Associations of insulin resistance and beta-cell function with abnormal lipid profile in newly diagnosed diabetes

Diabetes is the missing link between cardiometabolic index and gallstones: a large cross-sectional study

The cardiometabolic index (CMI), which integrates individual lipid and visceral fat parameters, represents a superior new predictive tool for cardiovascular and metabolic disorders, but its predictive value for gallstones (GS) is unclear. Therefore, the present study used this vacancy to explore the relationship between CMI levels and GS in US adults, assess the mediating role of diabetes mellitus in the pathogenesis of both, and provide new clinical ideas for early prevention and screening of GS in patients with diabetes mellitus. This survey extracted information from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 vintage cycle. Cross-sectional analyses and a variety of statistical techniques were used to analyze the correlation between CMI and GS, including logistic regression, propensity score matching, subject work curves, and restricted cubic spline (RCS). Furthermore, mediation analysis was used to investigate whether and to what extent diabetes mediated the effect of CMI on GS. After analysis of 3,395 participants, a significant positive correlation was observed between elevated CMI levels and increased prevalence of GS In the fully corrected model (Model 4), the prevalence of GS exhibited a 23% increase for every incremental unit rise in logarithmically transformed CM. Mediation analysis showed that diabetes largely mediated the association between CMI and GS, with a mediation ratio of 15.1%. Higher CMI levels are closely linked to a greater occurrence of GS, and diabetes plays a key mediating role in the pathogenesis of both. Addressing dyslipidemia while not neglecting blood glucose levels, and co-management of the two may be a proven way to reduce GS risk.

Association between serum uric acid and dyslipidaemia in type 2 diabetes: a cross-sectional study

BACKGROUND

The association between serum uric acid (SUA) and dyslipidaemia is still unclear in patients with type 2 diabetes mellitus (T2DM). This study aimed to examine the association between SUA and dyslipidaemia and to explore whether there is an optimal SUA level corresponding to the lower risk of suffering from dyslipidaemia.

RESEARCH DESIGN AND METHODS

This cross-sectional study included 1036 inpatients with T2DM and the clinical data were extracted from the hospital medical records. Multivariate logistic regression analysis was performed to assess the association between hyperuricaemia and dyslipidaemia. Restricted cubic splines (RCS) analysis was performed to determine the optimal SUA level for the lower risk of dyslipidaemia.

RESULTS

After adjustment for the potential confounders, hyperuricaemia was significantly associated with dyslipidaemia (OR=3.72, 95% CI: 2.28, 6.07) and hypertriglyceridaemia (OR=2.63, 95% CI: 1.68, 4.12). Notably, mediation analysis revealed a significant mediating effect of SUA in this relationship (indirect effect=0.08, p<0.001), elucidating 20.1% of the total relationship.

CONCLUSIONS

Hyperuricaemia was positively associated with dyslipidaemia and hypertriglyceridaemia. SUA mediated the effect of insulin resistance on triglyceride metabolism in patients with T2DM. A potential benefit of stricter control of SUA levels among patients with T2DM is possibly reducing the risk of dyslipidaemia.

Association between simple, combined lipid markers and 20-year cumulative incidence of type 2 diabetes: the ATTICA cohort study (2002-2022)

BACKGROUND

The aim of this study was to evaluate the association between simple, combined lipid biomarkers, and 20-year cumulative incidence of new type 2 diabetes mellitus (T2DM) among adults participating in the ATTICA cohort study (2002-2022).

METHODS

The present analysis included data from 2000 individuals free of T2DM at baseline (age 43 ± 13 years; 51% women). Sociodemographic, anthropometric, lifestyle, clinical, and biochemical parameters were collected at baseline and follow-up examinations; combined lipid markers were evaluated.

RESULTS

The 20-year cumulative incidence of T2DM was 26.3% (95%CI 24.4, 28.3%). All, simple and combined lipid markers were independently associated with new T2DM onset. The accuracy of simple and combined markers was approximately 75%, without any significant differences between simple and combined indices. The additive correct classification gain of lipid markers to glucose metabolism indices on 20-year new T2DM cumulative incidence varied between 0.9% for cardiometabolic index to 10.6% for LDL-cholesterol.

CONCLUSIONS

Lipid profile is associated with the long-term onset of T2DM. Evaluated through simple or combined markers, lipid profiles can be utilized for identifying and improving risk stratification in individuals at high risk for T2DM, while also enhancing the effectiveness of primary prevention measures and public health strategies.

