Cardiovascular disease prediction model for Indonesian adult population with prediabetes and diabetes mellitus: The Bogor Cohort study of Noncommunicable Diseases Risk Factors

BACKGROUND AND AIMS

This study aims to develop a predictive model of cardiovascular events in dysglycemia among the Indonesian adult population.

METHODS

This is a retrospective cohort study conducted on subjects over 25 years in the "The Bogor Cohort Study of Noncommunicable Diseases Risk Factors" from 2011 to 2018. Data associated with age, gender, blood pressure, body mass index, waist circumference, blood glucose, cholesterol, smoking habits, family history of cardiovascular disease, and physical activity were obtained. Cardiovascular events in six years were observed; this included coronary heart disease, stroke, or all-cause cardiovascular mortality. Cox proportional hazards regression models were used to determine independent predictors of cardiovascular events.

RESULTS

A total of 1085 subjects with prediabetes and diabetes mellitus were included in this study, with 73.5% female. The cumulative incidence of cardiovascular events in six years was 9.7%. Predictors of cardiovascular events were age ≥45 years (HR = 2.737; 95% CI 1.565-4.787) and hypertension (HR = 2.580; 95% CI 1.619-4.112).

CONCLUSIONS

Age ≥45 years and hypertension were predictors of cardiovascular events in six years among the adult Indonesian population with prediabetes and diabetes, necessitating targeted intervention among these subjects.

The northeast glucose drift: Stratification of post-breakfast dysglycemia among predominantly Hispanic/Latino adults at-risk or with type 2 diabetes

BACKGROUND

There is minimal experience in continuous glucose monitoring (CGM) among underserved racial/ethnic minority populations with or at risk of type 2 diabetes (T2D), and therefore a lack of CGM-driven insight for these individuals. We analyzed breakfast-related CGM profiles of free-living, predominantly Hispanic/Latino individuals at-risk of T2D, with pre-T2D, or with non-insulin treated T2D.

METHODS

Starting February 2019, 119 participants in Santa Barbara, CA, USA, (93 female, 87% Hispanic/Latino [predominantly Mexican-American], age 54·4 [±12·1] years), stratified by HbA_1c levels into (i) at-risk of T2D, (ii) with pre-T2D, and (iii) with non-insulin treated T2D, wore blinded CGMs for two weeks. We compared valid CGM profiles from 106 of these participants representing glucose response to breakfast using four parameters.

FINDINGS

A "northeast drift" was observed in breakfast glucose responses comparing at-risk to pre-T2D to T2D participants. T2D participants had a significantly higher pre-breakfast glucose level, glucose rise, glucose incremental area under the curve (all p < 0·0001), and time to glucose peak (p < 0·05) compared to pre-T2D and at-risk participants. After adjusting for demographic and clinical covariates, pre-breakfast glucose and time to peak (p < 0·0001) were significantly associated with HbA_1c. The model predicted HbA_1c within (0·55 ± 0·67)% of true laboratory HbA_1c values.

INTERPRETATION

For predominantly Hispanic/Latino adults, the average two-week breakfast glucose response shows a progression of dysglycemia from at-risk of T2D to pre-T2D to T2D. CGM-based breakfast metrics have the potential to predict HbA_1c levels and monitor diabetes progression.

FUNDING

US Department of Agriculture (Grant #2018-33800-28404), a seed grant from the industry board fees of the NSF Engineering Research Center for Precise Advanced Technologies and Health Systems for Underserved Populations (PATHS-UP) (Award #1648451), and the Elsevier foundation.

The role of Intestinal-Fatty Acid Binding Proteins and Chitinase-3-Like Protein 1 across the spectrum of dysglycemia

BACKGROUND AND AIMS

Recent studies underlie the importance of intestinal permeability and chronic inflammation in the pathogenesis of T2DM. Our study compared the concentrations of FABP2 and YKL40 as markers of intestinal permeability and inflammation among normoglycemia, prediabetes and T2DM.

METHODS

We recruited 122 participants (45 normoglycemic, 26 prediabetes, and 51 T2DM) of whom we measured the fasting serum levels of FABP2 and YKL-40 using ELISA method.

RESULTS

The levels of FABP2 were significantly higher in the T2DM group [2.890 (1.880-4.070)] in comparison to both prediabetes [2.025 (1.145-2.343), p = 0.0085] and normoglycemia group [1.72 (1.250-2.645), p = 0.011]. The levels of YKL-40 were also significantly higher in the T2DM group [68.70 (44.61-166.6)] in comparison to both prediabetes [28.85 (20.64-41.53), p < 0.0001] and normoglycemia group [28.64 (19.25-43.87), p < 0.001].

CONCLUSIONS

Our study observed that the levels of FABP2 and YKL-40 were highest in the T2DM group supporting the available evidences on the role of intestinal permeability disruption and chronic low-grade inflammation in the pathogenesis of T2DM.

