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Sugiyama T, Yamada Y, Ito Y, Mineo R, Iwamoto R, Tamba S, Fujimoto T, Yamamoto K, Matsuzawa Y. Increase in glycemic set point, alongside a decrease in waist circumference, in the non-diabetic population during the Japanese National Intervention Program for metabolic syndrome: A single-center, large-scale, matched-pair analysis. PLoS One 2022; 17:e0268450. [PMID: 35947600 PMCID: PMC9365144 DOI: 10.1371/journal.pone.0268450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background In 2008, the Japanese government implemented a National Intervention Program for metabolic syndrome. Low-risk individuals were not direct targets of this intervention. Nevertheless, they were indirectly enlightened by this massive campaign. Documentation of the metabolic shifts in low-risk individuals following the program launch may inform public health policy regarding approaches to metabolic risks in the general population. Methods We conducted a cross-sectional analysis of data from non-diabetic participants who underwent general health check-ups at the Physical Check-up Center of Sumitomo Hospital. Participants during 2007–2008 were pair-matched with those during 2015–2016 with respect to sex, age, smoking status, hemoglobin level, and red blood cell (RBC) count. Each participant was included only once in the study. Results Totals of 3,140 men and 2,048 women were pair-matched. The non-diabetic participants showed lower waist circumference, blood pressure, heart rate, and serum lipid concentrations during the second study period. In contrast, the entire distributions of fasting plasma glucose (FPG) concentration in both sexes and glycated hemoglobin (HbA1c) in women were shifted upwards. In men, Δ FPG was +1.6 mg/dL (P < 0.001) and Δ HbA1c was ±0% (P = 0.6). In women, Δ FPG was +3.0 mg/dL (P < 0.001), and Δ HbA1c was +0.1% (P < 0.001). Δ Homeostasis model assessment of β-cell function was −6.6 in men (P < 0.001) and −10.3 in women (P < 0.001). The homeostasis model assessment of insulin resistance did not change significantly. Conclusions The “glycemic set point” has increased in non-diabetic people in Japan during recent years. Lifestyle or environmental changes may have caused this metabolic shift through obesity-independent pathways, possibly through effects on pancreatic β-cell function. The underlying mechanism awaits further investigation.
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Affiliation(s)
- Takuya Sugiyama
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
- * E-mail:
| | - Yuya Yamada
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yoshito Ito
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Ryohei Mineo
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Ryuya Iwamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Sachiko Tamba
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | | | - Koji Yamamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yuji Matsuzawa
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
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van Olden CC, Muilwijk M, Stronks K, van den Born BJ, Moll van Charante EP, Nicolau M, Zwinderma AH, Nieuwdorp M, Groen AK, van Valkengoed IGM. Differences in the prevalence of intermediate hyperglycaemia and the associated incidence of type 2 diabetes mellitus by ethnicity: The HELIUS study. Diabetes Res Clin Pract 2022; 187:109859. [PMID: 35367312 DOI: 10.1016/j.diabres.2022.109859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS We aimed to describe differences in the prevalence of intermediate hyperglycaemia (IH) between six ethnic groups. Moreover, to investigate differences in the association of the classifications of IH with the incidence of T2DM between ethnic groups. METHODS We included 3759 Dutch, 2826 African Surinamese, 1646 Ghanaian, 2571 Turkish, 2691 Moroccan and 1970 South Asian Surinamese origin participants of the HELIUS study. IH was measured by fasting plasma glucose (FPG) and HbA1c. We calculated age-, BMI and physical-activity-adjusted prevalence of IH by sex, and calculated age and sex-adjusted hazard ratios (HR)for the association between IH and T2DM in each ethnic group. RESULTS The prevalence of IH was higher among ethnic minority groups (68.6-41.7%) than the Dutch majority (34.9%). The prevalence of IH categories varied across subgroups. Combined increased FPG and HbA1c was most prevalent in South-Asian Surinamese men (27.6%, 95 %CI: 24.5-30.9%), and in Dutch women (4.2%, 95 %CI: 3.4-5.1%). The HRs for T2DM for each IH-classification did not differ significantly between ethnic groups. HRs were highest for the combined classification, e.g., HR = 8.1, 95 %CI: 2.5-26.6 in the Dutch. CONCLUSION We found a higher prevalence of IH in ethnic minority versus majority groups, but did not find evidence for a differential association of IH with incident T2DM.
