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1.
Medicine (Baltimore) ; 98(44): e17805, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689862

RESUMO

Carotid intima-media thickness (C-IMT) increases in patients with adult type-2 diabetes mellitus (DM) and is used for early detection of macrovascular complications. We aimed to investigate the change of C-IMT in prediabetes and type-2 DM patients compared to subjects with normal glucose metabolism (NGM).A total of 180 individuals (60 subjects with NGM, 60 patients with prediabetes and 60 patients with type-2 DM) were included in this study. Routine laboratory and micro-macrovascular involvement were investigated. Urine albumin-creatinine ratio (ACR) was measured for urinary albuminuria detection. In addition to routine laboratory examination, right-left common and internal C-IMT (CC-IMT and IC-IMT) were measured.Systolic and diastolic blood pressure values were found to be higher in prediabetes and type-2 DM groups than NGM group. The prevalence of nephropathy and presence of CAD were higher in type-2 DM groups than prediabetes. Glucose, glycated hemoglobin (HbA1c), total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, blood urea nitrogen, creatinine, high sensitive C reactive protein (hs-CRP) levels and urinary ACR were significantly higher in patients within prediabetes and type-2 DM groups than NGM group. Glucose, HbA1c and hs-CRP levels were found to be higher in type-2 DM groups than prediabetes. Estimated glomerular filtration rate and high-density lipoprotein (HDL) cholesterol level was found to be lower in patients within prediabetes and type-2 DM groups than NGM group. Right-left-mean CC-IMT and IC-IMT values were found to be higher in prediabetes and type-2 DM groups than NGM group. Left IC-IMT, left CC-IMT, and mean IC-IMT values were found to be higher in type-2 DM patients compared to prediabetes. LDL and HDL cholesterols, HbA1c, and hs-CRP levels were independently associated with IC-IMT and CC-IMT.C-IMT values were significantly higher in impaired glucose metabolism compared to NGM. C-IMT measurement may be used as part of routine screening of macrovascular complication in patients with prediabetes and newly diagnosed type-2 DM.


Assuntos
Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Angiopatias Diabéticas/diagnóstico , Estado Pré-Diabético/diagnóstico por imagem , Idoso , Glicemia/metabolismo , Pressão Sanguínea , Proteína C-Reativa/metabolismo , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/diagnóstico , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/fisiopatologia
2.
Diabetes Metab Syndr ; 13(4): 2705-2713, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405697

RESUMO

BACKGROUND: Yoga is an ancient system of wellness with Asana and Pranayama as its most popular and propagated modules for management of lifestyle disorders. OBJECTIVES: The aim of the study was to characterise the liver abnormalities, biochemical changes, and stress levels after Yoga intervention in prediabetic females. MATERIALS AND METHODS: 37 females were randomly divided into Yoga practising and non-practising control groups. The Yoga practising group performed Diabetic Yoga Protocol (DYP) for 3 months. Parameters including size of liver, fatty infiltration, and grade of severity were measured using ultrasonography along with biochemical parameters and stress levels at baseline and after Yoga practice. RESULTS: The glycosylated hemoglobin (HbA1c) and glucose levels were found significantly reduced in prediabetic (p = 0.015) women after practising DYP, although cholesterol levels increased in menopausal women. No escalation of fatty liver was noted among women practising DYP. CONCLUSION: DYP reduced the HbA1c and stress levels and therefore, could be a cost-effective tool for preventing prediabetes to diabetes progression.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/prevenção & controle , Fígado/fisiologia , Estado Pré-Diabético/terapia , Estresse Fisiológico , Ioga , Glicemia/análise , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Estilo de Vida , Fígado/diagnóstico por imagem , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico por imagem , Prognóstico , Ultrassonografia/métodos
3.
Horm Metab Res ; 51(3): 191-199, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30572349