22-year trends in dysglycemia and body mass index: A population-based cohort study in Savitaipale, Finland

AIMS

We describe a 22-year prospective observational population-based study that determined the prevalence and incidence of type 2 diabetes (T2D) and intermediate hyperglycaemia (IH), obesity, hypertension, and disorders of lipid metabolism in a middle-age population in the Finnish municipality of Savitaipale.

METHODS

1151 people participated in the baseline survey in 1996-1999, following two follow-up examinations, in 2007-2008 and 2018-2019. Follow-up studies comprised clinical measurements, 2-h oral glucose tolerance test and other biochemistry, questionnaires, and registry data.

RESULTS

The prevalence of T2D quadrupled to 27% and the proportion of normoglycemic people decreased from 73% to 44% while IH increased only slightly during the 22-year follow-up. A large proportion of people who died between the surveys were diabetic. The mean body mass index (BMI) did not, whereas mean waist circumference increased significantly, by 5-6 cm (P = 0.001) during the 22 years. Systolic blood pressure increased by 13-15 mmHg from baseline (P = 0.0001) but diastolic blood pressure did not. The mean plasma levels of total and LDL-cholesterol decreased 10.8% and 8.9% in women (P = 0.001), 21.5% and 22.2% in men (P = 0.001), respectively, while HDL-cholesterol and triglycerides remained stable. The proportion of those achieving targets in the treatment of dyslipidaemia increased significantly (P < 0.001).

CONCLUSIONS

In this 22-year prospective follow-up study of in middle-aged Europeans with high participation rates, the progression of dysglycaemia to overt diabetes with aging was rapid, even without a significant change in BMI.

The interrelationship and accumulation of cardiometabolic risk factors amongst young adults in the United Arab Emirates: The UAE Healthy Future Study

INTRODUCTION

Similar to other non-communicable diseases (NCDs), people who develop cardiovascular disease (CVD) typically have more than one risk factor. The clustering of cardiovascular risk factors begins in youth, early adulthood, and middle age. The presence of multiple risk factors simultaneously has been shown to increase the risk for atherosclerosis development in young and middle-aged adults and risk of CVD in middle age.

OBJECTIVE

This study aimed to address the interrelationship of CVD risk factors and their accumulation in a large sample of young adults in the United Arab Emirates (UAE).

METHODS

Baseline data was drawn from the UAE Healthy Future Study (UAEHFS), a volunteer-based multicenter study that recruits Emirati nationals. Data of participants aged 18 to 40 years was used for cross-sectional analysis. Demographic and health information was collected through self-reported questionnaires. Anthropometric data and blood pressure were measured, and blood samples were collected.

RESULTS

A total of 5126 participants were included in the analysis. Comorbidity analyses showed that dyslipidemia and obesity co-existed with other cardiometabolic risk factors (CRFs) more than 70% and 50% of the time, respectively. Multivariate logistic regression analysis of the risk factors with age and gender showed that all risk factors were highly associated with each other. The strongest relationship was found with obesity; it was associated with four-fold increase in the odds of having central obesity [adjusted OR 4.70 (95% CI (4.04-5.46)], and almost three-fold increase odds of having abnormal glycemic status [AOR 2.98 (95% (CI 2.49-3.55))], hypertension (AOR 3.03 (95% CI (2.61-3.52))] and dyslipidemia [AOR 2.71 (95% CI (2.32-3.15)]. Forty percent of the population accumulated more than 2 risk factors, and the burden increased with age.

CONCLUSION

In this young population, cardiometabolic risk factors are highly prevalent and are associated with each other, therefore creating a heavy burden of risk factors. This forecasts an increase in the burden of CVD in the UAE. The robust longitudinal design of the UAEHFS will enable researchers to understand how risk factors cluster before disease develops. This knowledge will offer a novel approach to design group-specific preventive measures for CVD development.

Cardiometabolic risk: New chronic care models

Cardiometabolic risk factors and the chronic cardiovascular diseases (CVD) that result from them are highly prevalent in the U.S. and amenable to clinical nutrition interventions. This creates an urgency to develop comprehensive care models that incorporate prevention-based actions by improving lifestyle routines. Such care models should account for social determinants of health, ethnocultural variables, and challenges to sustainability. The relevance of these newly designed chronic care models are to inform and facilitate early intervention, primarily consisting of lifestyle change and healthy nutrition, which mitigates progression from one stage to subsequent, higher morbidity stages to a greater extent than late intervention. In this paper, the mechanistic drivers and ethno-cultural validation of the Cardiometabolic-Based Chronic Disease (CMBCD) model are reviewed. Main findings are that in CMBCD, primary (genetics, environment, and behavior) and metabolic (obesity as Adiposity-Based Chronic Disease [ABCD], type 2 diabetes as Dysglycemia-Based Chronic Disease [DBCD], hypertension, and dyslipidemia) drivers initiate and perpetuate the progression of CVD. Epidemiological findings and molecular mechanisms support intra ABCD/DBCD, as well as ABCD to DBCD stage progression culminating in CVD. The ABCD definition overcomes weight stigma and BMI underperformance by considering adiposity amount, distribution, and function; and the DBCD definition overcomes criticisms of prediabetes and an exclusive glucocentric approach by considering insulin resistance and residual vascular risk along a clinical spectrum. In conclusion, clinicians should approach patients using the CMBCD model to incorporate lifestyle change as early as possible to optimally mitigate the burden of CVD. This article is protected by copyright. All rights reserved.