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Affiliation(s)
- C C van Olden
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
| | - M Muilwijk
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B J van den Born
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - E P Moll van Charante
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M Nicolau
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A H Zwinderma
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A K Groen
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - I G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Mackay D, Mollard RC, Granger M, Bruce S, Blewett H, Carlberg J, Duhamel T, Eck P, Faucher P, Hamm NC, Khafipour E, Lix L, McMillan D, Myrie S, Ravandi A, Tangri N, Azad M, Jones PJH. The Manitoba Personalized Lifestyle Research (TMPLR) study protocol: a multicentre bidirectional observational cohort study with administrative health record linkage investigating the interactions between lifestyle and health in Manitoba, Canada. BMJ Open 2019; 9:e023318. [PMID: 31604781 PMCID: PMC6797260 DOI: 10.1136/bmjopen-2018-023318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Lifestyle factors, such as diet, physical activity and sleep, are associated with the development of many chronic diseases. The objective of The Manitoba Personalized Lifestyle Research study is to understand how these lifestyle factors interact with each other and with other factors, such as an individual's genetics and gut microbiome, to influence health. METHODS An observational study of adults, with extensive phenotyping by objective health and lifestyle assessments, and retrospective assessment of early life experiences, with retrospective and prospective utilisation of secondary data from administrative health records. STUDY POPULATION A planned non-random convenience sample of 840 Manitobans aged 30-46 recruited from the general population, stratified by sex (equal men and women), body mass index (BMI; 60% of participants with a BMI>25 kg/m2) and geography (25% from rural areas). These stratifications were selected based on Manitoba demographics. MEASUREMENTS Lifestyle factors assessed will include dietary pattern, physical activity, cardiovascular fitness, and sleep. Factors such as medical history, socioeconomic status, alcohol and tobacco consumption, cognition, stress, anxiety, and early life experiences will also be documented. A maternal survey will be performed. Body composition and bone density will be measured by dual energy X-ray absorptiometry. Blood pressure, pulse wave velocity, and augmentation index will be measured on two consecutive days. Chronic disease risk biomarkers will be measured in blood and urine samples. DNA will be extracted for genetic analysis. A faecal sample will be collected for microbiome analysis. Participants may provide their Manitoba personal health information number to link their study data with administrative health records. ETHICS AND DISSEMINATION Ethics approval has been obtained from the University of Manitoba Health Research Ethics Board (protocol # HS18951; 05/01/2016). Data analysis, release of results and publication of manuscripts are scheduled to start in early 2019. Additional information at www.TMPLR.ca. TRIAL REGISTRATION NUMBER NCT03674957; Pre-results.
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Affiliation(s)
- Dylan Mackay
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Rebecca C Mollard
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharon Bruce
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Blewett
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Agriculture and Agri-Food Canada, Winnipeg, Manitoba, Canada
| | - Jared Carlberg
- Department of Agribusiness and Agricultural Economics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd Duhamel
- Health, Leisure and Human Performance Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Peter Eck
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Patrick Faucher
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Naomi C Hamm
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Ehsan Khafipour
- Department of Animal Science, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Lisa Lix
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Diana McMillan
- Health, Leisure and Human Performance Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba College of Nursing, Winnipeg, Manitoba, Canada
| | - Semone Myrie
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amir Ravandi
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
- Section of Cardiology, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Meghan Azad
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter JH Jones
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada
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Rudvik A, Månsson M. Evaluation of surrogate measures of insulin sensitivity - correlation with gold standard is not enough. BMC Med Res Methodol 2018; 18:64. [PMID: 29940866 PMCID: PMC6019831 DOI: 10.1186/s12874-018-0521-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background Impaired insulin sensitivity is a key abnormality underlying the development of type 2 diabetes. Measuring insulin sensitivity is therefore of importance in identifying individuals at risk of developing diabetes and for the evaluation of diabetes-focused interventions. A number of measures have been proposed for this purpose. Among these the hyperinsulinemic euglycemic clamp (HEC) is considered the gold standard. However, as the HEC is a costly, time consuming and invasive method requiring trained staff, there is a need for simpler so called surrogate measures. Main message A frequently used approach to evaluate surrogate measures is through correlation with the HEC. We discuss limitations with this method. We suggest other aspects to take into consideration, such as repeatability, reproducibility, systematic biases and discrimination ability. In addition, we focus on three frequently used surrogate measures. We argue that they are one-to-one transformations of each other, and therefore question the benefits of further comparison between them. They give the same results in all rank-based methods, for instance Spearman correlations, Mann-Whitney tests and receiver operating characteristic (ROC) analysis. Conclusions We suggest investigating further aspects than correlation alone when evaluating a surrogate measure of insulin sensitivity. We recommend choosing one of the three surrogate measures HOMA-IR, QUICKI and FIRI for analysis of a clinical study. Electronic supplementary material The online version of this article (10.1186/s12874-018-0521-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Rudvik
- AstraZeneca, Pepparedsleden 1, Mölndal, 43153, Sweden.
