Detecting people at high risk of type 2 diabetes- How do we find them and who should be treated?

Young-Onset Diabetes in East Asians: From Epidemiology to Precision Medicine

Precision diagnosis is the keystone of clinical medicine. In East Asians, classical type 1 diabetes is uncommon in patients with youngonset diabetes diagnosed before age of 40, in whom a family history, obesity, and beta-cell and kidney dysfunction are key features. Young-onset diabetes affects one in five Asian adults with diabetes in clinic settings; however, it is often misclassified, resulting in delayed or non-targeted treatment. Complex aetiologies, long disease duration, aggressive clinical course, and a lack of evidence-based guidelines have contributed to variable care standards and premature death in these young patients. The high burden of comorbidities, notably mental illness, highlights the numerous knowledge gaps related to this silent killer. The majority of adult patients with youngonset diabetes are managed as part of a heterogeneous population of patients with various ages of diagnosis. A multidisciplinary care team led by physicians with special interest in young-onset diabetes will help improve the precision of diagnosis and address their physical, mental, and behavioral health. To this end, payors, planners, and providers need to align and re-design the practice environment to gather data systematically during routine practice to elucidate the multicausality of young-onset diabetes, treat to multiple targets, and improve outcomes in these vulnerable individuals.

Identifying diabetes risks among Indonesians: A cross-sectional study in a community setting

Background

There is an upward surge in diabetes patients worldwide, including in Indonesia, annually. Diabetes can lead to new diseases that burden patients' lives further. Nurses can reduce this problem by identifying people at risk of developing diabetes and educating them on how to prevent diabetes.

Objective

The study aimed to determine the risk of diabetes in the Indonesian population.

Methods

The descriptive research involved a sample of 1216 Indonesians living in North Sumatra Province. Participants were nondiabetic individuals selected using the convenience method from May to October 2020. This study utilized the Indonesian version of the Finnish Diabetes Risk Score (FINDRISC) tool and employed various statistical analyses, including frequencies, percentages, chi-square test, and Fisher's exact test.

Results

Of the total samples, 372 were males (30.6%), and 844 were females (69.4%). The risk of developing diabetes was classified as low (57.1%), slightly elevated (36.4%), moderate (5.3%), high (1.0%), and very high (0.2%). Only one of the eight risk factors that differed significantly between men and women was a history of elevated blood glucose levels, with a p-value of 0.02.

Conclusion

The study identified a portrait of the number and percentage of diabetes risk factors in a community setting in Indonesia. Nurses must provide education on diabetes prevention to not only members of the local community at the research site but also the general public, nationally and globally.

Using HbA1c measurements and the Finnish Diabetes Risk Score to identify undiagnosed individuals and those at risk of diabetes in primary care

BACKGROUND

Prevalence of prediabetes and type 2 diabetes mellitus (T2DM) is increasing worldwide. The objective of this study was to determine the proportion of people in Northern Iceland with prediabetes, at risk of developing T2DM or with manifest undiagnosed T2DM, as this information is lacking in Iceland.

METHODS

A cross-sectional study. Clients of the three largest primary health care centres in the Health Care Institution of North Iceland (HSN) were invited to participate if fulfilling the following inclusion criteria: a) aged between 18 and 75 years, b) not diagnosed with diabetes, c) speaking and understanding Icelandic or English fluently and d) living in the included service area. Data collection took place via face-to-face interviews between 1 March 2020 and 15 May 2021. Participation included answering the Finnish Diabetes Risk Score (FINDRISC), measuring the HbA1c levels and background information.

RESULTS

Of the 220 participants, 65.9% were women. The mean age was 52.1 years (SD ± 14.1) and FINDRISC scores were as follows: 47.3% scored ≤8 points, 37.2% scored between 9 and 14 points, and 15.5% scored between 15 and 26 points. The mean HbA1c levels in mmol/mol, were 35.5 (SD ± 3.9) for men and 34.4 (SD ± 3.4) for women, ranging from 24 to 47. Body mass index ≥30 kg/m² was found in 32% of men and 35.9% of women. Prevalence of prediabetes in this cohort was 13.2%. None of the participants had undiagnosed T2DM. Best sensitivity and specificity for finding prediabetes was by using cut-off points of ≥11 on FINDRISC, which gave a ROC curve of 0.814.

