Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 981
Filtrar
1.
Zhonghua Fu Chan Ke Za Zhi ; 54(10): 654-659, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31648440

RESUMO

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic ß cell function index (HOMA-ß) were used to evaluate insulin resistance and pancreatic ß cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-ß within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.


Assuntos
Glicemia/análise , Diabetes Gestacional/diagnóstico , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Hemoglobinas/análise , Resistência à Insulina , Primeiro Trimestre da Gravidez/sangue , Adulto , Grupo com Ancestrais do Continente Asiático , Glicemia/metabolismo , Índice de Massa Corporal , China/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Incidência , Gravidez , Fatores de Risco
2.
Diabetes Metab Syndr ; 13(4): 2329-2334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405638

RESUMO

OBJECTIVE: To investigate which of two indexes (TyG or TG/HDL) are the best predictors for insulin resistance (IR) and to evaluate the magnitude of each cardiometabolic risk factor in Mexican schoolchildren of 5-9 years with overweight-obesity and normal weight. MATERIAL AND METHODS: We realized a comparative cross-sectional prospective study in accordance of STARD guidelines. Setting was Family Medicine Unit (FMU) No. 80 of Mexican Institute of Social Security(IMSS) of Morelia, Michoacán, Mexico. Children between 5 and 9 years, both genders, 104 with normal weight(NW), 97 with Overweight-Obesity(OO Group) were included. Once the informed consent was signed we obtained the BMI, waist circumference, blood pressure(BP) and 5 mL of blood collected for glucose, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, uric acid and insulin. As main outcome measures TyG or TG/HDL, HOMA-IR, and Receiving Operating Curves(ROC), sensitivity, specificity by ROC were obtained. RESULTS: Cutoff point TyG: 8.5 by ROC had an area under curve (AUC):0.802 IC95% 0.77to0.893, P = 0.0001; diagnostic accuracy of 73%. TG/HDL: 2.22; AUC:0.729 IC95% 0.622to0.837, P = 0.014; diagnostic accuracy of 52%. TyG can identify cardiometabolic alterations more than HOMA and TG/HDL. Cardiometabolic alterations in the OO group were hypertriglyceridemia:49.5%, low HDL:63.9%, IR:39.2% and in NW group were hypertriglyceridemia:30.8%, low HDL:60.6%, IR:9.6%. CONCLUSIONS: We reported high frequency of hypertriglyceridemia and low HDL in Mexican children. TyG and TG/HDL are good predictors for IR. TyG has a better diagnostic accuracy. We need implementing TyG for identifying alterations and intervening in a timely manner to delay the onset of chronic diseases in children.


Assuntos
Biomarcadores/sangue , Glicemia/análise , HDL-Colesterol/sangue , Intolerância à Glucose/diagnóstico , Resistência à Insulina , Obesidade Pediátrica/fisiopatologia , Triglicerídeos/sangue , Índice de Massa Corporal , Estudos Transversais , Feminino , Seguimentos , Intolerância à Glucose/sangue , Intolerância à Glucose/epidemiologia , Humanos , Masculino , México , Prognóstico , Estudos Prospectivos , Curva ROC
3.
Diabetes Metab Syndr ; 13(4): 2683-2687, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405694

RESUMO

AIMS: Simple surrogate indices of insulin sensitivity have been conceived to deal with costly and complicated approaches, such as the hyperinsulinemic-euglycemic clamp; however, their use has not been widespread given their variabilities in different populations. In this paper, we present two simple surrogate indices, one that uses fasting glucose and insulin values and the other based on the values from the oral glucose tolerance test. MATERIALS AND METHODS: The proposed methods integrate easy-to-obtain anthropometric measures. Evolutionary algorithms were used to optimize the proposed methods by maximizing its correlation with the Stumvoll MCR method. RESULTS AND CONCLUSION: When the proposed indices were applied to three study groups (control subjects, metabolic syndrome, marathon runners), a reduction in the intergroup variability of the insulin sensitivity was obtained. Moreover, the proposed index based on the oral glucose tolerance test (OGTT), which considers the glucose metabolism process and the hepatic and peripheral insulin sensitivity, showed stronger correlations with the Stumvoll method and lower intergroup variability than the fasting one.