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Bruna Stråket 11B, Gothenburg, 41345, Sweden
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Gujral U, Mohan V, Pradeepa R, Deepa M, Anjana R, Mehta N, Gregg E, Narayan K. Ethnic Variations in Diabetes and Prediabetes Prevalence and the roles of Insulin Resistance and β-cell Function: The CARRS and NHANES Studies. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2016; 4:19-27. [PMID: 27042403 PMCID: PMC4811044 DOI: 10.1016/j.jcte.2016.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We compared the hyperglycemia prevalence in Asian Indians to other ethnic groups. The prevalence of diabetes was higher in Indians compared to other ethnic groups. The prevalence of prediabetes was lower in Indians compared to other ethnic groups. These differences may be driven by impaired β-cell function.
Aims It is unclear how the prevalence of diabetes in Asian Indians in urban India compares to that of race/ethnic groups in the US that may have different underlying susceptibilities. Therefore, we examined ethnic variations in the prevalence of type 2 diabetes, iIFG, iIGT, IFG + IGT, and the associated risk factors in Asian Indians in Chennai, India, and Whites, Blacks, and Hispanics in the United States. Methods Cross-sectional analyses, using representative samples of 4867 Asian Indians aged 20–74 years from Chennai, India, in the Centre for Cardiometabolic Risk Reduction in South-Asia study (CARRS) (2010–2011) and 6512 US Whites, Blacks, and Hispanics aged 20–74 years from the National Health and Nutrition Examination Survey (NHANES) (2007–2012). Results The age-adjusted prevalence of type 2 diabetes was highest in Asian Indians (men: 28.4, 95% CI: 25.9, 31.0; women: 30.6, 95% CI, 27.5, 33.9) and lowest in Caucasians (men: 12.2, 95% CI, 10.3, 14.4, women: 9.5, 95% CI, 7.9, 11.5). Asian Indians had the lowest prediabetes prevalence (men: 19.0, 95% CI, 17.2, 20.8; women: 27.2, 95% CI, 22.8, 32.1) and Caucasians had the highest (men; 46.5, 95% CI, 43.5, 49.6, women: 34.4, 95% CI, 31.7, 37.3). However, there were differences in prediabetes prevalence by gender and prediabetes state. The inclusion of HOMA-β in standardized polytomous logistic regression models resulted in a greater odds of diabetes in Blacks and Hispanics compared to Asian Indians. Conclusions The high prevalence of diabetes in Asian Indians may be due to innate susceptibilities for β-cell dysfunction in this high risk population.
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Affiliation(s)
- U.P. Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, USA
- Corresponding author. Tel.: +1 626 589 8512; fax: +1 404 727 6123.
| | - V. Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - R. Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - M. Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - R.M. Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, IDF Centre of Education, Chennai, India
| | - N.K. Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - E.W. Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K.M. Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Liu S, Hempe JM, McCarter RJ, Li S, Fonseca VA. Association between Inflammation and Biological Variation in Hemoglobin A1c in U.S. Nondiabetic Adults. J Clin Endocrinol Metab 2015; 100:2364-71. [PMID: 25867810 PMCID: PMC4454807 DOI: 10.1210/jc.2014-4454] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/08/2015] [Indexed: 01/01/2023]
Abstract
CONTEXT Inflammation is associated with higher glycated hemoglobin (HbA1c) levels. Whether the relationship is independent of blood glucose concentration remains unclear. OBJECTIVE The hemoglobin glycation index (HGI) was used to test the hypothesis that interindividual variation in HbA1c is associated with inflammation. PARTICIPANTS This study used nondiabetic adults from the National Health and Nutrition Examination Survey (1999-2008). MAIN OUTCOME MEASURES A subsample of participants was used to estimate the linear regression relationship between HbA1c and fasting plasma glucose (FPG). Predicted HbA1c were calculated for 7323 nondiabetic participants by inserting FPG into the equation, HbA1c = 0.017 × FPG (mg/dL) + 3.7. HGI was calculated as the difference between the observed and predicted HbA1c and the population was divided into low, moderate, and high HGI subgroups. Polymorphonuclear leukocytes (PMNL), monocytes, and C-reactive protein (CRP) were used as biomarkers of inflammation. RESULTS Mean HbA1c, CRP, monocyte, and PMNL levels, but not FPG, progressively increased in the low, moderate, and high HGI subgroups. There were disproportionately more Blacks than whites in the high HGI subgroup. CRP (ß, 0.009; 95% confidence interval [CI], 0.0001-0.017), PMNL (ß, 0.036; 95% CI, 0.010-0.062), and monocyte count (ß, 0.072; 95% CI, 0.041-0.104) were each independent predictors of HGI after adjustment for age, sex, race, triglycerides, hemoglobin level, mean corpuscular volume, red cell distribution width, and obesity status. CONCLUSIONS HGI reflects the effects of inflammation on HbA1c in a nondiabetic population of U.S. adults and may be a marker of risk associated with inflammation independent of FPG, race, and obesity.
