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1.
PLoS One ; 15(12): e0242332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33270683

RESUMO

We have reported previously that renal hemodynamic abnormalities exist in the prediabetic stage of type II diabetic rats. At this prediabetic stage these rats have hyperinsulinemia, insulin resistance and metabolic syndrome. It is well known that insulin resistance is frequently associated with renal abnormalities, but the mechanism underlying this association has remained speculative. Although insulin is known to modify renal hemodynamics, little is known about the roles of insulin receptor substrates (IRS1, IRS2) in the renal actions of insulin. To address this issue, the effects of insulin on renal function and renal hemodynamics were investigated in C57BL/6 (WT: wild type), insulin receptor substrate 1- knockout (IRS1-/-), and IRS2-knockout (IRS2-/-) mice. IRS2-/-mice had elevated glucose level as expected. 24-h urine collections and serum creatinine revealed that creatinine clearance did not significantly differ between these groups. Albuminuria was found in IRS1-/-and IRS2-/-groups. We examined the effects on the IRS during the administration of Losartan, which is widely used for diabetic nephropathy. After the administration of Losartan the IRS displayed improved renal hemodynamics. Moreover, the subjects were also given Pioglitazone, which improves insulin resistance. Losartan significantly reduced albuminuria in both groups. Pioglitazone also showed similar results. We assessed the autoregulatory responses of the total renal blood flow (RBF), the superficial (SBF) and the deep renal cortical blood flow (DBF) with stepwise reductions of renal perfusion pressure (RPP), which was induced by a manual clamp on the abdominal aorta. During the clamp induced reductions of the RPP by 10 to 20mm HG, RBF, SBF and the DBF fell significantly more in the IRS1 and IRS2 than in the WT mice. Furthermore micropuncture studies showded that compared to the WT tubuloglomerular feedback (TGF) responses of the stop flow pressure (Psf) were reduced in both the IRS1 -/- and IRS2 -/-. The results of the IRS1 and IRS2 mice displayed the pressence of hemodynamic abnormalities. Losartan and Pioglitazone have shown the potential to improve these abnormalities. In conclusion the results indicate that IRS plays a major role in the stimulation of renal functions and renal hemodynamics in type type II diabetes.


Assuntos
Diabetes Mellitus Tipo 2/genética , Nefropatias Diabéticas/genética , Hiperinsulinismo/genética , Proteínas Substratos do Receptor de Insulina/genética , Albuminúria/sangue , Albuminúria/genética , Animais , Glicemia/genética , Creatinina/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/patologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/patologia , Monitorização Hemodinâmica/métodos , Hemodinâmica , Hiperinsulinismo/sangue , Hiperinsulinismo/patologia , Insulina/sangue , Resistência à Insulina/genética , Rim/irrigação sanguínea , Rim/metabolismo , Rim/patologia , Masculino , Camundongos , Camundongos Knockout , Estado Pré-Diabético/sangue , Estado Pré-Diabético/genética , Estado Pré-Diabético/patologia , Ratos , Circulação Renal/genética , Transdução de Sinais/genética
2.
JMIR Public Health Surveill ; 6(4): e22471, 2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-33284130

RESUMO

BACKGROUND: Recent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death). OBJECTIVE: This study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment. METHODS: This cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients. RESULTS: Of the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1c level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (P<.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization-all of whom were in the intensive care unit. CONCLUSIONS: Majority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.


Assuntos
/mortalidade , Diabetes Mellitus/mortalidade , Hospitalização/estatística & dados numéricos , Estado Pré-Diabético/mortalidade , Adulto , Idoso , Biomarcadores/sangue , /virologia , Comorbidade , Cuidados Críticos/estatística & dados numéricos , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/virologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/virologia , Prognóstico , Fatores de Risco , Emirados Árabes Unidos/epidemiologia
3.
PLoS One ; 15(11): e0242415, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33216783

