The association of triglyceride-glucose index and combined obesity indicators with chest pain and risk of cardiovascular disease in American population with pre-diabetes or diabetes.

Aim: To investigate the correlation of the triglyceride-glucose (TyG) index and its combined obesity indicators with chest pain and cardiovascular disease (CVD) in the pre-diabetes and diabetes population. Methods: This cross-sectional investigation encompassed 6488 participants with diabetes and pre-diabetes who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. The association of the TyG and combined obesity index with chest pain and CVD was investigated using weighted logistic regression models and restricted cubic spline (RCS) analysis. The receiver operating characteristic (ROC) curve analysis was performed to compare different indicators. Results: In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between TyG, TyG-BMI, TyG-WC, and TyG-WHtR and chest pain, with adjusted ORs (95% CI) of 1.21 (1.05, 1.39), 1.06 (1.01, 1.11), 1.08 (1.04, 1.14), and 1.27 (1.08, 1.48), respectively. For total-CVD, the adjusted ORs (95% CI) were 1.32 (1.08, 1.61), 1.10 (1.03, 1.17), 1.13 (1.06, 1.19), and 1.63 (1.35, 1.97), respectively, among which TyG, TyG-WC, and TyG-WHtR present curvilinear associations in RCS analysis (all P-nonlinear < 0.05). Furthermore, the ROC curve showed that TyG-WC had the most robust predictive efficacy for total-CVD, coronary heart disease (CHD), and myocardial infarction (MI), while TyG-WHtR had the best predictive ability for angina and heart failure. Conclusion: There are significant associations of TyG and its related indicators with chest pain and total-CVD among the pathoglycemia population. TyG-WC and TyG-WHtR demonstrated superior predictive capability for the incidence of cardiovascular events.

Survival and Endoscopic/Clinical Features of Patients with Colorectal Cancer Resected by Cold Snare Polypectomy: The Importance of Chronic Kidney Disease.

BACKGROUND AND AIMS: Colorectal polyps resected by cold snare polypectomy (CSP) are rarely diagnosed as colorectal cancer (CRC). We aimed to investigate the prevalence, clinical features, and prognosis of patients with CRC resected by CSP. SUBJECTS: Patients with colorectal polyps treated with CSP between 2018 and 2022 were enrolled and regularly followed up (median observation period: 30.6 months). Logistic regression analysis and decision tree analysis were employed to investigate the clinical features of the patients. RESULTS: A total of 5,064 colorectal polyps from 2,530 patients were resected by CSP. Of these, 0.24% were diagnosed as CRC; however, no patients died due to CRC. eGFR was an independent risk factor for the presence of CRC (unit 10, OR 0.716, 95%CI 0.525-0.973, P=0.0323) and its optimal cut-off value was 59.9 mL/min/1.73 m2. The decision-tree analysis revealed that 2.03% of patients with creatinine ≥ 1.0 mg/dL had CRC. CONCLUSION: CRC was diagnosed in 0.24% of the polyps; however, no patients died due to CRC. eGFR <60 mL/min/1.73 m2 and creatinine >1.0 mg/dL were associated with CRC. Thus, colorectal polyps should be carefully examined in patients with chronic kidney disease.

Effects of Gossypetin on Glucose Homeostasis in Diet-Induced Pre-Diabetic Rats.

Natural flavonoids exert many potential health benefits, including anti-hyperglycaemic effects. However, the effects of gossypetin (GTIN) on glucose homeostasis in pre-diabetes have not yet been investigated. This study examined the effects of GTIN on key markers of glucose homeostasis in a diet-induced pre-diabetic rat model. Pre-diabetes was induced by allowing the animals to feed on a high-fat high-carbohydrate (HFHC) diet supplemented with 15% fructose water for 20 weeks. Following pre-diabetes induction, the pre-diabetic animals were sub-divided into five groups (n = 6), where they were either orally treated with GTIN (15 mg/kg) or metformin (MET) (500 mg/kg), both with and without dietary intervention, over a 12-week period. The results demonstrated that animals in the untreated pre-diabetic (PD) control group exhibited significantly higher fasting and postprandial blood glucose levels, as well as elevated plasma insulin concentrations and increased homeostatic model assessment for insulin resistance (HOMA2-IR) index, relative to the non-pre-diabetic (NPD) group. Similarly, increased caloric intake, body weight and plasma ghrelin levels were observed in the PD control group. Notably, these parameters were significantly reduced in the PD animals receiving GTIN treatment. Additionally, glycogen levels in the liver and skeletal muscle, which were disturbed in the PD control group, showed significant improvement in both GTIN-treated groups. These findings may suggest that GTIN administration, with or without dietary modifications, may offer therapeutic benefits in ameliorating glucose homeostasis disturbances associated with the PD state.