CONCLUSIONS

The FINDRISC is a non-invasive and easily applied screening instrument for prediabetes. Used in advance of other more expensive and invasive testing, it can enable earlier intervention by assisting decision making, health promotion actions and prevention of the disease burden within primary health care.

TRIAL REGISTRATION

This study is a pre-phase of the registered study "Effectiveness of Nurse-coordinated Follow up Program in Primary Care for People at risk of T2DM" at www.

CLINICALTRIALS

gov (NCT01688359). Registered 30 December 2020.

Linking the Fasting Blood Glucose Level to Short-Term-Exposed Particulate Constituents and Pollution Sources: Results from a Multicenter Cross-Sectional Study in China

Ambient PM_2.5 (fine particulate matter with aerodynamic diameters ≤ 2.5 μm) is thought to be associated with the development of diabetes, but few studies traced the effects of PM_2.5 components and pollution sources on the change in the fasting blood glucose (FBG). In the present study, we assessed the associations of PM_2.5 constituents and their sources with the FBG in a general Chinese population aged over 40 years. Exposure to PM_2.5 was positively associated with the FBG level, and each interquartile range (IQR) increase in a lag period of 30 days (18.4 μg/m³) showed the strongest association with an elevated FBG of 0.16 mmol/L (95% confidence interval: 0.04, 0.28). Among various constituents, increases in exposed elemental carbon, organic matter, arsenic, and heavy metals such as silver, cadmium, lead, and zinc were associated with higher FBG, whereas barium and chromium were associated with lower FBG levels. The elevated FBG level was closely associated with the PM_2.5 from coal combustion, industrial sources, and vehicle emissions, while the association with secondary sources was statistically insignificant. Improving air quality by tracing back to the pollution sources would help to develop well-directed policies to protect human health.

What is the effectiveness of a personalised video story after an online diabetes risk assessment? A Randomised Controlled Trial

Background

Online risk assessment tools for type 2 diabetes communicate risk information to motivate individuals to take actions and reduce their risk if needed. The impact of these tools on follow-up behaviours (e.g., General Practitioner (GP) visits, improvement in health behaviours) is unknown. This study examined effectiveness of a personalised video story and text-based message on GP and health professional visitations and health behaviours, of individuals assessed as ‘high risk’ following completion of the online Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK).

Methods

A Randomised Controlled Trial (conducted between October 2018 and April 2019) included 477 participants with a high score (≥12). The control group received a text-based message (TM) and the intervention group received both the text-based message and a personalised video story (TM+VS) encouraging them to take follow-up action. Participants reported follow-up actions (one- and three months), and physical activity (PA), dietary behaviours and body weight (baseline, one and three months). Generalized Linear Mixed Models and chi-squared tests were used to test differences in outcomes between groups over time.

Results

The intervention was not more effective for the TM+VS group compared to the TM only group (p-values>0.05 for all outcomes). More participants in the TM only group (49.8% compared to 40.0% in the VS+TM group) visited either a GP or health professional (p = 0.18). During the 3-month follow-up: 44.9% of all participants visited a GP (36.7%) and/or other health professional (31.0%). Significant improvements were found between baseline and three months, in both groups for weekly physical activity, daily fruit and vegetable intake and weight status.

Conclusions

Messages provided with online diabetes risk assessment tools to those with high-risk, positively influence GP and health professional visitations and promote short-term improvements in health behaviours that may contribute to an overall reduction in the development of type 2 diabetes.

Trial registration

Australia New Zealand Clinical Trials Registry; ACTRN12619000809134.

Risk of type 2 diabetes mellitus in women with prior hypertensive disorders of pregnancy: a systematic review and meta-analysis

AIMS/HYPOTHESIS

The association between a history of hypertensive disorders of pregnancy (HDP) and subsequent type 2 diabetes (referred to throughout as diabetes) remains inconclusive. We reviewed the most recent evidence to quantify the association of previous HDP with incident diabetes.