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Affiliation(s)
- Shuqian Liu
- Department of Medicine (S.L., V.A.F.), Tulane University Health Sciences Center, New Orleans, Louisiana 70112; Department of Global Health System and Development (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Pediatrics (J.M.H.), Louisiana State University Health Sciences Center and Children's Hospital Research Institute for Children, New Orleans, Louisiana 70118; Research Division of Biostatistics and Study Methodology (R.J.M.), Children's National Medical Center, Washington, District of Columbia 20010; Department of Epidemiology (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112
| | - James M Hempe
- Department of Medicine (S.L., V.A.F.), Tulane University Health Sciences Center, New Orleans, Louisiana 70112; Department of Global Health System and Development (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Pediatrics (J.M.H.), Louisiana State University Health Sciences Center and Children's Hospital Research Institute for Children, New Orleans, Louisiana 70118; Research Division of Biostatistics and Study Methodology (R.J.M.), Children's National Medical Center, Washington, District of Columbia 20010; Department of Epidemiology (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112
| | - Robert J McCarter
- Department of Medicine (S.L., V.A.F.), Tulane University Health Sciences Center, New Orleans, Louisiana 70112; Department of Global Health System and Development (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Pediatrics (J.M.H.), Louisiana State University Health Sciences Center and Children's Hospital Research Institute for Children, New Orleans, Louisiana 70118; Research Division of Biostatistics and Study Methodology (R.J.M.), Children's National Medical Center, Washington, District of Columbia 20010; Department of Epidemiology (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112
| | - Shengxu Li
- Department of Medicine (S.L., V.A.F.), Tulane University Health Sciences Center, New Orleans, Louisiana 70112; Department of Global Health System and Development (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Pediatrics (J.M.H.), Louisiana State University Health Sciences Center and Children's Hospital Research Institute for Children, New Orleans, Louisiana 70118; Research Division of Biostatistics and Study Methodology (R.J.M.), Children's National Medical Center, Washington, District of Columbia 20010; Department of Epidemiology (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112
| | - Vivian A Fonseca
- Department of Medicine (S.L., V.A.F.), Tulane University Health Sciences Center, New Orleans, Louisiana 70112; Department of Global Health System and Development (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112; Department of Pediatrics (J.M.H.), Louisiana State University Health Sciences Center and Children's Hospital Research Institute for Children, New Orleans, Louisiana 70118; Research Division of Biostatistics and Study Methodology (R.J.M.), Children's National Medical Center, Washington, District of Columbia 20010; Department of Epidemiology (S.L.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112
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Lilja M, Eliasson M, Eriksson M, Söderberg S. A rightward shift of the distribution of fasting and post-load glucose in northern Sweden between 1990 and 2009 and its predictors. Data from the Northern Sweden MONICA study. Diabet Med 2013; 30:1054-62. [PMID: 23586854 DOI: 10.1111/dme.12208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
Abstract
AIMS Most Swedish studies show stable diabetes prevalence despite increasing obesity, but glucose levels may shift upwards below the diagnostic threshold for diabetes. Our aim was to explore trends in glucose distribution in northern Sweden; whether these trends were uniformly distributed throughout the spectrum of glucose concentrations; and to relate trends to traditional risk factors and the obesity-related adipokine leptin. METHODS The project consisted of four cross-sectional surveys between 1990 and 2009, with 7069 participants aged 25-64 years. The overall participation rate was 74.4%. Trend analyses of glucose concentrations along the entire distribution and linear regression in relation to survey years and risk markers were used. RESULTS Fasting and post-load glucose increased in women (both P < 0.001) and post-load glucose in men (P = 0.004). The increase was seen in most deciles of glucose concentrations. The prevalence of impaired glucose tolerance doubled in women to 14.5% and tripled in men to 10.1% (both P = 0.004). The prevalence of impaired fasting glucose rose in women from 4.5 to 7.7% (P < 0.001). The prevalence of diabetes was unchanged-6.4% in 2009. In men, leptin, together with traditional risk factors, explained 7.8 and 10.8% of the variance in fasting (P = 0.008) and post-load (P < 0.001) glucose, respectively. CONCLUSIONS Increasing fasting and post-load glucose concentrations were seen in most deciles of the glucose distribution, indicating a shift in the entire population. Leptin was significantly associated with fasting and post-load glucose in men.