RESUMO

The study was aimed to investigate gut hormone responses to mixed meal test in individuals with new-onset prediabetes or diabetes after acute pancreatitis (cases) compared with healthy controls, and the effect of body fat parameters. A total of 29 cases and 29 age- and sex-matched healthy controls were recruited. All participants were given standard mixed meal drink and blood samples were collected to measure dipeptidyl peptidase IV, gastric inhibitory peptide, glucagon like peptide-1, insulin, oxyntomodulin, and peptide YY. Body fat parameters were measured using magnetic resonance imaging. Repeated measures and linear regression analyses were conducted in unadjusted and adjusted models. Gastric inhibitory peptide levels were significantly higher whereas oxyntomodulin levels were significantly lower in cases compared with controls in both the unadjusted (p<0.001 and p<0.001, respectively) and adjusted (p<0.001 and p<0.001, respectively) models. In cases, liver fat % contributed up to 13.4% (vs. 2.9% in controls) to variance in circulating levels of gastric inhibitory peptide whereas body mass index - up to 20.8% (vs. 9.9% in controls) in circulating levels of oxyntomodulin. New-onset prediabetes/diabetes after acute pancreatitis is characterised by increased levels of gastric inhibitory peptide and decreased levels of oxyntomodulin. Further, liver fat % and body mass index appear to be the body fat parameters that contribute most significantly to gastric inhibitory peptide and oxyntomodulin levels, respectively.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Hormônios Gastrointestinais/sangue , Pancreatite/complicações , Período Pós-Prandial/fisiologia , Estado Pré-Diabético/sangue , Adulto , Idoso , Glicemia , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/etiologia , Dipeptidil Peptidase 4/sangue , Feminino , Polipeptídeo Inibidor Gástrico/sangue , Glucagon/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Humanos , Insulina/sangue , Imagem por Ressonância Magnética , Masculino , Refeições , Pessoa de Meia-Idade , Oxintomodulina/sangue , Pancreatite/sangue , Pancreatite/diagnóstico por imagem , Peptídeo YY/sangue , Estado Pré-Diabético/diagnóstico por imagem , Estado Pré-Diabético/etiologia , Gordura Subcutânea/diagnóstico por imagem
4.
Eur J Radiol ; 105: 261-268, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30017292

RESUMO

OBJECTIVES: Intra- and intermyocellular lipid deposition and adipose tissue are part of glucose homeostasis and insulin resistance; however, their role in type 2 diabetes mellitus (T2DM) remains unclear. We assessed differences in the degree of abdominal myosteatosis among subjects with T2DM and prediabetes. MATERIALS AND METHODS: Asymptomatic subjects from the general population were classified as subjects with T2DM, prediabetes or healthy controls and underwent multi-echo Dixon magnetic resonance imaging (MRI) (TR 8.90 ms, six echo times, flip-angle 4°). Abdominal myosteatosis was quantified as proton-density fat-fraction (PDFFmuscle) by a standardized segmentation-algorithm. Cardiometabolic risk factors were prospectively obtained in a comprehensive health assessment and visceral and subcutaneous adipose tissue (VAT and SAT) were quantified semi-automatically. Uni- and multivariate quantile regression were used to examine associations. RESULTS: Among 349 included subjects (mean age: 56.0 ±â€¯8.0years, 56.7% males), 45 were classified as subjects with T2DM and 84 with prediabetes (12.9% and 24.1%; respectively). Median PDFFmuscle was significantly higher in subjects with T2DM and prediabetes compared to healthy controls (13.1% (IQR10.5-16.6%); 11.1% (IQR8.9-15.0%) and 10.1% (IQR7.5-13.3%); respectively, p < 0.001). The observed differences were independent of age and gender (all p < 0.002) but attenuated after adjustment for BMI (ß: -0.02, 95%CI: -1.49 to 1.44, p = 0.974; ß: 0.47, 95%CI: -0.91 to 1.86, p = 0.506; prediabetes and T2DM, respectively). This effect was attributable to VAT, which remained independently associated with PDFFmuscle after full adjustment (ß: 0.01, 95%CI: 0.01-0.02, p = 0.002). CONCLUSIONS: There are significant differences in the degree of abdominal myosteatosis between subjects with T2DM, prediabetes and healthy controls, that may be confounded by VAT. However, abdominal myosteatosis by MRI might serve as a cardiometabolic imaging-biomarker, specifically in the setting of impaired glucose metabolism.


Assuntos
Abdome/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Imagem por Ressonância Magnética , Estado Pré-Diabético/diagnóstico por imagem , Abdome/patologia , Tecido Adiposo/patologia , Adiposidade , Adulto , Análise de Variância , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Resistência à Insulina , Fígado/metabolismo , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/fisiopatologia , Músculos Psoas/diagnóstico por imagem , Fatores de Risco
5.
Eur Radiol ; 28(7): 3105-3113, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29423576

