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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.
Int J Mol Sci ; 20(17)2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480394

RESUMO

Feeding rats with high-fat diet (HFD) with a single streptozotocin (STZ) injection induced obesity, slightly elevated fasting blood glucose and impaired glucose and insulin tolerance, and caused cardiac hypertrophy and mild diastolic dysfunction as published before by Koncsos et al. in 2016. Here we aimed to explore the renal consequences in the same groups of rats. Male Long-Evans rats were fed normal chow (CON; n = 9) or HFD containing 40% lard and were administered STZ at 20 mg/kg (i.p.) at week four (prediabetic rats, PRED, n = 9). At week 21 blood and urine samples were taken and kidney and liver samples were collected for histology, immunohistochemistry and for analysis of gene expression. HFD and STZ increased body weight and visceral adiposity and plasma leptin concentration. Despite hyperleptinemia, plasma C-reactive protein concentration decreased in PRED rats. Immunohistochemistry revealed elevated collagen IV protein expression in the glomeruli, and Lcn2 mRNA expression increased, while Il-1ß mRNA expression decreased in both the renal cortex and medulla in PRED vs. CON rats. Kidney histology, urinary protein excretion, plasma creatinine, glomerular Feret diameter, desmin protein expression, and cortical and medullary mRNA expression of TGF-ß1, Nrf2, and PPARγ were similar in CON and PRED rats. Reduced AMPKα phosphorylation of the autophagy regulator Akt was the first sign of liver damage, while plasma lipid and liver enzyme concentrations were similar. In conclusion, glomerular collagen deposition and increased lipocalin-2 expression were the early signs of kidney injury, while most biomarkers of inflammation, oxidative stress and fibrosis were negative in the kidneys of obese, prediabetic rats with mild heart and liver injury.


Assuntos
Colágeno/metabolismo , Glomérulos Renais/lesões , Glomérulos Renais/metabolismo , Lipocalina-2/metabolismo , Obesidade/metabolismo , Estado Pré-Diabético/metabolismo , Tecido Adiposo/metabolismo , Animais , Biomarcadores/metabolismo , Peso Corporal , Dieta Hiperlipídica , Fibrose , Regulação da Expressão Gênica , Inflamação/genética , Inflamação/patologia , Glomérulos Renais/patologia , Lipídeos/sangue , Fígado/enzimologia , Fígado/patologia , Fígado/fisiopatologia , Masculino , MicroRNAs/genética , MicroRNAs/metabolismo , Obesidade/sangue , Estresse Oxidativo/genética , Fosforilação , Fosfosserina/metabolismo , Estado Pré-Diabético/sangue , Proteínas Proto-Oncogênicas c-akt/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Long-Evans , Estreptozocina
3.
Transplant Proc ; 51(8): 2527-2532, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31473010

RESUMO

OBJECTIVES: To study the outcome of living kidney donors with prediabetes and to evaluate the utilization of baseline HbA1c to identify donors at high risk for developing diabetes during the postdonation follow-up period. PATIENTS AND METHODS: Living kidney donors with prospectively collected preoperative fasting glucose and HbA1c results were included in the study. Donors were categorized to the high-risk group when both results were in the prediabetic range, the low-risk group when only 1 result was in the prediabetic range, and the control group when both results were normal. RESULTS: Ninety-three donors were followed for 75.9 ± 23.3 months. A higher proportion of donors in the high-risk group progressed to diabetes compared with donors in the low-risk and control groups (31.3% vs 6.5% vs 0.0%, respectively; P < .001). Donors with prediabetes were not at a higher risk for new-onset hypertension (4.4% vs 10.0% vs 7.7%, in control, low-risk, and high-risk groups, respectively; P = .519) or microproteinuria (7.3% vs 10.3% vs 0.0%, in control, low-risk, and high-risk groups, respectively; P = .478) and exhibited equivalent postdonation renal function compared with donors with normal glucose metabolism. CONCLUSIONS: HbA1c can identify donors with prediabetes who are at risk for progression to diabetes. Our results indicate that carefully accepted donors with prediabetes are not at increased risk of renal function deterioration in the immediate postdonation period.


Assuntos
Diabetes Mellitus/sangue , Seleção do Doador/métodos , Hemoglobina A Glicada/análise , Doadores Vivos/estatística & dados numéricos , Estado Pré-Diabético/sangue , Jejum/sangue , Feminino , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Fatores de Risco
4.
Diabetes Metab Syndr ; 13(4): 2403-2408, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405651