Early impaired insulin tolerance among Vietnamese diabetes with or without dyslipidemia

This study aims to evaluate impaired insulin tolerance among Vietnamese diabetes with or without dyslipidemia. Diabetes mellitus (DM) remains the serious global health and social burden that has increased over the past few decades. It progresses silently to vascular injury and disability of injured vascular-perfused tissues/organs. Insulin intolerance and dyslipidemia exacerbate and accelerate the implications of DM. Thus, early detection and more evidence of early insulin intolerance and dyslipidemia is needed for proactive management. This cross-sectional descriptive study recruited 100 healthy control (HC) and 297 DM patients in Military Hospital 103 from 2021 to 2023. Patients with DM were subgrouped into lipid metabolism disorder (LMD, n = 98) and non-LMD (NLMD, n = 99). The biochemists' serum levels were measured automatically and the accuracy of the test result was strictly controlled. Insulin tolerance indices (HOMA2-IR, HOMA2-%S and HOMA2-%B) were compared between HC, DM with or without dyslipidemia as well as correlated with lipid ingredients (total Cholesterol, triglyceride, LDL-C and HDL-C). Among DM patients, HOMA2-IR was significantly high and HOMA2-%S and HOMA2-%B were significantly low. HOMA2-IR was higher and HOMA2-%S and HOMA2-%B were lower in DM with LMD than in DM without LMD. In addition, HOMA2-IR was positively correlated with serum cholesterol, triglyceride and LDL-C concentration, and negatively correlated to HDL-C concentration. In contrast, HOMA2-%S and HOMA2-%B was negatively correlated with serum cholesterol, triglyceride and LDL-C, and positively correlated with HDL-C. Impaired insulin intolerance occurred in early stage of DM, and more serious among DM with LMD, compared to DM with NLMD.

Effects of a combination of dyslipidemia and hypertension on the glycemic control of patients with type 2 diabetes mellitus: a cross-sectional study

Objectives

Both dyslipidemia and hypertension contribute to poor glycemic control in patients with type 2 diabetes mellitus, but the combined effect of dyslipidemia and hypertension on glycemic control in patients with type 2 diabetes mellitus has not been evaluated. The aim of this study was to analyze the interaction effect between dyslipidemia and hypertension on glycemic control in patients with type 2 diabetes mellitus.

Methods

A total of 2485 patients with type 2 diabetes mellitus were selected from the Xuzhou community of China by multi-stage cluster random sampling for a cross-sectional survey. Their glycated hemoglobin, dyslipidemia, and hypertension were assessed, and the interaction effects between dyslipidemia and hypertension on glycemic control were analyzed using relative excess risk due to the interaction, the synergy index, and the attributable proportion of the additive interaction.

Results

Of the participants, 62.13% (1544/2485) had dyslipidemia and 55.01% (1367/2485) had hypertension. Of the participants, 76.66% (1905/2485) who had both dyslipidemia and hypertension also had poor glycemic control. The prevalence of poor glycemic control was higher in those with both dyslipidemia and hypertension (odds ratio 2.735, 95% confidence interval 2.117-3.532; p < 0.001) compared with those who had normal blood lipids and without hypertension, after adjustment for confounders. The relative excess risk due to the interaction, the attributable proportion, and the synergy index were 1.077 (95% confidence interval 0.558-1.596), 2.637 (95% confidence interval 1.268-4.006), and 0.394 (95% confidence interval 0.230-0.558), respectively, for the interaction between dyslipidemia and hypertension.

Conclusions

Dyslipidemia and hypertension have an additive interaction on poor glycemic control in patients with type 2 diabetes mellitus.

Chinese expert consensus on blood lipid management in patients with diabetes (2024 edition)

Diabetes is a significant independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with dyslipidemia playing a critical role in the initiation and progression of ASCVD in diabetic patients. In China, the current prevalence of dyslipidemia in diabetes is high, but the control rate remains low. Therefore, to enhance lipid management in patients with diabetes, the Endocrinology and Metabolism Physician Branch of the Chinese Medical Doctor Association, in collaboration with the Experts' Committee of the National Society of Cardiometabolic Medicine, has convened experts to develop a consensus on the management of dyslipidemia in patients with type 1 or type 2 diabetes. The development of this consensus is informed by existing practices in lipid management among Chinese diabetic patients, incorporating contemporary evidence-based findings and guidelines from national and international sources. The consensus encompasses lipid profile characteristics, the current epidemiological status of dyslipidemia, ASCVD risk stratification, and lipid management procedures in diabetic patients. For the first time, both low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol have been recommended as primary targets for lipid intervention in diabetic patients. The consensus also includes a summary and recommendations for lipid management strategies in special diabetic populations, including children and adolescents, individuals aged 75 years and older, patients with chronic kidney disease, metabolic-associated fatty liver disease, and those who are pregnant. This comprehensive consensus aims to improve cardiovascular outcomes in diabetic patients by contributing to the dissemination of key clinical advancements and guiding clinical practice.