RESUMO

OBJECTIVES: The aim of this study was to assess subclinical changes in right ventricular volumes and function in subjects with prediabetes and diabetes and controls without a history of cardiovascular disease. METHODS: Data from 400 participants in the KORA FF4 study without self-reported cardiovascular disease who underwent 3-T whole-body MRI were obtained. The right ventricle was evaluated using the short axis and a four-chamber view. Diabetes was defined according to WHO criteria. Associations between glucose tolerance and right ventricular parameters were assessed using multivariable adjusted linear regression models. RESULTS: Data from 337 participants were available for analysis. Of these, 43 (13%) had diabetes, 87 (26%) had prediabetes, and 207 (61%) were normoglycaemic controls. There was a stepwise decrease in right ventricular volumes in men with prediabetes and diabetes in comparison with controls, including right ventricular end-diastolic volume (ß = -20.4 and ß = -25.6, respectively; p ≤ 0.005), right ventricular end-systolic volume (ß = -12.3 and ß = -12.7, respectively; p ≤ 0.037) and right ventricular stroke volume (ß = -8.1 and ß = -13.1, respectively, p ≤ 0.016). We did not observe any association between prediabetes or diabetes and right ventricular volumes in women or between prediabetes or diabetes and right ventricular ejection fraction in men and women. CONCLUSIONS: This study points towards early subclinical changes in right ventricular volumes in men with diabetes and prediabetes. KEY POINTS: • MRI was used to detect subclinical changes in right ventricular parameters. • Diabetes mellitus is associated with right ventricular dysfunction. • Impairment of right ventricular volumes seems to occur predominantly in men.


Assuntos
Diabetes Mellitus/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus/fisiopatologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Modelos Lineares , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico por imagem , Estado Pré-Diabético/fisiopatologia , Volume Sistólico/fisiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita/fisiologia
6.
Atherosclerosis ; 269: 50-56, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29274507

RESUMO

BACKGROUND AND AIMS: Endothelial dysfunction (ED) plays a key role in the development of atherosclerotic cardiovascular disease (ASCVD). Likewise, type 2 diabetes (T2D) is a major CVD risk factor. Therefore, our objective was to explore whether long-term consumption of a Mediterranean diet (MedDiet) rich in olive oil or a low-fat diet (LF diet) was associated with an improvement in ED and whether the potential benefits were similar in patients with or without T2D in the CORDIOPREV clinical trial (NCT00924937). METHODS: Endothelial function was measured in 805 participants who had completed follow-up ultrasound image studies, using ultrasonography of brachial artery to calculate flow mediated vasodilatation (FMD) before and after 1.5 years of intervention with a MedDiet [35% of calories from fat (22% monounsaturated) and 50% from carbohydrates] and LF diet [28% fat (12% monounsaturated) and 55% of calories from carbohydrates]. We categorized participants as patients with T2D, prediabetes, and without T2D according to the American Diabetes Association (ADA) criteria. RESULTS: MedDiet increased FMD in patients with T2D [5.2 ± 0.4 at 1.5 years vs. 3.8 ± 0.4 at baseline; p=0.04] and prediabetes [4.9 ± 0.4 vs. 3.8 ± 0.4; p=0.04] and induced an improvement in FMD compared to LF diet in patients with diabetes [5.2 ± 0.4 (MedDiet) vs.3.7 ± 0.4 (LF diet); p=0.01]; whereas both diets maintained FMD stable in patients without diabetes. CONCLUSIONS: Habitual consumption of a MedDiet rich in extra virgin olive oil improves endothelial function in patients with prediabetes and diabetes. This takes great importance given that diet must be the cornerstone of treatment of patients with diabetes at high cardiovascular risk.


Assuntos
Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Gorduras , Dieta Mediterrânea , Endotélio Vascular/fisiopatologia , Estado Pré-Diabético/dietoterapia , Vasodilatação , Artéria Braquial/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Azeite de Oliva/administração & dosagem , Estado Pré-Diabético/diagnóstico por imagem , Estado Pré-Diabético/fisiopatologia , Estudos Prospectivos , Fatores de Proteção , Recuperação de Função Fisiológica , Fatores de Risco , Método Simples-Cego , Espanha , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
7.
J Diabetes Res ; 2017: 4174292, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29238728

RESUMO

Background: Patients with prediabetes are at risk for diabetes, cardiovascular events, and microvascular complications. The rtx1 (Imagine Eyes, France) permits early detection of changes in the retinal photoreceptors and vessels. Objective: Cone parameters and retinal microvasculature were analyzed with the rtx1 in 12 prediabetic patients and 22 healthy subjects. The analysis was based on cone density (DM), interphotoreceptor distance (SM), cone packing regularity, and retinal vessel parameters: wall thickness, lumen diameter (LD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall. Results: DM in the prediabetic group was not significantly lower than that in the control group (18,935 ± 1713 cells/mm2 and 19,900 ± 2375 cells/mm2, respectively; p = 0.0928). The LD and WLR means differed significantly between the prediabetic and the control groups (LD 94.3 ± 10.9 versus 101.2 ± 15, p = 0.022; WLR 0.29 ± 0.05 versus 0.22 ± 0.03, p < 0.05). A multivariate regression analysis showed that the WLR was significantly correlated with BMI and total cholesterol. Conclusions: Abnormalities found in rtx1 examinations indicated early signs of arteriolar dysfunction, prior to impaired glucose tolerance progressing to diabetes. The rtx1 retinal image analysis offers noninvasive measurement of early changes in the vasculature that routine clinical examination cannot detect.