RESUMO

AIM: This systematic review aimed to ascertain the diagnostic accuracy (sensitivity and specificity) of screening tests for early detection of type 2 diabetes and prediabetes in previously undiagnosed adults. METHODS: This systematic review included published studies that included one or more index tests (random and fasting tests, HbA1c) for glucose detection, with 75-gram Oral Glucose Tolerance Test (or 2-hour post load glucose) as a reference standard (PROSPERO ID CRD42018102477). Seven databases were searched electronically (from their inception up to March 9, 2020) accompanied with bibliographic and website searches. Records were manually screened and full text were selected based on inclusion and exclusion criteria. Subsequently, data extraction was done using standardized form and quality assessment of studies using QUADAS-2 tool. Meta-analysis was done using bivariate model using Stata 14.0. Optimal cut offs in terms of sensitivity and specificity for the tests were analysed using R software. RESULTS: Of 7,151 records assessed by title and abstract, a total of 37 peer reviewed articles were included in this systematic review. The pooled sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR-) for diagnosing diabetes with HbA1c (6.5%; venous sample; n = 17 studies) were 50% (95% CI: 42-59%), 97.3% (95% CI: 95.3-98.4), 18.32 (95% CI: 11.06-30.53) and 0.51 (95% CI: 0.43-0.60), respectively. However, the optimal cut-off for diagnosing diabetes in previously undiagnosed adults with HbA1c was estimated as 6.03% with pooled sensitivity of 73.9% (95% CI: 68-79.1%) and specificity of 87.2% (95% CI: 82-91%). The optimal cut-off for Fasting Plasma Glucose (FPG) was estimated as 104 milligram/dL (mg/dL) with a sensitivity of 82.3% (95% CI: 74.6-88.1%) and specificity of 89.4% (95% CI: 85.2-92.5%). CONCLUSION: Our findings suggest that at present recommended threshold of 6.5%, HbA1c is more specific and less sensitive in diagnosing the newly detected diabetes in undiagnosed population from community settings. Lowering of thresholds for HbA1c and FPG to 6.03% and 104 mg/dL for early detection in previously undiagnosed persons for screening purposes may be considered.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/diagnóstico , Teste de Tolerância a Glucose/métodos , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Adulto , Diabetes Mellitus Tipo 2/sangue , Técnicas e Procedimentos Diagnósticos , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/patologia , Masculino , Programas de Rastreamento/métodos , Estado Pré-Diabético/sangue , Sensibilidade e Especificidade
4.
PLoS One ; 15(11): e0241121, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147251

RESUMO

BACKGROUND: Central obesity is known to be associated with diabetes. Increasing lower extremity circumference was hypothesized in association with lower risk of diabetes. OBJECTIVE: This study determined which anthropometric patterns correlates the best with pre-diabetic and diabetic status among healthy adults. DESIGN: Cross-sectional study with nationwide population sampling of participants was designed. PARTICIPANTS: In total, 1,358 ethnic Chinese adult participants were recruited from the Nutrition and Health Survey in Taiwan 2013-2016; the whole-body composition was measured through dual-energy X-ray absorptiometry. MAIN OUTCOME MEASURES: Fat and lean mass in whole and specific parts of body among heathy Asian adults with normal glycemic, pre-diabetic, and diabetic states were measured, separately. STATISTICAL ANALYSES PERFORMED: The generalized linear model was used to investigate the association between body composition (lean and fat mass) and hyperglycemic status. The reduced rank regression (RRR) was used to confirm the correlation between glycemic status and predicting factors (body composition parameters). RESULTS: Trunk fat positively correlated with the fasting glucose level (r = 0.327, P < 0.001) and HbA1c (r = 0.329, P < 0.001), whereas limb fat negatively correlated with the fasting glucose level (r = -0.325, P < 0.001) and HbA1c (ρ = -0.342, P < 0.001), respectively. In RRR analyses, fasting glucose and HbA1c exhibited a high positive association on fat amount per lean mass of the trunk (factor loading = 0.5319 and 0.5599, respectively) and of android area (0.6422 and 0.6104) and a high negative association fat amount per lean mass of the legs (-0.3863 and -0.3083) and gynoid area (-0.3414 and -0.3725). CONCLUSIONS: For healthy community participants, increasing trunk fat had a greater risk of hyperglycemic status. Increasing lower extremity mass may confer lower risk of diabetes.


Assuntos
Distribuição da Gordura Corporal , Diabetes Mellitus/epidemiologia , Obesidade Abdominal/epidemiologia , Estado Pré-Diabético/epidemiologia , Absorciometria de Fóton , Adulto , Idoso , Glicemia/análise , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/sangue , Obesidade Abdominal/diagnóstico , Obesidade Abdominal/metabolismo , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/metabolismo , Fatores de Risco , Taiwan/epidemiologia
5.
Sci Rep ; 10(1): 16310, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004816

RESUMO

The intra-individual variability of the human serum metabolome over a period of 4 weeks and its dependence on metabolic health and nutritional status was investigated in a single-center study under tightly controlled conditions in healthy controls, pre-diabetic individuals and patients with type-2 diabetes mellitus (T2DM, n = 10 each). Untargeted metabolomics in serum samples taken at three different days after overnight fasts and following intake of a standardized mixed meal showed that the human serum metabolome is remarkably stable: The median intra-class correlation coefficient (ICC) across all metabolites and all study participants was determined as 0.65. ICCs were similar for the three different health groups, before and after meal intake, and for different metabolic pathways. Only 147 out of 1438 metabolites (10%) had an ICC below 0.4 indicating poor stability over time. In addition, we confirmed previously identified metabolic signatures differentiating healthy, pre-diabetic and diabetic individuals. To our knowledge, this is the most comprehensive study investigating the temporal variability of the human serum metabolome under such tightly controlled conditions.