Systemic nitric oxide metabolites and the chance of pre-diabetes regression to normoglycemia: A 9-year cohort study.

Introduction: We aimed to track longitudinal changes of glycemic status in subjects with pre-diabetes (Pre-DM) in relation to their baseline levels of systemic nitric oxide (NO) production [i.e., measured as serum NO metabolites (NOx), crude and body weight (BW)-adjusted NOx to creatinine ratio (NOx-to-Cr)] over 9 years. Methods: This cohort study included 541 middle-aged Iranian men and women with Pre-DM, recruited in 2006-2008 and followed up to 2015-2017. The colorimetric Griess method was used to measure serum NOx concentration. Multinomial logistic regression analyses estimated the odds ratios (OR) of Pre-DM regression and progression across tertiles (tertile 3 vs. tertile 1 and tertile 2) of serum NOx, crude, and BW-adjusted NOx-to-Cr ratio. Results: Participants who regressed to normoglycemia (NG) had a higher BW-adjusted NOx-to-Cr ratio than those who developed type 2 diabetes (T2D) or those who remained Pre-DM (0.52±0.34 vs. 0.43±0.25 and 0.48±0.29, P=0.023). Higher BW-adjusted NOx-to-Cr increased chance of returning to NG (OR=2.05, 95% CI= 0.98-4.32, P=0.058) and decreased levels of 2h-serum glucose over time (P time×group=0.025), as well as the decreased overall mean of fasting (106, 95% CI=103-109 vs. 110, 95% CI=108-112 mg/dL, P=0.008) and 2h-serum glucose (153, 95% CI=146-159 vs. 163, 95% CI=158-168 mg/dL, P=0.018). Conclusion: A higher endogenous NO production (i.e., indirectly measured by BW- and Cr-adjusted serum NOx concentration) in Pre-DM subjects is associated with the chance of returning to NG.

A systematic review and meta-analysis of ischemia-modified albumin in diabetes mellitus.

Aim: There is an ongoing search for novel biomarkers of diabetes. We conducted a systematic review and meta-analysis of the serum concentrations of ischemia-modified albumin (IMA), a candidate biomarker of oxidative stress, acidosis, and ischemia, in patients with pre-diabetes, different types of diabetes mellitus (type 1, T1DM, type 2, T2DM, and gestational, GDM), and healthy controls. Methods: We searched for case-control studies published in PubMed, Web of Science, and Scopus from inception to December 31, 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. Results: In 29 studies, T2DM patients had significantly higher IMA concentrations when compared to controls (standard mean difference, SMD = 1.83, 95 % CI 1.46 to 2.21, p˂0.001; I2 = 95.7 %, p < 0.001; low certainty of evidence). Significant associations were observed between the SMD and glycated hemoglobin (p = 0.007), creatinine (p = 0.003), triglycerides (p = 0.029), and the presence of diabetes complications (p = 0.003). Similar trends, albeit in a smaller number of studies, were observed in T1DM (two studies; SMD = 1.59, 95 % CI -0.09 to 3.26, p˂0.063; I2 = 95.8 %, p < 0.001), GDM (three studies; SMD = 3.41, 95 % CI 1.14 to 5.67, p = 0.003; I2 = 97.0 %, p < 0.001) and pre-diabetes (three studies; SMD = 15.25, 95 % CI 9.86 to 20.65, p˂0.001; I2 = 99.3 %, p < 0.001). Conclusion: Our study suggests that IMA is a promising biomarker for determining the presence of oxidative stress, acidosis, and ischemia in pre-diabetes and T1DM, T2DM, and GDM. However, the utility of measuring circulating IMA warrants confirmation in prospective studies investigating clinical endpoints in pre-diabetes and in different types of diabetes (PROSPERO registration number: CRD42024504690).

Long-term outcome of patients with diabetic-range hyperglycemia first detected during admission for COVID-19: A single-center observational study.

Background and Objective: Diabetic-range hyperglycemia has been reported for the first time in many patients during their hospitalization with coronavirus disease 2019 (COVID-19). This study was undertaken to determine the proportion of such patients who actually have new-onset diabetes mellitus rather than transient hyperglycemia during acute illness. Methods: This descriptive study included patients with diabetic-range hyperglycemia first detected at or during admission for COVID-19 but no prior history of diabetes. The study protocol involved patient identification, data recording from the case-notes, and telephonic follow-ups. Blood sugar levels done at least two weeks after discharge or the last dose of steroids, whichever was later, were recorded, and patients were categorized as diabetic, pre-diabetic, or non-diabetic accordingly. Results: Out of 86 patients, ten (11.6%) were found to have developed diabetes, and 13 (15.1%) had pre-diabetes on follow-up. About 63 (73.3%) patients had become normoglycemic. Eight (80%) out of the ten patients with new-onset diabetes were on treatment, with five (50%) achieving the target glycemic levels. The associations of new-onset diabetes with age, gender, comorbidities, intensive care stay, and steroid administration were not found to be statistically significant (p-values 0.809, 0.435, 0.324, 0.402, and 0.289, respectively). Interpretation and Conclusions: While a majority of post-COVID patients with diabetic-range hyperglycemia returned to a normoglycemic state after the acute illness had settled down, one in ten developed new-onset diabetes, and an additional one in seven had impaired glucose tolerance. Thus, regular glucose screening is crucial for such patients and lifestyle modifications should be encouraged to reduce the risk of diabetes. Loss to follow-up and reliance on a single set of blood sugar readings for classification were some of the limitations of this study.