RESUMO

BACKGROUND: Adipolin and cathepsin S are intricately involved in pathophysiology of metabolic syndrome (MetS) and prediabetes (PreDM). AIMS & METHODS: This cross-sectional study aimed to compare and correlate between these metabolic biomarkers as well as between them and adiposity, atherogenicity and hematological indices in MetS patients. Our cross-sectional study involved recruiting 29 normoglycemic MetS, 30 newly diagnosed drug naïve PreDM-MetS patients versus 29 lean, healthy and normoglycemic controls. RESULTS: Adipolin and cathepsin S plasma levels were significantly higher in both MetS (normoglycemic and PreDM) groups vs. healthy controls. Evidently proportional adipolin-cathepsin S association was markedly signified in 59 MetS participants (normoglycemic and PreDM). Distinctively unlike adipolin, inverse cathepsin S-diastolic blood pressure (DBP) but direct cathepsin S-monocyte count and its monocyte -to- lymphocyte ratio cross-correlated were marked. Notably unlike cathepsin S, adipolin was positively associated with each of FPG, A1C and TG, visceral adiposity index, lipid accumulation product and atherogenic index of plsama in the MetS pool of participants (N = 59). CONCLUSIONS: Given the intergroup discrepancies in adiposity, atherogenicity indices and their correlations (as well as hematological indices) with biomarkers; this cross-sectional study cannot rule out either biomarker as an associative predictor or as a surrogate indicator and putative prognostic tool for the prediction/prevention and treatment of metabolism dysregularities.


Assuntos
Adipocinas/sangue , Biomarcadores/sangue , Catepsinas/sangue , Síndrome Metabólica/diagnóstico , Estado Pré-Diabético/diagnóstico , Adulto , Glicemia/análise , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Prognóstico
5.
Diabetes Metab Syndr ; 13(4): 2733-2737, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405701

RESUMO

AIMS: To compare conversion rates of diabetes in subjects with elevated 1 h plasma glucose (1hrPG) during an OGTT with normal glucose tolerance(NGT) subjects over a period of 11 years. METHODS: 4023 subjects were selected from electronic data base of medical records.233 subjects who were followed up for a period of 11 years were included.160 with isolated prediabetes and their combinations were excluded.The remaining 73 were categorized into group1 NGT (n = 37) and group-2 (n = 36) with elevated 1hrPG.Kaplan Meier curves for incident diabetes and Cox proportional hazard model were compared between groups. RESULTS: During follow up, 10.8% and 44.4% converted to DM in group1 and group2 (p = 0.003). Elevated 1hrPG was associated with incident diabetes(HR 7.9[95%CI 2.2-28.1](p = 0.001)provided better risk assessment.The adjusted risk of event in subjects with elevated 1hrPG is likely to be 7 times more when compared to NGT.Subjects with elevated1hrPG remained free of diabetes for a median period of 7.6 years (95% CI 5.8-7.8) whereas NGT subjects remained free for 10 years (95% CI 8.5-10.0) (p < 0.001). CONCLUSION: In conclusion, conversion to DM was higher and risk was 7 times more in subjects with elevated 1hrPG. Elevated 1hrPG during OGTT has to be considered as a distinct entity.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/diagnóstico , Jejum , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose/métodos , Resistência à Insulina , Estado Pré-Diabético/diagnóstico , Adulto , Biomarcadores/análise , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Seguimentos , Intolerância à Glucose/sangue , Intolerância à Glucose/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Prevalência , Prognóstico , Fatores de Risco
6.
Phytother Res ; 33(11): 2841-2848, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31429148

RESUMO

Maintaining glycemic control in diabetes and prediabetes is necessary to prevent many health complications and mortality. Although different hypoglycemic drugs are used for this purpose, there is still a growing interest in the use of medicinal plants due to their low price, easy availability, and fewer or no side effects. Moringa (Moringa oleifera Lam.) is a medicinal plant that has been traditionally used in the management of diabetes. This review aims to present the existing literature published until February 2019 on the role of moringa leaves in glycemia and their physiological mechanisms. In the conducted studies, moringa leaves have shown to reduce glycemia, without causing any adverse effects. The proposed mechanisms for reducing glycemia include inhibition of α-amylase and α-glucosidase activities, increased glucose uptake in the muscles and liver, inhibition of glucose uptake from the intestine, decreased gluconeogenesis in the liver, and increased insulin secretion and sensitivity. However, these studies are limited in numbers and mostly conducted in animals, in vitro and in vivo. Therefore, long-term human studies are required to determine the hypoglycemic effect of moringa leaves, their physiological mechanisms, active ingredients, and safety. Overall, this review provides evidence that moringa leaves have the possibility to be used as a glycemic control agent in diabetes and prediabetes.