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Affiliation(s)
- M Lilja
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
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Hunt LM, Kreiner MJ. Pharmacogenetics in primary care: the promise of personalized medicine and the reality of racial profiling. Cult Med Psychiatry 2013; 37:226-35. [PMID: 23264029 PMCID: PMC3593998 DOI: 10.1007/s11013-012-9303-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Many anticipate that expanding knowledge of genetic variations associated with disease risk and medication response will revolutionize clinical medicine, making possible genetically based Personalized Medicine where health care can be tailored to individuals, based on their genome scans. Pharmacogenetics has received especially strong interest, with many pharmaceutical developers avidly working to identify genetic variations associated with individual differences in drug response. While clinical applications of emerging genetic knowledge are becoming increasingly available, genetic tests for drug selection are not as yet widely accessible, and many primary care clinicians are unprepared to interpret genetic information. We conducted interviews with 58 primary care clinicians, exploring how they integrate emerging pharmacogenetic concepts into their practices. We found that in their current practices, pharmacogenetic innovations have not led to individually tailored treatment, but instead have encouraged use of essentialized racial/ethnic identity as a proxy for genetic heritage. Current manifestations of Personalized Medicine appear to be reinforcing entrenched notions of inherent biological differences between racial groups, and promoting the belief that racial profiling in health care is supported by cutting-edge scientific authority. Our findings raise concern for how pharmacogenetic innovations will actually affect diverse populations, and how unbiased treatment can be assured.
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Affiliation(s)
- Linda M Hunt
- Department of Anthropology, Michigan State University, 338 Baker Hall, East Lansing, MI 48824, USA.
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Kim C. Does Menopause Increase Diabetes Risk? Strategies for Diabetes Prevention in Midlife Women. WOMENS HEALTH 2012; 8:155-67. [DOI: 10.2217/whe.11.95] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Menopause is a significant milestone for midlife women. The characteristic changes in sex hormones and associated symptoms mark a time of increased risk for chronic disease, most notably cardiovascular disease. The diabetes epidemic, combined with recent epidemiologic studies linking sex hormone profiles with incident diabetes risk, have recently raised the possibility that the menopause may increase diabetes risk as well. This report reviews studies of menopause and diabetes risk, as well as the potential mechanisms through which menopause might affect traditional and more novel diabetes risk factors. Diabetes risk appears to be more strongly linked with factors associated with chronological aging and sex hormones rather than changes in menopausal status per se. Strategies to reduce diabetes risk, namely lifestyle changes, hormone therapy and other pharmacologic interventions are also discussed vis à vis midlife women and menopause.