Impact of glucose variability on coronary plaque vulnerability in patients with dysglycemia: A whole coronary analysis with multislice computed tomography

BACKGROUND

Dysglycemia is associated with an increased risk of acute coronary syndrome caused by the disruption of vulnerable plaques. The relationship between glycemic variability (GV), which is a component of impaired glucose metabolism, and coronary plaque vulnerability has not been fully elucidated. This study investigated the impact of GV on whole coronary plaque vulnerability using multislice computed tomography (MSCT).

METHODS

We analyzed 88 patients with dysglycemia who underwent 24 h blood glucose monitoring and MSCT. The mean amplitude of glycemic excursion (MAGE) was calculated as an index of the GV. We defined a CT-derived vulnerable plaque as a plaque with a remodeling index > 1.10 and a mean CT density < 30 HU. We calculated the percentage of low-attenuation plaque (% LAP) as the ratio of the low-attenuation component (CT density < 30HU) volume to the total vessel volume.

RESULTS

Vulnerable plaques were detected in 27 patients (31%). Patients with vulnerable plaques had higher MAGE (110.0 ± 40.7 vs. 71.7 ± 21.7, p < 0.01) than patients without vulnerable plaques. A univariate logistic regression analysis showed that vulnerable plaques were associated with the MAGE [odds ratio (OR) 1.04, 95% confidence interval (CI), 1.02-1.07, p < 0.01]. In a multivariate model, the MAGE (OR 1.05, 95% CI 1.02-1.07) remained a significant predictor of vulnerable plaque presence. Patients with multivessel-vulnerable plaques had higher MAGE values than those with single-vessel involvement or no vulnerable plaques (132.3 ± 39.4 vs. 102.2 ± 39.7, vs. 71.7 ± 21.7, p < 0.01). The regression analysis showed a positive correlation between MAGE levels and the % LAP (r = 0.55, p < 0.01). In a multiple linear regression analysis, the MAGE was independently associated with the % LAP (β = 0.42, p < 0.01).

CONCLUSIONS

Increased GV is associated with the presence and extent of vulnerable plaques.

Dysglycemia in Critically Ill Children Admitted to Jimma Medical Centre, Southwest Ethiopia

Background

Abnormal blood glucose level is one of the most frequently encountered problems in children with severe illnesses. However, its magnitude and outcome have rarely been determined in Ethiopia. We aimed to determine the magnitude, associated factors and outcome of dysglycemia in critically ill children admitted to Jimma Medical Center.

Methods

Prospective longitudinal study was conducted on children aged 28 days to 14 years admitted with critical illnesses at the different units of the Department of Pediatrics and Child Health of Jimma Medical Center, Southwest Ethiopia, from June to August 2019. Data were collected by trained medical personnel using structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) windows version 20.0. Dysglycemia was considered whenever the child had a random blood sugar >150mg/dl or <45mg/dl.

Result

Dysglycemia was seen at admission in 139/481, 28.9% children; 24 (5.0%) had hypoglycemia whereas 115 (23.9%) had hyperglycemia. The factors associated with dysglycemia at admission were severe acute malnutrition (p=002, AOR=3.09, CI=1.18,7.77), impaired mental status (p=0.003, AOR=4.63, CI=1.68, 12.71), place of residence (p=0.01, AOR=1.85, CI=1.15-2.96) and presence of diarrhea on date of admission. Among the children who had dysglycemia at admission, 16/139, 11.5% died.

Conclusion

Dysglycemia is a common problem in critically ill children in the setting. Blood glucose level should be determined for all critically ill children, and routine empirical administration of dextrose should be minimized since most of the children with dysglycemia had hyperglycemia than hypoglycemia.

Physical activity levels by glycemia status: A population-based cross-sectional study in Peru

OBJECTIVE

To assess whether the prevalence of low physical activity levels and time spent watching TV differ depending on glycemia status.

METHODS

A secondary analysis using data from a population-based study was conducted. Two were the outcomes: physical activity levels, derived from the International Physical Activity Questionnaire, and sitting time watching TV. The exposure was glycemia status, defined based on results of the oral glucose tolerance tests (OGTT): euglycemia, dysglycemia, and T2DM. The T2DM group was further split into: aware and unaware of T2DM diagnosis. Prevalence ratios (PR) and 95% CI were reported using Poisson regression models.