Assuntos
Biomarcadores/análise , Glicemia/análise , Jejum , Intolerância à Glucose/diagnóstico , Resistência à Insulina , Insulina/sangue , Síndrome Metabólica/fisiopatologia , Adulto , Estudos de Casos e Controles , Seguimentos , Técnica Clamp de Glucose/métodos , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/metabolismo , Teste de Tolerância a Glucose/métodos , Humanos , Incidência , Masculino , Prognóstico , Venezuela/epidemiologia
4.
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
5.
Int J Gynaecol Obstet ; 147(1): 108-114, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31304595

RESUMO

OBJECTIVE: To evaluate the incidence of abnormal third trimester oral glucose tolerance tests (OGTT) results in non-diabetic women and to compare the obstetric and neonatal outcomes with those of women with normal OGTT results. METHODS: Women with third trimester singleton pregnancies with negative gestational diabetes test results earlier in their pregnancy were enrolled into an observational prospective study at a tertiary care hospital between June 1, 2014 and September 30, 2017. All underwent an additional 75 g OGTT between 32 and 36 weeks and were classified as having normal or abnormal results. Healthcare professionals were blinded to the results. Pregnancy and perinatal outcomes were compared. RESULTS: Four hundred and sixty-seven women agreed to participate and 334 fulfilled the inclusion criteria. Forty-five (13.5%) had an abnormal third trimester OGTT result. In this group, post-term induction of labor was more frequent (70.6% vs 38.1%, adjusted odds ratio (aOR) 4.28, 95% confidence interval (CI) 1.33-13.77, P=0.015) as was cesarean delivery (31.1% vs 15.2%, aOR 2.57, 95% CI 1.14-5.81, P=0.023), regardless of surgery indication. Macrosomia was more common, but not significantly after adjusting for confounders (17.8% vs 4.2%, aOR 3.80, 95% CI 0.60-24.17, P=0.157). No other significant differences were found. CONCLUSION: Post-term induction of labor and cesarean delivery were more frequent in women with an abnormal third trimester OGTT result, but there was no increased risk of serious maternal or perinatal adverse outcomes.


Assuntos
Intolerância à Glucose/sangue , Teste de Tolerância a Glucose/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Intolerância à Glucose/diagnóstico , Humanos , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos
6.
Artigo em Inglês | MEDLINE | ID: mdl-31284480

RESUMO

Background: Early-onset diabetes results in longer lifetime hyperglycemic exposure that consequently leads to earlier chronic diabetes complications and premature death. The aim of this study was to quantify the prevalence and risk factors of undiagnosed diabetes and undiagnosed prediabetes in apparently healthy young adults aged <40 years. Methods: This study used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey conducted by the Korean Ministry of Health and Welfare from 2014 to 2017. A total of 4442 apparently healthy young adults enrolled in this study. Multivariate logistic regression analyses were conducted separately to evaluate associated risk factors with undiagnosed diabetes and undiagnosed prediabetes in groups stratified by sex. Results: The prevalence of undiagnosed diabetes and undiagnosed prediabetes was 1.2% and 25.0%, respectively. Obesity (body mass index ≥ 30.0 kg/m2) was a significant risk factor of undiagnosed diabetes regardless of sex (men, odds ratio (OR): 9.808, 95% confidence interval (CI): 1.619-59.412; women, OR: 7.719, 95% CI: 1.332-44.747). Family history of diabetes was significantly associated with undiagnosed diabetes (OR: 3.407, 95% CI: 1.224-9.481) in women only. Increased age, obesity status, and family history of diabetes were significant risk factors for undiagnosed prediabetes. Alcohol consumption was found to be negatively associated with undiagnosed prediabetes in women. Conclusions: Increased attention and implementation of precise strategies for identifying young adults at high risk for undiagnosed diabetes would allow for increased wellbeing as well as reduced healthcare burdens associated with diabetes.


Assuntos
Intolerância à Glucose/epidemiologia , /epidemiologia , Adulto , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Feminino , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/etiologia , Humanos , Masculino , Inquéritos Nutricionais , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etiologia , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , /etiologia , Adulto Jovem
7.
Nutrients ; 11(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340493