Assuntos
Retinopatia Diabética/diagnóstico por imagem , Células Fotorreceptoras de Vertebrados/patologia , Estado Pré-Diabético/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Estudos Transversais , Retinopatia Diabética/patologia , Feminino , Humanos , Masculino , Microvasos , Pessoa de Meia-Idade , Estado Pré-Diabético/patologia , Vasos Retinianos/patologia
8.
Sci Rep ; 7(1): 10531, 2017 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-28874821

RESUMO

Type 2 diabetes mellitus (T2DM) is associated with reduced myocardial glucose uptake (GU) and increased free fatty acid uptake (FFAU). Sprint interval training (SIT) improves physical exercise capacity and metabolic biomarkers, but effects of SIT on cardiac function and energy substrate metabolism in diabetic subjects are unknown. We tested the hypothesis that SIT is more effective than moderate-intensity continuous training (MICT) on adaptations in left and right ventricle (LV and RV) glucose and fatty acid metabolism in diabetic subjects. Twenty-six untrained men and women with T2DM or prediabetes were randomized into two-week-long SIT (n = 13) and MICT (n = 13) interventions. Insulin-stimulated myocardial GU and fasted state FFAU were measured by positron emission tomography and changes in LV and RV structure and function by cardiac magnetic resonance. In contrast to our hypothesis, SIT significantly decreased GU compared to MICT in LV. FFAU of both ventricles remained unchanged by training. RV end-diastolic volume (EDV) and RV mass increased only after MICT, whereas LV EDV, LV mass, and RV and LV end-systolic volumes increased similarly after both training modes. As SIT decreases myocardial insulin-stimulated GU compared to MICT which may already be reduced in T2DM, SIT may be metabolically less beneficial than MICT for a diabetic heart.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Terapia por Exercício/métodos , Fluordesoxiglucose F18/farmacocinética , Ventrículos do Coração/diagnóstico por imagem , Condicionamento Físico Humano/métodos , Estado Pré-Diabético/fisiopatologia , Compostos Radiofarmacêuticos/farmacocinética , Adulto , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/efeitos adversos , Feminino , Ventrículos do Coração/metabolismo , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Condicionamento Físico Humano/efeitos adversos , Tomografia por Emissão de Pósitrons , Estado Pré-Diabético/diagnóstico por imagem , Estado Pré-Diabético/terapia , Função Ventricular
9.
Diabetes Care ; 40(11): 1514-1521, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28916531

RESUMO

OBJECTIVE: To examine the associations of prediabetes, diabetes, and diabetes severity (as assessed by HbA1c and diabetes duration) with brain volumes and vascular pathology on brain MRI and to assess whether the associations of diabetes with brain volumes are mediated by brain vascular pathology. RESEARCH DESIGN AND METHODS: Cross-sectional study of 1,713 participants in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) (mean age 75 years, 60% female, 27% black, 30% prediabetes, and 35% diabetes) who underwent 3T brain MRI scans in 2011-2013. Participants were categorized by diabetes-HbA1c status as without diabetes (<5.7% [reference]), with prediabetes (5.7 to <6.5%), and with diabetes ([defined as prior diagnosis or HbA1c ≥6.5%] <7.0% vs. ≥7.0%), with further stratification by diabetes duration (<10 vs. ≥10 years). RESULTS: In adjusted analyses, compared with participants without diabetes and HbA1c <5.7%, participants with prediabetes and those with diabetes and HbA1c <7.0% did not have significantly different brain volumes or vascular pathology (all P > 0.05), but those with diabetes and HbA1c ≥7.0% had smaller total brain volume (ß -0.20 SDs, 95% CI -0.31, -0.09), smaller regional brain volumes (including frontal, temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all P < 0.05]), and increased burden of white matter hyperintensities (WMH) (P = 0.016). Among participants with diabetes, those with HbA1c ≥7.0% had smaller total and regional brain volumes and an increased burden of WMH (all P < 0.05) compared with those with HbA1c <7.0%. Similarly, participants with longer duration of diabetes (≥10 years) had smaller brain volumes and higher burden of lacunes (all P < 0.05) than those with a diabetes duration <10 years. We found no evidence for mediation by WMH in associations of diabetes with smaller brain volumes by structural equation models (all P > 0.05). CONCLUSIONS: More-severe diabetes (defined by higher HbA1c and longer disease duration) but not prediabetes or less-severe diabetes was associated with smaller brain volumes and an increased burden of brain vascular pathology. No evidence was found that associations of diabetes with smaller brain volumes are mediated by brain vascular pathology, suggesting that other mechanisms may be responsible for these associations.