RESULTS

Data of 1607 individuals, mean age 48.2 (SD: 10.6) years, 809 (50.3%) females, were analyzed. Dysglycemia and T2DM was present in 16.9% (95% CI: 15.1%-18.8%) and 11.0% (95% CI: 9.5%-12.6%) of participants, respectively. A total of 605 (37.6%; 95% CI: 35.2%-39.9%) participants had low levels of physical activity and 1019 (63.3%; 95% CI: 60.9%-65.7%) subjects spent ≥2 h per day sitting watching TV. In multivariable model, there was no significant association between glycemia status and physical activity levels (PR = 1.14; 95% CI: 0.95-1.36). Similar result was found between glycemia status and sitting time watching TV. However, those aware of T2DM diagnosis were more likely to have low levels of physical activity (PR = 1.31; 95% CI: 1.06-1.61) compared to the euglycemia group.

CONCLUSIONS

We found a no relationship between glycemia status and physical activity level or sitting time watching TV, pointing out similar levels of physical (in)activity among those with euglycemia, dysglycemia and T2DM. Individuals aware of having T2DM were 30% more likely to have low physical activity levels compared to the euglycemic group. There is a need to increase physical activity levels among T2DM individuals.

Mean and visit-to-visit variability of glycemia and left ventricular diastolic dysfunction: A longitudinal analysis of 3025 adults with serial echocardiography

OBJECTIVE

We aimed to determine the mean glucose thresholds to increase the risk of left ventricular diastolic dysfunction (LVDD) and whether visit-to-visit variability of fasting plasma glucose (FPG) and glycated hemoglobin (A1C) could independently increase the risk in a cohort with serial echocardiography.

METHODS

This was a 3.5-year (range, 0.5-8.3) retrospective longitudinal cohort study of 3025 adults (age, 55.15 ± 7.6 years; without diabetes, n = 2755) with LV ejection fraction > 50% by serial echocardiography between 2006 and 2016. Mean, standard of deviation (SD) and coefficient of variation (CV) of FPG and A1C obtained from three consecutive measurements preceding the first echocardiography. The definition of LVDD in this study was primarily based on early peak mitral inflow velocity and early diastolic mitral annulus motion velocity.

RESULTS

LVDD developed in 611/3025 subjects (20.2%). Cox proportional hazard models showed increased adjusted hazard ratios (HRs) for incident LVDD in the highest quartile of FPG-mean (HR 1.76, 95% confidence interval [CI]; 1.36-2.30), FPG-SD (HR 1.63, 95% CI; 1.27-2.09), FPG-CV (HR 1.47, 95% CI; 1.15-1.89), and A1C-mean (HR 1.83, 95% CI; 1.41-2.38) versus the lowest quartile, which was consistent even in subjects without diabetes. Mean glucose thresholds for the increased risk were below the lower limits for pre-diabetes.

CONCLUSIONS

In terms of mean glycemia, LVDD may be initiated in the earliest diabetic continuum, and such changes could be measurable within several years. Visit-to-visit variability of FPG, but not that of A1C, predicted accelerated development of LVDD.

Clinical and metabolomic predictors of regression to normoglycemia in a population at intermediate cardiometabolic risk

Background

Impaired fasting glucose (IFG) is a prevalent and potentially reversible intermediate stage leading to type 2 diabetes that increases risk for cardiometabolic complications. The identification of clinical and molecular factors associated with the reversal, or regression, from IFG to a normoglycemia state would enable more efficient cardiovascular risk reduction strategies. The aim of this study was to identify clinical and biological predictors of regression to normoglycemia in a non-European population characterized by high rates of type 2 diabetes.

Methods

We conducted a prospective, population-based study among 9637 Mexican individuals using clinical features and plasma metabolites. Among them, 491 subjects were classified as IFG, defined as fasting glucose between 100 and 125 mg/dL at baseline. Regression to normoglycemia was defined by fasting glucose less than 100 mg/dL in the follow-up visit. Plasma metabolites were profiled by Nuclear Magnetic Resonance. Multivariable cox regression models were used to examine the associations of clinical and metabolomic factors with regression to normoglycemia. We assessed the predictive capability of models that included clinical factors alone and models that included clinical factors and prioritized metabolites.

Results

During a median follow-up period of 2.5 years, 22.6% of participants (n = 111) regressed to normoglycemia, and 29.5% progressed to type 2 diabetes (n = 145). The multivariate adjusted relative risk of regression to normoglycemia was 1.10 (95% confidence interval [CI] 1.25 to 1.32) per 10 years of age increase, 0.94 (95% CI 0.91–0.98) per 1 SD increase in BMI, and 0.91 (95% CI 0.88–0.95) per 1 SD increase in fasting glucose. A model including information from age, fasting glucose, and BMI showed a good prediction of regression to normoglycemia (AUC = 0.73 (95% CI 0.66–0.78). The improvement after adding information from prioritized metabolites (TG in large HDL, albumin, and citrate) was non-significant (AUC = 0.74 (95% CI 0.68–0.80), p value = 0.485).