Assuntos
Glicemia/efeitos dos fármacos , Hipoglicemiantes/farmacologia , Moringa oleifera/química , Extratos Vegetais/farmacologia , Animais , Glicemia/metabolismo , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico , Avaliação de Medicamentos/estatística & dados numéricos , Humanos , Hipoglicemiantes/uso terapêutico , Fígado/efeitos dos fármacos , Fitoterapia/métodos , Extratos Vegetais/uso terapêutico , Folhas de Planta/química , Plantas Medicinais/química , Estado Pré-Diabético/sangue , Estado Pré-Diabético/tratamento farmacológico , Transdução de Sinais/efeitos dos fármacos
7.
Eur J Epidemiol ; 34(9): 853-861, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31399939

RESUMO

Intake of individual antioxidants has been related to a lower risk of type 2 diabetes. However, the overall diet may contain many antioxidants with additive or synergistic effects. Therefore, we aimed to determine associations between total dietary antioxidant capacity and risk of type 2 diabetes, prediabetes and insulin resistance. We estimated the dietary antioxidant capacity for 5796 participants of the Rotterdam Study using a ferric reducing ability of plasma (FRAP) score. Of these participants, 4957 had normoglycaemia and 839 had prediabetes at baseline. We used covariate-adjusted proportional hazards models to estimate associations between FRAP and risk of type 2 diabetes, risk of type 2 diabetes among participants with prediabetes, and risk of prediabetes. We used linear regression models to determine the association between FRAP score and insulin resistance (HOMA-IR). We observed 532 cases of incident type 2 diabetes, of which 259 among participants with prediabetes, and 794 cases of incident prediabetes during up to 15 years of follow-up. A higher FRAP score was associated with a lower risk of type 2 diabetes among the total population (HR per SD FRAP 0.84, 95% CI 0.75; 0.95) and among participants with prediabetes (HR 0.85, 95% CI 0.73; 0.99), but was not associated with risk of prediabetes. Dietary FRAP was also inversely associated with HOMA-IR (ß - 0.04, 95% CI - 0.06; - 0.03). Effect estimates were generally similar between sexes. The findings of this population-based study emphasize the putative beneficial effects of a diet rich in antioxidants on insulin resistance and risk of type 2 diabetes.


Assuntos
Antioxidantes/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Dieta , Resistência à Insulina , Avaliação Nutricional , Estado Pré-Diabético/metabolismo , Adulto , Idoso , Antioxidantes/administração & dosagem , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Frutas , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/fisiologia , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Fatores de Risco
8.
Eur J Appl Physiol ; 119(9): 2011-2024, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31346789

RESUMO

PURPOSE: Training intensity and health effects of football were investigated gender specifically in individuals with prediabetes. METHODS: Participants with prediabetes (age 60 ± 6 years) were randomised into a football and dietary advice group (FD-men n = 13 and FD-women n = 14) or a dietary advice only group (D-men n = 12 and D-women n = 11). FD performed football training (twice/week for 16 weeks), while both groups received dietary advice. Body composition, bone variables, blood pressure, blood lipid profile and peak oxygen uptake (VO2peak) were determined pre- and post-intervention. RESULTS: Mean heart rate during football training was 79 ± 2 and 80 ± 3% HRmax for FD-men and FD-women, respectively, with peak heart rate values of 96 ± 1 and 97 ± 2% HRmax, with no gender differences. VO2peak increased more (P < 0.05) in FD-men and FD-women than in D-men and D-women. However, relative delta change in VO2peak was 21 ± 14% in FD-women, which was greater (P < 0.05) than in FD-men (11 ± 12%). Reduction in SBP and DBP, respectively, was similar in FD-men (- 10.8 ± 13.0 and - 7.3 ± 11.8 mmHg) and FD-women (- 11.3 ± 11.0 and - 7.1 ± 6.2 mmHg), with within-gender differences for men. Total plasma cholesterol and LDL cholesterol decreased (P < 0.05) by - 0.7 ± 1.1 and - 0.5 ± 0.9 mmol L-1, respectively, in FD-women and - 0.2 ± 0.4 and - 0.2 ± 0.3 mmol L-1 in FD-men, with no significant gender differences (P = 0.08). Body fat content was lowered (P < 0.05) by 3 and 4%-points in FD-men and FD-women, respectively. CONCLUSION: Gender-mixed football training combined with dietary advice causes broad-spectrum health effects for men and women with prediabetes, with minor gender-specific differences. Thus, the intensity and training-induced effects of football training are also high for elderly women with prediabetes.


Assuntos
Futebol Americano/fisiologia , Estado Pré-Diabético/fisiopatologia , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Composição Corporal/fisiologia , LDL-Colesterol/sangue , Feminino , Identidade de Gênero , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Estado Pré-Diabético/sangue
9.
Medicine (Baltimore) ; 98(29): e16317, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335679