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Affiliation(s)
- Catherine Kim
- 300 North Ingalls Building, Room 7C13, Mailstop 5429, Ann Arbor, MI 48109-45429, USA, Tel.: +1 734 936 4787, Fax: +1 734 936 8944,
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Magliano DJ, Söderberg S, Zimmet PZ, Chen L, Joonas N, Kowlessur S, Larhubarbe J, Gaoneadry D, Pauvaday V, Tuomilehto J, Alberti KGMM, Shaw JE. Explaining the increase of diabetes prevalence and plasma glucose in Mauritius. Diabetes Care 2012; 35:87-91. [PMID: 22100964 PMCID: PMC3241310 DOI: 10.2337/dc11-0886] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Secular trends in the epidemiology of diabetes are best described by studying the same population over time, but few such studies exist. Using surveys from Mauritius in 1987 and 2009, we examined 1) the change in the prevalence of diabetes, 2) the extent to which changes in traditional diabetes risk factors explained the increase, and 3) the change in the distribution of plasma glucose levels over time. RESEARCH DESIGN AND METHODS Independent population-based surveys were undertaken in Mauritius in 1987 and 2009 using similar methodology in adults aged 20-74 years. Physical measurements and fasting blood samples were taken, and an oral glucose tolerance test was performed at both surveys. RESULTS The age-standardized prevalence of diabetes in 2009 was 22.3% (95% CI 20.0-24.6) among men and 20.2% (18.3-22.3) among women, representing an increase since 1987 of 64 and 62% among men and women, respectively. Concurrent changes in the distribution of age, ethnicity, waist circumference, BMI, physical activity, smoking, family history of diabetes, and hypertension explained more of the increase in the prevalence of diabetes in men than in women. Increases in plasma glucose (especially fasting glucose) were seen across the population but were greater at the upper levels. CONCLUSIONS In Mauritius, there has been a marked increase in diabetes prevalence over 22 years. This mainly results from changes in traditional risk factors, leading to population-wide increases in plasma glucose levels. Interventions to control this escalation of diabetes should focus on population-wide strategies.
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Wang J, Geiss LS, Cheng YJ, Imperatore G, Saydah SH, James C, Gregg EW. Long-term and recent progress in blood pressure levels among U.S. adults with diagnosed diabetes, 1988-2008. Diabetes Care 2011; 34:1579-81. [PMID: 21602427 PMCID: PMC3120172 DOI: 10.2337/dc11-0178] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/16/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether there were long-term (between 1988-1994 and 2001-2008) and recent (between 2001-2004 and 2005-2008) changes in blood pressure (BP) levels among U.S. adults with diagnosed diabetes. RESEARCH DESIGN AND METHODS Using data from National Health and Nutrition Examination Surveys (NHANES), we examined changes in BP distributions, mean BPs, and proportion with BP<140/90 mmHg. RESULTS Between 1988-1994 and 2001-2008, for adults with diabetes, mean BPs decreased from 135/72 mmHg to 131/69 mmHg (P<0.01) and the proportion with BP<140/90 mmHg increased from 64 to 69% (P=0.01). Although hypertension prevalence increased, hypertension awareness, treatment, and control improved. However, there was no evidence of improvement for adults 20-44 years old. Between 2001-2004 and 2005-2008, there were no significant changes in BP levels. CONCLUSIONS BP levels among adults with diabetes improved between 1988-1994 and 2001-2008, but the progress stalled between 2001-2004 and 2005-2008. The lack of improvement among young adults is concerning.
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Affiliation(s)
- Jing Wang
- National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Pugh ME, Robbins IM, Rice TW, West J, Newman JH, Hemnes AR. Unrecognized glucose intolerance is common in pulmonary arterial hypertension. J Heart Lung Transplant 2011; 30:904-11. [PMID: 21493097 DOI: 10.1016/j.healun.2011.02.016] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/25/2011] [Accepted: 02/21/2011] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Animal and human data suggest insulin resistance is common in pulmonary arterial hypertension (PAH). Although routine assessment of insulin resistance is difficult, hemoglobin A(1c) (HbA(1c)) is a sensitive test to detect diabetes mellitus (DM) and those at high risk for DM. We aimed to define the prevalence of elevated HbA(1c) in PAH patients and to correlate HbA(1c) levels with functional assessment. METHODS HbA(1c) was measured in 41 PAH patients without a diagnosis of DM, along with demographic, functional, and hemodynamic data. Using published criteria, HbA(1c) ≤ 5.9% defined normal, 6.0% to 6.4% was glucose intolerance, and ≥ 6.5% was DM. RESULTS Twenty-three patients (56%) had HbA(1c) ≥ 6.0%, and 6 (15%) had unrecognized DM (HbA(1c) ≥ 6.5%). Age and body mass index were similar in patients with HbA(1c) ≥ 6.0% vs < 6.0%. There was a trend towards lower mean 6-minute walk distance in patients with elevated HbA(1c) (331.0 ± 126.6 vs 413.6 ± 74.9 meters, p = 0.07). The 6-month event-free survival was not significantly different in patients with elevated HbA(1c). CONCLUSIONS Unrecognized glucose intolerance as assessed by HbA(1c) is common in PAH. Further studies are needed to discern if glucose or insulin dysregulation mediates PAH pathogenesis or is secondary to advanced PAH.
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Affiliation(s)
- Meredith E Pugh
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2650, USA.
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