Assuntos
Aterosclerose/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Diabetes Mellitus/diagnóstico por imagem , Transtornos Neurocognitivos/diagnóstico por imagem , Estado Pré-Diabético/diagnóstico por imagem , Biomarcadores/sangue , Encéfalo/fisiopatologia , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/metabolismo , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Fatores de Risco
10.
Int J Clin Pract ; 71(8)2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28758307

RESUMO

BACKGROUND: Screening and early diagnosis of prediabetes and diabetes can prevent or delay disease onset and complications. To that end, a free public health station was established in a large, government medical centre. This study evaluated the long-term outcomes of abnormal random blood glucose results among patients with no history of diabetes or prediabetes. METHODS: The Diabetes Unit supervised a public dysglycaemia and hypertension screening station. Participants with blood glucose >140 mg/dL and no history of diabetes or prediabetes were contacted by telephone for follow-up. RESULTS: Among screened subjects, 868 (average age 57.5±12 years) had a random blood glucose level >140 mg/dL and 341 (39.3%) responded to the telephone survey. Of these, 313 (91.8%) subsequently had fasting blood glucose measured at their health maintenance organisation (HMO), of which 101 (32.3%) were abnormal. A total of 173 (51%) respondents initiated interventions: 59 (17.3%) antidiabetic treatment; 145 (42.5%) sugar-restricted diet; and 96 (28.2%) a physical activity programme. Of patients with abnormal fasting blood glucose, 17 (14.5%) reported having had this result previously compared with 9 (4.2%) with normal fasting glucose (P=.001). Among respondents, 216 (63.3%) stated the screening was effective and 273 (80.1%) would recommend it. CONCLUSION: The station was effective in promoting additional screening among high-risk age groups and encourages subjects to make lifestyle changes. Operating the screening station is simple and effective; therefore it may serve as a complementary step in promoting community healthcare.


Assuntos
Glicemia/análise , Estilo de Vida Saudável , Hiperglicemia/diagnóstico , Estado Pré-Diabético/diagnóstico , Saúde Pública/métodos , Idoso , Dieta , Exercício , Feminino , Humanos , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico por imagem , Estudos Prospectivos , Fatores de Risco
11.
Biomed Res Int ; 2017: 6513076, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28808662

RESUMO

OBJECTIVE: The aim of the study was to investigate the prevalence and the risk factors of maculopathy detected by optical coherence tomography (OCT) in a Chinese population with diabetes or prediabetes. Methods. 8,155 people were randomly selected to participate in the 2011 annual Health Examination Survey in Beijing. A 75 g oral glucose tolerance test (OGTT) was tested in 3760 subjects with fasting plasma glucose (FPG) ≥ 5.6 mmol/L. Of 3,760 subjects, 583 were also randomly selected to take OCT. RESULTS: In this study population, 21 (3.95%) patients had maculopathy. Eight patients had diabetes macular edema (DME) and the prevalence was 6.72% in diabetes patients and 1.51% in all subjects. Eleven patients had age-related macular degeneration (AMD) and the prevalence was 3.36% in diabetes patients and 2.07% in all subjects. Logistic regression model confirmed that elevated HbA1c (p < 0.001) and systolic pressure (p < 0.05) made significant contributions to DME. Stepwise regression analysis revealed that HbA1c and blood creatinine were significantly independent influence factors for central subfield thickness (CST) (p = 0.01, p < 0.001). CONCLUSIONS: High prevalence of maculopathy was found in patients with diabetes in a Chinese population. Maculopathy poses a significant public health problem in China with rapid rising trend of diabetes.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Degeneração Macular/epidemiologia , Estado Pré-Diabético/epidemiologia , Adolescente , Adulto , Idoso , Complicações do Diabetes/diagnóstico por imagem , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Degeneração Macular/diagnóstico por imagem , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico por imagem , Estado Pré-Diabético/fisiopatologia , Tomografia de Coerência Óptica
12.
Int J Cardiol ; 243: 479-484, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28539206

