing period are highly required to prevent the still higher morbidity during pregnancy.

Impact of dietary fat composition on prediabetes: a 12-year follow-up study.

OBJECTIVE: Dietary fatty acid composition likely affects prediabetic conditions such as isolated impaired fasting glucose (IFG) or impaired glucose tolerance (IGT); however, this risk has not been evaluated in a large population nor has it been followed prospectively. DESIGN: Diet, physical activity, anthropometric, socio-economic and blood glucose data from the Atherosclerosis Risk in Communities (ARIC) study were obtained from BioLINCC. Cox proportional hazards regression models were used to evaluate associations of dietary SFA, MUFA, PUFA, n-3 fatty acid (FA) and n-6 FA intakes with incidence of one (isolated IFG) or two (IFG with IGT) prediabetic conditions at the end of 12-year follow-up. SETTING: Study volunteers were from counties in North Carolina, Mississippi, Minnesota and Maryland, USA. SUBJECTS: Data from 5288 volunteers who participated in the ARIC study were used for all analyses reported herein. RESULTS: The study population was 62% male and 84 % white, mean age 53·5 (sd 5·7) years and mean BMI 26·2 (sd 4·6) kg/m2. A moderately high intake of dietary MUFA (10-15 % of total daily energy) was associated with a 10 % reduced risk of isolated IFG incidence, while a high intake of n-3 FA (>0·15 % of total daily energy) was associated with a 10 % increase in risk. Curiously, moderately high intake of n-6 PUFA (4-5 % of total daily energy) was associated with a 12 % reduction in IFG and IGT incidence. CONCLUSIONS: MUFA, n-3 and n-6 FA contribute differently to the development of isolated IFG v. IFG with IGT; and their mechanism may be more complex than originally proposed.

Supplemental iron intake and the risk of glucose intolerance in pregnancy: re-analysis of a randomised controlled trial in Finland.

Observational studies suggest that high iron intake during pregnancy is associated with the risk of gestational diabetes. As such studies are prone to bias, we re-analysed data from a randomised controlled trial of iron supplementation to see whether it supports the risk found in observational studies. The trial was conducted in primary health care setting in five municipalities in Finland in 1985-1986. The participants were 2944 women (95% of pregnant women in the area) who were randomly allocated either to (1) the selective iron group (elemental iron 50 mg twice a day only if diagnosed as anaemic, continuing until their haemoglobin increased to 110 g L(-1)) or (2) the routine iron group (elemental iron 100 mg day(-1) throughout the pregnancy regardless of haemoglobin level). The numbers of women in the analyses were 1358 and 1336, respectively. The main outcome measure was a composite variable including any glucose intolerance-related outcome (e.g. glucosuria, gestational diabetes, large-for-gestational-age child) in mothers' or children's patient records during pregnancy and post-partum. There were no statistically significant differences in the incidence of the primary outcome between the selective iron and the routine iron groups (13.0 vs. 11.0%, P = 0.12). The most common outcome was large-for-gestational-age calculated from children's hospital data (8.3 vs. 8.2%, P = 0.95). The results were mainly similar when stratified by the mothers' baseline haemoglobin level, body mass index or gestational weight gain. Routine iron supplementation throughout pregnancy did not increase the risk of glucose intolerance during pregnancy. The results need to be confirmed in future trials.

Pre-germinated brown rice reduced both blood glucose concentration and body weight in Vietnamese women with impaired glucose tolerance.

We have reported that newly diagnosed type 2 diabetes mellitus (DM) patients in Vietnam have a low body mass index (BMI) of around 23 and that the major factor for this is high white rice (WR) intake. Brown rice (BR) is known to be beneficial in the control of blood glucose levels; however, it has the property of unpleasant palatability. Pre-germinated brown rice (PGBR) is slightly germinated by soaking BR in water as this reduces the hardness of BR and makes it easier to eat. This study was designed to evaluate the effect of a 4-mo PGBR administration on various parameters in Vietnamese women aged 45-65 y with impaired glucose tolerance (IGT). Sixty subjects were divided into a WR or PGBR group. For the first 2 wk, WR was replaced by 50% PGBR, then for 2 wk by 75% PGBR and from the second month 100%. Before the beginning of the study and at the end of the study, 1) anthropometric measurements, 2) a nutrition survey for 3 nonconsecutive days by the 24 h recall method and 3) blood biochemical examinations were conducted. Fasting plasma concentrations of glucose and lipids and the obesity-related measurements and blood pressure were favorably improved only in the PGBR diet group. The present results suggest that replacing WR with PGBR for 4 mo may be useful in controlling body weight as well as blood glucose and lipid levels in Vietnamese women with IGT.