METHODS

A systematic search of MEDLINE, Embase and CINAHL was performed up to 17 February 2020 to identify observational studies of the association between HDP (pre-eclampsia or gestational hypertension) and incident diabetes. Studies of women with pre-pregnancy diabetes were excluded. Two independent reviewers screened citations and abstracted results. Study quality was assessed in duplicate using the Newcastle-Ottawa Scale. Random-effects models were used to pool effect estimates. Heterogeneity was assessed using the I² statistic.

RESULTS

After screening 4617 citations, 16 cohort studies with a total of 3,095,457 participants were included (unspecified HDP n = 5, pre-eclampsia only n = 4, gestational hypertension and pre-eclampsia n = 7). Risks of subsequent diabetes were significantly higher in women with a history of any HDP (HDP: adjusted hazard ratio [aHR] 2.24, 95% CI 1.95, 2.58; gestational hypertension: aHR 2.19 [95% CI 1.69, 2.84]; pre-eclampsia: aHR 2.56 [95% CI 2.02, 3.24]; preterm pre-eclampsia: aHR 3.05 [95% CI 2.05, 4.56]). The association between HDP and diabetes persisted in studies that adjusted for gestational diabetes mellitus (aHR 2.01 [95% CI 1.77, 2.28]).

CONCLUSIONS/INTERPRETATION

HDP are independently associated with a higher risk of diabetes. Further study is needed to determine how HDP contribute to diabetes risk prediction to develop evidence-based screening and prevention strategies. Graphical abstract.

Long-term exposure to ambient fine particulate matter and fasting blood glucose level in a Chinese elderly cohort

Fasting blood glucose level is the primary indicator for the diagnosis of diabetes. We aim to conduct a longitudinal study on the association between long-term fine particulate matter (PM2.5) exposure and fasting blood glucose concentrations. We recruited and followed up 1449 participants older than 65 years of age in 2009, 2012, 2014, and 2017 in eight counties in China. Fasting blood glucose was repeatedly measured 3697 times in total among these participants. Data on annual ground-level PM2.5 concentrations with a 0.01° spatial resolution from 2005 to 2016 were used to assess exposures. An increase of 10 μg/m3 in 3-year average exposure to PM2.5 was associated with an increase of 0.146 mmol/L (95% confidence interval [CI]: 0.045, 0.248) in fasting blood glucose in all participants. The association was more pronounced among the subgroup with diabetes compared to the subgroup without diabetes (P < .05). In conclusion, Long-term PM2.5 exposure was associated with an increase in fasting blood glucose levels among elderly people. Elderly individuals with diabetes are particularly vulnerable to high level exposures of PM2.5. SUMMARY: Long-term PM2.5 exposure was associated with an increase in fasting blood glucose levels among elderly people. Elderly individuals with diabetes are particularly vulnerable to high level exposures of PM2.5.

Body Composition and the Components of Metabolic Syndrome in Type 2 Diabetes: The Roles of Disease Duration and Glycemic Control

PURPOSE

Data about body compositional changes throughout the course of type 2 diabetes (T2D) are limited and inconsistent. We investigated the roles of the disease duration and glycemic control in T2D-associated changes of body composition and the components of metabolic syndrome (MetS).

PATIENTS AND METHODS

A total of 25 non-diabetic controls and 92 individuals aged 20-60 years with T2D were included in a case-control study conducted at King Faisal Specialist Hospital, Saudi Arabia. Based on disease duration (newly diagnosed: within the first year and long duration: ≥5 years) and glycemic control (glycated hemoglobin [HbA1C] level ≤7%), the patients were divided into the following groups: newly diagnosed and controlled (N&C, n=25), newly diagnosed and uncontrolled (N&U, n=17), old and controlled (O&C, n=25), and old and uncontrolled (O&U, n=25). Blood samples were collected to assess fasting blood glucose level, HbA1C level, and lipid profile. Anthropometric data were evaluated, and body composition was assessed using a bio-impedancemetry analyzer. Nonparametric tests and multivariable logistic regression analyses were performed.