Anthropometric, Metabolic, and Endocrine Parameters as Predictors of Estimated Average Glucose and Other Biomarkers of Dysglycemia in Women with Different Phenotypes of Polycystic Ovary Syndrome

The aim of the study was to evaluate the efficacy of anthropometric, metabolic, and endocrine abnormalities as predictors of estimated average glucose and other biomarkers of dysglycemia in women with different phenotypes of polycystic ovary syndrome (PCOS). This cross-sectional study included 648 women with PCOS and 330 controls. A single protocol of investigation was applied for all subjects. PCOS women were divided by phenotypes according to the Rotterdam criteria. Biomarkers of dysglycemia were considered dependent variables and anthropometric, lipid, and hormone alterations as independent variables using univariate and multivariate logistic regressions. Univariate logistic regression analysis, controlled for age and BMI, showed that many biomarkers of dysglycemia could be predicted by anthropometric, lipid, and endocrine variables. Multivariate logistic models showed that in non-PCOS women estimated average glucose (eAG) was predicted by lower TSH levels (OR=0.39; p=0.045); fasting glucose was predicted by increased T (OR=2.3). For PCOS, phenotype A, eAG was predicted by decreased HDL-C (OR=0.17, p=0.023) and high levels of free estradiol (OR=7.1, p<0.001). Otherwise, in PCOS, phenotype D, eAG was predicted by higher levels of HDL-C. The current study demonstrated that eAG was poorly predicted by anthropometric, lipid, and hormone parameters. Nevertheless, without adding significant benefits, it was comparable with other established markers of dysglycemia in women with different PCOS phenotypes.

Correlation Between Abdominal Fat Distribution and Serum Uric Acid in Patients Recently Diagnosed with Type 2 Diabetes

Objective

To investigated the link between the distribution of abdominal fat and the concentration of serum uric acid (SUA) in individuals recently diagnosed with type 2 diabetes.

Methods

Studied 364 individuals had been diagnosed with type 2 diabetes within one month, and evaluated factors such as the distribution of fat in the abdomen, indicators related to glucose and lipid metabolism. The participants' SUA concentrations were divided into a normal control group (CG) and a hyperuricemia group (HG).

Results

The HG group had elevated abdominal subcutaneous fat area (SFA), visceral fat content (VFA), body mass index (BMI), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG), glycosylated albumin (GA), serum creatinine (SCr), triacylglycerol (TG), and lower values in glomerular filtration rate (eGFR), high-density lipoprotein cholesterol (HDL-C) when compared to the CG group (P < 0.05). Among the obese individuals, the hyperuricemia subgroup exhibited higher measurements in waistline, hipline, VFA, SFA, BMI, PBG, SCr, TG, and lower HDL-C (P < 0.05) compared to the subgroup with normal uric acid levels. In the non-obese group, the hyperuricemia subgroup showed higher VFA, SCr, and FBG levels, and lower HDL-C (P < 0.05). There was a positive correlation between VFA and serum uric acid (SUA) levels (r = 0.329, P < 0.0001). Logistic regression analysis indicated a 24% increased risk of hyperuricemia with every 10cm2 increase in abdominal VFA. Generate the Receiver Operating Characteristic (ROC) curve analysis revealed that VFA was the most effective predictor of hyperuricemia and insulin resistance (P < 0.05).

Conclusion

Newly diagnosed type 2 diabetes patients exhibit a strong correlation between abdominal visceral fat and SUA concentration, the former is identified as an autonomous risk factor for hyperuricemia and an effective indicator for assessing the presence of hyperuricemia and predicting insulin resistance.

Prevalence of maturity-onset diabetes of the young in phenotypic type 2 diabetes in young adults: a nationwide, multi-center, cross-sectional survey in China

BACKGROUND

Maturity-onset diabetes of the young (MODY) is the most common monogenic diabetes. The aim of this study was to assess the prevalence of MODY in phenotypic type 2 diabetes (T2DM) among Chinese young adults.