Shining the light on Sunshine: a systematic review of the influence of sun exposure on type 2 diabetes mellitus-related outcomes.

Prospective observational studies uniformly link vitamin D deficiency with the incidence of type 2 diabetes mellitus (T2DM), yet trials supplementing participants at risk of T2DM with vitamin D to reduce progression to T2DM have yielded inconsistent results. Inconsistencies between supplementation trials may be due to insufficient dosing or small sample sizes. Observational studies may also have reported spurious associations due to uncontrolled confounding by lifestyle or genetic factors. Alternatively, observational and intervention studies may not be entirely comparable. Observational studies show an association between higher vitamin D status, which is predominantly derived from sun exposure, and decreased incidence of T2DM. Trials intervene with vitamin D supplementation, and therefore may be missing alternate causes of the effect of sun exposure, as seen in observational studies. We propose that sun exposure may be the driving force behind the associations seen in observational studies; sun exposure may have additional benefits beyond increasing serum 25-hydroxyvitamin D (25OHD) levels. We performed an electronic literature search to identify articles that examined associations between sun exposure and T2DM and/or glucose metabolism. A best evidence synthesis was then conducted using outcomes from analyses deemed to have high methodological quality. Ten eligible full-text articles were identified, yielding 19 T2DM-related outcomes. The best evidence analysis considered 11 outcomes which were grouped into six outcome types: T2DM, fasting glucose, glucose tolerance, fasting insulin, insulin secretion and insulin sensitivity. There was moderate evidence to support a role of recreational sun exposure in reducing odds of T2DM incidence. High-level evidence was lacking; evidence presented for other outcomes was of low or insufficient level. This review highlights significant gaps in research pertaining to sun exposure and T2DM-related outcomes. Further research is encouraged as we aim to identify novel preventative strategies for T2DM.

Vitamin D and diabetes mellitus: an update 2013.

Vitamin D deficiency and diabetes mellitus are two common conditions and they are widely prevalent across all ages, races, geographical regions, and socioeconomic conditions. Epidemiologic studies have shown association of vitamin D deficiency and increased risk of chronic diseases, such as cancer, cardiovascular disease, type 2 diabetes, and autoimmune diseases, such as multiple sclerosis and type 1 diabetes mellitus. The identification of 1,25(OH)2D receptors and 1-α-hydroxilase expression in pancreatic beta cells, in cells of the immune system, and in various others tissues, besides the bone system support the role of vitamin D in the pathogenesis of type 2 diabetes. Observational studies have revealed an association between 25(OH) D deficiency and the prevalence of type 1 diabetes in children and adolescents. This review will focus on the concept of vitamin D deficiency, its prevalence, and its role in the pathogenesis and risk of diabetes mellitus and cardiovascular diseases.

Vitamin D and diabetes mellitus: an update 2013 / Vitamin D e diabetes melito: uma atualização 2013

Vitamin D deficiency and diabetes mellitus are two common conditions and they are widely prevalent across all ages, races, geographical regions, and socioeconomic conditions. Epidemiologic studies have shown association of vitamin D deficiency and increased risk of chronic diseases, such as cancer, cardiovascular disease, type 2 diabetes, and autoimmune diseases, such as multiple sclerosis and type 1 diabetes mellitus. The identification of 1,25(OH)2D receptors and 1-α-hydroxilase expression in pancreatic beta cells, in cells of the immune system, and in various others tissues, besides the bone system support the role of vitamin D in the pathogenesis of type 2 diabetes. Observational studies have revealed an association between 25(OH) D deficiency and the prevalence of type 1 diabetes in children and adolescents. This review will focus on the concept of vitamin D deficiency, its prevalence, and its role in the pathogenesis and risk of diabetes mellitus and cardiovascular diseases.