RESUMO

Increased glycemic variability (GV) is an independent risk factor for cardiovascular complications in patients with diabetes. We evaluated the risk of future development of cardiovascular disease (CVD) and death according to GV in a general population without diabetes.We used the National Health Insurance Service, providing a population-based, nationwide database of Koreans. We included individuals without diabetes who underwent glucose measurement at least 3 times during 2002 to 2006. GV was calculated as standard deviation (SD) of fasting plasma glucose (FPG) levels. We observed development of CVD or all-cause death from 2007 to 2015, and also evaluated the mortality within 1 year after CVD.Among 3,211,319 people, we found 23,374 incident cases of myocardial infarction (MI), 27,705 cases of stroke, and 63,275 deaths during 8.3 years of follow-up. After multivariate adjustment, GV was found to be a significant predictor of MI, stroke and all-cause death for their highest quartile, with corresponding hazard ratios (HR) of 1.08 (95% confidence interval, CI 1.04-1.11), 1.09 (95% CI 1.06-1.13), and 1.12 (95% CI 1.10-1.15), respectively. The risk of death increased more in those who had both impaired fasting glucose and the highest quartile of GV (HR 1.24 [95% CI 1.21-1.28]). Moreover, early death rate after 1 year of CVD was higher in the highest quartile of GV compared to the lowest quartile (HR 1.21 [95% CI 1.03-1.41]).Long-term FPG variation was independently associated with CVD and mortality in a general population without diabetes.


Assuntos
Glicemia/análise , Doenças Cardiovasculares , Jejum/sangue , Infarto do Miocárdio , Acidente Vascular Cerebral , Adulto , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Causas de Morte , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Estado Pré-Diabético/sangue , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
10.
Medicine (Baltimore) ; 98(27): e16259, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277146

RESUMO

BACKGROUND: The number of people with diabetes and pre-diabetes is growing exponentially. Human studies have shown that zinc supplementation is beneficial for pre-diabetes. However, owing to the low quality, small sample size, and methodological heterogeneity of these studies, this conclusion is not convincing. Consequently, in order to determine whether zinc supplementation is effective and safe in pre-diabetic patients, it is necessary to conduct a meta-analysis of high-quality clinical trials. METHODS: We will retrieve MEDLINE (PubMed), EMBASE, the Web of Science, Cochrane Library, and the ClinicalTrials.gov website without restriction on language. Randomized controlled trials (RCTs) of Zinc supplementation for adult patients with pre-diabetes will be searched in multiple databases from inception to October 2020. The primary outcome of the meta-analysis is the HbA1c. The secondary outcomes include the fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). Two assessors will utilize the Cochrane Collaboration's risk of bias tool to evaluate the RCTs and all statistical data will be analyzed by using the Review Manage software V5.3.0. RESULTS: This study will provide high-quality synthesis of effectiveness and safety of zinc supplementation for pre-diabetes. CONCLUSION: This systematic review and meta-analysis will provide the available evidence to assess whether the zinc supplementation is beneficial to glucose control and insulin resistance in patients with pre-diabetes. PROSPERO REGISTRATION NUMBER: CRD 42018095724.


Assuntos
Glicemia/metabolismo , Protocolos Clínicos , Suplementos Nutricionais , Estado Pré-Diabético/terapia , Zinco/farmacologia , Humanos , Estado Pré-Diabético/sangue
11.
Nutrients ; 11(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340611

RESUMO

Milk proteins have been hypothesized to protect against type 2 diabetes (T2DM) by beneficially modulating glycemic response, predominantly in the postprandial status. This potential is, amongst others, attributed to the high content of whey proteins, which are commonly a product of cheese production. However, native whey has received substantial attention due to its higher leucine content, and its postprandial glycemic effect has not been assessed thus far in prediabetes. In the present study, the impact of a milk protein hydrolysate of native whey origin with alpha-glucosidase inhibiting properties was determined in prediabetics in a randomized, cross-over trial. Subjects received a single dose of placebo or low- or high-dosed milk protein hydrolysate prior to a challenge meal high in carbohydrates. Concentration-time curves of glucose and insulin were assessed. Incremental areas under the curve (iAUC) of glucose as the primary outcome were significantly reduced by low-dosed milk peptides compared to placebo (p = 0.0472), and a minor insulinotropic effect was seen. A longer intervention period with the low-dosed product did not strengthen glucose response but significantly reduced HbA1c values (p = 0.0244). In conclusion, the current milk protein hydrolysate of native whey origin has the potential to modulate postprandial hyperglycemia and hence may contribute in reducing the future risk of developing T2DM.


Assuntos
Glicemia/metabolismo , Suplementos Nutricionais , Inibidores de Glicosídeo Hidrolases/administração & dosagem , Proteínas do Leite/administração & dosagem , Período Pós-Prandial , Estado Pré-Diabético/dietoterapia , Hidrolisados de Proteína/administração & dosagem , Adulto , Idoso , Biomarcadores/sangue , Estudos Cross-Over , Suplementos Nutricionais/efeitos adversos , Método Duplo-Cego , Feminino , Alemanha , Hemoglobina A Glicada/metabolismo , Inibidores de Glicosídeo Hidrolases/efeitos adversos , Inibidores de Glicosídeo Hidrolases/metabolismo , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Proteínas do Leite/efeitos adversos , Proteínas do Leite/metabolismo , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Hidrolisados de Proteína/efeitos adversos , Hidrolisados de Proteína/metabolismo , Fatores de Tempo , Resultado do Tratamento
12.
Trials ; 20(1): 464, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358022