RESUMO

BACKGROUND: There are limited data regarding the influence of glycemic status on the risk of subclinical coronary atherosclerosis on coronary computed tomographic angiography (CCTA) in asymptomatic individuals. METHODS: We analyzed 6434 asymptomatic individuals who underwent CCTA. The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. Of study participants, 2197 (34.1%), 3122 (48.5%), and 1115 (17.3%) were categorized as normal, prediabetic and diabetic individuals, respectively. RESULTS: Compared with normal individuals, there were no statistically differences in the adjusted odds ratios of prediabetic individuals for significant coronary artery stenosis (0.98, 95% confidence interval [CI] 0.80-1.22, p=0.888), any plaque (0.96, 95% CI 0.86-1.07, p=0.483), calcified plaque (0.90, 95% CI 0.79-1.01, p=0.080), non-calcified plaque (1.02, 95% CI 0.88-1.17, p=0.803), and mixed plaque (1.00, 95% CI 0.82-1.22, p=0.983). However, adjusted odds ratios for significant coronary artery stenosis (1.71, 95% CI 1.34-2.19, p<0.001), any plaque (1.45, 95% CI 1.26-1.68, p<0.001), calcified plaque (1.35, 95% CI 1.15-1.57, p<0.001), non-calcified plaque (1.33, 95% CI 1.11-1.59, p=0.002), and mixed plaque (1.64, 95% CI 1.30-2.07, p<0.001) of diabetic individuals were significantly higher than those of the normal individuals. CONCLUSION: In asymptomatic individuals, diabetic individuals had a higher risk for subclinical coronary atherosclerosis, but prediabetic individuals were not associated with an increased risk of subclinical coronary atherosclerosis.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Estado Pré-Diabético/diagnóstico por imagem , Estado Pré-Diabético/epidemiologia , Glicemia/metabolismo , Angiografia Coronária/métodos , Doença da Artéria Coronariana/sangue , Diabetes Mellitus/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
13.
Circ J ; 81(8): 1165-1173, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28420816

RESUMO

BACKGROUND: The association between cardiovascular risk factors (CVRF) and the risk of coronary events is widely acknowledged. Whether individual risk factors may be associated with distinct plaque characteristics is currently unclear. We investigated the relationship between CVRF and coronary plaque burden and phenotype.Methods and Results:We assessed coronary atherosclerotic plaque characteristics by optical coherence tomography in 67 patients with stable coronary artery disease undergoing coronary angiography. The plaque burden and the distinct plaque phenotypes were compared with regard to different CVRF. Overall plaque burden was significantly greater in patients with diabetes mellitus (P=0.010), prediabetes (P=0.035) and obesity (P=0.024), and correlated with the number of CVRF (R=0.358, P=0.003). Patients with diabetes had a greater extent of fibroatheroma (P=0.015), calcific fibroatheroma (P=0.031), thin-cap fibroatheroma (TCFA-P=0.011) and plaque erosion (P=0.002). Obese patients showed a greater extent of fibroatheroma (P=0.007), TCFA (P=0.015) and macrophage load (P=0.043). The number of CVRF correlated with fibroatheroma (R=0.425, P<0.001), calcific fibroatheroma (R=0.321, P=0.008), TCFA (R=0.347, P=0.004), macrophage load (R=0.314, P=0.010) and erosion (R=0.271, P=0.029). In the multivariate analysis, altered glycemic status and obesity were the only independent predictors of TCFA (P=0.026 and P=0.046, respectively), whereas altered glycemic status was the only independent predictor of plaque erosion (P=0.001). CONCLUSIONS: Patients with diabetes, prediabetes and obesity show more extensive coronary atherosclerosis and more vulnerable plaque phenotypes.


Assuntos
Doença da Artéria Coronariana , Complicações do Diabetes/diagnóstico por imagem , Obesidade , Placa Aterosclerótica , Estado Pré-Diabético , Tomografia de Coerência Óptica , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/etiologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/diagnóstico por imagem , Sistema de Registros
14.
Diabetes Technol Ther ; 19(2): 96-102, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28118051

RESUMO

BACKGROUND: The evaluation of brown adipose tissue (BAT) and its role in metabolism and obesity remains an important topic in the recent literature. This study evaluated the influence of the BAT triglyceride content measured by proton magnetic resonance (MR) spectroscopy in patients with type 2 diabetes mellitus (DM2) and prediabetes on insulin sensitivity. METHODS: A total of 25 patients with DM2 and prediabetes (45.9 ± 10.1 years old, body mass index [BMI] of 31.6 ± 5.4 kg/m2) underwent anthropometric measurements (BMI), insulin sensitivity analysis (M value during euglycemic hyperinsulinemic clamp and homeostasis model assessment of insulin resistance), proton MR spectroscopy, and blood tests (total cholesterol, low-density lipoproteins, high-density lipoproteins, and triglycerides). The relationship between the triglyceride content in the supraclavicular fat depot and insulin sensitivity, anthropometric measurements, and blood test results was assessed. RESULTS: The triglyceride content in the supraclavicular fat depot varied between 79.2% and 97.1% (mean: 92.6% ± 4.2%). The triglyceride content in the subcutaneous white adipose tissue of the neck was significantly higher (85.3%-99.3%; mean: 95.5% ± 2.9%; P = 0.0007). The triglyceride content in the supraclavicular fat depot exhibited a significantly moderate correlation with the BMI (r = 0.64; P = 0.0009). A significant weak negative correlation between the supraclavicular fat content and M value was revealed (r = -0.44; P = 0.002). Patients with high insulin resistance (IR) had a higher triglyceride content in the supraclavicular fat depot than patients with normal and lower IR (94.3% ± 2.0% vs. 90.4% ± 5.2%; P = 0.02). CONCLUSIONS: Reducing the BAT content in the supraclavicular fat depot can influence the development of IR in patients with DM2 and prediabetes.