Assuntos
Sangue/metabolismo , Nível de Saúde , Metaboloma , Estado Nutricional , Adulto , Biomarcadores/sangue , Análise Química do Sangue , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Jejum/sangue , Feminino , Humanos , Masculino , Redes e Vias Metabólicas , Metaboloma/fisiologia , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Estado Pré-Diabético/sangue , Estado Pré-Diabético/metabolismo , Fatores de Tempo
6.
Diabetes Res Clin Pract ; 169: 108457, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32979420

RESUMO

AIMS: Considering a surge in the incidence of Diabetes mellitus (DM) across all ethnic groups and lack of any representative data from the tribal communities of Jammu and Kashmir, the present study aimed to assess the prevalence of DM and prediabetes in them. METHODS: Subjects were recruited from five districts of Kashmir valley using multistage cluster sampling by probability proportional to size (PPS) technique. Data collection included recording of socio-demographic, medical facts, assessment of anthropometric parameters and biochemical evaluation HbA1c and random blood glucose measurements as per the American Diabetes Association (ADA) criteria were used for diagnosis of DM. RESULTS: A total of 6808 subjects were recruited in this study including 2872 (42%) men and 3936 (58%) women with mean age of 39.60 ± 20.19 years and 35.17 ± 16.70 years, respectively. Around 8.60% subjects were obese, 38.9% were found to be hypertensive, 73% had dyslipidemia and 3.75% had metabolic syndrome. About 1.26% (0.5% males and 0.9% females) had DM and 11.64% had prediabetes based on HbA1c cut offs. Increasing age, body mass index and family history portend significant risk factors while smoking and sedentary lifestyle increased the risk marginally. CONCLUSIONS: Although the prevalence of DM among tribals of Kashmir valley is lower than general population, the higher prediabetes to DM ratio may indicate a future trend of increasing DM prevalence in this disadvantageous subpopulation.


Assuntos
Diabetes Mellitus/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Estado Pré-Diabético/epidemiologia , Adolescente , Adulto , Glicemia/análise , Índice de Massa Corporal , Diabetes Mellitus/sangue , Dislipidemias/epidemiologia , Feminino , Hemoglobina A Glicada/análise , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estado Pré-Diabético/sangue , Prevalência , Fatores de Risco , Adulto Jovem
7.
Nat Commun ; 11(1): 4592, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32929089

RESUMO

Prediabetes is a state of glycaemic dysregulation below the diagnostic threshold of type 2 diabetes (T2D). Globally, ~352 million people have prediabetes, of which 35-50% develop full-blown diabetes within five years. T2D and its complications are costly to treat, causing considerable morbidity and early mortality. Whether prediabetes is causally related to diabetes complications is unclear. Here we report a causal inference analysis investigating the effects of prediabetes in coronary artery disease, stroke and chronic kidney disease, complemented by a systematic review of relevant observational studies. Although the observational studies suggest that prediabetes is broadly associated with diabetes complications, the causal inference analysis revealed that prediabetes is only causally related with coronary artery disease, with no evidence of causal effects on other diabetes complications. In conclusion, prediabetes likely causes coronary artery disease and its prevention is likely to be most effective if initiated prior to the onset of diabetes.


Assuntos
Doenças Cardiovasculares/complicações , Estado Pré-Diabético/complicações , Glicemia/metabolismo , Doenças Cardiovasculares/genética , Intervalos de Confiança , Doença da Artéria Coronariana/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Jejum/sangue , Humanos , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Razão de Chances , Estado Pré-Diabético/sangue , Estado Pré-Diabético/genética , Insuficiência Renal Crônica/complicações , Fatores de Risco , Acidente Vascular Cerebral/complicações
8.
Acta Diabetol ; 57(12): 1473-1480, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32740702