Effectiveness of NSW health get healthy telephone coaching in adults screened from general practices.

BACKGROUND: The effectiveness of the NSW Health "Get Healthy Information and Coaching Service®"(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake. METHODS: Men and women aged 40-70 years (n = 154) with pre-diabetes (5.7% < HbA1c < 6.5%) were referred from GP Practices to the Get Healthy Service, NSW Health. A subset (n = 98) participated in the "Zinc In Preventing the Progression of pre-Diabetes" (ZIPPeD) trial (ACTRN12618001120268). RESULTS: The self-reported outcomes showed a statistically significant improvement from baseline to 12 months in weight (mean 2.7 kg loss, p < 0.001), BMI (mean 1 unit reduction, p < 0.001), and waist circumference (mean 4.3 cm reduction, p < 0.001). However, in the objectively measured outcomes from ZIPPeD, the differences were more modest, with point estimates of 0.8 kg mean weight loss (p = 0.1), 0.4 unit reduction in BMI (p = 0.03), and 1.8 cm reduction in waist circumference (p = 0.04). Bland-Altman plots indicated that discrepancies were due to a small number of participants who dramatically underestimated their weight or BMI. There were minimal changes in nutrition, physical activity, and alcohol. CONCLUSIONS: The potential benefits of Get Healthy should be interpreted with caution as we have shown significant differences between self-reported and objectively measured values. More valid and objective evidence is needed to determine the program's effectiveness and cost-effectiveness.

Making the Most of Familismo to Curb the Diabetes Epidemic: Early Evidence of Success Delivering the Same Intervention to Latinas at Risk for and With Diabetes.

Background/objectives: In the USA, diabetes disproportionately affects Hispanics/Latinx, continuing to contribute to health disparities. To address the diabetes epidemic, separate programs for pre-diabetes and diabetes are promoted nationwide. However, engagement by Hispanics/Latinx in either program is lagging. Recent evidence suggests that offering a single community health worker delivered intervention that includes both groups and allows family members to participate may be more effective and in harmony with Latino cultural values, especially if offered to Latino women (Latinas) who traditionally are in charge of food preparation. Our objective was to explore the results of an intervention delivered to low-income Latinas at various dysglycemic levels (diabetic and pre-diabetic). Methods: In this quasi-experimental mixed-methods cohort study we longitudinally assessed biometric outcomes and health behaviors among obese Latinas at risk for-and with-diabetes, participating in the same intervention. Data were collected at baseline and 3 months post-intervention. Focus group discussions and interviews provided qualitative data to help contextualize findings. Results: Participants at different levels of the dysglycemic spectrum benefited equally from the intervention across most measures. Among participants whose relatives had diabetes, weight loss exceeded that of participants without diagnosed relatives. Domestic partners' support, attending the program in a group setting, and previous diagnoses from a healthcare professional were associated with better results. Conclusions: Our findings indicate that a community health worker-delivered intervention for Hispanics/Latinx with-and at-risk for-diabetes is feasible and could be more effective in reducing Hispanics/Latinx' diabetes burden. Health educators and clinicians should consider tapping into the collective nature of the Latinx/Hispanic culture to encourage healthy behaviors among individuals whose family members have diabetes, regardless of their dysglycemic status. We recommend replicating this study with a more rigorous randomized design, a larger number of participants and longer-term follow-up.

METHODS: In this study, participants were Latino women (Latinas) from Southern California who either had diabetes or were on the path to having diabetes because of their weight or lab results. They all enrolled in a program where community health workers encouraged them to eat better and to exercise. We checked weight, labs and behaviors before and after the program and interviewed some after they completed it. RESULTS: all benefited from the program. But those whose relatives had diabetes, those whose doctors told them they had prediabetes/diabetes, and those attending in groups did better. CONCLUSION: using the proposed family-based approach among Latinos may lead to better diabetes prevention and management in clinical settings.

