Subject(s)
Bariatric Surgery/methods , Diabetes Mellitus, Type 2/surgery , Metabolic Syndrome/surgery , Obesity, Morbid/surgery , Patient Selection , Body Mass Index , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/metabolism , Humans , Metabolic Syndrome/complications , Metabolic Syndrome/metabolism , Obesity/complications , Obesity/metabolism , Obesity/surgery , Obesity, Morbid/complications , Obesity, Morbid/metabolism , Practice Guidelines as TopicABSTRACT
BACKGROUND: Type 2 diabetes, an extreme state of glucose intolerance, has been found to be associated with cancer mortality; less is known about impaired glucose tolerance and cancer incidence. OBJECTIVES: To examine the association between fasting and post-load plasma glucose and insulin, and the 20 year incidence of cancer. METHODS: We followed a sample of the Jewish Israeli population (n = 2780), free of cancer at baseline, from 1977-1980 to 1999 for cancer incidence and mortality. Baseline fasting and 1 and 2 hour post-load plasma glucose levels were recorded, as was insulin, in 1797 of them. RESULTS: During 20 years, 329 individuals (11.8%) developed cancer. Cancer incidence for all sites differed between men and women (13.0% and 10.7%, P = 0.03), and among different glucose tolerance status groups (P = 0.01). Cancer incidence hazard ratio, by glucose status adjusted for gender, age, ethnicity, smoking and body mass index, was 1.24 (95% CI 0.96-1.62, P = 0.10) for impaired fasting glucose or impaired glucose tolerance, and 1.32 (95% CI 0.96-1.81, P = 0.09) for type 2 diabetes mellitus, compared with those who were normoglycemic at baseline. Fasting insulin and cancer incidence were not associated. CONCLUSIONS: An increased long-term cancer risk for individuals with impaired fasting glucose or glucose tolerance, or diabetes, is suggested. Even this modest association could have substantial public health consequences.
Subject(s)
Blood Glucose/analysis , Neoplasms/epidemiology , Chi-Square Distribution , Comorbidity , Diabetes Mellitus, Type 2/epidemiology , Female , Glucose Intolerance/epidemiology , Glucose Tolerance Test , Humans , Incidence , Israel/epidemiology , Male , Middle Aged , Neoplasms/blood , Proportional Hazards ModelsABSTRACT
OBJECTIVE: The aim of the study was to investigate the efficacy and tolerability of long-term acarbose therapy in type 2 diabetic patients. STUDY DESIGN: In this double-blind, single-centre group comparison, patients were randomised to receive either acarbose or matching placebo, in addition to their regular antidiabetic therapy, over a period of 78 weeks. Eligibility for inclusion in the efficacy evaluation included a study duration of >/=510 days. METHODS: The primary efficacy parameter was the change in glycosylated haemoglobin (HbA(1)) from baseline to end of study. Secondary variables included changes in blood glucose and lipid parameters, as well as signs of retinopathy and nephropathy. PATIENTS: A total of 139 patients were assessed for safety and 88 patients (44 in each treatment group) were included in the efficacy analysis. Patients were generally overweight and the majority had previously been treated with sulphonylureas. RESULTS: Acarbose significantly improved fasting and 1-hour postprandial blood glucose levels compared with placebo (p = 0.039 and 0.009), and improvements in HbA(1) with acarbose versus placebo fell just short of significance (p = 0.057). There were no differences between treatments in changes in microvascular complications, but blood pressure improved with acarbose treatment. Two patients in the acarbose group experienced elevated liver enzyme levels. Generally, acarbose had a good safety profile and was well tolerated. CONCLUSION: Long-term treatment with acarbose was safe and efficacious in patients with type 2 diabetes mellitus that was insufficiently controlled by other oral antidiabetics.