RESUMO

AIM: The aim of this study was to examine attendance for early postpartum follow-up among women with gestational diabetes mellitus (GDM), and to identify factors that influenced their likelihood of attending. METHODS: One thousand eight hundred and nineteen women with GDM were retrospectively analyzed. During pregnancy, the following data were collected: age, family history of diabetes, ethnicity, prepregnancy BMI, fasting plasma glucose, glycated hemoglobin, gestational week of GDM diagnosis, timing and mode of delivery, newborn's birth weight and length. Glycemia and insulinemia during OGTT, lipid profile and postpartum BMI were assessed at follow-up. Based on the OGTT, women were classified as having normal glucose tolerance (NGT) or abnormal glucose tolerance (AGT), which included impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG + IGT, and DM2. Factors predicting postpartum attendance for follow-up and onset of AGT were considered. RESULTS: Of the 889 (48.9%) who attended the scheduled postpartum OGTT, 741 (83.4%) had NGT, while 148 (16.6%) had AGT (IFG 6.7%, IGT 7.7%, IFG + IGT 0.8%, DM2 1.5%). The predictors of adherence to follow-up were: not belonging to an immigrant group; family history of DM2; and insulin therapy in pregnancy. The same factors were also predictive of AGT. Our data suggest a role of ethnicity in both attendance for postpartum follow-up and its outcome. CONCLUSION: Despite efforts to provide care for women with GDM, postpartum screening rates are still low among Italian women, and especially among immigrants. Hence, the need to improve these patients' awareness of the severe risk of developing diabetes after pregnancy, concentrating efforts especially on women belonging to the most at risk ethnic groups.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/terapia , Cooperação do Paciente/estatística & dados numéricos , Período Pós-Parto , Serviços Preventivos de Saúde , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/estatística & dados numéricos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Seguimentos , Intolerância à Glucose/sangue , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/reabilitação , Teste de Tolerância a Glucose , Humanos , Período Pós-Parto/sangue , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/terapia , Gravidez , Serviços Preventivos de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
9.
Acta Diabetol ; 57(12): 1481-1491, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32748175

RESUMO

AIMS: To identify socioeconomic, behavioral and clinical factors that are associated with prediabetes according to different prediabetes definition criteria. METHODS: Analyses use pooled data of the population-based Cooperative Health Research in the Region of Augsburg (KORA) studies (n = 5312 observations aged ≥ 38 years without diabetes). Prediabetes was defined through either impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or elevated HbA1c according to thresholds of the American Diabetes Association. Explanatory variables were regressed on prediabetes using generalized estimating equations. RESULTS: Mean age was 58.4 years; 50% had prediabetes (33% had IFG, 16% IGT, and 26% elevated HbA1c, 10% fulfilled all three criteria). Age, obesity, hypertension, low education, unemployment, statutory health insurance, urban residence and physical inactivity were associated with prediabetes. Male sex was a stronger risk factor for IFG (OR = 2.5; 95%-CI: 2.2-2.9) than for IGT or elevated HbA1c, and being unemployed was a stronger risk factor for IGT (OR = 3.2 95%-CI: 2.6-4.0) than for IFG or elevated HbA1c. CONCLUSIONS: The overlap of people with IFG, IGT and elevated HbA1c is small, and some factors are associated with only one criterion. Knowledge on sociodemographic and socioeconomic risk factors can be used to effectively target interventions to people at high risk for type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Intolerância à Glucose/diagnóstico , Hemoglobina A Glicada/metabolismo , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Medicina Preventiva/tendências , Adulto , Idoso , Glicemia/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Jejum/sangue , Feminino , Alemanha/epidemiologia , Intolerância à Glucose/sangue , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/etiologia , Hemoglobina A Glicada/análise , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/etiologia , Medicina Preventiva/métodos , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
10.
J Interv Cardiol ; 2020: 1710439, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32733169

RESUMO

Objective: To compare major clinical outcomes after successful percutaneous coronary intervention (PCI) with first-generation (1G) drug-eluting stents (DES) and second-generation (2G) DES in patients with acute myocardial infarction (AMI) and prediabetes. Background: Patients with prediabetes are associated with an increased incidence of coronary artery disease. The relative superiority of 1G- and 2G-DES in these patients is not well established. Methods: A total of 4997 patients with AMI and prediabetes were divided into two groups: the 1D-DES group (n = 726) and the 2G-DES group (n = 4271). The primary outcomes were the patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any disease revascularization at 2-year follow-up. The secondary outcome was probable or definite stent thrombosis (ST). Results: After propensity score-matching (PSM) analysis, two PSM groups (698 pairs, n = 1396, C-statistics = 0.725) were generated. The cumulative incidence rates of POCOs (hazard ratio (HR): 1.467; 95% confidence interval (CI): 1.068-2.015; p = 0.018), any disease revascularization (HR: 2.259; 95% CI: 1.397-3.654; p = 0.001), and ST (HR: 4.361; 95% CI: 1.243-15.30; p = 0.021) in the 1G-DES group were significantly higher than those in the 2G-DES group. However, the cumulative incidence rates of all-cause death, cardiac death, and Re-MI were similar between the two groups. Conclusions: In patients with AMI and prediabetes, 2G-DES implantation was more efficacious than 1G-DES implantation over a 2-year follow-up period. However, further studies are needed to confirm these results.