RESUMO

The aim of the study was to find out whether participation in earlier intervention had an effect on the occurrence of retinopathy in study participants. We also examined risk factors (age, sex, weight, fasting and 2 h glucose, fasting insulin, blood pressure, serum lipids) for early retinal changes. The study included 522 individuals (mean 55 years old, range 40-64 years) with impaired glucose tolerance who were randomized into intervention (weight loss, healthy diet, and physical activity, N = 265) and control groups (N = 257). Intervention lasted for median of four years in 1993-2000, after which annual follow-up visits at study clinics were conducted. In the years 2002-2006 (at least five years after stopping intervention), fundus photography was offered for all study participants in four of five study clinics. Photographs were assessed by two experienced ophthalmologists (A.A. and K.K.), masked for the group assignment. After exclusion of poor quality photographs, the data of 211 individuals (N = 113 for intervention and N = 98 for control group) were included in the present study. The occurrence of microaneurysms was significantly higher in the control (37/98, 38%) than in the intervention group (27/113, 24%; p = 0.029). In the model, including age, sex, diabetes diagnosis before the retinal assessment, body mass index (BMI), and treatment group, the odds ratio for microaneurysms was markedly lower in intervention group (OR 0.52; 0.28-0.97, p = 0.039). The only risk factor that predicted the occurrence of microaneurysms was serum triglycerides at baseline (mean ± SD 1.9 ± 0.9 vs. 1.6 ± 0.7, mmol/L, with and without microaneurysms, respectively, p = 0.003). Triglycerides associated with decreased microaneurysms in regression analysis for age, sex, fasting glucose, and intervention group (OR 1.92, p = 0.018). Lifestyle intervention in overweight and obese individuals with impaired glucose tolerance showed decreased occurrence of retinal microaneurysms. Elevated serum triglycerides were associated to the development of early diabetic microangiopathy.


Assuntos
Intolerância à Glucose/terapia , Estilo de Vida Saudável , Microaneurisma/prevenção & controle , Obesidade/terapia , Doenças Retinianas/prevenção & controle , Comportamento de Redução do Risco , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Exercício , Feminino , Finlândia , Intolerância à Glucose/sangue , Intolerância à Glucose/complicações , Intolerância à Glucose/diagnóstico , Humanos , Masculino , Microaneurisma/sangue , Microaneurisma/diagnóstico , Microaneurisma/etiologia , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/diagnóstico , Fatores de Proteção , Doenças Retinianas/sangue , Doenças Retinianas/diagnóstico , Doenças Retinianas/etiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Triglicerídeos/sangue , Perda de Peso
8.
Diabetes Metab Syndr ; 13(3): 2057-2060, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235136

RESUMO

Patients with Diabetic nephropathy (DN) have an increase in cardiovascular mortality, and since IR may be a contributing factor. Therefore, the aim of this study was to assess the role of pro insulin/insulin ratio as a predictor of insulin resistance in patients with diabetic nephropathy PATIENTS AND METHODS: A Case-control study was conducted in a total of 50 patients who diagnosed with type 2 diabetes mellitus from July 2017 to March 2018. The patients were divided into 2 groups according to presence of diabetic nephropathy. Demographic and clinical data were collected. RESULTS: There is a significant increase in serum pro insulin/insulin ratio in patients with diabetic nephropathy patients compared to patients without diabetic nephropathy An association was found between increase serum pro insulin/insulin ratio and increase predicting of insulin resistance. Cut-off value of serum pro insulin/insulin ratio ≥0.1145 with sensitivity and specificity of 92.3 and 60.3 respectively as a predictor for insulin resistance CONCLUSION: This study demonstrate a strong relationship between insulin resistance and CKD and this relationship was stronger in the presence of obesity. Pro insulin/insulin ratio was found to be a significant predictor for insulin resistance.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/complicações , Intolerância à Glucose/diagnóstico , Resistência à Insulina , Insulina/sangue , Proinsulina/sangue , Glicemia/análise , Estudos de Casos e Controles , Feminino , Seguimentos , Intolerância à Glucose/sangue , Intolerância à Glucose/etiologia , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
9.
BMC Endocr Disord ; 19(1): 44, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053128

RESUMO

Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder in pregnancy, and it is associated with increased risk of morbidity in maternal-fetal outcomes. GDM is also associated with a higher risk to develop diabetes in the future. Diabetes-related autoantibodies (AABs) have been detected in a small percentage (usually less than 10%) of women with gestational diabetes. The prevalence in gestational diabetes of these autoimmune markers of type 1 diabetes (T1D) has been assessed in many studies, together with the risk of progression of AABs-positive GDM towards impaired glucose regulation (IFG or IGT) and overt diabetes after pregancy. The question whether it is necessary to test for T1D autoantibodies in all pregnancies with GDM is still debated. Here we examine the epidemiology of T1D autoantibodies in GDM, their clinical relevance in term of future risk of diabetes or impaired glucose regulation and in term of maternal-fetal outcomes, and discuss when it may be the most appropriate time to search for T1D autoantibodies in women with gestational diabetes.