RESULTS

Compared to the control group, the fat mass (FM) was significantly higher in all groups; furthermore, the fat mass/fat-free mass (FM/FFM) ratio was significantly higher in the N&C. The N&U and O&U groups showed significantly higher percentages of all components of MetS. Among all selected independent factors, only age increased the likelihood of MetS diagnosis by 7% (OR: 1.07; 95% CI: 1.004-1.149; P<0.05). Besides, age, gender, adherence to diet regimen, and T2D duration showed lower odds of increased FM/FFM ratio.

CONCLUSION

This study provided evidence about the impact of T2D on body composition and the other components of MetS. Thus, further characterization of T2D contributes to defining the etiology of the disease to detect and treat poor cardiometabolic health.

Trends in diabetes and pre-diabetes prevalence and diabetes awareness, treatment and control across socioeconomic gradients in rural southwest China

Background

This study aimed to determine trends in pre-diabetes and diabetes prevalence and diabetes awareness, treatment and control across socioeconomic gradients in rural southwest China.

Methods

Data were collected from two cross-sectional health interviews and examination surveys among individuals aged ≥35 years in rural China. Fasting blood sugar levels were measured for each participant.

Results

From 2009 to 2016, the overall prevalence of pre-diabetes and diabetes increased from 8.4 and 7.7% to 19.0 and 9.5%, respectively, while awareness, treatment and control of diabetes increased from 32.7, 20.0 and 6.1% to 49.3, 32.1 and 13.5%, respectively (P < 0.01). Participants with higher annual incomes had higher diabetes prevalence and treatment levels than their counterparts and showed a remarkably high increase in rate of pre-diabetes (P < 0.01). Whereas prevalence of pre-diabetes and diabetes increased across all ethnic groups during the study period, increased rates of diabetes awareness, treatment and control were only observed among Han Chinese (P < 0.01). Diabetic patients with higher levels of education had higher awareness, control and treatment of diabetes than their counterparts (P < 0.05).

Conclusions

The prevalence of pre-diabetes and diabetes and the level of diabetes awareness, treatment and control increased substantially across all socioeconomic gradients in rural southwest China.

Light at night exacerbates metabolic dysfunction in a polygenic mouse model of type 2 diabetes mellitus

AIMS

Electric lighting is beneficial to modern society; however, it is becoming apparent that light at night (LAN) is not without biological consequences. Several studies have reported negative effects of LAN on health and behavior in humans and nonhuman animals. Exposure of non-diabetic mice to dim LAN impairs glucose tolerance, whereas a return to dark nights (LD) reverses this impairment. We predicted that exposure to LAN would exacerbate the metabolic abnormalities in TALLYHO/JngJ (TH) mice, a polygenic model of type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

We exposed 7-week old male TH mice to either LD or LAN for 8-10 weeks in two separate experiments. After 8 weeks of light treatment, we conducted intraperitoneal glucose tolerance testing (ipGTT) followed by intraperitoneal insulin tolerance testing (ipITT). In Experiment 1, all mice were returned to LD for 4 weeks, and ipITT was repeated.

KEY FINDINGS

The major results of this study are i) LAN exposure for 8 weeks exacerbates glucose intolerance and insulin resistance ii) the effects of LAN on insulin resistance are reversed upon return to LD, iii) LAN exposure results in a greater increase in body weight compared to LD exposure, iv) LAN increases the incidence of mice developing overt T2DM, and v) LAN exposure decreases survival of mice with T2DM.

SIGNIFICANCE

In conclusion, LAN exacerbated metabolic abnormalities in a polygenic mouse model of T2DM, and these effects were reversed upon return to dark nights. The applicability of these findings to humans with T2DM needs to be determined.

Short-Term Trends in Economic Burden and Catastrophic Costs of Type 2 Diabetes Mellitus in Rural Southwest China

OBJECTIVES

This study is aimed at gaining insights on the changing prevalence, economic burden, and catastrophic costs of diabetes in rural southwest China.

MATERIALS AND METHODS

Data were collected from two cross-sectional health interviews and examination surveys among individuals aged ≥ 35 years in rural Yunnan Province. A prevalence-based cost-of-illness method was used to estimate the cost of diabetes. Information about the participants' demographic characteristics and economic consequences of diabetes was obtained using a standard questionnaire. Fasting blood sugar levels were recorded for each study participant.