A deficiência de vitamina D e o diabetes melito são enfermidades comuns na população e são altamente prevalentes em todas as raças, idades, regiões geográficas e situação socioeconômica. Estudos epidemiológicos mostram uma associação entre hipovitaminose D com o aumento do risco de doenças crônicas, tais como câncer, doença cardiovascular, diabetes melito do tipo 2 e doenças autoimunes como a esclerose múltipla e o diabetes mellitus do tipo 1. A identificação de receptores da 1,25(OH)2 D e da expressão da 1 α-hidroxilase nas células betapancreáticas, em células do sistema imunológico e em uma variedade de células do organismo além do tecido ósseo, suporta o papel da vitamina D na patogênese do diabetes tipo 2 e do tipo 1. Esta revisão apresenta e discute o conceito de deficiência de vitamina D, sua prevalência e seu papel na patogênese e no risco de desenvolvimento do diabetes melito e doenças cardiovasculares.

Coffee consumption, serum γ-glutamyltransferase, and glucose tolerance status in middle-aged Japanese men.

BACKGROUND: Recently, coffee consumption has been related to decreased risk of type 2 diabetes mellitus (DM) among those with high levels of serum γ-glutamyltransferase (GGT). We examined the association between coffee and glucose tolerance, determined by a 75 g oral glucose tolerance test, and the effect modification of serum GGT on the association. METHODS: The study subjects were 5320 men aged 46-60 years who received a health examination at two Self-Defense Forces hospitals from January 1997 to March 2004. Those medicated for DM were excluded. Coffee consumption was classified into <1, 1-2, 3-4, and ≥5 cups/day. Statistical adjustment was made for age, body mass index, smoking, alcohol use, leisure-time physical activity, green tea consumption, parental diabetes, hospital, and rank in the Self-Defense Forces. RESULTS: Men with normal glucose tolerance, isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), combined IFG/IGT, and type 2 DM numbered 3384, 398, 790, 348, and 400, respectively. The prevalence odds of isolated IGT, combined IFG/IGT, and type 2 DM, but not of isolated IFG, decreased with increasing consumption of coffee. An inverse association with coffee was observed for isolated IGT in both low (≤40 IU/L) and high (>40 IU/L) GGT groups, and for combined IFG/IGT and type 2 DM in the latter group. CONCLUSIONS: Coffee drinking is protective against glucose intolerance. A possible effect modification of GGT on the coffee-DM association warrants further studies.

Post-prandial glucose levels and consumption of omega 3 fatty acids and saturated fats among two rural populations in Kenya.

BACKGROUND: Amount and quality of dietary fat modifies glucose tolerance. Omega 3 Fatty Acids (n-3F A) are polyunsaturated fats, mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found primarily in fish and they have a positive effect on glucose tolerance. OBJECTIVE: To compare risk of type 2 diabetes mellitus (T2DM), as demonstrated thourough impaired glucose tolerance (IGT), and n-3FA intake among two rural populations. DESIGN: A descriptive, cross-sectional comparative study. SETTING: Bondo District (Luo Community) and Kericho District (Kipsigis Community) of the Lake Victoria basin of Kenya. SUBJECTS: Sample of 150 individuals, aged above 18 years was randomly selected from each of the two communities. INTERVENTIONS: Impaired glucose tolerance (IGT) was measured according to World Health Organisation diagnostic criteria. The intake of n-3FA was determined using a 24 hour dietary recall and food frequency schedule. Data was analysed using SPSS and Pearson Correlation Coefficient was used to test correlation between n-3FA consumption and IGT. The inter-group comparisons were done using the t-test and analysis of variance. RESULTS: The prevalence of IGT was 11.8% among the Kipsigis and 4.8% among the Luo (P<0.001). The mean EPA and DHA intake was found to be 0.29 g/day and 0.34 g/day respectively among the Luo and 0.01 g/day and 0.01 g/day among the Kipsigis (P<0.001). The relationship between 2 hour post-prandial glucose level and consumption of DHA was (r=-0.111, p<0.05), EPA (r=-0.123, p<0.05), polyunsaturated fatty acids (r=-0.128, p<0.05) and saturated fats (r=-0.002, p=0.973). CONCLUSION: The levels of IGT were significantly lower (P<0.001) among the Luo, than among the Kipsigis. There was also evidence of significant inverse relationship between IGT and consumption of n-3FA and polyunsaturated fatty acids (PUFA) but no association between saturated fats intake and IGT. The saturated fat ingested did not affect the level of post-prandial glucose. The Luo who consumed higher n-3FA amounts, recorded lower levels of IGT than the Kipsigis who had significantly lower consumption. RECOMMENDATIONS: Effective screening methods should be used at the existing health units to determine risk factors of type 2 diabetes mellitus like IGT among patients. This could help in advising them accordingly on lifestyle changes, especially concerning diet and beneficial fats.