Assuntos
Autoanticorpos/sangue , Diabetes Mellitus Tipo 1/imunologia , Diabetes Gestacional/sangue , Intolerância à Glucose/diagnóstico , Autoanticorpos/imunologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/imunologia , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/etiologia , Teste de Tolerância a Glucose , Humanos , Gravidez , Prognóstico
10.
Diabetes Res Clin Pract ; 152: 146-155, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31063853

RESUMO

AIMS: To determine whether women with abnormal gestational diabetes (GDM) screening test results short of frank GDM have increased health-services utilization compared to women with normal results. METHODS: We conducted a retrospective-cohort study among 29,999 women enrolled in Kaiser Permanente Northwest who completed GDM screening (two-step method: 1-h, 50-g glucose-challenge test (GCT); 3-h, 100-g oral-glucose-tolerance test (OGTT)). Test results were categorized as normal GCT (referent, n = 25,535), normal OGTT (n = 2246), abnormal OGTT but not GDM (n = 1477), and GDM (n = 741). Rate ratios (RRs) were calculated for utilization measures and analyses were age- and BMI-adjusted. RESULTS: Compared to women with normal GCT, rates for obstetrical ultrasound, noninvasive and invasive antenatal testing, and ambulatory visits to the obstetrics department were significantly greater among women with abnormal OGTT (RRs 1.2 [95%CI 1.1, 1.4], 1.3 [1.1, 1.4], 1.7 [1.3, 2.3], and 1.1 [1.1, 1.1], respectively) and GDM (RRs 1.8, 1.8, 2.0, and 1.3, respectively). Women with abnormal OGTT results were more likely to visit a dietician than women with normal GCT; RRs ranged from 4.0 [3.3, 4.9] for women with abnormal GCT but normal OGTT to 72.1 [64, 81] for women with GDM. CONCLUSIONS: Health-services utilization increased with severity of glucose result, even among women without GDM.


Assuntos
Glicemia/análise , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez/sangue , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Glicemia/metabolismo , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Teste de Tolerância a Glucose , Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Rastreamento/métodos , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Adulto Jovem
11.
Acta Diabetol ; 56(9): 1061-1071, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31028529

RESUMO

AIMS: To quantify epicardial adipose tissue (EAT) and visceral adipose tissue (VAT) in Chinese adults with impaired glucose regulation (IGR) or diabetes and compare the contributions of EAT and VAT to the occurrence of IGR and diabetes with those of traditional obesity indices. METHODS: Cardiac and abdominopelvic noncontrast computed tomographic images of 668 individuals were used to measure EAT and VAT volume. Multivariable logistic regression and area under the receiver operating characteristic (ROC) curve were used to illustrate the contributions of these tissues. RESULTS: Patients with IGR or diabetes had larger EAT and VAT volumes than did the controls, and the VAT volume was significantly different between the IGR and diabetic groups. In multivariable models, higher EAT or VAT volume was positively associated with the presence of IGR and diabetes. After adjusting further for body mass index (BMI) and waist-to-hip ratio (WHR), a higher EAT volume was still positively associated with IGR (odds ratio (OR) = 1.46; 95% confidence interval (CI), 1.04-2.03), and a higher VAT volume was positively associated with IGR (OR = 1.86; 95% CI, 1.15-3.02) and diabetes (OR = 1.86; 95% CI, 1.16-2.99). The areas under the curve (AUCs) of the association of EAT (AUC = 0.751; 95% CI, 0.712-0.789) and VAT (AUC = 0.752; 95% CI, 0.713-0.792) with dysglycemia (IGR + diabetes) were significantly larger than those of the traditional obesity indices (all P < 0.05). CONCLUSIONS: High EAT or VAT volume is positively associated with IGR and diabetes in Chinese adults. With a given WHR and BMI, such an association still exists to some extent. The correlation may be stronger than those of the traditional obesity indices.