Conclusion

In individuals with IFG, information from three clinical variables easily obtained in the clinical setting showed a good prediction of regression to normoglycemia beyond metabolomic features. Our findings can serve to inform and design future cardiovascular prevention strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-021-01246-1.

Incidence and Predictors of Dysglycemia and Regression to Normoglycemia in Indian Adolescents and Young Adults: 10-Year Follow-Up of the ORANGE Study

Background: The prevalence of diabetes in youth is increasing worldwide in parallel with the obesity epidemic. This study aimed to determine the incidence rates of dysglycemia (diabetes or prediabetes) and evaluate the predictors of its progression or regression to normal glucose tolerance (NGT) in a cohort of children and adolescents studied in Chennai, South India. Methods: A longitudinal follow-up of the Obesity Reduction and Awareness of Noncommunicable Diseases through Group Education (ORANGE) cohort was performed after a median of 7.1 years (n = 845; 5928 person-years of follow-up). To determine their diabetes status at follow-up, participants underwent an oral glucose tolerance test (n = 811 with NGT and 34 with prediabetes at baseline), excluding those with diabetes at baseline. Incidence rates for dysglycemia were reported per 1000 person-years of follow-up. Cox proportional hazards model was used to estimate the predictors of progression and regression. Results: Out of 811 individuals with NGT at baseline, 115 developed dysglycemia giving an incidence rate of 20.2 per 1000 person-years (95% confidence interval: 16.8-24.2). Among those with prediabetes at baseline, 70.6% of the individuals converted to NGT and the remaining 29.4% either got converted to diabetes or remained as prediabetes. Higher age, body mass index, fasting plasma glucose, 2-hour plasma glucose (2-h PG), positive family history of diabetes, and systolic blood pressure (BP) were independent predictors of incident dysglycemia, whereas lower age, waist circumference, 2-h PG, systolic BP, and triglycerides predicted regression to normoglycemia. Conclusions: This study highlights the growing burden of dysglycemia in Asian Indian youth and emphasizes the need for targeted preventive actions.

Addition of routine blood biomarkers to TIMI risk score improves predictive performance of 1-year mortality in patients with ST-segment elevation myocardial infarction

Background

Several biomarkers have been proposed as independent predictors of poor outcomes in ST-segment elevation myocardial infarction (STEMI). We investigated whether adding information obtained from routine blood tests including hypoxic liver injury (HLI), dysglycemia, anemia, and high neutrophil to lymphocyte ratio (NLR) could improve the prognostic performance of the TIMI risk score for the prediction of 1-year mortality.

Methods

A total of 1057 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) between 2007 and 2014 were retrospectively enrolled from 4-regional hospitals. HLI and dysglycemia were defined as serum transaminase > twice the normal upper limit and glucose < 90 or > 250 mg/dL, respectively. The effect of adding biomarkers to the TIMI risk score on its discriminative ability was assessed using c-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

The 1-year mortality rate was 7.1%. The best cutoff value of NLR for the prediction of 1-year mortality was 4.3 (sensitivity, 67%; specificity, 65%). HLI (HR 2.019; 95% CI 1.104–3.695), dysglycemia (HR 2.535; 95% CI 1.324–3.923), anemia (HR 2.071; 95% CI 1.093–3.923), and high NLR (HR 3.651; 95% CI 1.927–6.918) were independent predictors of 1-year mortality. When these 4 parameters were added to the TIMI risk score, the c-statistic significantly improved from 0.841 to 0.876 (p < 0.001), and the NRI and IDI were estimated at 0.203 (95% CI 0.130–0.275; p < 0.001) and 0.089 (95% CI 0.060–0.119; p < 0.001), respectively.

Conclusions

The addition of HLI, dysglycemia, anemia, and high NLR to the TIMI risk score may be useful for very early risk stratification in patients with STEMI receiving primary PCI.

The Association Between Dietary Habits and Other Lifestyle Indicators and Dysglycemia in Saudi Adults Free of Previous Diagnosis of Diabetes

Objective:

Study the association of dietary habits and other indicators of lifestyle with dysglycemia in Saudi adults.

Methods:

In a cross-sectional design, data were obtained from 1403 Saudi adults (⩾20 years), not previously diagnosed with diabetes. Demographics, lifestyle variables and dietary habits were obtained using a predesigned questionnaire. Fasting plasma glucose, glycated hemoglobin and 1-hour oral glucose tolerance test were used to identify dysglycemia. Regression analysis was performed to determine the associations of dietary factors and other indicators of lifestyle with dysglycemia.