METHODS

From April 2015 to October 2017, this cross-sectional study involved 2429 consecutive patients from 46 hospitals in China, newly diagnosed between 15 years and 45 years, with T2DM phenotype and negative for standardized glutamic acid decarboxylase antibody at the core laboratory. Sequencing using a custom monogenic diabetes gene panel was performed, and variants of 14 MODY genes were interpreted as per current guidelines.

RESULTS

The survey determined 18 patients having genetic variants causing MODY (6 HNF1A , 5 GCK , 3 HNF4A , 2 INS , 1 PDX1 , and 1 PAX4 ). The prevalence of MODY was 0.74% (95% confidence interval [CI]: 0.40-1.08%). The clinical characteristics of MODY patients were not specific, 72.2% (13/18) of them were diagnosed after 35 years, 47.1% (8/17) had metabolic syndrome, and only 38.9% (7/18) had a family history of diabetes. No significant difference in manifestations except for hemoglobin A1c levels was found between MODY and non-MODY patients.

CONCLUSION

The prevalence of MODY in young adults with phenotypic T2DM was 0.74%, among which HNF1A -, GCK -, and HNF4A -MODY were the most common subtypes. Clinical features played a limited role in the recognition of MODY.

Association between aspartate aminotransferase to alanine aminotransferase ratio and the risk of diabetes in Chinese prediabetic population: A retrospective cohort study

Background

Accumulating evidence has revealed that the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio is a promising novel biomarker for insulin resistance (IR) and metabolic diseases. However, research on the association between the AST/ALT ratio and the incidence of diabetes progressing from prediabetes remains lacking. Herein, this study aimed to evaluate the relationship between the baseline AST/ALT ratio and risks of diabetes in patients with prediabetes.

Methods

This was a retrospective cohort study involving a total of 82,683 participants across 32 regions and 11 cities in China from 2010 to 2016. Data was obtained based on the DATADRYAD database from the health check screening program. Participants were stratified according to the interquartile range of the AST/ALT ratio (groups Q1 to Q4). The Cox proportional hazard model and smooth curve fitting were used to explore the relationship between the baseline AST/ALT ratio and the risk of diabetes in prediabetic patients. In addition, subgroup analysis was used to further validate the stability of the results.

Results

The mean age of the selected participants was 49.9 ± 14.0 years, with 66.8% of them being male. During the follow-up period 1,273 participants (11.3%) developed diabetes progressing from prediabetes during the follow-up period. Participants who developed diabetes were older and were more likely to be male. The fully-adjusted Cox proportional hazard model revealed that the AST/ALT ratio was negatively associated with the risk of diabetes in prediabetic patients (HR = 0.40, 95% CI: 0.33 to 0.48, P < 0.001). Higher AST/ALT ratio groups (Q4) also presented with a lower risk of progressing into diabetes (HR = 0.35, 95% CI: 0.29 to 0.43, P < 0.001, respectively) compared with the lowest quintile group (Q1). Through subgroup analysis and interaction tests, it was found that the association stably existed in all subgroup variables, and there were a stronger interactive effects in people with age < 45 years, and TG ≤ 1.7 mmol/L in the association between AST/ALT ratio and diabetes incidences in patients with prediabetes (P for interaction < 0.05).

Conclusion

According to our study, a higher AST/ALT ratio is associated with a lower risk of progressing into diabetes from prediabetes. Regular monitoring of AST/ALT ratio dynamics and corresponding interventions can help prevent or slow prediabetes progression for diabetes.

Lipid metabolism in type 1 diabetes mellitus: Pathogenetic and therapeutic implications

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease with insulin deficiency due to pancreatic β cell destruction. Multiple independent cohort studies revealed specific lipid spectrum alterations prior to islet autoimmunity in T1DM. Except for serving as building blocks for membrane biogenesis, accumulative evidence suggests lipids and their derivatives can also modulate different biological processes in the progression of T1DM, such as inflammation responses, immune attacks, and β cell vulnerability. However, the types of lipids are huge and majority of them have been largely unexplored in T1DM. In this review, based on the lipid classification system, we summarize the clinical evidence on dyslipidemia related to T1DM and elucidate the potential mechanisms by which they participate in regulating inflammation responses, modulating lymphocyte function and influencing β cell susceptibility to apoptosis and dysfunction. This review systematically recapitulates the role and mechanisms of various lipids in T1DM, providing new therapeutic approaches for T1DM from a nutritional perspective.