RESUMO

BACKGROUND: The rates of pre-diabetes and type 2 diabetes mellitus are increasing worldwide, producing significant burdens for individuals, families, and healthcare systems. In New Zealand, type 2 diabetes mellitus and pre-diabetes disproportionally affect Maori, Pacific, and South Asian peoples. This research evaluates the efficacy, acceptability, and economic impact of a probiotic capsule and a prebiotic cereal intervention in adults with pre-diabetes on metabolic and mental health and well-being outcomes. METHODS: Eligible adults (n = 152) aged 18-80 years with pre-diabetes (glycated haemoglobin 41-49 mmol/mol) will be enrolled in a 2 × 2 factorial design, randomised, parallel-group, placebo-controlled trial. Computer-generated block randomization will be performed independently. Interventions are capsulated Lactobacillus rhamnosus HN001 (6 × 109 colony-forming units/day) (A) and cereal containing 4 g ß-glucan (B), placebo capsules (O1), and calorie-matched control cereal (O2). Eligible participants will receive 6 months intervention in the following groups: AB, AO1, BO2, and O1O2. The primary outcome is glycated haemoglobin after 6 months. Follow-up at 9 months will assess the durability of response. Secondary outcomes are glycated haemoglobin after 3 and 9 months, fasting glucose, insulin resistance, blood pressure, body weight, body mass index, and blood lipid levels. General well-being and quality of life will be measured by the Short-Form Health Survey 36 and Depression Anxiety Stress Scale 21 at 6 and 9 months. Outcome assessors will be blind to capsule allocation. An accompanying qualitative study will include 24 face-to-face semistructured interviews with an ethnically balanced sample from the ß-glucan arms at 2 months, participant focus groups at 6 months, and three health professional focus groups. These will explore how interventions are adopted, their acceptability, and elicit factors that may support the uptake of interventions. A simulation model of the pre-diabetic New Zealand population will be used to estimate the likely impact in quality-adjusted life years and health system costs of the interventions if rolled out in New Zealand. DISCUSSION: This study will examine the efficacy of interventions in a population with pre-diabetes. Qualitative components provide rich description of views on the interventions. When combined with the economic analysis, the study will provide insights into how to translate the interventions into practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617000990325. Prospectively registered on 10 July 2017.


Assuntos
Hemoglobina A Glicada/metabolismo , Lactobacillus rhamnosus/fisiologia , Estado Pré-Diabético/dietoterapia , Probióticos/administração & dosagem , beta-Glucanas/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Cápsulas , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Prebióticos/administração & dosagem , Prebióticos/efeitos adversos , Prebióticos/economia , Estado Pré-Diabético/sangue , Estado Pré-Diabético/economia , Estado Pré-Diabético/microbiologia , Probióticos/efeitos adversos , Probióticos/economia , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem , beta-Glucanas/efeitos adversos , beta-Glucanas/economia
13.
Environ Int ; 129: 343-353, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31150976

RESUMO

Exposure to per- and polyfluoroalkyl substances (PFASs) may interfere with lipid regulation. However, most previous studies were cross-sectional with the risk of reverse causation, suggesting a need for long-term prospective studies. We examined the relationship of baseline plasma PFAS concentrations with repeated measures of blood lipids. We included 888 prediabetic adults from the Diabetes Prevention Program (DPP) and DPP Outcomes Study, who had measurements of 6 plasma PFAS concentrations at baseline (1996-1999) and repeated measures of blood lipids over 15 years of follow-up, and were initially randomized to placebo or a lifestyle intervention. We used linear regression to examine cross-sectional associations of PFAS concentrations and lipid levels at baseline, and evaluated prospective risks of hypercholesterolemia and hypertriglyceridemia using Cox proportional hazard models, and tested for effect modification by study arm. Participants (65.9% female, 57.0% White, 65.9% aged 40-59 years) had comparable PFAS concentrations [e.g., median (IQR) perfluorooctanoic acid (PFOA) 4.9 ng/mL (3.2)] with the general U.S. population in 1999-2000. We observed higher total cholesterol at baseline per doubling of PFOA (ß: 6.1 mg/dL, 95% CI: 3.1, 9.04), perfluorohexane sulfonic acid (PFHxS, ß: 2.2 mg/dL, 95% CI: 0.2, 4.3), and perfluorononanoic acid (PFNA, ß: 2.9 mg/dL, 95% CI: 0.7, 5.0). Prospectively, baseline concentrations of several PFASs, including PFOA, PFOS, PFHxS and PFNA, predicted higher risks of incident hypercholesterolemia and hypertriglyceridemia, but only in the placebo group and not the lifestyle intervention group. For example, participants in the placebo group with PFOA concentration > median (4.9 ng/mL) were almost twice as likely (HR: 1.90, 95% CI: 1.25, 2.88) to develop hypertriglyceridemia compared to those ≤median. Findings suggest adverse effects of some PFASs on lipid profiles in prediabetic adults. However, the detrimental effect was attenuated with a lifestyle intervention.