Assuntos
Stents Farmacológicos , Hemoglobina A Glicada/análise , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/instrumentação , Estado Pré-Diabético , Pesquisa Comparativa da Efetividade , Stents Farmacológicos/efeitos adversos , Stents Farmacológicos/classificação , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Seleção de Pacientes , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Resultado do Tratamento
11.
Open Heart ; 7(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32847993

RESUMO

INTRODUCTION: In Nepal, approximately 31% of adult industrial employees have diabetes. While the prevention of type 2 diabetes through behavioural intervention has been disseminated, worksite could be an effective platform for the translation of this knowledge into action as employed adults spend most of their workday waking hours at workplaces. METHODS AND ANALYSIS: We will conduct a randomised controlled trial to assess the effectiveness of a behavioural and a canteen intervention on diabetes risk reduction among those who are prediabetic at two worksites in eastern Nepal. We will recruit 162 adult full-time factory workers with haemoglobin A1c (HbA1c) of 5.7%-6.4% at baseline or fasting blood sugar of 100-125 mg/dL. The 8-14 months' control period will be followed by the behavioural intervention where half of the participants will be randomised to receive the behavioural intervention and half will act as a control and will not receive any intervention. Then, all participants will receive the canteen intervention. The analysis will be intent-to-treat, comparing the difference in the change in HbA1c% between the behavioural intervention group and the control group using a two-sample t-test. The within-participant changes in HbA1c after 6 or more months on the canteen intervention among those not randomised to the behavioural intervention in the previous period will be assessed using the paired t-test. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Review Board at Yale School of Public Health, New Havens, USA and the Nepal Health Research Council. TRIAL REGISTRATION NUMBER: NCT04161937.


Assuntos
Diabetes Mellitus/prevenção & controle , Comportamentos Relacionados com a Saúde , Estilo de Vida Saudável , Serviços de Saúde do Trabalhador , Estado Pré-Diabético/terapia , Prevenção Primária , Comportamento de Redução do Risco , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Hemoglobina A Glicada/metabolismo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Nepal/epidemiologia , Educação de Pacientes como Assunto , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
12.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32778539

RESUMO

BACKGROUND: The optimal approach to screening and diagnosis of prediabetes and diabetes in youth is uncertain. METHODS: We conducted a cross-sectional analysis of 14 119 youth aged 10 to 19 years in the 1999-2016 NHANES. First, we examined the performance of American Diabetes Association risk-based screening criteria. Second, we evaluated the performance of current clinical definitions of prediabetes and diabetes based on hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), either HbA1c or FPG, or both HbA1c and FPG (confirmatory definition) to identify youth at high cardiometabolic risk. RESULTS: Overall, 25.5% of US youth (10.6 million in 2016) were eligible for screening. Sensitivity and specificity of the screening criteria for detecting any hyperglycemia were low for both HbA1c ≥5.7% (sensitivity = 55.5%, specificity = 76.3%) and FPG ≥100 mg/dL (sensitivity = 35.8%, specificity = 77.1%). Confirmed undiagnosed diabetes (HbA1c ≥6.5% and FPG ≥126 mg/dL) was rare, <0.5% of youth. Most (>85%) cases of diabetes were diagnosed. Associations with cardiometabolic risk were consistently stronger and more specific for HbA1c-defined hyperglycemia (specificity = 98.6%; sensitivity = 4.0%) than FPG-defined hyperglycemia (specificity = 90.1%; sensitivity = 19.4%). CONCLUSIONS: One-quarter of US youth are eligible for screening for diabetes and prediabetes; however, few will test positive, especially for diabetes. Most cases of diabetes in US youth are diagnosed. Regardless of screening eligibility, we found that HbA1c is a specific and useful nonfasting test to identify high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular risk in adulthood.