Encouraging similar habits around eating for all family members - whether at risk of or with diabetes - is in keeping with one of the key latino values: putting family first. Preliminary results point to more success for everyone when a "family first" strategy - instead of promoting individual treatment plans - is applied among latinas with diabetes or at risk of developing diabetes In the USA, Latinos are among the groups with the highest rates of obesity and diabetes. People with obesity often have diabetes too. We know that, when a person in the family has diabetes, almost always other family members will be on the path to developing diabetes, if they do not yet have it. We also know that exercise and healthy eating habits can help prevent and control diabetes. In the USA, instead of offering the entire family (those on their way to diabetes and those with diabetes) the same program - "eat healthier and exercise" - there are separate programs or options based on each diagnosis: a program for those with diabetes, a program for those who qualify as having prediabetes, and no program for those who do not qualify but are on their way to having pre-diabetes due to obesity. Offered programs have not been successful among Latinos for several reasons in part because they just don't attend as many classes as other groups. For Latinos, family - and specially having mealtimes together - is extremely important ("familismo" concept). This is even more critical for women preparing meals for their families. Separate diets and mealtimes goes against, and may sometimes interfere with, that sense of unity.

Cytokine and chemokine profiles in pulmonary tuberculosis with pre-diabetes.

Introduction: Tuberculosis (TB) remains a significant health concern in India, and its complexity is exacerbated by the rising occurrence of non-communicable diseases such as diabetes mellitus (DM). Recognizing that DM is a risk factor for active TB, the emerging comorbidity of TB and PDM (TB-PDM) presents a particular challenge. Our study focused on the impact of PDM on cytokine and chemokine profiles in patients with pulmonary tuberculosis TB) who also have PDM. Materials and methods: We measured and compared the cytokine (GM-CSF, IFN-γ, IL-1α/IL-1F1, IL-1ß/IL-1F2, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p70, IL-13, IL-17/IL-17A, IL-18/IL-1F4, TNF-α) and chemokine (CCL1, CCL2, CCL3, CCL4, CCL11, CXCL1, CXCL2, CXCL9, CXCL10, and CXCL11) levels in plasma samples of TB-PDM, only TB or only PDM using multiplex assay. Results: We observed that PDM was linked to higher mycobacterial loads in TB. Patients with coexisting TB and PDM showed elevated levels of various cytokines (including IFNγ, TNFα, IL-2, IL-17, IL-1α, IL-1ß, IL-6, IL-12, IL-18, and GM-CSF) and chemokines (such as CCL1, CCL2, CCL3, CCL4, CCL11, CXCL1, CXCL9, CXCL10, and CXCL11). Additionally, cytokines such as IL-18 and GM-CSF, along with the chemokine CCL11, were closely linked to levels of glycated hemoglobin (HbA1c), hinting at an interaction between glycemic control and immune response in TB patients with PDM. Conclusion: Our results highlight the complex interplay between metabolic disturbances, immune responses, and TB pathology in the context of PDM, particularly highlighting the impact of changes in HbA1c levels. This emphasizes the need for specialized approaches to manage and treat TB-PDM comorbidity.

The association of body weight change and regression to normoglycemia in different phenotypes of pre-diabetes: Findings of a longitudinal cohort study.

AIM: We investigated the association of a 3-year change in body weight (BW) and regression to normal glucose regulation (NGR) among different phenotypes of pre-diabetes (Pre-DM), i.e., isolated impaired glucose tolerance (iIGT), isolated impaired fasting glucose (iIFG) and combined IFG-IGT. RESEARCH DESIGN AND METHODS: 1458 Pre-DM subjects (iIFG = 618, iIGT = 462, and IFG-IGT = 378) were assessed for 3-year change-percent in BW (2006-2008 to 2009-2011) and then followed up to 2015-2017, within the national cohort of Tehran Lipid and Glucose Study (TLGS). Binary logistic regression models were used to estimate the probability (odds ratio, ORs) of regression to NGR across categories of 3-year BW change (i.e., ≥5% BW loss, <5% BW loss, BW gain) in different phenotypes of Pre-DM. RESULTS: The mean age of the participants was 53.0 ± 13.7, and 46.8% were men. Over a median of 6 years of follow-up, the rate of regression to normoglycemia was 50.6, 43.2, and 12.7% in iIGT, iIFG, and combined IFG-IGT, respectively. The baseline-adjusted mean of 3-year BW change was not significantly different across Pre-DM phenotypes (0.68 ± 0.19, 0.32 ± 0.22, and 0.23 ± 0.24 kg, in iIFG, iIGT, and IFG-IGT). Three-year BW loss ≥5% was associated with a greater NGR probability in iIGT than other phenotypes (OR = 4.29 vs. 3.90 and 2.84 in IFG-IGT and iIFG, respectively). A modest reduction (<5% of initial BW) resulted in an increased chance of Pre-DM regression among subjects with iIGT (OR = 1.61, 95% CI = 1.03-2.52) but not iIFG or IFG-IGT phenotypes. CONCLUSION: Short-term intensive BW loss (≥5% of initial BW) increased NGR probability in all Pre-DM phenotypes, with an order of iIGT > combined IFG-IGT > iIFG. Only iIGT takes advantage of moderate BW loss (<5% of initial BW) to increase the chance of Pre-DM regression.