RESULTS

During the study period, the overall prevalence of diabetes increased from 7.7% to 9.5% (P < 0.01) and the economic cost of diabetes increased 1.52-fold. The largest increases were observed in hospital costs (1.77-fold increase), while unit medication costs fell by 18.6%. Both in 2009 and in 2016, males had higher overall direct and indirect costs of diabetes than females (P < 0.05). Direct costs represented the largest component of economic cost of diabetes while hospital costs were the main drivers of direct medical expenditures, accounting for 66.2% of the total direct costs in 2009 and 75.9% in 2016. The incidence of household catastrophic health payment and household impoverishment due to diabetes was 24.0% and 17.9% in 2009 and 23.6% and 17.6% in 2016, respectively. These rates did not differ between the two survey years (P > 0.05).

CONCLUSIONS

The prevalence and economic burden of diabetes increased substantially from 2009 to 2016 in rural southwest China. The findings underscore an urgent need for the government to invest more financial resources in the prevention of diabetes and improvement of access to affordable medication in rural southwest China.

Cardiovascular Effects of Flavonoids

:

Cardiovascular Disease (CVD) is the major cause of death worldwide, especially in Western society. Flavonoids are a large group of polyphenolic compounds widely distributed in plants, present in a considerable amount in fruit and vegetable. Several epidemiological studies found an inverse association between flavonoids intake and mortality by CVD. The antioxidant effect of flavonoids was considered the main mechanism of action of flavonoids and other polyphenols. In recent years, the role of modulation of signaling pathways by direct interaction of flavonoids with multiple protein targets, namely kinases, has been increasingly recognized and involved in their cardiovascular protective effect. There are strong evidence, in in vitro and animal experimental models, that some flavonoids induce vasodilator effects, improve endothelial dysfunction and insulin resistance, exert platelet antiaggregant and atheroprotective effects, and reduce blood pressure. Despite interacting with multiple targets, flavonoids are surprisingly safe. This article reviews the recent evidence about cardiovascular effects that support a beneficial role of flavonoids on CVD and the potential molecular targets involved.

Factors associated with undiagnosed diabetes among adults with diabetes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

AIMS

To investigate sociodemographic and health factors associated with undiagnosed diabetes among adults with diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

METHODS

Among 3384 adults with self-reported diabetes or undiagnosed diabetes in the baseline HCHS/SOL, we estimated odds ratios (OR) of being undiagnosed for demographic, cultural, access to care, and health factors.

RESULTS

Among individuals with diabetes, 37.0% were undiagnosed. After adjustment and compared to people of Mexican heritage, people of Cuban and South American heritage had 60% (OR = 1.60, 95% CI = 1.02-2.50) and 91% (OR = 1.91, 1.16-3.14) higher odds of being undiagnosed, respectively. Individuals with a higher odds of being undiagnosed were women (OR = 1.64, 1.26-2.13), those with no health insurance (OR = 1.31, 1.00-1.71), individuals who received no healthcare in the past year (OR = 3.59, 2.49-5.16), those who were overweight (vs. normal weight) (OR = 1.60, 1.02-2.50), and those with dyslipidemia (OR = 1.38, 1.10-1.74). Individuals with lower odds of being undiagnosed were those with a family history of diabetes (OR = 0.54, 0.43-0.68), and those with hypertension (OR = 0.46, 0.36-0.58).

CONCLUSIONS

Variation by Hispanic heritage group, sex, and access to medical care highlight where concentrated efforts are need to improve diabetes awareness. Our findings will inform clinical and public health practices to improve diabetes awareness among vulnerable populations.