Assuntos
Tecido Adiposo Marrom/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Resistência à Insulina/fisiologia , Estado Pré-Diabético/metabolismo , Triglicerídeos/metabolismo , Tecido Adiposo Marrom/diagnóstico por imagem , Adulto , Índice de Massa Corporal , Colesterol/sangue , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Humanos , Lipoproteínas/sangue , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico por imagem
15.
Korean J Intern Med ; 32(2): 286-294, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27919159

RESUMO

BACKGROUND/AIMS: The aim of this study was to investigate atrial conduction times and left atrial mechanical functions, the noninvasive predictors of atrial fibrillation, in prediabetic patients with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). METHODS: Study included 59 patients (23 males, 36 females; mean age 52.5 ± 10.6 years) diagnosed with IFG or IGT by the American Diabetes Association criteria, and 43 healthy adults (22 males, 21 females; mean age 48.5 ± 12.1 years). Conventional and tissue Doppler echocardiography were performed. The electromechanical delay parameters were measured from the onset of the P wave on the surface electrocardiogram to the onset of the atrial systolic wave on tissue Doppler imaging from septum, lateral, and right ventricular annuli. The left atrial volumes were calculated by the disk method. Left atrial mechanical functions were calculated. RESULTS: The mitral E/A and E'/A' ratios measured from the lateral and septal annuli were significantly lower in the prediabetics compared to the controls. The interatrial and left atrial electromechanical delay were significantly longer in prediabetic group compared to the controls. Left atrial active emptying volume (LAAEV) and fraction (LAAEF) were significantly higher in the prediabetics than the controls. LAAEV and LAAEF were significantly correlated with E/A, lateral and septal E'/A'. CONCLUSIONS: In the prediabetic patients, the atrial conduction times and P wave dispersion on surface electrocardiographic were longer before the development of overt diabetes. In addition, the left atrial mechanical functions were impaired secondary to a deterioration in the diastolic functions in the prediabetic patients.


Assuntos
Estado Pré-Diabético/fisiopatologia , Adulto , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Estudos de Casos e Controles , Diástole , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/complicações , Estado Pré-Diabético/diagnóstico por imagem
16.
Ann Nutr Metab ; 69(2): 142-149, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27760418

RESUMO

BACKGROUND/AIMS: Our aim was to evaluate whether visceral adiposity index (VAI) could predict the risk of type 2 diabetes (T2D) in different genders and to compare the predictive ability between VAI and other fatness indices. METHODS: Four thousand seventy-eight participants including 1,817 men and 2,261 women, aged 18 and older and free of T2D at baseline were enrolled in 2010 and followed up for 4 years. New cases of T2D were identified via the annual medical examination. Cox regression analysis was used to assess the association between VAI and incidence of T2D. Receiver operating characteristic curve and area under the curves (AUC) were applied to compare the prediction ability of T2D between VAI and other fatness indices. RESULTS: During the 4-year follow-up, 153 (8.42%) of 1,817 men and 88 (3.89%) of 2,261 women developed T2D. The multivariable-adjusted hazards ratios for developing T2D in the highest tertile of VAI scores were 2.854 (95% CI 1.815-4.487) in men and 3.551 (95% CI 1.586-7.955) in women. The AUC of VAI was not higher than that of other fatness indices. CONCLUSIONS: VAI could predict the risk of T2D among Chinese adults, especially in women. However, the prediction ability of T2D risk for VAI was not higher than that of the other fatness indices.