Atrial fibrillation and prediabetes: A liaison that merits attention!

Atrial fibrillation (AF) and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role. The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event (MACCE) events. However, the same has not convincingly been verified in real-world settings. In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE, prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables. However, certain questions like the role of metformin, quantifying the risk for MACCE amongst prediabetes compared to diabetes, the positive impact of reversion to normoglycemia remain unanswered. We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.

Screening type 2 Diabetes mellitus among Indians using inflammatory biomarkers.

Diabetes is a metabolic disorder associated with chronic inflammation; pre-diabetes phase promotes to inflammatory mechanism then finally progress to diabetes and its associated complications. Therefore, it is of interest to investigate the changes in inflammatory biomarkers Evidence that inflammatory markers play a role in the development as well as severity of Type 2 diabetes mellitus (T2DM). This study has been designed to decipher the involvement of Tumor Necrosis Factor (TNFα), Interleukin-6 (IL-6), Nesfatin-1 and Blood sugar in the etiopathogenesis of T2DM. This retrospective observational study analyzed patient records from our hospital, focusing on those with diabetes or pre-diabetes. Glycosylated hemoglobin, inflammatory biomarkers, Fasting Blood Glucose, and Post-Prandial Blood Glucose were assessed. SPSS 28 facilitated statistical analysis; utilizing Bivariate Correlation assessed the relationship between inflammatory biomarkers and diabetes status (glycosylated hemoglobin). In the pre-diabetic vs. diabetic groups, significant differences exist in IL-6 (p=0.0344), TNF-α (p=0.041), Nesfatin-1 (p=0.0485), fasting blood glucose (p=0.036), and 2h post-prandial blood glucose (p=0.048). IL6 (AUC=0.729, p<0.001), TNF (AUC=0.761, p<0.001), and Nesfatin1 (AUC=0.892, p<0.001) show moderate discriminative power. PP (AUC=0.992, p<0.001) and hbA1c (AUC=0.993, p<0.001) exhibit excellent discriminatory ability. Correlations: IL6 with TNF (r=0.672, p<0.001) and Nesfatin1 (r=0.542, p<0.001); TNF with Nesfatin1 (r=0.591, p<0.001), hbA1c (r=0.683, p<0.001), and PP (r=0.367, p<0.001); Nesfatin1 with PP (r=0.594, p<0.001) and hbA1c (r=0.800, p<0.001). Age has a negative correlation with hbA1c (r=-0.119, p=0.086). Thus, data shows a significant association between inflammatory markers, blood glucose levels, and the progression from pre-diabetes to diabetes.

Integrating point-of-care diabetes detection with lifestyle counselling in community settings: outcomes from Western Sydney, Australia.

INTRODUCTION: Early detection and prevention of type 2 diabetes and its complications are global health priorities. Optimal outcomes depend on individual awareness and proactive self-management of health risks. This study evaluates the effectiveness of a community-based diabetes detection and intervention program in a high-risk area in western Sydney, Australia. RESEARCH DESIGN AND METHODS: We collaborated with the Workers Lifestyle Group, Tamil Association Arts and Culture Association, and the National Aboriginal and Islanders Day Observance Committee to implement our program. Participants underwent HbA1C testing via point-of-care blood spot testing. They received personalized feedback, education on diabetes management, and were offered opportunities to enrol in lifestyle modification programs. Participants identified with pre-diabetes (HbA1C 5.7-6.4%) or diabetes (HbA1C > 6.4%) were advised to consult their General Practitioners (GPs). A follow-up questionnaire was distributed 3-8 months post-intervention to evaluate the programs usefulness and relevance and lifestyle changes implemented by the participants. RESULTS: Over eight months, 510 individuals participated. Of these, 19% had an HbA1C > 6.4%, and 38% had levels between 5.7 and 6.4%. Among those with diabetes, HbA1C levels ranged as follows: 56% <7%; 20% 7-7.9%; 18% 8-8.9%; and 5% >9%. Post intervention survey indicated that the program was well-received, with 62.5% of responses reporting lifestyle changes and 36.3% seeking further advice from their local healthcare providers. CONCLUSION: The study demonstrates a significant prevalence of pre-diabetes and diabetes in the community, similar to findings from larger-scale hospital and general practice studies. Point-of-care testing combined with personalized education effectively motivated participants toward healthier lifestyle choices and medical consultations. The paper discusses the scalability of this approach for broader population.

Gut Microbiota in the Progression of Type 2 Diabetes and the Potential Role of Exercise: A Critical Review.