Pharmacogenomics of Sulfonylureas Response in Relation to rs7754840 Polymorphisms in Cyclin-Dependent Kinase 5 Regulatory Subunit-associated Protein 1-like (CDKAL1) Gene in Iranian Type 2 Diabetes Patients

Background:

Sulfonylureas are important drugs of choice for treatment of type 2 diabetes mellitus (T2DM). It is suggested that differential response to sulfonylureas from T2DM patients is under influence of single nucleotide polymorphisms in some of the target genes. In spite of favorable therapeutic effects, sulfonylureas are associated with some adverse side effects such as microvascular complications and stroke, especially in older patients. Therefore, for T2DM patients who are getting less benefit, sulfonylureas should be avoided. Cyclin-dependent kinase 5 regulatory subunit-associated protein 1-like (CDKAL1) gene variation is reported to be associated with sulfonylureas effectiveness. Due to the inconsistency of available data regarding association of rs7754840 in CDKAL1 gene with sulfonylureas response in T2DM patients, the present study is conducted.

Materials and Methods:

Fifty-one diabetic patients sensitive to sulfonylureas and 51 patients resistant to sulfonylureas treatment were recruited to this study. After extraction of DNA from patients' peripheral blood samples, rs7754840 single-nucleotide polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism assay using MaeII (Tail) restriction enzyme.

Results:

Frequency of G allele in resistant group was more than sensitive group (71, 6% vs. 57, 8%). Regression analysis was shown significant association between GG genotype and higher risk of resistance to sulfonylureas treatment (odds ratio = 2.250 [95% confidential intervals: 1.010–5.012]; P = 0.046).

Conclusion:

Our data confirmed that genotypes of rs7754840 are significantly associated with sulfonylureas treatment response. rs7754840 in CDKAL1 gene in combination with other clinicopathological findings would help to move towards personalized therapy of T2DM patients.

Clinical Characteristics of People with Newly Diagnosed Type 2 Diabetes between 2015 and 2016: Difference by Age and Body Mass Index

BACKGROUND

We evaluated the clinical characteristics of insulin resistance and β-cell dysfunction in newly diagnosed, drug-naive people with type 2 diabetes by analyzing nationwide cross-sectional data.

METHODS

We collected the clinical data of 912 participants with newly diagnosed diabetes from 83 primary care clinics and hospitals nationwide from 2015 to 2016. The presence of insulin resistance and β-cell dysfunction was defined as a homeostatic model assessment of insulin resistance (HOMA-IR) value ≥2.5 and fasting C-peptide levels <1.70 ng/mL, respectively.

RESULTS

A total of 75.1% and 22.6% of participants had insulin resistance and β-cell dysfunction, respectively. The proportion of participants with insulin resistance but no β-cell dysfunction increased, and the proportion of participants with β-cell dysfunction but no insulin resistance decreased as body mass index (BMI) increased. People diagnosed with diabetes before 40 years of age had significantly higher HOMA-IR and BMI than those diagnosed over 65 years of age (HOMA-IR, 5.0 vs. 3.0; BMI, 28.7 kg/m² vs. 25.1 kg/m²). However, the β-cell function indices were lower in people diagnosed before 40 years of age than in those diagnosed after 65 years of age (homeostatic model assessment of β-cell function, 39.3 vs. 64.9; insulinogenic index, 10.3 vs. 18.7; disposition index, 0.15 vs. 0.25).

CONCLUSION

We observed that the main pathogenic mechanism of type 2 diabetes is insulin resistance in participants with newly diagnosed type 2 diabetes. In addition, young adults with diabetes are more likely to have higher insulin resistance with obesity and have higher insulin secretory defect with severe hyperglycemia in the early period of diabetes than older populations.

Predictive factors of endocrine and exocrine insufficiency after resection of a benign tumour of the pancreas

BACKGROUND

The aim of the present study is to evaluate the risk factors of endocrine and exocrine insufficiency occurring few years after pancreatic resections in a consecutive series of patients who underwent pancreatoduodenectomy (PD), left pancreatectomy (LP) or enucleation for benign neoplasms at a referral centre.

METHODS

Pancreatic exocrine insufficiency (PEI) was defined by the onset of steatorrhea associated with weight loss, and endocrine insufficiency was determinate by fasting plasma glucose. Association between pancreatic insufficiency and clinical, pathological, and perioperative features was studied using univariate and multivariate Cox regression analysis.