Results:

A total 1075 adults (596 men, and 479 women) had normoglycemia, and 328 (195 men, and 133 women) had dysglycemia. Following adjustment for age, BMI and waist circumference, in men the weekly intake of 5 portions or more of red meat and Turkish coffee were associated with decreased odds of having dysglycemia odds ratio (OR) 0.444 (95% CI: 0.223, 0.881; P = .02) and 0.387 (95% CI: 0.202, 0.74; P = .004), respectively. In women, the intake of fresh juice 1 to 4 portions per week and 5 portions or more were associated with OR 0.603 (95% CI: 0.369, 0.985; P = .043) and OR 0.511 (95% CI: 0.279, 0.935; P = .029) decreased odds of having dysglycemia, respectively compared with women who did not drink fresh juice. The intake of 5 times or more per week of hibiscus drink was associated with increased odds of having dysglycemia, OR 5.551 (95% CI: 1.576, 19.55, P = .008) compared with women not using such a drink. Other lifestyle factors were not associated with dysglycemia.

Conclusion:

Dietary practices by studied Saudis have some impact on risk of dysglycemia, with obvious sex differences.

Serum cortisone and glucocorticoid receptor gene (NR3C1) polymorphism in human dysglycemia

PURPOSE

We aimed to explore the associations of serum cortisone and glucocorticoid receptor (GR) polymorphism with glucose metabolism and type 2 diabetes mellitus (T2DM) among Chinese adults.

METHODS

A total of 2315 participants were included in the present study. Serum cortisone was measured by liquid chromatography-tandem mass spectrometry. Multivariable logistic regression and linear regression were employed to assess the associations between serum cortisone and different glucose metabolism status.

RESULTS

Serum cortisone was positively associated with impaired fasting glucose (IFG) and T2DM ((Quartile 4 vs Quartile 1, odds ratio (OR) = 1.36, 95% confidence interval (CI) 1.01, 1.84, and OR = 2.08, 95% CI 1.50, 2.89, respectively)). A 100% increase in cortisone was associated with a 0.015 (95% CI 0.005, 0.025) mg/dl higher fasting plasma glucose (FPG), a 0.007 (95% CI 0.001, 0.013) higher glycosylated hemoglobin (HbA1c), a 0.4% (95% CI - 0.007, 0.000) lower HOMA2-IR, and a 58.1% (95% CI - 0.788, - 0.373) lower HOMA2-β. After stratification by genotype, the association between serum cortisone and T2DM was not significant in TT genotype carriers. In addition, at the higher concentrations of cortisone, TT genotype carriers had a lower FPG, HbA1c, and HOMA2-IR and a higher HOMA2-β than GG and GT carriers.

CONCLUSIONS

Elevated serum cortisone was associated with an increased risk of IFG and T2DM, and the associations may be modified by rs9324924 polymorphism.

Dysglycemia risk score in Saudi Arabia: A tool to identify people at high future risk of developing type 2 diabetes

AIMS/INTRODUCTION

To develop a non-invasive risk score to identify Saudis having prediabetes or undiagnosed type 2 diabetes.

METHODS

Adult Saudis without diabetes were recruited randomly using a stratified two-stage cluster sampling method. Demographic, dietary, lifestyle variables, personal and family medical history were collected using a questionnaire. Blood pressure and anthropometric measurements were taken. Body mass index was calculated. The 1-h oral glucose tolerance test was carried out. Glycated hemoglobin, fasting and 1-h plasma glucose were measured, and obtained values were used to define prediabetes and type 2 diabetes (dysglycemia). Logistic regression models were used for assessing the association between various factors and dysglycemia, and Hosmer-Lemeshow summary statistics were used to assess the goodness-of-fit.

RESULTS

A total of 791 men and 612 women were included, of whom 69 were found to have diabetes, and 259 had prediabetes. The prevalence of dysglycemia was 23%, increasing with age, reaching 71% in adults aged ≥65 years. In univariate analysis age, body mass index, waist circumference, use of antihypertensive medication, history of hyperglycemia, low physical activity, short sleep and family history of diabetes were statistically significant. The final model for the Saudi Diabetes Risk Score constituted sex, age, waist circumference, history of hyperglycemia and family history of diabetes, with the score ranging from 0 to 15. Its fit based on assessment using the receiver operating characteristic curve was good, with an area under the curve of 0.76 (95% confidence interval 0.73-0.79). The proposed cut-point for dysglycemia is 5 or 6, with sensitivity and specificity being approximately 0.7.

CONCLUSION

The Saudi Diabetes Risk Score is a simple tool that can effectively distinguish Saudis at high risk of dysglycemia.

Five-Year Glycemic Trajectories Among Healthy African-American and European-American Offspring of Parents With Type 2 Diabetes

BACKGROUND

Cross-sectional surveys report a higher prevalence of diagnosed type 2 diabetes mellitus (T2DM) in African Americans (AA) than European Americans (EA). We studied 5-year glycemic excursions among AA and EA in the Pathobiology of Prediabetes in A Biracial Cohort study, to assess ethnic disparities.

MATERIALS AND METHODS

Pathobiology of Prediabetes in A Biracial Cohort followed normoglycemic offspring of parents with T2DM for 5 years, with serial assessments of oral glucose tolerance test , anthropometry, body fat, insulin sensitivity and beta-cell function. The primary outcome was progression to prediabetes (impaired fasting glucose and/or impaired glucose tolerance). We further analyzed 5-year changes in fasting (FPG) and 2-hour plasma glucose (2hrPG).