Type 2 diabetes (T2D) is the predominant metabolic epidemic posing a major threat to global health. Growing evidence indicates that gut microbiota (GM) may critically influence the progression from normal glucose tolerance, to pre-diabetes, to T2D. On the other hand, regular exercise contributes to the prevention and/or treatment of the disease, and evidence suggests that a possible way regular exercise favorably affects T2D is by altering GM composition toward health-promoting bacteria. However, research regarding this potential effect of exercise-induced changes of GM on T2D and the associated mechanisms through which these effects are accomplished is limited. This review presents current data regarding the association of GM composition and T2D and the possible critical GM differentiation in the progression from normal glucose, to pre-diabetes, to T2D. Additionally, potential mechanisms through which GM may affect T2D are presented. The effect of exercise on GM composition and function on T2D progression is also discussed.

Anthropometric indicators and cardiovascular diseases risk in pre-diabetic and diabetic adults: NHANES 1999-2018 cross-sectional analysis.

BACKGROUND: Since cardiovascular disease (CVD) stands as the primary cause of death in those with diabetes, and given the substantial influence of obesity as a common risk factor for both diabetes and atherosclerotic conditions, this investigation sought to find the relationship between anthropometric indicators and CVD risk within these populations. METHODS: Our study examined 36,329 adults, including those with diagnosed diabetes, pre-diabetes, and without diabetes from National Health and Nutrition Examination Survey (NHANES) data spanning 1999 to 2018. Various anthropometric indicators such as body mass index (BMI), waist circumference, weight-adjusted waist index (WWI), waist-to-height ratio (WHtR), weight, and height were assessed. Baseline characteristics were compared among the three groups after weighting. Participants were then grouped based on anthropometric indicators, and logistic regression models were used to analyze the association between these indicators and CVD risk in the total diabetes group (including diabetic and pre-diabetic individuals). Threshold effect analysis was conducted to explore nonlinear relationships, and mediation analyses assessed whether serum parameters influenced these relationships. RESULTS: This cross-sectional study involved 36,329 participants, weighted to a count of approximately 160.9 million, including over 45.9 million pre-diabetic individuals and around 16.6 million diabetic individuals. Baseline analysis showed significant associations between all six anthropometric indicators and CVD risk across patients with different diabetes statuses. Weighted restricted cubic spline (RCS) curve analysis highlighted increased CVD risk among the total diabetes group for each anthropometric indicator compared to the non-diabetic group. Anthropometric indicators were then divided into quartiles, and after adjusting for confounders, Model 3 revealed that the highest BMI group had a heightened risk of CVD compared to the lowest BMI group. Similar trends were observed in the WWI and WHtR subgroups. Threshold effect analysis of anthropometric indicators unveiled nonlinear associations between waist circumference, height, WWI and CVD risk. Mediation analysis suggested that lipid parameters, especially HDL, significantly mediated these relationships. CONCLUSION: In individuals with diabetes and pre-diabetes, BMI, weight, and WHtR displayed a consistent, linear increase correlation with CVD risk. Conversely, the link between waist circumference, height, and WWI and CVD risk showcased a more complex, nonlinear pattern. Moreover, HDL level emerged as notable mediator in the association between anthropometric indicators and the risk of CVD.

Association between heme oxygenase-1 and hyperlipidemia in pre-diabetic patients: a cross-sectional study.

Background: Although the importance and benefit of heme oxygenase-1 (HO-1) in diabetes rodent models has been known, the contribution of HO-1 in the pre-diabetic patients with hyperlipidemia risk still remains unclear. This cross-sectional study aims to evaluate whether HO-1 is associated with hyperlipidemia in pre-diabetes. Methods: Serum level of HO-1 was detected using commercially available ELISA kit among 1,425 participants aged 49.3-63.9 with pre-diabetes in a multicenter Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) prospective observational study. Levels of total cholesterol (TC) and triglyceride (TG) were measured and used to defined hyperlipidemia. The association between HO-1 and hyperlipidemia was explored in different subgroups. Result: The level of HO-1 in pre-diabetic patients with hyperlipidemia (181.72 ± 309.57 pg/ml) was obviously lower than that in pre-diabetic patients without hyperlipidemia (322.95 ± 456.37 pg/ml). High level of HO-1 [(210.18,1,746.18) pg/ml] was negatively associated with hyperlipidemia (OR, 0.60; 95% CI, 0.37-0.97; p = 0.0367) after we adjusted potential confounding factors. In subgroup analysis, high level of HO-1 was negatively associated with hyperlipidemia in overweight pre-diabetic patients (OR, 0.50; 95% CI, 0.3-0.9; p = 0.034), especially in overweight women (OR, 0.42; 95% CI, 0.21-0.84; p = 0.014). Conclusions: In conclusion, elevated HO-1 level was negatively associated with risk of hyperlipidemia in overweight pre-diabetic patients, especially in female ones. Our findings provide information on the exploratory study of the mechanism of HO-1 in hyperlipidemia, while also suggesting that its mechanism may be influenced by body weight and gender.