Assuntos
Tecido Adiposo/metabolismo , Diabetes Mellitus/metabolismo , Intolerância à Glucose/metabolismo , Gordura Intra-Abdominal/metabolismo , Pericárdio , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Índice de Massa Corporal , China/epidemiologia , Estudos Transversais/legislação & jurisprudência , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Feminino , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/patologia , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/patologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/metabolismo , Obesidade/patologia , Pericárdio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Relação Cintura-Quadril , Adulto Jovem
12.
J Pak Med Assoc ; 69(4): 527-532, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000858

RESUMO

OBJECTIVE: To explore the knowledge and perceptions about pre-diabetes screening and management amongst physicians, final year medical students, and patients. METHODS: The cross-sectional observational study was conducted at Shifa International Hospital, Shifa Foundation Clinic and Shifa College of Medicine, Islamabad, Pakistan, from November 2017 to February 2018. A structured questionnaire was used to assess doctors' and final year medical students' knowledge about screening and management of pre-diabetes. A group of patients were also interviewed about pre-diabetes awareness and their primary resources for health-related information. Data was analysed using SPSS 23. RESULTS: Of the 267 participants, there were 85(32%) doctors, 82(31%) medical students and 100(37%) patients. Only 61(71.8%), 44(51.7%) and 34(39.8%) physicians and 53(64.6%), 30(36.5%) and 26(31.6%) students could accurately identify impaired fasting blood glucose, glycated haemoglobin and impaired glucose tolerance criteria for pre-diabetes, respectively. Regarding risk factors for pre-diabetes screening, ethnicity, cardiovascular diseases and gestational diabetes were identified by 8(9.4%), 6(7.1%) and 9(10.6%) physicians and 10(12.2%), 6(7.3%) and 15(18.3%) students, respectively. There was no statistically significant relation of correct identification of pre-diabetes criteria with specialties, designations and years of experience post-qualification (p>0.5). Only 3(3%) patients were aware of pre-diabetes or borderline diabetes. CONCLUSIONS: Knowledge and perception of doctors, medical students and patients about pre-diabetes was found to be deficient. Efforts are required to reinforce its identification and management at all levels..


Assuntos
Competência Clínica , Conhecimentos, Atitudes e Prática em Saúde , Médicos , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/terapia , Estudantes de Medicina , Adulto , Glicemia/metabolismo , Informação de Saúde ao Consumidor , Feminino , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/metabolismo , Intolerância à Glucose/terapia , Hemoglobina A Glicada/metabolismo , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Paquistão , Estado Pré-Diabético/metabolismo , Televisão , Centros de Atenção Terciária , Adulto Jovem
13.
BMC Endocr Disord ; 19(1): 41, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31030672

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2D) is a leading cause of morbidity and mortality in Mexico. Here, we aimed to report incidence rates (IR) of type 2 diabetes in middle-aged apparently-healthy Mexican adults, identify risk factors associated to ID and develop a predictive model for ID in a high-risk population. METHODS: Prospective 3-year observational cohort, comprised of apparently-healthy adults from urban settings of central Mexico in whom demographic, anthropometric and biochemical data was collected. We evaluated risk factors for ID using Cox proportional hazard regression and developed predictive models for ID. RESULTS: We included 7636 participants of whom 6144 completed follow-up. We observed 331 ID cases (IR: 21.9 per 1000 person-years, 95%CI 21.37-22.47). Risk factors for ID included family history of diabetes, age, abdominal obesity, waist-height ratio, impaired fasting glucose (IFG), HOMA2-IR and metabolic syndrome. Early-onset ID was also high (IR 14.77 per 1000 person-years, 95%CI 14.21-15.35), and risk factors included HOMA-IR and IFG. Our ID predictive model included age, hypertriglyceridemia, IFG, hypertension and abdominal obesity as predictors (Dxy = 0.487, c-statistic = 0.741) and had higher predictive accuracy compared to FINDRISC and Cambridge risk scores. CONCLUSIONS: ID in apparently healthy middle-aged Mexican adults is currently at an alarming rate. The constructed models can be implemented to predict diabetes risk and represent the largest prospective effort for the study metabolic diseases in Latin-American population.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Síndrome Metabólica/fisiopatologia , Modelos Estatísticos , Medição de Risco/métodos , Adulto , Algoritmos , Estudos de Casos e Controles , Feminino , Seguimentos , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco
14.
S D Med ; 72(2): 67-73, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30855734