Assuntos
Glicemia/análise , Diabetes Mellitus/diagnóstico , Jejum/sangue , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Adolescente , Criança , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/etnologia , Programas de Rastreamento/estatística & dados numéricos , Síndrome Metabólica/diagnóstico , Inquéritos Nutricionais , Obesidade Pediátrica/epidemiologia , Guias de Prática Clínica como Assunto , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etnologia , Prevalência , Sensibilidade e Especificidade , Estados Unidos/epidemiologia , Adulto Jovem
13.
J Med Life ; 13(2): 132-137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742503

RESUMO

Diabetes mellitus (DM) is a chronic metabolic disorder with significant co-morbidities and healthcare burdens. Many large studies have investigated the association between perceived stress and DM; however, none investigated this in a larger Indian population. We hypothesized stress as one of the reasons for the progression of people with prediabetes into DM. The present study was, therefore, planned to report on associations between perceived stress and blood glucose markers stratified by diabetic status. The current descriptive study was a subset analysis of the nationwide cross-sectional survey, conducted in all Indian zones under the National Multicentric Diabetes Control Program. The study examined the perceived stress levels using a perceived stress scale (PSS-10) in people with prediabetes (n=649) and DM (n=485) and then segregated them into three categories (minimum, moderate, and severe). Blood glucose markers (fasting blood glucose, postprandial blood glucose, and HbA1c) were evaluated to report their association with the perceived stress. The study revealed a significantly higher HbA1c level in people with prediabetes, particularly those with severe perceived stress (6.12 ± 0.27) compared to other categories. Those with DM had a higher fasting blood glucose level, particularly with severe perceived stress (239.28 ± 99.52). An increased HbA1c level is noted in severely stressed people with prediabetes, requiring a comprehensive analysis with a longitudinal study of the role of perceived stress in the progression of prediabetes into DM. Additionally, higher fasting blood glucose levels in patients with DM and severe perceived stress suggests the need for establishing comprehensive diabetic care inclusive of stress management.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Estado Pré-Diabético/sangue , Estado Pré-Diabético/psicologia , Estresse Psicológico/sangue , Estudos Transversais , Humanos , Índia
14.
Acta Diabetol ; 57(11): 1359-1366, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32601731

RESUMO

AIM: The aim of this study was to investigate the effectiveness of metformin in diabetes prevention in a prediabetic population across a range of fasting plasma glucose (FPG) levels at baseline. A secondary aim was to assess the effectiveness of metformin in preventing diabetes in those participants where impaired fasting glucose (IFG) was relatively more pronounced as opposed to impaired glucose tolerance (IGT). METHODS: Participants randomised to metformin and placebo arms in the Diabetes Prevention Program study were stratified into cohorts according to level of FPG at baseline. Cumulative incidence of diabetes for the different cohorts was assessed. Change in FPG, insulin sensitivity, and levels of fasting insulin and proinsulin for the different cohorts were also calculated. RESULTS: The largest reductions in incidence of diabetes and FPG occurred within prediabetic persons with a higher level of FPG at baseline. Metformin was able to stabilise insulin sensitivity in every stratified sub-cohort except one. Sub-cohorts which had higher levels of insulin sensitivity at baseline experienced the largest increases in insulin sensitivity. Metformin reduced the incidence of diabetes by 43% (RR 0.57, CI 0.4-0.9) in those prediabetic persons whose IFG was more pronounced compared to a 26% (RR 0.74 CI 0.7-0.8) when all participants in the study were included. CONCLUSION: The largest reductions in both incidence of diabetes and FPG occurred in prediabetic persons with a higher level of FPG at baseline. Metformin was able to stabilise insulin sensitivity and was more effective in persons with more pronounced IFG.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Metformina/administração & dosagem , Estado Pré-Diabético/tratamento farmacológico , Adulto , Glicemia/metabolismo , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Jejum/sangue , Feminino , Humanos , Insulina/metabolismo , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue
15.
Cardiovasc Diabetol ; 19(1): 104, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631321

RESUMO

BACKGROUND: The atherogenicity of remnant cholesterol (RC) has been underlined by recent guidelines, which was linked to coronary artery disease (CAD), especially for patients with diabetes mellitus (DM). This study aimed to examine the prognostic value of plasma RC in the patients with CAD under different glucose metabolism status. METHODS: Fasting plasma RC were directly calculated or measured in 4331 patients with CAD. Patients were followed for the occurrence of major adverse cardiovascular events (MACEs) and categorized according to both glucose metabolism status [DM, pre-DM, normoglycemia (NG)] and RC levels. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals. RESULTS: During a mean follow-up of 5.1 years, 541 (12.5%) MACEs occurred. The risk for MACEs was significantly higher in patients with elevated RC levels after adjustment for potential confounders. No significant difference in MACEs was observed between pre-DM and NG groups (p > 0.05). When stratified by combined status of glucose metabolism and RC, highest levels of calculated and measured RC were significant and independent predictors of developing MACEs in pre-DM (HR: 1.64 and 1.98; both p < 0.05) and DM (HR: 1.62 and 2.05; both p < 0.05). High RC levels were also positively associated with MACEs in patients with uncontrolled DM. . CONCLUSIONS: In this large-scale and long-term follow-up cohort study, data firstly demonstrated that higher RC levels were significantly associated with the worse prognosis in DM and pre-DM patients with CAD, suggesting that RC may be a target for patients with impaired glucose metabolism.