Association between atherogenic index of plasma and new-onset stroke in individuals with different glucose metabolism status: insights from CHARLS.

BACKGROUND: Circulating atherogenic index of plasma (AIP) levels has been proposed as a novel biomarker for dyslipidemia and as a predictor of insulin resistance (IR) risk. However, the association between AIP and the incidence of new-onset stroke, particularly in individuals with varying glucose metabolism status, remains ambiguous. METHODS: A total of 8727 participants aged 45 years or older without a history of stroke from the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. The AIP was calculated using the formula log [Triglyceride (mg/dL) / High-density lipoprotein cholesterol (mg/dL)]. Participants were divided into four groups based on their baseline AIP levels: Q1 (AIP ≤ 0.122), Q2 (0.122 < AIP ≤ 0.329), Q3 (0.329 < AIP ≤ 0.562), and Q4 (AIP > 0.562). The primary endpoint was the occurrence of new-onset stroke events. The Kaplan-Meier curves, multivariate Cox proportional hazard models, and Restricted cubic spline analysis were applied to explore the association between baseline AIP levels and the risk of developing a stroke among individuals with varying glycemic metabolic states. RESULTS: During an average follow-up of 8.72 years, 734 participants (8.4%) had a first stroke event. The risk for stroke increased with each increasing quartile of baseline AIP levels. Kaplan-Meier curve analysis revealed a significant difference in stroke occurrence among the AIP groups in all participants, as well as in those with prediabetes mellitus (Pre-DM) and diabetes mellitus (DM) (all P values < 0.05). After adjusting for potential confounders, the risk of stroke was significantly higher in the Q2, Q3, and Q4 groups than in the Q1 group in all participants. The respective hazard ratios (95% confidence interval) for stroke in the Q2, Q3, and Q4 groups were 1.34 (1.05-1.71), 1.52 (1.19-1.93), and 1.84 (1.45-2.34). Furthermore, high levels of AIP were found to be linked to an increased risk of stroke in both pre-diabetic and diabetic participants across all three Cox models. However, this association was not observed in participants with normal glucose regulation (NGR) (p > 0.05). Restricted cubic spline analysis also demonstrated that higher baseline AIP levels were associated with higher hazard ratios for stroke in all participants and those with glucose metabolism disorders. CONCLUSIONS: An increase in baseline AIP levels was significantly associated with the risk of stroke in middle-aged and elderly individuals, and exhibited distinct characteristics depending on the individual's glucose metabolism status.

Prevalence of Obesity-Related Disease in a Danish Population - The Results of an Algorithm-Based Screening Program.

Purpose: The prevalence of obesity continues to rise. People with obesity are at increased risk of several diseases. We tested an algorithm-based screening program for people with a BMI above 30 kg/m2 and present data on the prevalence of previously undiagnosed obesity-related diseases. Patients and Methods: Seven hundred and sixty-nine persons with BMI > 30 kg/m2 and age 18-60 years were screened for diabetes (assessed by glycosylated hemoglobin and oral glucose tolerance test at HbA1c 43-48 mmol/mol), sleep apnea (screened by questionnaires and assessed by cardiorespiratory monitoring at indication of sleep disorder), liver steatosis or liver fibrosis (assessed by biochemistry and fibroscan) and arterial hypertension (assessed by both office and 24-hour blood pressure measurement). A reference group of people with a BMI of 18.5-29.9 kg/m2 was established. Results: Of those referred, 73.0% were women. We identified new diabetes in 4.2%, prediabetes in 9.1%, moderate-to-severe sleep apnea in 25.1%, increased liver fat and increased liver stiffness in 68.1% and 17.4%, respectively, and hypertension or masked hypertension in 19.0%. The prevalence of diseases was much higher among men and increased with BMI. Except for hypertension, we found few participants with undiagnosed disease in the reference group. Conclusion: An algorithm-based screening program is feasible and reveals undiagnosed obesity-related disease in a large proportion of the participants. The disproportional referral pattern calls for a tailored approach aiming to include more men with obesity. Trial Registration: Inclusion of the non-obese group was approved by the Scientific Ethics Committee of The Region of Southern Denmark (project identification number: S-20210091), and the study was reported at clinicaltrials.gov (NCT05176132).