RESUMO

The enormous implications caused by type 2 diabetes on patients, families and health systems in the U.S. require health care providers to apply measures that reduce its burden. Scientific evidence clearly shows that proper screening of populations at risk, implementation of interventions proven beneficial in preventing type 2 diabetes and the use of modern technology in educating patients to adopt a healthier lifestyle are paramount in decreasing the incidence of type 2 diabetes. In this article, we try to answer some of the questions raised by both patients and health care providers about how lifestyle modifications can play a key role in ameliorating and reversing impaired glucose tolerance and type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Intolerância à Glucose/diagnóstico , Estado Pré-Diabético/diagnóstico , Intolerância à Glucose/terapia , Humanos , Estilo de Vida , Programas de Rastreamento , Estado Pré-Diabético/terapia
15.
J Coll Physicians Surg Pak ; 29(4): 333-336, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30925955

RESUMO

OBJECTIVE: To evaluate glucose tolerance patterns in pregnant ladies undergoing 2-hour oral glucose tolerance test (OGTT) for comparing fasting, 1-hour, 2-hour post-glucose load results, HbA1c, sum of all glucose readings with and without gestational diabetes mellitus (GDM) using International Association of the Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria. STUDY DESIGN: Cross-sectional analysis. PLACE AND DURATION OF STUDY: PNS Hafeez, Naval Hospital, Islamabad, from January 2016 to July 2017. METHODOLOGY: For 280 evaluated subjects reporting in mid-pregnancy for OGTT, results were segregated into four groups based upon comparison of 2-hour glucose result with 1-hour glucose. Group-1 2-hour results drop being >2.0 mmol/L than1-hour results, group-2 with 2-hour result between <2.0 to >0.5 mmol/L than peak at 1-hour, and group-3 with either 2-hour glucose drop being <0.5mmol/L or >1-hour results. Further, the ROC curve analysis was performed to compare the AUC for fasting plasma glucose, 1-hour post OGTT result, 2-hour post-OGTT result, factor additive of all OGTT readings and HbA1c. RESULTS: There was a progressive rise in HbA1c from group-1 to group-3 (p<0.001). Area under curve (AUC) for various diagnostic parameters for diagnosing GDM for additive value of all glucose results was 0.962 (95% CI: 0.935-0.988), 0.881 (95% CI: 0.818-0944) for plasma glucose at 2-hour, for plasma glucose at 1-hour 0.898 (95% CI: 0.0.842-0.954), 0.831 (95% CI: 0.0.762-0.901) for fasting plasma glucose and 0.668 (95% CI: 0.0.578-0.759) for HbA1c (p<0.001). CONCLUSION: Pregnant ladies demonstrating poor tolerance to glucose at 2-hour were observed to have higher HbA1c levels.


Assuntos
Glicemia/análise , Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Hemoglobina A Glicada/análise , Gravidez/metabolismo , Adulto , Área Sob a Curva , Glicemia/metabolismo , Estudos Transversais , Diabetes Gestacional/sangue , Diabetes Gestacional/metabolismo , Jejum/sangue , Feminino , Intolerância à Glucose/diagnóstico , Humanos , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade
16.
Ann Endocrinol (Paris) ; 80(2): 72-76, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30825997

RESUMO

OBJECTIVE: To investigate the relations of circulating adhesion molecule vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) with carotid artery elasticity in patients with impaired glucose regulation (IGR). METHODS: A total of 208 subjects were enrolled from January 2013 to March 2014. One hundred forty-eight were IGR patients, and 60 had normal glucose tolerance (NGT). Carotid intima-media thickness (IMT), carotid artery pressure-strain elasticity coefficient (Eρ), stiffness (ß), arterial compliance (AC), and pulse wave velocity (PWVß), as well as blood pressure, body mass index, blood glucose, blood lipids, insulin resistance index, VCAM-1, and ICAM-1 were measured and compared between IGR and NGT patients. RESULTS: Eρ, ß and PWVß were significantly higher in the IGR group than in the NGT group (P<0.05), but the IMT showed no significant difference (P>0.05). VCAM-1 and ICAM-1 were significantly higher in the IGR group than in the NGT group (P<0.05). VCAM-1 and ICAM-1 were positively correlated with Eρ, ß, and PWVß and negatively correlated with AC in IGR patients. CONCLUSIONS: Changes in carotid artery elasticity and endothelial dysfunction are found in patients with IGR. Early comprehensive intervention should be performed in such IGR populations.