RESULTS

One hundred and one (52 AA, 49 EA) out of 343 subjects developed prediabetes during follow-up. The change in FPG ranged from -24 mg/dl to +38 mg/dl. The FPG remained stable (± 5 mg/dl from baseline) in 50% of EA and 46.8% of AA and the 2hrPG remained stable (± 25 mg/dl from baseline) in 73.7% of EA and 71.0 % of AA during follow-up. The proportions with change in FPG of 5mg/dl to >25 mg/dl and 2hrPG of 25 mg/dl to >50 mg/dl were similar in EA and AA offspring, as were the 10th - 90th percentiles of the distribution of 5-year changes in FPG and 2hrPG.

CONCLUSIONS

During 5 years of follow-up, black and white offspring of parents with T2DM exhibited remarkable phenotypic concordance of glycemic trajectories. Thus, parental history of T2DM may be a stronger factor than race/ethnicity in the prediction of longitudinal glycemic trends.

Reproducibility of a prediabetes classification in a contemporary population

Aims

To assess whether meeting both fasting plasma glucose (FPG) and HbA1c criteria for prediabetes in people at high risk indicates with near certainty the presence of dysglycemia on repeat testing.

Methods

Observational study using data from Vitamin D and Type 2 Diabetes (D2d) study. HbA1c, FPG were measured at screening visit 1; FPG, HbA1c and 2 h plasma glucose (2hPG) measured at screening visit 2 (a median of 21 days later); participants classified as having normal glucose regulation (all 3 tests in normal range), prediabetes or diabetes (at least 1 of 3 tests in diabetes range). A predictive model was developed to estimate the probability of confirming dysglycemia and for detecting diabetes at screening visit 2 based on values of FPG and HbA1c at screening visit 1.

Results

Of 1271 participants who met both FPG and HbA1c criteria for prediabetes at screening visit 1, 98.6% exhibited dysglycemia (defined as prediabetes or diabetes) on repeat testing (84.5% were classified as having prediabetes, 14.1% were reclassified as having diabetes). Of those with diabetes, 62.6% were identified by 2hPG alone.

Conclusions

Combined measurement of FPG and HbA1c is a reliable and reproducible measure to identify presence of dysglycemia among people at high risk. A prediction model is provided to help clinicians decide whether an oral glucose tolerance test will provide value in detecting diabetes based on the 2hPG criterion.

The role of childhood BMI in predicting early adulthood dysglycemia: Tehran lipid and glucose study

BACKGROUND AND AIM

Increased adiposity is associated with insulin resistance and glycemic disturbances. We aimed to determine whether childhood overweight or obesity are independent factors in predicting adulthood dysglycemia (prediabetes or type 2 diabetes).

METHODS AND RESULTS

In this population-based cohort study, 1290 normoglycemic subjects aged 3-11 years were followed for incidence of dysglycemia. Cox-proportional hazard models were employed to evaluate the association of obesity and overweight with incidence of dysglycemia by adjustments for age, sex, parental risk factors and baseline individual risk factors. The participants, with a mean age of 7.7 ± 2.5 years, were followed for a median of 14.9 years. During follow up, 158 subjects developed dysglycemia (18 type 2 diabetes, 140 prediabetes), contributing to a total cumulative incidence of 24.7%. The unadjusted HR for developing adult dysglycemia were 1.6 (95% CI; 1.0-2.4) and 1.7 (95% CI; 1.0-3.0) in overweight and obese children, respectively. Further adjustments for age, sex, parental risk factors and baseline individual risk factors changed the results in both overweight and obese children.

CONCLUSION

These findings show that overweight or obesity in childhood have no independent role for developing adulthood dysglycemia.

Lipidomic profiling identifies signatures of metabolic risk

BACKGROUND

Metabolic syndrome (MetS), the clustering of metabolic risk factors, is associated with cardiovascular disease risk. We sought to determine if dysregulation of the lipidome may contribute to metabolic risk factors.

METHODS

We measured 154 circulating lipid species in 658 participants from the Framingham Heart Study (FHS) using liquid chromatography-tandem mass spectrometry and tested for associations with obesity, dysglycemia, and dyslipidemia. Independent external validation was sought in three independent cohorts. Follow-up data from the FHS were used to test for lipid metabolites associated with longitudinal changes in metabolic risk factors.

RESULTS

Thirty-nine lipids were associated with obesity and eight with dysglycemia in the FHS. Of 32 lipids that were available for replication for obesity and six for dyslipidemia, 28 (88%) replicated for obesity and five (83%) for dysglycemia. Four lipids were associated with longitudinal changes in body mass index and four were associated with changes in fasting blood glucose in the FHS.

CONCLUSIONS

We identified and replicated several novel lipid biomarkers of key metabolic traits. The lipid moieties identified in this study are involved in biological pathways of metabolic risk and can be explored for prognostic and therapeutic utility.