Assuntos
Glicemia/metabolismo , Colesterol/sangue , Remanescentes de Quilomícrons/sangue , Doença da Artéria Coronariana/sangue , Diabetes Mellitus/sangue , Estado Pré-Diabético/sangue , Idoso , Biomarcadores/sangue , China/epidemiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
16.
J Assoc Physicians India ; 68(4): 42-46, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32610846

RESUMO

Background: The pathophysiological effects of diabetes on the heart and the rest of the cardiovascular system begins much earlier in its precedent stage of prediabetes and one major underlying defect is insulin resistance. Heart-type fatty acid binding protein (H-FABP) is a recently studied molecule inherent to the cardiac myocytes found to rise in both coronary and non-coronary heart diseases. The utility of the molecule in prediabetes and its relationship with insulin resistance is being studied. Objective: The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with Homeostatic model assessment - insulin resistance (HOMA-IR). Methods: 50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum fasting and postprandial blood sugars, glycosylated hemoglobin (HbA1c), fasting insulin levels were measured in cases and controls. HOMA-IR index was calculated from fasting glucose and insulin values. Serum H-FABP was measured in both cases and controls using Immunoturbidimetric method with anti- H-FABP coated latex reagent kits. The values were compared between both the groups. Results: The mean serum fasting insulin level among cases was 12.22mIU/ml and that of the control group was 5.37mIU/ml (p value <0.0001). HOMA- IR mean values were 3.31 ± 1.56 and 1.16 ± 0.44 in cases and controls respectively (p- <0.001). The mean serum levels of H-FABP among cases and controls were 6.38± 2.76ng/ml and 3.24 ± 2.47 ng/ml respectively (p <0.0001). The correlation between the two variables, HOMA-IR and H-FABP was also found to be strongly positive (r=0.675). Linear regression analysis showed that for 1 unit increase in HOMA-IR, H-FABP increased by 1.095 and for 1 unit increase in Fasting insulin, H-FABP increased by 0.038. Conclusion: Prediabetics have a higher risk of cardiovascular morbidity when compared to normoglycemics with insulin resistance being the single most important contributor. Serum H-FABP levels are elevated in prediabetes representing a marker of subclinical cardiovascular disease (CVD).


Assuntos
Biomarcadores/metabolismo , Sistema Cardiovascular , Resistência à Insulina , Estado Pré-Diabético/sangue , Glicemia , Estudos de Casos e Controles , Proteína 3 Ligante de Ácido Graxo/sangue , Proteínas de Ligação a Ácido Graxo/sangue , Humanos , Insulina
17.
Open Heart ; 7(1)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32487771

RESUMO

BACKGROUND: Disturbances of glucose metabolism are important risk factors for coronary artery disease and are associated with an increased mortality risk. The aim was to investigate the association between preoperative disturbances of glucose metabolism and long-term all-cause mortality after coronary artery bypass grafting (CABG). METHODS: Patients undergoing a first isolated CABG in 2005-2013 were included. All patients without previously known diabetes underwent an oral glucose tolerance test (OGTT) before surgery. They were categorised as having normal glucose tolerance (NGT), pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose) or newly discovered diabetes. Data were collected from nationwide healthcare registers. Cox regression was used to calculate adjusted HR with 95% CI for death in patients with pre-diabetes and diabetes, using NGT as reference. RESULTS: In total, 497 patients aged 40-86 years were included. According to OGTT, 170 (34%) patients had NGT, 219 (44%) patients with pre-diabetes and 108 (22%) patients had newly discovered diabetes. Baseline characteristics were similar between the groups except for slightly higher age among patients with newly discovered diabetes. There were 133 (27%) deaths during a mean follow-up time of 10 years. The cumulative 10-year survival was 77% (69%-83%), 83% (77%-87%) and 71% (61%-79%) in patients with NGT, pre-diabetes and newly discovered diabetes, respectively. There was no significant difference in all-cause mortality between the groups after multivariable adjustment. CONCLUSION: In this study, patients with pre-diabetes or newly discovered diabetes prior to CABG had similar long-term survival compared with patients with NGT.