Efficacy of Dapagliflozin Combined with Lifestyle Intervention in Obesity Control

Objective

To explore the best treatment of obesity in middle and old age.

Methods

80 obese patients in our hospital from January 2020 to December 2021 were randomly divided into the control group and the intervention group according to the numerical table method. The control group was treated with lifestyle intervention, while the intervention group was treated with dapagliflozin combined with lifestyle intervention. The effects of body weight, body mass index (BMI), waist circumference, and blood lipids (LDL, HDL, TC, and TG) were measured and compared. Anxiety and depression scores were assessed using the 2018 Revised Anxiety and Depression Scale.

Results

There were no significant differences in body weight, BMI, and waist circumference between the control group and the intervention group before treatment. After treatment, the weight, BMI, and waist circumference of the intervention group were lower than those of the control group, and the difference was statistically significant (P < 0.05). After treatment, LDL, TC, and TG in the two groups were decreased, and HDL was significantly increased (P < 0.05). After treatment, the blood lipid level in the intervention group was significantly lower than that in the control group (P < 0.05). Anxiety and depression symptoms improved in both groups, and there were no serious adverse effects.

Conclusion

Dapagliflozin in combination with a lifestyle intervention effectively and safely treats excess weight in middle-aged and older adults, reverses obesity-related markers, and improves psychological symptoms. Its curative effect is better than that of using lifestyle intervention alone.

Vitamin D Levels as an Important Predictor for Type 2 Diabetes Mellitus and Weight Regain Post-Sleeve Gastrectomy

Weight Loss Surgery (WLS), including sleeve-gastrectomy (SG), results in significant weight loss and improved metabolic health in severe obesity (BMI ≥ 35 kg/m2). Previous studies suggest post-operative health benefits are impacted by nutrient deficiencies, such as Vitamin D (25(OH)D) deficiency, while it is currently unknown whether nutrient levels may actually predict post-surgery outcomes. As such, this study investigated whether 25(OH)D levels could predict metabolic improvements in patients who underwent SG. Patients with severe obesity (n = 309; 75% female) undergoing SG participated in this ethics-approved, non-randomized retrospective cohort study. Anthropometry, clinical data, 25(OH)D levels and serum markers were collected at baseline, 6-, 12- and 18-months post-surgery. SG surgery resulted in significant improvements in metabolic health at 6- and 12-months post-surgery compared with baseline, as expected. Patients with higher baseline 25(OH)D had significantly lower HbA1c levels post-surgery (p < 0.01) and better post-surgical T2DM outcomes, including reduced weight regain (p < 0.05). Further analysis revealed that baseline 25(OH)D could predict HbA1c levels, weight regain and T2DM remission one-year post-surgery, accounting for 7.5% of HbA1c divergence (p < 0.01). These data highlight that higher circulating 25(OH)D levels are associated with significant metabolic health improvements post-surgery, notably, that such baseline levels are able to predict those who attain T2DM remission. This highlights the importance of 25(OH)D as a predictive biomarker of post-surgery benefits.

Dyslipidemia and 10-year diabetes incidence in Japanese people: Population-based Panasonic cohort study 9

Low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and LDL/HDL ratio have been associated with new-onset diabetes; however, their cut-off levels have not been determined. We clarified the association between dyslipidemia and the incidence of diabetes. People who underwent a health checkup under a program conducted by Panasonic Corporation from 2008 to 2018 were included. In total, 87,570 participants were included, of whom 5,110 developed type 2 diabetes. Cox regression analyses and time-dependent receiver operating characteristic (ROC) curves were used to evaluate the association between LDL cholesterol, HDL cholesterol, or LDL/HDL ratio and incident diabetes and to identify the cut-off values for incident diabetes. Multivariate analysis showed that LDL cholesterol, HDL cholesterol, and LDL/HDL ratio were significantly associated with the risk of incident type 2 diabetes. Further, the area under the ROC curve and optimized cut-off values for LDL cholesterol, HDL cholesterol, and LDL/HDL ratio for incident type 2 diabetes at 10 years were 0.613 and 124 mg/dl, 0.640 and 54 mg/dl, and 0.662 and 2.4 mg/dl, respectively. The LDL/HDL ratio with a cut-off value of 2.4 was a better predictor of incident diabetes within 10 years than LDL and HDL cholesterol.