Assuntos
Poluentes Ambientais/sangue , Fluorcarbonetos/sangue , Lipídeos/sangue , Estado Pré-Diabético/sangue , Adulto , Caprilatos/sangue , Colesterol/sangue , Estudos Transversais , Feminino , Seguimentos , Humanos , Estilo de Vida , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Projetos de Pesquisa
14.
Diabetes Res Clin Pract ; 153: 66-75, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31152806

RESUMO

AIMS: We studied the role of lifestyle factors associated to type 2 diabetes (T2DM) onset according to type of prediabetes. METHODS: We used data from the observational prospective cohort study in Primary Health Care on the Evolution of Patients with Prediabetes in Spain (PREDAPS). Participants were classified by American Diabetes Association criteria using either fasting plasma glucose levels (100-125 mg/dL) (group 1), HbA1c (5.7%-6.4%) (group 2) or both impaired parameters (group 3). Relationship between lifestyles and diabetes onset according to prediabetes at third year of follow up were estimated by Hazard Ratios (HRs) using three sequential models. RESULTS: Incidence rate of diabetes was 2.27 cases per 1000 person-years (95% CI: 1.4-3.6) for group 1, 1.18 (95% CI: 0.65-2.13) for group 2 and 6.68 (95% CI: 5.71-8.23) for group 3. The most important risk factors were: abdominal obesity (HR: 2.29 (95% CI: 1.49-3.52)) and hypertension (HR: 2.16 (95% CI: 1.41-3.30)). Using as reference group 2, group 3 had a HR of 5.82 (3.13-10.82) and 1.83 (95% CI: 0.85-3.93) for group 1, estimates remained constant when adjusting by lifestyle and metabolic factors. CONCLUSIONS: Lifestyle and metabolic do not seem to explain the differences on T2DM onset by type of prediabetes.


Assuntos
Estilo de Vida , Estado Pré-Diabético/sangue , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Espanha
15.
N Engl J Med ; 381(6): 520-530, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31173679

RESUMO

BACKGROUND: Observational studies support an association between a low blood 25-hydroxyvitamin D level and the risk of type 2 diabetes. However, whether vitamin D supplementation lowers the risk of diabetes is unknown. METHODS: We randomly assigned adults who met at least two of three glycemic criteria for prediabetes (fasting plasma glucose level, 100 to 125 mg per deciliter; plasma glucose level 2 hours after a 75-g oral glucose load, 140 to 199 mg per deciliter; and glycated hemoglobin level, 5.7 to 6.4%) and no diagnostic criteria for diabetes to receive 4000 IU per day of vitamin D3 or placebo, regardless of the baseline serum 25-hydroxyvitamin D level. The primary outcome in this time-to-event analysis was new-onset diabetes, and the trial design was event-driven, with a target number of diabetes events of 508. RESULTS: A total of 2423 participants underwent randomization (1211 to the vitamin D group and 1212 to the placebo group). By month 24, the mean serum 25-hydroxyvitamin D level in the vitamin D group was 54.3 ng per milliliter (from 27.7 ng per milliliter at baseline), as compared with 28.8 ng per milliliter in the placebo group (from 28.2 ng per milliliter at baseline). After a median follow-up of 2.5 years, the primary outcome of diabetes occurred in 293 participants in the vitamin D group and 323 in the placebo group (9.39 and 10.66 events per 100 person-years, respectively). The hazard ratio for vitamin D as compared with placebo was 0.88 (95% confidence interval, 0.75 to 1.04; P = 0.12). The incidence of adverse events did not differ significantly between the two groups. CONCLUSIONS: Among persons at high risk for type 2 diabetes not selected for vitamin D insufficiency, vitamin D3 supplementation at a dose of 4000 IU per day did not result in a significantly lower risk of diabetes than placebo. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; D2d ClinicalTrials.gov number, NCT01942694.).