Assuntos
Artérias Carótidas/fisiopatologia , Intolerância à Glucose/sangue , Intolerância à Glucose/fisiopatologia , Molécula 1 de Adesão Intercelular/sangue , Molécula 1 de Adesão de Célula Vascular/sangue , Rigidez Vascular/fisiologia , Adulto , Idoso , Glicemia/metabolismo , Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Elasticidade/fisiologia , Feminino , Intolerância à Glucose/diagnóstico , Humanos , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/fisiopatologia , Análise de Onda de Pulso , Ultrassonografia , Adulto Jovem
17.
Diab Vasc Dis Res ; 16(4): 337-343, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30755013

RESUMO

AIM: The aim of this study was to gain insight into the pathophysiological significance of elevated plasma glucose concentrations (mmol/L) 60 min post oral glucose load in apparently healthy individuals. METHODS: Comparison of resistance to insulin action and associated cardio-metabolic risk factors in 490 apparently healthy persons, subdivided into those with a plasma glucose concentration 60 min following a 75-g oral glucose challenge of <8.6 versus ⩾8.6. RESULTS: Insulin resistance was significantly greater in persons with normal glucose tolerance whose 60-min glucose concentration was ⩾8.6, associated with higher blood pressure, plasma concentrations of glucose, insulin, triglyceride and lower high-density lipoprotein cholesterol concentrations. Similar differences were seen in persons with impaired fasting glucose, but not in those with impaired glucose tolerance or both impaired fasting glucose and impaired glucose tolerance. The group whose 60-min glucose was <8.6 (n = 318) contained primarily persons with normal glucose tolerance (88%), whereas the majority of those whose 60-min value was ⩾8.6 (n = 172) had prediabetes (59%) and in particular combined impaired fasting glucose and impaired glucose tolerance. CONCLUSION: Plasma glucose concentration of ⩾8.6 mmol/L 60 min post oral glucose identifies higher proportions of combined impaired fasting glucose and impaired glucose tolerance individuals as well as normal glucose tolerance and impaired fasting glucose individuals with a more adverse cardio-metabolic profile, contributing to observed increased overall risk of type 2 diabetes and other metabolic diseases.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/etiologia , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Resistência à Insulina , Adulto , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Progressão da Doença , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/complicações , Intolerância à Glucose/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
PLoS One ; 14(1): e0211483, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703147

RESUMO

BACKGROUND: Glycated haemoglobin (HbA1c) test has been increasingly promoted as an alternative to fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT) to diagnose dysglycaemia but its performance in HIV-infected Africans has yet to be established. This study aimed to assess the diagnostic accuracy of HbA1c for dysglycaemia including FPG-defined and OGTT-defined dysglycaemia, and OGTT-defined diabetes in HIV-infected Africans, and the effect of HbA1c-predicted dysglycaemia on Joint Interim Statement (JIS)-based prevalent metabolic syndrome (MS). METHODS: A cross-sectional study included HIV-positive patients recruited across public healthcare facilities in the Western Cape. The recommended HbA1c cut-points were tested alongside the optimal cut-points obtained from receiver operating characteristic curve analyses, while the agreement between the MS criteria were assessed using kappa statistic. RESULTS: 748 participants (157 men), median age 38 years, 93% on anti-retroviral drugs were included. The optimal HbA1c cut-points of 5.75% (39.3 mmol/mol) showed 54% sensitivity, 84% specificity for FPG-defined dysglycaemia, and 52% sensitivity, 85% specificity for OGTT-defined dysglycaemia. The HbA1c value of 5.85% (40.4 mmol/mol) (63% sensitivity, 99% specificity) was optimal for diabetes. The internationally advocated cut-point of 6.5% (48 mmol/mol) had 37% sensitivity and 99% specificity for diabetes, while HbA1c ≥5.7% (≥39 mmol/mol) yielded similar performance with the study-specific cut-point for any dysglycaemia. MS prevalence by the JIS criteria (28.2%) increased to 29.7% when using HbA1c ≥5.75% (≥39.3 mmol/mol) and to 32.9% with HbA1c ≥5.7% (≥39 mmol/mol); agreement between the original and modified criteria was generally good. CONCLUSIONS: This study agrees with the internationally recommended HbA1c cut-point for detecting dysglycaemia, but not for diabetes in HIV-infected Africans. In line with previous studies in general African populations, our findings suggest that similar factors interfere with HbA1c values regardless of HIV infection status. Replacing FPG-based with HbA1c-predicted dysglycaemia in the JIS criteria to diagnose MS is feasible in HIV-infected Africans.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus/fisiopatologia , Intolerância à Glucose/diagnóstico , Hemoglobina A Glicada/análise , Infecções por HIV/complicações , Programas de Rastreamento/métodos , Síndrome Metabólica/diagnóstico , Adulto , África/epidemiologia , Estudos Transversais , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/etiologia , Teste de Tolerância a Glucose , HIV/isolamento & purificação , Infecções por HIV/virologia , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Prevalência , Curva ROC
19.
J Endocrinol Invest ; 42(8): 987-993, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30701438