RESULTS

A prospective cohort of 92 patients underwent PD (48%), LP (44%) or enucleation (8%) for benign tumours, from 2005 to 2016 in the University Hospital in Poitiers (France). The median follow-up was 68.6±42.4months. During the following, 54 patients developed exocrine insufficiency whereas 32 patients presented endocrine insufficiency. In the Cox model, a BMI>28kg/m², being a man and presenting a metabolic syndrome were significantly associated with a higher risk to develop postoperative diabetes. The risks factors for the occurrence of PEI were preoperative chronic pancreatitis, a BMI<18.5kg/m², tumours located in the pancreatic head, biological markers of chronic obstruction and fibrotic pancreas. Undergoing LP or enucleation were protective factors of PEI. Histological categories such as neuroendocrine tumours and cystadenomas were also associated with a decreased incidence of PEI.

CONCLUSION

Men with metabolic syndrome and obesity should be closely followed-up for diabetes, and patients with obstructive tumours, pancreatic fibrosis or chronic pancreatitis require a vigilant follow up on their pancreatic exocrine function.

Metabolic Syndrome and Its Components Predict the Risk of Type 2 Diabetes Mellitus in the Mainland Chinese: A 3-Year Cohort Study

INTRODUCTION

It has well established that metabolic syndrome (MetS) can predict the risk of type 2 diabetes mellitus (T2DM) in some population groups. However, limited evidence is available regarding the predictive effect of MetS for incident T2DM in mainland Chinese population.

METHODS

A 3-year cohort study was performed for 9735 Chinese without diabetes at baseline. MetS and its components were assessed by multivariable analysis using Cox regression. Prediction models were developed. Discrimination was assessed with area under the receiver operating characteristic curves (AUCs), and performance was assessed by a calibration curve.

RESULTS

The 3-year cumulative incidence of T2DM was 11.29%. Baseline MetS was associated with an increased risk of T2DM after adjusting for age (HR = 2.68, 95% CI, 2.27-3.17 in males; HR = 2.59, 95% CI, 1.83-3.65 in females). Baseline MetS exhibited relatively high specificity (88% in males, 94% in females) and high negative predictive value (90% in males, 94% in females) but low sensitivity (36% in males, 23% in females) and low positive predictive value (31% in males and females) for predicting the 3-year risk of T2DM. AUCs, including age and components of MetS, for the prediction model were 0.779 (95% CI: 0.759-0.799) in males and 0.860 (95% CI: 0.836-0.883) in females. Calibration curves revealed good agreement between prediction and observation results in males; however, the model could overestimate the risk when the predicted probability is >40% in females.

CONCLUSIONS

MetS predicts the risk of T2DM. The quantitative MetS-based prediction model for T2DM risk may improve preventive strategies for T2DM and present considerable public health benefits for the people in mainland China.

Defining the Association between Diabetes and Plastic Surgery Outcomes: An Analysis of Nearly 40,000 Patients

Background:

Diabetes is an increasingly prevalent comorbidity in patients presenting for surgery, impacting nearly 14% of adults in the United States. Although it is known that diabetic patients are at an increased risk for postoperative complications, there is a paucity of literature on the specific ramifications of diabetes on different surgical procedures.

Methods:

Using the American College of Surgeons National Surgical Quality Improvement Program dataset, demographics, outcomes, and length of in-patient hospitalization were examined for patients who underwent plastic surgery between 2007 and 2012. Adjusted multivariable logistic regression models were used to assess the relationship between diabetes status and a spectrum of medical and surgical postoperative outcomes.

Results:

Thirty-nine thousand four hundred seventy-five plastic surgery patients were identified, including 1,222 (3.10%) with insulin-dependent diabetes mellitus (IDDM) and 1,915 (4.75%) with non–insulin-dependent diabetes mellitus (NIDDM), who had undergone breast, hand/upper and lower extremity, abdominal, or craniofacial procedures. Logistic regression analyses showed that only insulin-dependent diabetics had a higher likelihood of surgical complications (IDDM: P value < 0.0001; NIDDM: P value < 0.103), whereas patients with both IDDM and NIDDM had increased likelihoods of medical complications (IDDM: P value < 0.001; NIDDM: P value = 0.0093) compared with nondiabetics. Average hospital stay for diabetics was also longer than for nondiabetics.