Assuntos
Colecalciferol/uso terapêutico , Diabetes Mellitus Tipo 2/prevenção & controle , Suplementos Nutricionais , Estado Pré-Diabético/tratamento farmacológico , Vitaminas/uso terapêutico , Administração Oral , Idoso , Colecalciferol/administração & dosagem , Intervalo Livre de Doença , Método Duplo-Cego , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Fatores de Risco , Falha de Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitaminas/administração & dosagem
16.
Diabetes Metab Syndr ; 13(3): 1785-1790, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235095

RESUMO

BACKGROUND AND OBJECTIVES: Data to support the use of risk scores in screening programs to detect people with prediabetes and undiagnosed diabetes in low- and middle-income countries are limited. We evaluated a targeted screening program involving a diabetes risk score in a community setting in India in terms of its uptake, yield, and costs. METHODS: In the Kerala Diabetes Prevention Program, 2586 individuals (age 30-60 years) without known diabetes were screened using a two-step procedure. Step 1: screening with the Indian Diabetes Risk Score at participants' homes by trained non-medical staff. Step 2: oral glucose tolerance test (OGTT) among those with IDRS score ≥60 ("screen-positive") at community-based clinics. Screening costs were expressed in 2013 US dollars. RESULTS: 96.3% of those invited for the IDRS screening consented and 79.1% of screen-positives attended clinics for an OGTT. Older age and male gender were associated with higher IDRS uptake. Female gender, higher monthly household expenditure, and higher IDRS score were associated with higher OGTT uptake. The number needed to screen (yield) to detect one person with prediabetes and undiagnosed diabetes was two and six, respectively. The average screening cost of identifying one person with prediabetes and undiagnosed diabetes was $33.8 and $116.5, respectively. CONCLUSION: This targeted screening program had a high uptake and high yield for prediabetes and undiagnosed diabetes in a community setting in India. Alternative strategies are likely required to enhance the uptake of screening in certain groups.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus/diagnóstico , Estilo de Vida , Programas de Rastreamento/métodos , Estado Pré-Diabético/diagnóstico , Adulto , Glicemia/análise , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Teste de Tolerância a Glucose , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Prognóstico
17.
Diabetes Metab Syndr ; 13(3): 1813-1819, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235099

RESUMO

BACKGROUND: Diabetes prevalence in HIV is not well characterized for India, despite the high burden of both individual diseases. Epidemiology of insulin resistance (IR): a precursor to diabetes, and its associated risk factors are also poorly understood in Asian Indian people living with HIV (PLHIV). We assessed the prevalence of diabetes and IR in Pune, India and the associated risk factors for IR. METHODS: Cross-sectional analysis of adult (≥18 years) PLHIV receiving care at Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India (BJGMC- SGH). Proportions and medians of PLHIV characteristics by diabetes status and IR were described. Homeostatic Model Assessment (HOMA) index value ≥2 was used to define IR. Line of least squares assessed the relationship between IR and hyperinsulinemia. Association between sociodemographic, clinical factors with IR was determined using logistic regression. RESULTS: Of 485 enrollees, 47% were men, median age was 40 years (IQR: 35-46), median CD4 counts were 389 cells/mm3 (246-609). Thirty-five percent were centrally obese, 75% were adherent to WHO recommended physical activity guidelines. Prevalence of diabetes, prediabetes, IR were 9%, 16% and 38%, respectively. Twenty-nine percent non-diabetics had IR and it occurred much prior to the threshold for hyperinsulinemia. IR was associated with the use of ART drugs (OR: 6.6, 95% CI: 2.9-15.2 and 5.4, 95% CI: 2.2-13.6 for first- and second line ART respectively) and central obesity (OR:1.9, 95% CI: 1.1-3.4). CONCLUSIONS: One fourth of the study population was diabetic or prediabetic and more than a third had IR. Better understanding of diabetes disease progression in relation to IR and the effect of physical activity on central obesity among Asian Indian PLHIV is mandated.


Assuntos
Biomarcadores/análise , Diabetes Mellitus/epidemiologia , Infecções por HIV/complicações , HIV/isolamento & purificação , Hiperinsulinismo/epidemiologia , Resistência à Insulina , Estado Pré-Diabético/epidemiologia , Adulto , Glicemia/análise , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/virologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Infecções por HIV/virologia , Humanos , Hiperinsulinismo/sangue , Hiperinsulinismo/virologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/virologia , Prevalência , Prognóstico , Fatores de Risco
18.
Diabetes Metab Syndr ; 13(3): 2242-2248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235164

RESUMO

AIMS: Plasma glucose and insulin concentrations in fasting and postprandial reflect the metabolism of glucose by the human body and are useful in the diagnosis of metabolic diseases, such as diabetes and insulin resistance. In this work, these concentrations are jointly analyzed in Venezuelan women and 28 classes that better specify each metabolic condition are generated. MATERIALS AND METHODS: Each class comprises a combination of fasting and postprandial ranges of glucose and insulin concentrations defined in the literature as normal, impaired and diabetic. A hypothesis test was used to find statistically significant differences between the classes, and confidence intervals for age and glucose and insulin concentrations were defined for each class. RESULTS AND CONCLUSION: The process of deterioration of glucose metabolism advances with the age of the subject, more than half of the prediabetics have impaired glucose levels in fasting but normal in postprandial and normal insulin levels in fasting and postprandial, and one third of diabetics have diabetic glucose levels in fasting and postprandial and normal insulin levels in fasting and postprandial. This categorization of subjects would allow the application of a more specific treatment and the possibility of predicting the progress of the metabolic disorder.