Assuntos
Glicemia/metabolismo , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus/sangue , Estado Pré-Diabético/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/mortalidade , Sistema de Registros , Medição de Risco , Fatores de Risco , Suécia/epidemiologia , Fatores de Tempo , Resultado do Tratamento
18.
Sci Rep ; 10(1): 9974, 2020 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-32561792

RESUMO

There are few studies assessing pre-hypertension and an impaired fasting glucose (IFG) and their combined effects on the cancer risk. We investigated the impact of pre-hypertension on cancer risk and IFG, and their combined effects on the cancer risk. This study included 371,762 subjects (≥40 years) who had never been diagnosed with hypertension, diabetes mellitus (DM), and cancer before. During a mean follow-up of 10.06 ± 1.86 years, 35,605 (9.58%) of the subjects developed cancer. In men only, cancer risk was significantly increased with an increase in the blood pressure (BP) (P for trend < 0.001), and were increased in the hypertension range, but not the pre-hypertension range. When analyzing the combination effect of BP and fasting glucose, cancer risks were serially increased with an increase in the fasting glucose in a dose-dependent manner, but not with an increase in BP. These results were more consistently significant in the never-smoker and non-alcohol drinking groups. However, in women, there was no significant difference. In conclusions, increased BP status or the fasting serum glucose level status were associated with cancer risk in men. Furthermore, the combination of both pre-hypertension and IFG also was associated with a cancer risk in men.


Assuntos
Neoplasias/etiologia , Pré-Hipertensão/complicações , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Jejum/sangue , Jejum/fisiologia , Feminino , Humanos , Hipertensão/sangue , Hipertensão/metabolismo , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Neoplasias/metabolismo , Estado Pré-Diabético/sangue , Estado Pré-Diabético/metabolismo , Pré-Hipertensão/sangue , Pré-Hipertensão/metabolismo , Fatores de Risco
19.
Arch Med Res ; 51(6): 556-563, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32553458

RESUMO

BACKGROUND: We aimed to investigate associations between the genetics of the rs659366 polymorphism of the uncoupling protein-2 gene (UCP2) with prediabetes (pre-DM) and type 2 diabetes (T2DM) in a northern Chinese population. METHODS: This case-control study recruited 1476 adults: 470 each with pre-DM or T2DM, and 536 healthy controls. The ligase detection reaction on blood samples from all participants was used to identify polymorphisms. Differences in genotype and allele distributions were compared by the χ2 test and one-way analysis of variance, and a post hoc pairwise analysis was performed using the Tukey test. RESULTS: The frequency of AA (11%) genotypes was significantly higher in pre-DM patients than controls (odds ratio [OR] = 1.83, 95% confidence interval [CI] = 1.16-2.89, p = 0.008). In the T2DM group, GA (48%) and AA (15%) genotypes were significantly increased compared with the control group (GA: OR = 1.72, 95% CI = 1.32-2.24, p = 0.001; AA: OR = 3.05, 95% CI = 1.97-4.72, p = 0.001). The frequency of the A allele (control 27%, pre-DM 33% and T2DM 39%) was significantly increased in the pre-DM and T2DM groups compared with the control group, and was significantly associated with an increased risk of pre-DM (OR = 1.33, 95% CI = 1.01-1.74, p = 0.04) and T2DM (OR = 1.72, 95% CI = 1.32-2.24, p = 0.001). Furthermore, insulin levels in the pre-DM and T2DM groups were significantly decreased in those with the AA genotype compared with the GG and GA genotypes. CONCLUSION: UCP2 rs659366 may be involved in the mechanism of insulin secretion and could lead to an increased risk of pre-DM and T2DM.


Assuntos
Diabetes Mellitus Tipo 2/genética , Polimorfismo Genético/genética , Estado Pré-Diabético/genética , Proteína Desacopladora 2/efeitos adversos , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Proteína Desacopladora 2/genética
20.
Diabetes Res Clin Pract ; 165: 108233, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32497744

RESUMO

Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity.


Assuntos
Glicemia/análise , Transtornos do Metabolismo de Glucose/diagnóstico , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Automonitorização da Glicemia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Criança , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Frutosamina/sangue , Intolerância à Glucose/sangue , Transtornos do Metabolismo de Glucose/sangue , Teste de Tolerância a Glucose , Humanos , Hiperglicemia/diagnóstico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Albumina Sérica/análise , Adulto Jovem
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