Conclusions:

Diabetes is associated with an increase in a multitude of postoperative complications and in hospital length of stay, in patients undergoing plastic surgery. Diabetes status should thus be evaluated and addressed when counseling patients preoperatively. Risks may be further stratified based on IDDM versus NIDDM status.

Accelerated oligosaccharide absorption and altered serum metabolites during oral glucose tolerance test in young Japanese with impaired glucose tolerance

AIMS/INTRODUCTION

Impaired glucose tolerance (IGT) is a subtype of prediabetes, a condition having high risk for development to diabetes mellitus, but its pathophysiology is not fully understood. In the present study, we examined metabolic changes in IGT by using two types (D-glucose [Glc] and partial hydrolysate of starch [PHS]) of oral glucose tolerance tests (OGTTs), with emphasis on serum incretins and metabolites.

MATERIALS AND METHODS

We carried out the two types of OGTT (Glc/OGTT and PHS/OGTT) in 99 young Japanese individuals who had tested either positive (GU+ ; n = 48) or negative (GU- ; n = 51) for glycosuria. After OGTT, they were sub-grouped into five categories: normal glucose tolerance (NGT) in the GU- group (GU- /NGT; n = 49), NGT in the GU+ group (GU+ /NGT; n = 28), IGT (n = 12), diabetes mellitus (n = 1) and renal glycosuria (n = 9). Serum incretin and metabolites of GU- /NGT and IGT were then measured.

RESULTS

When the serum insulin level at each time-point during PHS/OGTT was expressed as its ratio relative to Glc/OGTT, it was increased time-dependently in GU- /NGT, but not in IGT. Such an increase in the ratio was also detected of serum incretin levels in GU- /NGT, but not in IGT, suggesting a lack of deceleration of oligosaccharide absorption in IGT. Metabolome analysis showed a difference in the serum levels of two metabolites of unknown function in mammals, methylcysteine and sedoheptulose 1,7-bisphosphate, between GU- /NGT and IGT.

CONCLUSIONS

Comparison of PHS/OGTT and Glc/OGTT showed that oligosaccharide absorption was accelerated in IGT. Methylcysteine and sedoheptulose 1,7-bisphosphate could be novel markers for dysregulated glucose metabolism.

Glucose dysregulation and response to common anti-diabetic agents in the FATZO/Pco mouse

The FATZO/Pco mouse is the result of a cross of the C57BL/6J and AKR/J strains. The crossing of these two strains and the selective inbreeding for obesity, insulin resistance and hyperglycemia has resulted in an inbred strain exhibiting obesity in the presumed presence of an intact leptin pathway. Routinely used rodent models for obesity and diabetes research have a monogenic defect in leptin signaling that initiates obesity. Given that obesity and its sequelae in humans are polygenic in nature and not associated with leptin signaling defects, the FATZO mouse may represent a more translatable rodent model for study of obesity and its associated metabolic disturbances. The FATZO mouse develops obesity spontaneously when fed a normal chow diet. Glucose intolerance with increased insulin levels are apparent in FATZO mice as young as 6 weeks of age. These progress to hyperglycemia/pre-diabetes and frank diabetes with decreasing insulin levels as they age. The disease in these mice is multi-faceted, similar to the metabolic syndrome apparent in obese individuals, and thus provides a long pre-diabetic state for determining the preventive value of new interventions. We have assessed the utility of this new model for the pre-clinical screening of agents to stop or slow progression of the metabolic syndrome to severe diabetes. Our assessment included: 1) characterization of the spontaneous development of disease, 2) comparison of metabolic disturbances of FATZO mice to control mice and 3) validation of the model with regard to the effectiveness of current and emerging anti-diabetic agents; rosiglitazone, metformin and semaglutide.

CONCLUSION

Male FATZO mice spontaneously develop significant metabolic disease when compared to normal controls while maintaining hyperglycemia in the presence of high leptin levels and hyperinsulinemia. The disease condition responds to commonly used antidiabetic agents.