Impaired glucose regulation in a Sherpa indigenous population living in the Everest region of Nepal and in Kathmandu Valley.

The aim of this study was to determine the prevalence of impaired glucose regulation status in Sherpa adults living in the Everest area and in Kathmandu valley. A cross-sectional survey was conducted in Chaurikharka village (Everest area) and Kathmandu city on 119 and 121 randomly selected individuals, aged 30-70 years. They were assessed on conventional risk factors for diabetes, and an oral glucose tolerance test was performed. Based on the 2003 American Diabetes Association criteria, the prevalence in the Kathmandu city and Everest region of any impaired glucose regulation (IGR), isolated impaired fasting plasma glucose (isolated IFG), isolated impaired glucose tolerance (isolated IGT), and combined isolated IFG and isolated IGT were 55.4% vs. 23.5%, 42.1% vs. 14.3%, 1.7% vs. 0.8%, 11.6 vs. 8.4%, respectively. Using the subjects with normal glucose tolerance as the referent group and after adjusting for age, sex, physical activity, calories, and waist circumference, the odds ratios for isolated IFG and combined isolated IFG and isolated IGT of living in the highland region were 0.19 (0.08-0.44) and 0.33 (0.09-1.18), respectively. Isolated IFG was more common among the lowland Sherpas. Unlike combined isolated IFG and isolated IGT, this isolated IFG difference could not be explained by the difference of conventional diabetes mellitus risk factors.

A study of the effects of acarbose on glucose metabolism in patients predisposed to developing diabetes: the Dutch acarbose intervention study in persons with impaired glucose tolerance (DAISI).

BACKGROUND: We hypothesized that acarbose would delay conversion from impaired glucose tolerance (IGT) to type 2 diabetes by alleviating postprandial hyperglycaemia. Our study's main objective was to investigate the effect of acarbose in IGT-persons on their 2-h plasma glucose level and beta-cell function. SUBJECTS AND METHODS: The study included a random sample of 45-70-year-old residents of Hoorn, Netherlands, with mean fasting plasma glucose < 7.8 mmol/L and mean 2-h plasma glucose of 8.6-11.1 mmol/L (measured by two successive oral glucose tolerance tests). After a qualification period, participants were randomized to acarbose treatment or placebo. Insulin secretion and insulin sensitivity were measured by hyperglycaemic clamp. After a 3-year treatment, analyses were performed of both the intention-to-treat and the per-protocol groups. RESULTS: Of the 12 093 residents who received postal invitations, 118 participants were randomized. The mean difference of the post-load plasma glucose after 3 years, was - 1.16 mmol/L (95% CI: - 2.03; - 0.17). The absolute risk reduction for diabetes was 6% (95% CI: - 9; 21). No effect was seen on insulin secretion and insulin sensitivity. CONCLUSIONS: In patients with IGT, treatment with acarbose was associated with beneficial effects on 2-h plasma glucose levels but not with improvement of beta-cell function.