Assuntos
Biomarcadores/sangue , Glicemia/análise , Diabetes Mellitus Tipo 2/diagnóstico , Jejum , Insulina/sangue , Período Pós-Prandial , Estado Pré-Diabético/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Seguimentos , Intolerância à Glucose , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Prevalência , Prognóstico , Venezuela/epidemiologia , Adulto Jovem
19.
J Pediatr Endocrinol Metab ; 32(7): 707-714, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31211688

RESUMO

Background Obesity is known to cause metabolic disturbances including insulin resistance, dyslipidemia and alters bone mineralization. The effects of obesity on fibroblast growth factor 23 (FGF-23), which is important in bone mineralization, have not yet been clarified. Our aim was to investigate the association between FGF-23 concentration and obesity-associated dysmetabolism. Methods Subjects comprised 46 obese children and adolescents. The same number of age-matched, healthy controls were recruited. Markers of bone mineralization and glucose metabolism were measured. Thyroid function and insulin resistance were investigated in both groups. In obese subjects; an oral glucose tolerance test (OGTT) was performed and hemoglobin A1c and lipid fractions were measured. Bone mineral density and hepatic steatosis were investigated. Results Serum FGF-23, α-klotho and 1,25(OH)2D3 concentrations were significantly lower while fasting insulin, fasting glucose, C-peptide and alkaline phosphatase (ALP) concentrations and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly higher in the obese group compared to controls. A significant negative correlation was observed between free tri-iodothyronine (fT3) and both FGF-23 and α-klotho in the obese group. Significant negative correlation was found between FGF-23 and C-peptide and a positive correlation was found between FGF-23 and high density lipoprotein-cholesterol (HDL-c) in the obese subjects with impaired glucose tolerance (IGT). Significant negative correlations were found between FGF-23 and both fasting insulin levels and C-peptide levels in the obese subjects with hepatic steatosis. Conclusions In our study, insulin resistance-associated hyperinsulinism and/or lower 1,25(OH)2D3 levels, both present in obese children and adolescents, may lead to decreased serum FGF-23 concentrations in obese subjects.


Assuntos
Biomarcadores/sangue , Dislipidemias/sangue , Fatores de Crescimento de Fibroblastos/sangue , Resistência à Insulina , Obesidade Pediátrica/sangue , Estado Pré-Diabético/sangue , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Dislipidemias/etiologia , Feminino , Seguimentos , Humanos , Masculino , Obesidade Pediátrica/complicações , Estado Pré-Diabético/etiologia , Prognóstico
20.
Life Sci ; 231: 116577, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31211997

RESUMO

PURPOSE: Galectin-3 is associated with the process of inflammation and fibrosis. The aim of this study was both to evaluate of galectin-3, methylated arginines and hs-CRP in subjects with type 2 diabetes and prediabetes and to investigate a relation between serum galectin-3, methylated arginines and hs-CRP levels. METHODS: In this study, all subjects were defined as the control group, type 2 diabetes (n = 84) by fasting plasma glucose and prediabetes (n = 34) by 75-g oral glucose tolerance test. Also, participants with type 2 diabetes were divided into as group I (HbA1c ≤7%, n = 40) and group II (HbA1c ≥7%, n = 44). The analysis of serum methylated arginines levels was analyzed by tandem mass spectrometry. Galectin-3 levels were determined via chemiluminescent microparticle immunoassay (CMIA). RESULTS: Serum galectin-3, ADMA, L-NMMA and SDMA levels were significantly lower in the control group (13.3 ±â€¯3.42; 0.630 (0.13-1.36); 0.176 (0.02-0.53); 0.115 (0.04-0.26), respectively) compared to diabetic subjects (15.71 ±â€¯4.22; 0.825 (0.23-2.80); 0.366 (0.08-1.41); 0.1645 (0.06-0.47), p = 0.002, p = 0.01, p = 0.001 and p = 0.006, respectively). Galectin-3 was positively correlated with hs-CRP (r = 0.295 p = 0.001), L-NMMA (r = 0.181 p = 0.022), HbA1c (r = 0.247 p = 0.002), neopterin (r = 0.160 p = 0.045) and FPG (r = 0.207 p = 0.001) respectively. Also, there was positively correlated ADMA with FPG (r = 0.192 p = 0.016) and eAG (r = 0.235 p = 0.003). CONCLUSIONS: Thus, galectin-3 might be a useful prognostic marker in the population with prediabetes and diabetes. Moreover, it can be a marker showing the condition of developing complications in diabetic patients.


Assuntos
Arginina/sangue , Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 2/sangue , Galectina 3/sangue , Estado Pré-Diabético/sangue , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Jejum/sangue , Feminino , Galectina 3/análise , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Humanos , Resistência à Insulina , Masculino , Metilação , Pessoa de Meia-Idade
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