Assuntos
Adiposidade , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Gordura Intra-Abdominal/diagnóstico por imagem , Sobrepeso/diagnóstico por imagem , Estado Pré-Diabético/diagnóstico por imagem , Adiposidade/etnologia , Adulto , Biomarcadores , China/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/etiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Sobrepeso/etnologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/etnologia , Estado Pré-Diabético/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Circunferência da Cintura/etnologia , Relação Cintura-Quadril
19.
J Clin Endocrinol Metab ; 101(4): 1701-9, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-26885882

RESUMO

CONTEXT: Prediabetes is associated with atherosclerotic vascular damage. OBJECTIVE: We investigated the correlation of endogenous secretory receptor for advanced glycation end-products (esRAGE), total soluble RAGE (sRAGE) and markers of inflammation, with early cardiovascular disease in subjects with prediabetes. We particularly focused on individuals with prediabetes identified only by glycated hemoglobin A1c (HbA1c) (5.7­6.4%) who had normal fasting glucose and were normotolerant after oral glucose tolerance test. DESIGN: This was a cross-sectional study. SETTING: The study was conducted in the Department of Clinical and Molecular Medicine, University of Catania, Italy. MAIN OUTCOME MEASURE: sRAGE, esRAGE, carboxymethyl-lysine, S100A12, HbA1c, fasting glycemia, oral glucose tolerance test, pulse wave velocity, and intima-media thickness were evaluated in subjects with prediabetes. PATIENTS: Three hundred eighty subjects without previous history of diabetes were stratified into three groups: controls (n = 99), prediabetes (n = 220), and new-onset type 2 diabetes (n = 61). RESULTS: Subjects with prediabetes exhibited the following: lower esRAGE (0.29 ± 0.18 vs 0.45 ± 0.26 ng/mL; P < .05) and higher S100A12 levels than controls. RT-PCR analysis in mononuclear cells revealed that the mRNA expression level of the esRAGE splice variant progressively decreased in patients with prediabetes and type 2 diabetes with respect to controls. No difference was observed in sRAGE and carboxymethyl-lysine plasma levels between the groups. After multiple regression analyses, only age, HbA1c, and hs-CRP were independently associated with esRAGE levels. Age, HbA1c, and esRAGE were the major determinants of intima-media thickness, whereas S100A12 and systolic blood pressure were the major determinants of pulse wave velocity. When we analyzed the subjects with HbA1c prediabetes (normal fasting glucose/normotolerant and HbA1c 5.7­6.4%), esRAGE and inflammatory markers plasma levels still remained significantly different in respect to controls. CONCLUSIONS: Subjects with HbA1c prediabetes exhibited significantly reduced esRAGE levels and increased levels of markers of inflammation. These alterations are associated with early markers of cardiovascular disease.


Assuntos
Aterosclerose/sangue , Doenças das Artérias Carótidas/sangue , Diabetes Mellitus Tipo 2/sangue , Inflamação/sangue , Estado Pré-Diabético/sangue , Receptor para Produtos Finais de Glicação Avançada/sangue , Adulto , Aterosclerose/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Humanos , Inflamação/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico por imagem , Ultrassonografia , Rigidez Vascular/fisiologia
20.
Echocardiography ; 33(5): 681-5, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26711179

RESUMO

Vitamin D deficiency is common among African Americans in the United States and is associated with increased cardiovascular disease risk. In this study, prediabetic African American males who were found to be vitamin D-deficient were randomized to vitamin D supplementation and assessed for changes in left atrial (LA) volume. Prediabetic African American males who were vitamin D-deficient (25(OH)D: 5.0-29 ng/mL) were randomized to high-dose ergocalciferol or placebo. Echocardiography was performed at baseline and at 1 year. Ejection fraction (EF), septal and posterior wall thickness, LA area, LA length, LA volume, E, A, septal and lateral e' and a', deceleration time, and isovolumetric relaxation time were collected. Eighty-one of 158 (51%) subjects received vitamin D2 . Baseline characteristics were similar among both groups. In the placebo group, left atrial volume significantly increased on follow-up (LA volume increased 6.3 mL, P = 0.0025). Compared with placebo group, the treatment group with ergocalciferol had attenuated increases in left atrial volume (LA volume increased 2.6 mL, P = 0.29). Changes in left atrial volume persisted when indexed to body surface area. There was no significant difference in other diastolic parameters and blood pressure between groups. In conclusion, vitamin D-deficient prediabetic African American males who were treated with high-dose vitamin D2 were found to have attenuated increases in left atrial volume compared with controls over 12-month follow-up.


Assuntos
Afro-Americanos/estatística & dados numéricos , Átrios do Coração/efeitos dos fármacos , Obesidade/etnologia , Estado Pré-Diabético/etnologia , Deficiência de Vitamina D/etnologia , Deficiência de Vitamina D/prevenção & controle , Vitamina D/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Suplementos Nutricionais/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Estado Pré-Diabético/diagnóstico por imagem , Prevalência , Fatores de Risco , Resultado do Tratamento , Estados Unidos , Deficiência de Vitamina D/diagnóstico por imagem
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