Insulin resistance and dysglycemia are associated with left ventricular remodeling after myocardial infarction in non-diabetic patients

Background

Adverse cardiac remodeling after ST-segment elevation myocardial infarction (STEMI) is a major cause for poor cardiovascular outcomes such as heart failure. The predisposing factors and underlying mechanisms remain not fully understood. This study investigates the association of insulin resistance and dysglycemia with left ventricular (LV) remodeling after STEMI in non-diabetic patients.

Methods

A total of 485 non-diabetic subjects with STEMI who underwent primary percutaneous coronary intervention were consecutively enrolled and followed up for 12 months. Relation of homeostasis model assessment-estimated insulin resistance (HOMA-IR) and glucose levels to changes in echocardiography parameters was studied.

Results

Left ventricular dilation was detected in 49.1% of subjects at 12-month follow-up after STEMI, and was more severe in subjects with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and high HOMA-IR levels. HOMA-IR remained correlated to changes in LV dimensions after adjusting for confounding risk factors. Multivariate regression analysis demonstrated that higher HOMA-IR was independently associated with greater LV dilation after STEMI. A significant interaction term was present between HOMA-IR and IGT in the model (P = 0.001).

Conclusions

Our study reveals that insulin resistance and dysglycemia are prevalent in non-diabetic patients with STEMI and are predictors of the post-infarction LV dilation.

Trial registration Trials number, NCT02089360; registered on March 17, 2014

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0904-3) contains supplementary material, which is available to authorized users.

Dysglycemia and increased left ventricle mass in normotensive patients admitted with a first myocardial infarction: prognostic implications of dysglycemia during 14 years of follow-up

Background

Left ventricle mass (LVM) can be influenced by various conditions including hypertension and/or inherent cardiomyopathies. Dysglycemia is also thought to exert an anabolic effect on heart tissue by hyperinsulinemia and thereby promoting increased LVM. The primary aim of this study was to assess the influence of dysglycemia on LVM evaluated by an oral glucose tolerance test (OGTT) in patients admitted with a first myocardial infarction (MI) without hypertension. The secondary aim was to assess the impact of dysglycemia on major adverse cardiovascular events (MACE) and all-cause mortality during long-term follow-up.

Methods

Patients admitted with a first MI without known history of hypertension were included. All patients without previously known type 2 diabetes mellitus (T2DM) had a standardized 2-hour OGTT performed and were categorized as: normal glucose tolerance (NGT), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) and newly detected T2DM (new T2DM). LVM was measured by echocardiography using Devereaux formula and indexed by body surface area. Multivariate linear regression analysis was used to assess the impact of confounders (dysglycemia by OGTT, known T2DM, age, sex and type of MI) on LVM. Cox proportional hazard model was used to assess the impact of dysglycemia on all-cause mortality and a composite endpoint of MACE (all-cause mortality, MI, revascularisation due to stable angina, coronary artery bypass graft, ischemic stroke or hemorrhagic stroke).

Results

Two-hundred-and-five patients were included and followed up to 14 years. In multivariate regression analysis, LVM was only significantly increased in patients categorized as new T2DM (β = 25.3; 95% CI [7.5–43.0]) and known T2DM (β = 37.3; 95% CI [10.0-64.5]) compared to patients with NGT. Patients with new T2DM showed higher rates of MACE and all-cause mortality compared to patients with IFG/IGT and NGT; however no significantly increased hazard ratio was detected.

Conclusions

Dysglycemia is associated with increasing LVM in normotensive patients with a first acute myocardial infarction and the strongest association was observed in patients with new T2DM and patients with known T2DM. Dysglycemia in normotensive patients with a first MI is not an independent predictor of neither MACE nor all-cause mortality during long-term follow-up compared to normotensive patients without dysglycemia.

Electronic supplementary material

The online version of this article (10.1186/s12872-019-1084-5) contains supplementary material, which is available to authorized users.

Prevalence and associated factors of hospitalization for dysglycemia among elderly type 2 diabetes patients: A nationwide study

BACKGROUND

The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemia-related hospitalizations, are lacking.

AIM

To assess the prevalence and associated factors for dysglycemia-related hospitalizations among elderly diabetic patients in Thailand using nationwide patient sample.

METHODS

T2DM patients aged ≥ 65 years who received medical care at public hospitals in Thailand in the year 2014 were included. The prevalence of hospitalization due to dysglycemia within one year was examined. Multivariable logistic regression was performed to assess the independent factors associated with hospitalization due to hypoglycemia and hyperglycemia

RESULTS

A total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admissions due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use.

CONCLUSION

The prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand was 4.9%. Close monitoring of blood glucose should be provided in high-risk patients for prevention and early detection for these complications.

Performance of HbA1c versus oral glucose tolerance test (OGTT) as a screening tool to diagnose dysglycemic status in high-risk Thai patients

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.