Inhibidores de las disacaridasas / Disaccharide inhibitors

La acarbosa es el inhibidor de las alfaglucosidasas más conocido en el tratamiento de la diabetes tipo 2. Al inhibir estas enzimas, se logra retardar la hidrólisis de los hidratos de carbono de cadena larga y con ello se alcanza una reducción de los picos posprandiales de glucosa. Este efecto provoca una reducción de las cifras de hemoglobina glucadaentre un 0,7-1%. No produce episodios de hipoglucemia. Los efectos secundarios más destacados son flatulencia, meteorismo y, en casos esporádicos, diarreas. Está indicada como tratamiento antidiabético oral asociado a cambios en el estilo de vida, así como en combinación con otros agentes orales –metformina, glitazonas y sulfonilureas– y con insulina. Recientemente, se ha utilizado en prevención de la diabetes tipo 2 en la población con riesgo de padecerla (intolerantes a la glucosa).Los resultados han indicado que es capaz de retrasar la aparición de la enfermedad y, a su vez, de reducir el número de episodios cardiovasculares, en especial el infarto de miocardio (AU)

Acarbose in the best knownalpha-glucosidase inhibitor in the treatment of type 2 diabetes. By inhibiting these enzymes, hydrolysis of long-chain carbohydrates is delayed, thus reducing postprandial glucose peaks. This effect reduces glycosylated hemoglobin levels by 0.7-1% and does not produce hypoglycemic episodes. The most important adverse effects are flatulence, tympanites and, in sporadic cases, diarrhea. Acarbose is indicated as an oral anti-diabetic agent associated with lifestyle changes, as well as in combination with other oral agents–metformin, glitazones and sulfonylureas–and with insulin. Recently, acarbose has been used in the population at risk of developing type 2 diabetes (glucose intolerance). The results have indicated that this drug is able to delay the onset of the disease and, in turn, to reduce the number of cardiovascular events, especially myocardial infarction (AU)

Does coffee consumption reduce the risk of type 2 diabetes in individuals with impaired glucose?

OBJECTIVE: The purpose of this study was to investigate the association between coffee intake and incident diabetes based on an oral glucose tolerance test (OGTT) and examine coffee habits in those with impaired glucose separately from those with normal glucose at baseline. RESEARCH DESIGN AND METHODS: In this prospective study, 910 adults aged >/=50 years without diabetes at baseline in 1984-1987 were followed to 1992-1996, an average of 8 years after assessment of coffee intake. Logistic regression models were adjusted for sex, age, physical activity, BMI, smoking, alcohol, hypertension, and baseline fasting plasma glucose. RESULTS: Past and current coffee drinkers had a reduced risk of incident diabetes (odds ratio 0.38 [95% CI 0.17-0.87] and 0.36 [0.19-0.68], respectively) compared with those who never drank coffee. The 317 participants with baseline impaired glucose who were past or current coffee drinkers were also at reduced risk for incident diabetes (0.31 [0.11-0.87] and 0.36 [0.16-0.83], respectively). CONCLUSIONS: This study confirms a striking protective effect of caffeinated coffee against incident diabetes and extends these findings to incident diabetes based on OGTT independent of multiple plausible confounders.

[Coffee consumption and the decreased risk of diabetes mellitus type 2]. / Koffieconsumptie en het risico van diabetes mellitus type 2.

Coffee is among the most commonly consumed beverages in The Netherlands. Caffeine can acutely lower insulin sensitivity, but it is not clear whether tolerance for this effect develops after long-term regular intake. Furthermore, it is plausible that the effects of coffee are different from those of caffeine. Coffee contains hundreds of substances and there are indications that certain components may partly counter-act the effect of caffeine or may have independent beneficial effects. Intake of the coffee components chlorogenic acid, quinides, lignans, and trigonelline improved glucose metabolism in animal studies. Habitual coffee consumption has been studied in relation to the risk of diabetes mellitus type 2 in 12 cohort studies in Europe, the USA, and Japan. Generally, high coffee consumption was associated with a substantially lower risk of type-2 diabetes. The findings were similar for caffeinated and decaffeinated coffee, suggesting that the non-caffeine components of coffee may be responsible. Identification of these coffee components may lead to the development or selection of coffee types with improved effects on health.