The number of people with obesity is going up, and they are at a higher risk for various diseases. We tested a screening program for people referred with a BMI over 30 kg/m² and presented the prevalence of diseases related to obesity. We screened 769 people aged 18 to 60 years with a BMI over 30 kg/m² for diabetes (biochemistry and glucose tolerance test), sleep apnea (both questionnaires and home monitoring), liver disease (biochemistry and liver scan) and high blood pressure (office and 24-hour readings). We also tested a reference group of people with BMI 18.5-30 kg/m². Among those screened, 73.0% were women. We found new cases of diabetes in 4.2%, prediabetes in 9.1%, sleep apnea in 25.1%, increased liver fat in 68.1%, increased liver stiffness in 17.4%, and hypertension or masked hypertension in 19.0%. The diseases were more common in men and increased with both higher BMI and age. Except for hypertension, we found few cases in the reference groups. The screening program uncovered undiagnosed obesity-related diseases in a large group of individuals. The uneven distribution of referrals suggests we need a customized approach to include more men with obesity.

Association between pre-diabetes or diabetes and cognitive impairment in a community-dwelling older population: Bushehr Elderly Health (BEH) program.

Background: Persistent uncontrolled hyperglycemia is recognized as one of the risk factors for cognitive disorders. Accordingly, both type 1 and type 2 diabetes may predispose individuals to cognitive impairment, particularly in cases where glycemic control is insufficient. The objective of this comprehensive study is to separately assess cognitive dysfunctions in diabetic and non-diabetic older adults. Methods: This cross-sectional study is part of phase 2 of the Bushehr elderly health program (BEHP). Cognitive function was evaluated using the Mini-cog and categorical verbal fluency tests (CFTs). Patients were classified as non-diabetics, pre-diabetics, or diabetics based on the diagnostic criteria for diabetes mellitus (DM). To compare the means of the two groups, we utilized the t-test or the Mann-Whitney test. Additionally Multivariable logistic regression models were used to determine the association between pre-diabetes or DM and cognitive impairment. Results: Out of 1533 participants, 693 (45.2%) were identified as having cognitive impairment. The average hemoglobin A1C was higher in participants with cognitive impairment compared to those without cognitive impairment. (5.8 ± 1.6% vs. 5.5 ± 1.4%, P = 0.004). Furthermore, the mean blood glucose levels were found to be more elevated in cases of cognitive impairment (108.0 ± 47.4 mg/dL vs. 102.1 ± 0.35 mg/dL, P = 0.002). After adjusting for age, gender, body mass index (BMI), waist circumference, amount of physical activity, and smoking, the multivariable logistic regression model, declared an association between diabetes and cognitive impairment (OR = 1.48, P = 0.003). In addition, older patients, females, widows, and individuals with elevated LDL-Cs and those with high blood pressure were found to be more vulnerable to cognitive impairment. Conclusion: The Bushehr Elderly Health Program (BEHP) study revealed that individuals affected with cognitive impairment may exhibit higher levels of HbA1c. This suggests a positive correlation between elevated HbA1c and cognitive impairment.

Glucose Tolerance and the Risk Factors for Transmission in Japanese SARS-CoV-2/WA-1/2020 Epicenter: A Retrospective Study.

Purpose: The severe pathogenic ancient-type COVID-19, SARS-CoV-2/WA-1/2020 was the predominant gene variant in early 2020 in Japan, however, its transmissibility was uncertain. The period before the public commenced using any personal protective equipment (PPE) was evaluating to describe the transmissibility of the SARS-CoV-2/WA-1/2020. We analyzed the secondary attack rate (SAR) among close contacts and the risk factor for SAR. Methods: This retrospective cohort study included a total of 539 patients who were anticipated for the SARS-CoV-2/WA-1/2020 infection at Toho University Medical Center Omori Hospital from February to May 2020. We selected 54 patients with 1) exclude other pathogens infection, 2) include "Three Cs" condition: crowded places between distance< 6 feet, closed spaces indoor and close contact settings involving contact >15min with a person tested positive for SARS-CoV-2/WA-1/2020 without PPE. We evaluated alternative infection risks: the body mass index (BMI) and diabetes (DM) status (non-DM, pre-DM, and DM) as demographic determinants of transmissibility and infectivity of SARS-CoV2/WA-1/2020 cases during the incubation period. Results: The calculated SAR was 79.3%. BMI was significantly associated with the PCR positivity rate, which was significant in the univariate (CI 95%, 1.02-1.51; P = 0.03) and multivariate (CI 95%, 1.02-1.60; P = 0.03) analyses. Comparing the different BMI groups, the highest BMI group (25.5-35.8 kg/m2) had an elevated risk of SAR compared to the lowest BMI group (14.0-22.8 kg/m2), with an odds ratio of 1.41 (95% CI, 1.02-1.59; P = 0.03). There were no significant differences in the risk of SAR among different DM statuses. Conclusion: The transmissibility of SARS-CoV2/WA-1/2020 was high (79.3%) among household members without PPE who had "Three Cs" exposure. Although pre-DM and established DM did not confer a risk for transmissibility, higher BMI was associated with an increased risk of SAR. Trial Registration: UMIN Clinical Trials Registry, UMIN0000 50905.