RESUMO

PURPOSE: To evaluate the relationship between surrogate estimates of insulin resistance and a direct measurement of insulin-mediated glucose uptake women with and without PCOS. METHODS: Retrospective cohort study of 75 PCOS and 118 controls. Fasting plasma glucose and insulin concentrations, insulin resistance as determined by the insulin suppression test, calculation of multiple surrogate estimates of insulin resistance, total and free testosterone concentrations, and correlations between the direct measure and surrogate estimates of insulin resistance were evaluated. RESULT(S): Surrogate markers of insulin resistance were correlated to a variable, but statistically significant degree with the direct measure of insulin resistance in control population and the women with PCOS. There was no correlation between the surrogate estimates of insulin resistance and total or free plasma testosterone concentrations. CONCLUSION(S): The surrogate estimates of insulin resistance evaluated were significantly related to a direct measure of insulin resistance, and this was true of both the control population and women with PCOS. The magnitude of the relationship between the surrogate estimates and the direct measurement was comparable and not significantly altered by androgen levels. Fasting plasma insulin concentration seems to be at least as accurate as any other surrogate estimate, and is by far the simplest.


Assuntos
Biomarcadores/sangue , Intolerância à Glucose/diagnóstico , Resistência à Insulina , Insulina/sangue , Síndrome do Ovário Policístico/complicações , Adolescente , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Intolerância à Glucose/sangue , Intolerância à Glucose/etiologia , Teste de Tolerância a Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
20.
BMC Endocr Disord ; 19(1): 23, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30770743

RESUMO

BACKGROUND: Dysglycemic status defined by prediabetes and diabetes is known to be related with future risk of diabetic complications and cardiovascular diseases. Herein, we aimed to determine the diagnostic accuracy of glycated hemoglobin (HbA1c) when compared with oral glucose tolerance test (OGTT) as a reference test in identifying dysglycemic status among high-risk Thai patients receiving care in an out-patient setting. METHODS: An 11-year retrospective cross-sectional study of high-risk Thai patients who underwent OGTT during 2007-2017 was analysed. The OGTT was used as a reference test to identify subjects of dysglycemic status. The diagnostic accuracy of HbA1c and the agreement between HbA1c and OGTT were examined. Validated Thai diabetes risk score, Thai cardiovascular risk score (Thai CV risk score), and visceral fat area (VFA) were also compared in each glycemic status from OGTT as surrogate markers for future diabetes and cardiovascular diseases. RESULTS: A total of 512 subjects (females 60.5%, mean age of 50.3 ± 12.7 years, BMI of 26.5 ± 4.6 kg/m2) were reviewed. Normal glucose tolerance (NGT) was found in 220 patients (43.0%), impaired glucose tolerance (IGT) in 191 patients (37.3%), and diabetes in 101 patients (19.7%). The prevalence of diabetes using OGTT was approximately two times higher than those defined by HbA1c (19.7% versus 11.1%). There were poor agreements between the classifications of prediabetes and diabetes defined by OGTT and HbA1c (Cohen's Kappa 0.154 and 0.306, respectively). Using a cut-off value for HbA1c ≥6.5% as a threshold for HbA1c-defined criteria of diabetes, sensitivity was 32% (95% CI 23-41%) and specificity was 94% (95% CI 92-96%). The optimal cut-off HbA1c value for detecting diabetes by Youden's index was at HbA1c 6.2%. Thai CV risk score was much higher among the OGTT-defined diabetes group when compared with the NGT group (median score 10 vs. 3, p-value < 0.001). CONCLUSIONS: Despite the practicality and validity of HbA1c as a diagnostic test, our study suggested that HbA1c as a screening tool for diabetes in high-risk Thai patients is much inferior to OGTT. With limitations of HbA1c, physicians should continue to advocate OGTT as a screening tool for the identification of dysglycemic status in high-risk Thai patients.


Assuntos
Biomarcadores/sangue , Glicemia/análise , Diabetes Mellitus/diagnóstico , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose/métodos , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Intolerância à Glucose/sangue , Intolerância à Glucose/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA