Body mass index ≥23 is a risk factor for insulin resistance and diabetes in Japanese people: A brief report

Correlation of renal biomarkers, electrolyte imbalances and vitamin D levels in hypertensive subjects

The mechanisms behind persistent high blood pressure and its effects on renal function and electrolyte balance are not yet fully understood. The present study aimed to identify electrolyte imbalances in hypertensive patients and to determine their association with renal function and vitamin D levels. For this purpose, 155 subjects were recruited for the study, including 83 hypertensive subjects and 72 healthy normotensive subjects matched for sex and age as controls. Demographic data were collected using a questionnaire, and anthropometric parameters were measured using standard procedures. Sodium and potassium levels were determined using an ion selective electrolyte analyzer, while calcium, magnesium and phosphorus levels were measured using spectrophotometry. Uric acid, creatinine and urea levels were analyzed using a semi-auto chemistry analyzer, and vitamin D levels were assessed using ELISA. The results obtained revealed that body mass index, systolic and diastolic blood pressure, and creatinine, urea, uric acid, magnesium and sodium levels were significantly higher in the hypertensive subjects compared with the healthy controls (P<0.05); however, the vitamin D, calcium, potassium and phosphate levels were significantly lower in the hypertensive subjects compared to the healthy controls (P<0.05). There was no statistically significant difference in all parameters studied as regards age and sex (P>0.05). On the whole, the present study demonstrates that an electrolyte imbalance, renal dysfunction and vitamin D deficiency are observed in hypertensive subjects. These findings emphasize the importance of assessing and monitoring these biochemical markers as they could improve prognosis, aid in early diagnosis, and assist in determining the optimal level of therapeutic interventions.

Adherence to combined healthy lifestyle and odds of metabolic syndrome in Iranian adults: the PERSIAN Dena cohort study

The relationship between lifestyle choices and health outcomes has received significant scholarly attention. Research indicates that factors such as obesity, insufficient physical activity, tobacco use, and poor dietary habits may elevate the odds of developing metabolic disorders. This study aimed to investigate the association between the combined healthy lifestyle score (HLS) and the odds of metabolic syndrome (MetS) and its associated components in a population of apparently healthy adults. This cross-sectional study utilized data from the Dena PERSIAN cohort, which comprised 2,971 healthy adults. Participants' combined HLS were evaluated using validated questionnaires that assessed body mass index (BMI), physical activity level (PAL), smoking status, and dietary quality. The evaluation of dietary nutritional quality was conducted using the most recent version of the Healthy Eating Index (HEI), known as HEI-2020. The combined HLS was measured on a scale ranging from zero, indicating an unhealthy lifestyle, to four, representing the healthiest lifestyle. Individuals with the highest combined HLS score had 81% lower odds of having MetS compared to those with the lowest score (OR: 0.19; 95% CI: 0.11-0.33). Higher combined HLS scores were significantly associated with decreased odds of abdominal adiposity (OR: 0.11; 95% CI: 0.07-0.18), abnormal glucose homeostasis (OR: 0.55; 95% CI: 0.35-0.86), elevated serum triglycerides (OR: 0.41; 95% CI: 0.26-0.67), and low high-density lipoprotein cholesterol (HDL-C) levels (OR: 0.39; 95% CI: 0.24-0.65) after adjusting for sex, age, education level, and marital status (P < 0.05). The findings indicated a significant association between adherence to a combined HLS and a decreased odds of developing MetS and its associated components among Iranian adults.

Pregestational BMI Over 23 kg/m2 May Increase Insulin Utilization in Gestational Diabetes Mellitus Patients

The purpose of this study is to examine the pregestational BMI value that results in insulin use in Japanese patients with gestational diabetes mellitus (GDM) and to assess whether the type of GDM treatment affects postpartum glucose tolerance. This retrospective study included 21 GDM patients treated until parturition at our department from 2013 to 2017. We calculated the pregestational BMI related to insulin treatment and the significant elevation in homeostasis model assessment of insulin resistance (HOMA-IR) by receiver operating characteristics curve (ROC) analysis. We also analyzed whether the insulin treatment caused a difference in postpartum glucose tolerance. Seven of the eight patients who needed insulin treatment had a pregestational BMI over 23 kg/m2. The pregestational BMI cutoff value related to insulin treatment was 22.5 kg/m2 (sensitivity 100%, specificity 46.2%, area under the curve 0.668, and Confidence Interval=0.429-0.907) in ROC analysis. Insulin utilization was significantly higher in the group with a pregestational BMI of 22.5 or more (p=0.045). HOMA-IR at postpartum was higher in patients whose pregestational BMI was 22.5kg/m2 or more. Blood glucose levels, HOMA-IR, homeostasis model assessment of β-cell function (HOMA-β), and the insulinogenic index (IGI) after delivery did not differ between the diet and insulin treatment groups. In conclusion, Japanese women with GDM and a pregestational BMI over 23 kg/m2 may increase the risk of requiring insulin treatment during pregnancy. Postpartum glucose tolerance did not differ between patients treated with diet or insulin treatment for GDM.

Association of dietary and lifestyle inflammatory indices with type 2 diabetes risk in Iranian adults

BACKGROUND

Type 2 diabetes mellitus (T2DM) is often linked to chronic inflammation, which can be influenced by both lifestyle and dietary choices. However, the relationship between the inflammatory potential of diet and lifestyle factors and the risk of developing T2DM remains unclear. The present study aimed to investigate the associations of the empirical dietary inflammatory index (EDII), dietary inflammatory score (DIS), and lifestyle inflammatory score (LIS) with the risk of T2DM among Iranian adults.

METHODS

The current study was conducted on 5714 individuals from Yazd Health Study (YaHS) who were followed up for a mean period of six years. YaHS is a prospective cohort study which has been conducted since 2014. Dietary intakes were collected at baseline using the food frequency questionnaire. The relative risk (RR) of T2DM was calculated by Cox regression analysis across tertiles of EDII, DIS, and LIS, adjusted for potential confounders.

RESULTS

The mean ± SD for the age and body mass index of the study population were 47.0 ± 9.2 years and 26.7 ± 5.1 Kg.m2, respectively. A significant association between LIS and the risk of T2DM was observed (RR: 4.05, 95% CI: 2.61-6.27 P-trend < 0.001). Individuals in the highest compared to the lowest tertile of EDII-LIS (RR: 3.07, 95%CI: 2.01-4.68; P for trend < 0.001) and DIS-LIS (RR: 2.42, 95%CI: 1.69-3.49; P for trend < 0.001) had a higher risk of T2DM. However, no significant association was found between EDII and DIS scores and the risk of T2DM.

CONCLUSION

Greater adherence to LIS, EDII-LIS, and DIS-LIS scores was associated with a higher risk of T2DM, while no significant association was found between EDII and DIS with T2DM risk.

Evaluation of the Association between Insulin Resistance and Subclinical Hypothyroidism Using Triglyceride-Glucose Index: a Cross-Sectional Study

BACKGROUND

Thyroid disorders and diabetes mellitus are often known to co-exist, implying an interrelationship between thyroid dysfunction and insulin resistance. Triglyceride-glucose (TyG) index is a relatively new surrogate marker of insulin resistance, which is cost-effective and easily calculated with routine lab tests. Data about association of subclinical hypothyroidism (SCH) and insulin resistance, especially with reference to TyG index, is lacking.

OBJECTIVES

To evaluate the association of SCH and insulin resistance using the TyG index by comparing its value in patients with SCH and age- and gender-matched euthyroid controls. Also, to determine if there is a correlation between TyG index values and thyroid profile parameters (TSH, FT3 and FT4) in both study groups.

MATERIALS AND METHODS

Thirty-five patients with SCH and an equal number of age- and gender-matched euthyroid controls were included in the present study. The TyG index was calculated for each group and compared. The correlation between TyG index and thyroid profile parameters (TSH, FT3 and FT4) was also assessed.

RESULTS

The TSH values were significantly higher in the SCH group (6.6±1.7 µIU/mL) than the control one (2.5±1.2 µIU/mL; p<0.0001). There was no significant difference in FT3 in the SCH group (2.93±0.49 pg/ mL) and the control one (3.05±0.64 pg/mL; p=0.310). The level of FT4 was also not found to be significantly different in SCH subjects (1.23±0.44 ng/dL) and controls (1.4±0.42 ng/dL; p=0.077). The TyG index values were significantly higher in the SCH group (4.8±0.2) as compared to the control one (4.7±0.2; p = 0.015). The TyG index did not show any significant correlation with the thyroid parameters in any of the two groups.

CONCLUSION

There is a positive association between SCH and insulin resistance in terms of TyG index. This index may thus be helpful in early screening and management of such patients for insulin resistance related conditions like diabetes mellitus, metabolic syndrome and cardiovascular disorders.

Mechanism of muscle atrophy in a normal-weight rat model of type 2 diabetes established by using a soft-pellet diet

Dietary factors such as food texture affect feeding behavior and energy metabolism, potentially causing obesity and type 2 diabetes. We previously found that rats fed soft pellets (SPs) were neither hyperphagic nor overweight but demonstrated glucose intolerance, insulin resistance, and hyperplasia of pancreatic β-cells. In the present study, we investigated the mechanism of muscle atrophy in rats that had been fed SPs on a 3-h time-restricted feeding schedule for 24 weeks. As expected, the SP rats were normal weight; however, they developed insulin resistance, glucose intolerance, and fat accumulation. In addition, skeletal muscles of SP rats were histologically atrophic and demonstrated disrupted insulin signaling. Furthermore, we learned that the muscle atrophy of the SP rats developed via the IL-6-STAT3-SOCS3 and ubiquitin-proteasome pathways. Our data show that the dietary habit of consuming soft foods can lead to not only glucose intolerance or insulin resistance but also muscle atrophy.

Association of dietary and lifestyle inflammation score with type 2 diabetes mellitus and cardiometabolic risk factors in Iranian adults: Sabzevar Persian Cohort Study

Systemic inflammation may contribute to the initiation and progression of type 2 diabetes mellitus (T2DM) through diet and lifestyle. We examined the association of dietary inflammation score (DIS), lifestyle inflammation score (LIS) and dietary and lifestyle inflammation score (DLIS) with T2DM and cardiometabolic risk factors among Iranian adults. In this study, we identified and recruited 619 patients with T2DM and 2113 without T2DM from 35 to 75 years old men and women in the baseline phase of the Sabzevar Persian Cohort Study. Using a validated 115-item semi-quantitative FFQ, we calculated a 19-component DIS and a 3-component LIS weighted by circulating inflammation biomarkers. The DIS, LIS and DLIS associations with diabetes were assessed by multivariable logistic regression analysis. The average age of the participants was 48·29 (sd 8·53) (without T2DM: 47·66 (sd 8·42); with T2DM: 50·44 (sd 8·57)). Individuals in the highest compared with the lowest tertiles of DLIS (OR: 3·40; 95 % CI 2·65, 4·35; Ptrend < 0·001), DIS (OR: 3·41; 95 % CI 2·66, 4·38; Ptrend < 0·001) and LIS (OR: 1·15; 95 % CI 0·90, 1·46; Ptrend = 0·521) had an increased risk of T2DM. For those in the highest relative to the lowest joint DIS and LIS tertiles, the results were OR: 3·37; 95 % CI 2·13, 5·32; Pinteraction < 0·001. No significant associations were found between DLIS and cardiometabolic risk factors, including blood pressure, liver enzymes and glycaemic and lipid profiles, except for waist circumference (P < 0·001) and waist-to-hip ratio (P = 0·010). A higher DIS and DLIS score was associated with a higher risk of T2DM, while the LIS score was not associated with T2DM risk.

The Effects of a High-Carbohydrate versus a High-Fat Shake on Biomarkers of Metabolism and Glycemic Control When Used to Interrupt a 38-h Fast: A Randomized Crossover Study

This study aimed to determine the impact of various fast-interrupting shakes on markers of glycemic control including glucose, β-hydroxybutyrate (BHB), insulin, glucagon, GLP-1, and GIP. Twenty-seven sedentary adults (twelve female, fifteen male) with overweight or obesity completed this study. One condition consisted of a 38-h water-only fast, and the other two conditions repeated this, but the fasts were interrupted at 24 h by either a high carbohydrate/low fat (HC/LF) shake or an isovolumetric and isocaloric low carbohydrate/high fat (LC/HF) shake. The water-only fast resulted in 135.3% more BHB compared to the HC/LF condition (p < 0.01) and 69.6% more compared to the LC/HF condition (p < 0.01). The LC/HF condition exhibited a 38.8% higher BHB level than the HC/LF condition (p < 0.01). The area under the curve for glucose was 14.2% higher in the HC/LF condition than in the water condition (p < 0.01) and 6.9% higher compared to the LC/HF condition (p < 0.01), with the LC/HF condition yielding 7.8% more glucose than the water condition (p < 0.01). At the 25-h mark, insulin and glucose-dependent insulinotropic polypeptide (GIP) were significantly elevated in the HC/LF condition compared to the LC/HF condition (p < 0.01 and p = 0.02, respectively) and compared to the water condition (p < 0.01). Furthermore, insulin, GLP-1, and GIP were increased in the LC/HF condition compared to the water condition at 25 h (p < 0.01, p = 0.015, and p < 0.01, respectively). By the 38-h time point, no differences were observed among the conditions for any of the analyzed hormones. While a LC/HF shake does not mimic a fast completely, it does preserve some of the metabolic changes including elevated BHB and glucagon, and decreased glucose and insulin compared to a HC/LF shake, implying a potential for improved metabolic health.

Body Mass Index is Associated with blood pressure and vital capacity in medical students

BACKGROUND

The widely reported associations between body mass index (BMI) and various chronic diseases, such as hypertension and asthma, have garnered significant attention. Nonetheless, there remains a dearth of research dedicated to understanding the health impacts of medical school on the students, who experience considerable academic pressure. In that context, this study was driven by the goal of investigating the intricate interplay between BMI, blood pressure (BP), and vital capacity among medical students.

METHODS

This study included a cohort of 843 medical students enrolled at Southern Medical University who were selected through random cluster sampling. Within this cohort, measurements of height, weight, BP, and vital capacity were taken. Subsequently, both BMI and vital capacity index (VCI) were calculated for each participant. By categorizing the subjects into four groups according to BMI classifications, a comprehensive analysis that included correlation assessments and binomial logistic regression was conducted.

RESULTS

Within the participant pool, 9.4% and 3.8% of participants were classified as overweight and obese, respectively. Additionally, the prevalence of prehypertension, hypertension, and poor VCI was 18.1%, 2.7%, and 13.5%, respectively. Notably, male students exhibited a higher prevalence of the aforementioned health issues than their female counterparts. Correlation analysis revealed that BMI displayed positive associations with systolic blood pressure (SBP), diastolic blood pressure (DBP), and vital capacity (r = 0.372, 0.257, 0.428; P < 0.001). However, an inverse correlation emerged between BMI and VCI (r = -0.284, P < 0.001). Further analysis revealed that overweight and obese individuals faced an elevated risk of high blood pressure ([OR 2.05, 95% CI 1.15-3.67] and [OR 5.44, 95% CI 2.28-13.02], respectively) compared to their normal-weight counterparts. Moreover, these groups also exhibited a higher risk of poor VCI ([OR 5.25, 95% CI 3.04-9.06] and [OR 15.61, 95% CI 6.81-35.81], respectively), while underweight subjects experienced a reduced risk ([OR 0.19, 95% CI 0.07-0.52]).

CONCLUSIONS

BMI demonstrated a notably strong positive correlation with both BP and vital capacity and a negative correlation with VCI. Therefore, for medical students as well as the daily health care of patients, weight control is recommended to better combat obesity-related diseases, for example, cardiopulmonary diseases, gout and diabetes.

Triglyceride glucose-body mass index and hypertension risk in iranian adults: a population-based study

BACKGROUND

Insulin resistance (IR) and obesity are risk factors for hypertension; triglyceride-glucose (TyG) is known as a surrogate for IR. The present study investigated the association between the triglyceride-glucose body mass index (TyG-BMI) index and the risk of hypertension in Iranian adults.

METHODS

This study was conducted on a sample of 8,610 participants from the baseline phase of the Ravansar non- communicable diseases (RaNCD) in Iran. A logistic regression model was used to evaluate the relationship between TyG-BMI and hypertension. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the predictive power of TyG-BMI for hypertension.

RESULTS

A total of 4176 men and 4434 women with an average age of 46.74 years were examined. The anthropometric indices were significantly higher in hypertensive than normotensive subjects (P < 0.001). The level of physical activity was significantly higher in the bottom quartiles (P < 0.001). The odds of hypertension in the highest quartile and 3.10 (95% CI: 2.28, 4.16) times significantly higher than the bottom quartile of the TyG-BMI index. The discriminating ability of TyG-BMI to predict blood pressure was 61% (AUC: 0.61; 95% CI: 0.57, 0.63), and higher than BMI and TyG.

CONCLUSION

The TyG-BMI index is associated with an increase in the odds of hypertension. Therefore, the TyG-BMI index can be a new clinical index for early diagnosis of hypertension. Lifestyle modifications such as weight control through physical activity and a healthy diet can help improve IR and prevent hypertension.

Eating speed and height loss in relation to overweight: A retrospective study

Fast eating is an independent risk factor for weight gain. Our previous study involving Japanese workers revealed that overweight (body mass index ≥ 25.0 kg/m2) is an independent risk factor for height loss. However, no studies have clarified the association between eating speed and height loss in relation to overweight status. A retrospective study of 8,982 Japanese workers was conducted. Height loss was defined as being in the highest quintile of height decrease per year. Compared with slow eating, fast eating was revealed to be positively associated with overweight; the fully adjusted odds ratio (OR) and 95% confidence interval (CI) was 2.92 (2.29, 3.72). Among non-overweight participants, fast eaters had higher odds of height loss than slow eaters. Among overweight participants, fast eaters had lower odds of height loss; the fully adjusted OR (95% CI) was 1.34 (1.05, 1.71) for non-overweight individuals and 0.52 (0.33, 0.82) for overweight individuals. Since overweight was significantly positively associated with height loss [1.17(1.03, 1.32)], fast eating is not favorable for reducing the risk of height loss among overweight individuals. Those associations indicate that weight gain is not the main cause of height loss among Japanese workers who eat fast.

Development and validation of an insulin resistance model for a population without diabetes mellitus and its clinical implication: a prospective cohort study

Background

Insulin resistance (IR) is associated with diabetes mellitus, cardiovascular disease (CV), and mortality. Few studies have used machine learning to predict IR in the non-diabetic population.

Methods

In this prospective cohort study, we trained a predictive model for IR in the non-diabetic populations using the US National Health and Nutrition Examination Survey (NHANES, from JAN 01, 1999 to DEC 31, 2012) database and the Taiwan MAJOR (from JAN 01, 2008 to DEC 31, 2017) database. We analysed participants in the NHANES and MAJOR and participants were excluded if they were aged <18 years old, had incomplete laboratory data, or had DM. To investigate the clinical implications (CV and all-cause mortality) of this trained model, we tested it with the Taiwan biobank (TWB) database from DEC 10, 2008 to NOV 30, 2018. We then used SHapley Additive exPlanation (SHAP) values to explain differences across the machine learning models.

Findings

Of all participants (combined NHANES and MJ databases), we randomly selected 14,705 participants for the training group, and 4018 participants for the validation group. In the validation group, their areas under the curve (AUC) were all >0.8 (highest being XGboost, 0.87). In the test group, all AUC were also >0.80 (highest being XGboost, 0.88). Among all 9 features (age, gender, race, body mass index, fasting plasma glucose (FPG), glycohemoglobin, triglyceride, total cholesterol and high-density cholesterol), BMI had the highest value of feature importance on IR (0.43 for XGboost and 0.47 for RF algorithms). All participants from the TWB database were separated into the IR group and the non-IR group according to the XGboost algorithm. The Kaplan-Meier survival curve showed a significant difference between the IR and non-IR groups (p < 0.0001 for CV mortality, and p = 0.0006 for all-cause mortality). Therefore, the XGboost model has clear clinical implications for predicting IR, aside from CV and all-cause mortality.

Interpretation

To predict IR in non-diabetic patients with high accuracy, only 9 easily obtained features are needed for prediction accuracy using our machine learning model. Similarly, the model predicts IR patients with significantly higher CV and all-cause mortality. The model can be applied to both Asian and Caucasian populations in clinical practice.

Funding

Taichung Veterans General Hospital, Taiwan and Japan Society for the Promotion of Science KAKENHI Grant Number JP21KK0293.

Association between body mass index and reversion to normoglycemia from impaired fasting glucose among Chinese adults: a 5-year cohort study

Objective

Evidence regarding the relationship between body mass index (BMI) and reversion to normoglycemia from prediabetes is still limited. The purpose of our study is to survey the link of BMI on reversion to normoglycemia among patients with impaired fasting glucose (IFG).

Methods

This study, a retrospective cohort, covered 32 regions and 11 cities in China and collected 258,74 IFG patients who underwent a health check from 2010 to 2016. We investigated the association between baseline BMI and reversion to normoglycemia in patients with IFG using the Cox proportional-hazards regression model. The nonlinear relationship between BMI and reversion to normoglycemia was determined using a Cox proportional hazards regression with cubic spline functions and smooth curve fitting. In addition, we also performed a series of sensitivity analyses and subgroup analyses. A competing risk multivariate Cox regression was performed using progression to diabetes as a competing risk for reversal of normoglycemic events.

Results

After adjusting covariates, the results showed that BMI was negatively related to the probability of reversion to normoglycemia (HR=0.977, 95%CI:0.971-0.984). Compared with participants with normal BMI(<24kg/m²), overweight (BMI:24-28kg/m²) participants with IFG had a 9.9% lower probability of returning to normoglycemia (HR=0.901,95%CI:0.863-0.939), while obese patients (BMI ≥ 28kg/m²) had a 16.9% decreased probability of reverting from IFG to normoglycemia (HR=0.831,95%CI:0.780-0.886). There was also a nonlinear relationship between them, and the inflection point of BMI was 21.7kg/m². The effect sizes (HR) on the left sides of the inflection point were 0.972(95%CI:0.964-0.980). The competing risks multivariate Cox's regression and sensitivity analysis demonstrated the robustness of our results.

Conclusion

This study demonstrates a negative and nonlinear relationship between BMI and reversion to normoglycemia in Chinese patients with IFG. Minimizing BMI to 21.7 kg/m² in patients with IFG through aggressive intervention may significantly increase the probability of returning to normoglycemia.

Significant impact of body mass index on the relationship between increased white blood cell count and new-onset diabetes

An elevated white blood cell (WBC) count has been linked to incident diabetes. WBC count has been positively associated with body mass index (BMI), and elevated BMI has been reported to be a strong predictor of future diabetes. Hence, the association of increased WBC count with the subsequent development of diabetes may be mediated by increased BMI. This study was designed to address this issue. We selected subjects from the 104,451 participants enrolled from 2012 to 2018 in the Taiwan Biobank. We only included those with complete data at baseline and follow-up and those without diabetes at baseline. Finally, 24,514 participants were enrolled in this study. During an average 3.88 years of follow-up, 248 (1.0%) of the participants had new-onset diabetes. After adjusting for demographic, clinical, and biochemical parameters, increased WBC count was associated with new-onset diabetes in all of these participants (p ≤ 0.024). After further adjustment for BMI, the association became insignificant (p = 0.096). In addition, subgroup analysis of 23,430 subjects with a normal WBC count (range: 3500-10500/µl) demonstrated that increased WBC count was significantly associated with new-onset diabetes after adjusting for demographic, clinical, and biochemical parameters (p ≤ 0.016). After further adjustment for BMI, this association was attenuated (p = 0.050). In conclusion, our results showed that BMI had a significant impact on the relationship between increased WBC count and new-onset diabetes in all study participants, and BMI also attenuated the association in those with a normal WBC count. Hence, the association between increased WBC count and the future development of diabetes may be mediated by BMI.

Targeted gene panel analysis of Japanese patients with maturity-onset diabetes of the young-like diabetes mellitus: Roles of inactivating variants in the ABCC8 and insulin resistance genes

AIMS/INTRODUCTION

To investigate the genetic background of Japanese patients with suspected maturity-onset diabetes of the young (MODY).

MATERIALS AND METHODS

On 340 proband patients referred from across Japan, genomic variants were analyzed using a targeted multigene panel analysis combined with the multiplex ligation probe amplification (MLPA) analysis, mitochondrial m.3243A > G analysis and methylation-specific polymerase chain reaction of the imprinted 6q24 locus. Pathogenic/likely pathogenic variants were listed according to the 2015 American College of Medical Genetics and Genomics and the Association for Molecular Pathology criteria. Additionally, variants with a population frequency <0.001 and Combined Annotation Dependent Depletion score >20 (CS >20) were listed as rare variants of uncertain significance-CS >20.

RESULTS

A total of 157 pathogenic/likely pathogenic variants and 44 rare variants of uncertain significance-CS >20 were identified. In the pathogenic/likely pathogenic variants, alterations in the GCK gene were the most common (82, 52.2%) followed by HNF1A (29, 18.5%), HNF4A (13, 8.3%) and HNF1B (13, 8.3%). One patient was a 29.5% mosaic with a truncating INSR variant. In the rare variants of uncertain significance-CS >20, 20 (45.5%) were in the genes coding for the adenosine triphosphate-sensitive potassium channel, KCNJ11 or ABCC8, and four were in the genes of the insulin-signaling pathway, INSR and PIK3R1. Four variants in ABCC8 were previously reported in patients with congenital hyperinsulinism, suggesting the inactivating nature of these variants, and at least two of our patients had a history of congenital hyperinsulinism evolving into diabetes. In two patients with INSR or PIK3R1 variants, insulin resistance was evident at diagnosis.

CONCLUSIONS

Causative genomic variants could be identified in at least 46.2% of clinically suspected MODY patients. ABCC8-MODY with inactivating variants could represent a distinct category of MODY. Genes of insulin resistance should be included in the sequencing panel for MODY.

Significance of pancreatic duodenal homeobox-1 (PDX-1) genetic polymorphism in insulin secretion in Japanese patients with type 2 diabetes

INTRODUCTION

Pancreatic and duodenal homeobox factor-1 (PDX-1) is an imperative gene for insulin secretion in maturity-onset diabetes of the young 4. PDX-1 gene polymorphism was associated with lower first-phase insulin secretion in a genome-wide association study of intravenous glucose tolerance test. It was not associated with type 2 diabetes risk and insulin secretion in a genome-wide oral glucose tolerance test study. However, there have been no reports of overt type 2 diabetes and insulin resistance evaluation using a glucose clamp. We investigated PDX-1 polymorphism, insulin secretion, and insulin resistance in overt type 2 diabetes.

RESEARCH DESIGN AND METHODS

We performed a meal tolerance test (MTT) and hyperinsulinemic-euglycemic clamping on 63 Japanese subjects, 30 with type 2 diabetes and 33 non-diabetic. We analyzed the rs1124607 PDX-1 gene polymorphism and defined A/C and C/C as the high-risk group and A/A as the low-risk group.

RESULTS

HOMA-beta (homeostatic model assessment beta-cell function) was significantly lower in the high-risk group than in the low-risk group for all subjects (72.9±54.2% vs 107.0±63.5%, p<0.05). Glucose levels and glucose area under the curve (AUC) were not significantly different between both the risk groups. The insulin levels at 60 and 120 min and the insulin AUC after MTT were remarkably lower in the high-risk group than those in the low-risk group for all subjects (AUC 75.7±36.7 vs 112.7±59.5, p<0.05). High-risk subjects with type 2 diabetes had significantly lower insulin levels at 30 and 60 min and insulin AUC than low-risk subjects. Non-diabetic high-risk subjects depicted significantly lower insulin levels at 120 and 180 min. There were negligible differences in insulin resistance between the risk groups.

CONCLUSIONS

These results suggest that the PDX-1 genetic polymorphism is crucial for insulin secretion in Japanese patients with type 2 diabetes.

Dipeptidyl peptidase 4 inhibitor improves insulin resistance in Japanese patients with type 2 diabetes: a single-arm study, a brief report

BACKGROUND

Dipeptidyl peptidase 4 inhibitor (DPP4i) is an effective medicine for type 2 diabetes mellitus (T2DM). Some articles reported DPP4i improves insulin secretion and insulin resistance. However, these effects are not well established by glucose clamp test and test meal in Japanese. We investigated the effect of DPP4i on insulin resistance and insulin secretion by using the glucose clamp test and meal tolerance test (MTT).

METHODS

We performed a MTT, and the hyperinsulinemic-euglycemic clamp in 8 Japanese patients with T2DM. This study was a single-arm study. We measured fasting and postprandial glucose, insulin, incretins, and glucagon levels. We also measured serum adiponectin levels.

RESULTS

HbA1c was significantly decreased after 3 months. The fasting and postprandial glucose levels were significantly decreased. Fasting and postprandial insulin levels were not changed. The insulin resistance derived from the glucose clamp test was significantly improved. HOMA-IR was not significantly changed. GLP-1 and GIP were significantly increased but glucagon did not change. Adiponectin was not significantly changed.

CONCLUSIONS

Although the number of patients was very small, these results suggested that DPP4i treatment might improve insulin resistance without changing insulin secretion.

Higher scores of dietary and lifestyle inflammatory indices are associated with increased risk of insulin-related disorders in Iranian adults

BACKGROUND/OBJECTIVES

The roles of potential inflammation of diet and lifestyle in the risk of insulin-related disorders are unclear. In the current study, we aimed to assess the relationship between dietary inflammation scores (DIS), lifestyle inflammation scores (LIS), and dietary and lifestyle inflammation score (DLIS) and the risk of insulin resistance (IR) and hyperinsulinemia in Tehranian adults.

SUBJECTS/METHODS

A total of 1,244 participants, aged ≥20 years, who were free of insulin-related disorders at baseline (2006-08), were followed for 3.2 years (2009-11) to ascertain the incidence of hyperinsulinemia and IR. A food frequency questionnaire was used to determine the score of DIS, LIS, and DLIS at baseline. Logistic regression models were used to determine the odds ratio (ORs) of insulin-related disorders across tertiles of DIS, LIS, and DLIS.

RESULTS

Mean ± SD age of participants (42.7% men) was 43.0 ± 13.0 years. During the 3.2 years follow-up, the incidence of IR and hyperinsulinemia was 30.0% and 20.0%, respectively. In the multivariable model, there was a direct association between the higher score of DLIS (OR = 2.10; 95% CI: 1.17-3.74) and DIS (OR = 1.84; 95% CI: 1.09-3.11) with the risk of IR incident (P for trend <0.05). Also, the higher score of LIS was related to increased risk of IR (OR = 2.28; 95% CI: 1.19-4.37) and hyperinsulinemia (OR = 1.69; 95% CI: 1.02-2.85) (P for trend <0.05). However, no significant association was observed between the higher score of DLIS and DIS with risk of hyperinsulinemia CONCLUSION: The higher inflammatory potential of diet and lifestyle, determined by DLIS, DIS, and LIS scores, were associated with a higher risk of IR. Also, individuals with a higher score of LIS are more prone to hyperinsulinemia risk.

Construction of a Personalized Insulin Resistance Risk Assessment Tool in Xinjiang Kazakhs Based on Lipid- and Obesity-Related Indices

Purpose

This study aimed to explore the relationship between obesity- and lipid-related indices and insulin resistance (IR) and construct a personalized IR risk model for Xinjiang Kazakhs based on representative indices.

Methods

This cross-sectional study was performed from 2010 to 2012. A total of 2170 Kazakhs from Xinyuan County were selected as research subjects. IR was estimated using the homeostasis model assessment of insulin resistance. Multivariable logistic regression analysis, least absolute shrinkage and selection operator penalized regression analysis, and restricted cubic spline were applied to evaluate the association between lipid- and obesity-related indices and IR. The risk model was developed based on selected representative variables and presented using a nomogram. The model performance was assessed using the area under the ROC curve (AUC), the Hosmer–Lemeshow goodness-of-fit test, and decision curve analysis (DCA).

Results

After screening out 25 of the variables, the final risk model included four independent risk factors: smoking, sex, triglyceride-glucose (TyG) index, and body mass index (BMI). A linear dose–response relationship was observed for the BMI and TyG indices against IR risk. The AUC of the risk model was 0.720 based on an independent test and 0.716 based on a 10-fold cross-validation. Calibration curves showed good consistency between actual and predicted IR risks. The DCA demonstrated that the risk model was clinically effective.

Conclusion

The TyG index and BMI had the strongest association with IR among all obesity- and lipid-related indices, and the developed model was useful for predicting IR risk among Kazakh individuals.

Causal relationship of excess body weight on cardiovascular events through risk factors

Excess body weight is associated with cardiovascular events (CVEs) and premature death. This study aimed to find the causal pathways between excess body weight and CVEs through risk factors in a general adult population. A total of 7921 employees of the Electricity Generating Authority of Thailand were enrolled during 1997-2009. Baseline characteristics and blood test results were collected. A body mass index (BMI) ≥ 23 kg/m², using WHO criteria for Asians was defined as excess body weight. A mediation analysis was applied to assess potential causal pathways. BMI ≥ 23 kg/m² was considered as an independent variable, whereas diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD) were considered as mediators, and CVEs (i.e., fatal and non-fatal coronary artery disease or stroke) were considered as the outcomes. The prevalence of BMI ≥ 23 kg/m², DM, HT, and CKD were 62.7%, 7.8%, 28.1% and 11.8% respectively. During an average of 17.2 ± 5.5 years follow-up, subjects with BMI ≥ 23 kg/m² compared with those with lower BMIs more frequently developed CVEs (9.4 vs 6.2%, P < 0.001). The effects of BMI ≥ 23 kg/m² on CVEs were mediated indirectly through DM and HT with significant ORs of 1.61 (1.34, 2.09) and 1.57 (1.39, 1.80), respectively. The indirect effect of CKD on CVEs was significantly increased if mediated through DM → HT or HT [ORs of 1.17 (1.09, 1.32) and 1.20 (1.10, 1.32), respectively]. Subjects with excess body weight were prone to develop CVEs which were mediated indirectly through DM and HT. The effect of CKD on CVEs was small but enhanced if it occurred as a complication of DM or HT.

The sodium-glucose cotransporter 2 inhibitor ipragliflozin improves liver function and insulin resistance in Japanese patients with type 2 diabetes

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) treatment is a therapeutic approach for type 2 diabetes mellitus (T2DM). Some reports have shown that SGLT2i treatment improves insulin resistance; however, few studies have evaluated insulin resistance by the glucose clamp method. Hepatic insulin clearance (HIC) is a new pathophysiological mechanism of T2DM. The effect of SGLT2i treatment on hepatic insulin clearance and insulin resistance is not well known. We investigated the effect of SGLT2i treatment on insulin resistance, insulin secretion, incretin levels, body composition, and hepatic insulin clearance. We conducted a meal tolerance test (MTT) and a hyperinsulinemic-euglycemic clamp test in 9 T2DM patients. Ipragliflozin (50 mg/day) was administered, and the MTT and clamp test were performed after 4 months. We calculated HIC as the postprandial C-peptide AUC-to-insulin AUC ratio. We also measured GLP-1, GIP, and glucagon levels during the MTT. Body weight and HbA1c were decreased, although not significantly, after 4 months of treatment. Postprandial glucose, fasting insulin and postprandial insulin were significantly decreased. Insulin resistance with the glucose clamp was not changed, but the HOMA-IR and insulin sensitivity indices were significantly improved. Incretin and glucagon levels were not changed. Hepatic insulin clearance was significantly increased, but whole-body insulin clearance was not changed. The FIB-4 index and fatty liver index were significantly reduced. The HOMA-beta and insulinogenic indices were not changed, but the C-peptide index was significantly increased. Although the number of patients was small, these results suggested that SGLT2i treatment improved liver function, decreased hepatic insulin resistance, and increased hepatic insulin clearance, despite the small weight reduction.

Implementation of five machine learning methods to predict the 52-week blood glucose level in patients with type 2 diabetes

OBJECTIVE

For the patients who are suffering from type 2 diabetes, blood glucose level could be affected by multiple factors. An accurate estimation of the trajectory of blood glucose is crucial in clinical decision making. Frequent glucose measurement serves as a good source of data to train machine learning models for prediction purposes. This study aimed at using machine learning methods to predict blood glucose for type 2 diabetic patients. We investigated various parameters influencing blood glucose, as well as determined the most effective machine learning algorithm in predicting blood glucose.

PATIENTS AND METHODS

273 patients were recruited in this research. Several parameters such as age, diet, family history, BMI, alcohol intake, smoking status et al were analyzed. Patients who had glycosylated hemoglobin less than 6.5% after 52 weeks were considered as having achieved glycemic control and the rest as not achieving it. Five machine learning methods (KNN algorithm, logistic regression algorithm, random forest algorithm, support vector machine, and XGBoost algorithm) were compared to evaluate their performances in prediction accuracy. R 3.6.3 and Python 3.12 were used in data analysis.

RESULTS

The statistical variables for which p< 0.05 was obtained were BMI, pulse, Na, Cl, AKP. Compared with the other four algorithms, XGBoost algorithm has the highest accuracy (Accuracy=99.54% in training set and 78.18% in testing set) and AUC values (1.0 in training set and 0.68 in testing set), thus it is recommended to be used for prediction in clinical practice.

CONCLUSION

When it comes to future blood glucose level prediction using machine learning methods, XGBoost algorithm scores the highest in effectiveness. This algorithm could be applied to assist clinical decision making, as well as guide the lifestyle of diabetic patients, in pursuit of minimizing risks of hyperglycemic or hypoglycemic events.

The relationship between the level of exercise and hemoglobin A1c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

PURPOSE

The aim of the study was to evaluate the relationship between changes in hemoglobin A1c (HbA1c) and exercise levels in type 2 diabetes mellitus (T2DM) patients when performing various types of exercise.

METHODS

The inclusion criteria were randomized controlled trials involving adults with T2DM, intervention involving exercise alone, the overall duration of intervention ≥12 weeks, and reporting HbA1c. Weighted mean difference (WMD) was defined as the mean difference between the intervention group and the control group weighted by the inverse of the squared standard error for each study, and all WMDs were pooled as overall effects. A meta-regression analysis was performed to evaluate the relationship between the exercise level and the WMD in HbA1c.

RESULTS

Forty-eight studies (2395 subjects) were analyzed. The pooled WMD in HbA1c decreased significantly (-0.5% [95% confidence intervals: -0.6 to -0.4]) but contained significant heterogeneity (Q = 103.8, P < 0.01; I2 = 36.6%). A meta-regression analysis showed that the intensity (metabolic equivalents [METs]), time (min/session), or frequency (sessions/week) of the exercise was not associated with the HbA1c. However, the overall duration of exercise (weeks) was significantly associated with the WMD in HbA1c (meta-regression coefficient: 0.01 [95% confidence intervals: 0.002-0.016]; R2 = 70.0%), and that result did not contain significant heterogeneity (P > 0.05; I2 = 14.7%).

CONCLUSIONS

The exercise intervention decreases HbA1c in T2DM patients. In addition, exercise for an extended duration was associated with an increase in HbA1c, so the effects of exercise may be evident early on, but results suggested that exercise for a prolonged period alone may increase HbA1c.

Non-Invasive radial pressure wave analysis may digitally predict women's risks of type 2 diabetes (T2DM): A case and control group study

Background

Women not only have worse diabetes complications, but also have menstrual cycle, pregnancy, and menopause which can make managing diabetes more difficult. The aim of this study was to investigate if radial pressure wave analysis may non-invasively screen for women’s risk of type 2 diabetes.

Methods

Spectrum analysis of the radial pressure wave was performed to evaluate the first five harmonic components, C1 to C5. The study consisted of a total of 808 non-pregnant female subjects aged 20–95 over the period of 4 years, and 404 of them were diagnosed with Type 2 diabetes as the case group.

Result

The first five harmonic components are significantly different in a comparison of the case group and the control group. In the logistic regression analysis, T2DM was found to be associated with C1 (OR = 1.055, CI = 1.037–1.074, p < 0.001), C2 (OR = 1.051, CI = 1.019–1.085, p = 0.002), and C3 (OR = 0.972, CI = 0.950–0.994, p = 0.013). In the Receiver Operating Characteristic curve analysis, the Area Under Curve of using C3 only (70%, p <0.05), weighted C1, C2 and C3, (75%, p < 0.05), and weighted C1, C2 and C3 and Body mass Index (84%, p <0.05) were tested for the accuracy on how well these tests separate the women into the groups with and without the T2DM.

Conclusion

We thus concluded that pulse spectrum was a non-invasive predictor for women’s risk of T2DM.

Associations of insulin resistance, sex hormone-binding globulin, triglyceride, and hormonal profiles in polycystic ovary syndrome: A cross-sectional study

Background

Insulin resistance (IR) occurs in 50–70% of women with polycystic ovary syndrome (PCOS) and can be applied as a prediabetic feature in PCOS.

Objective

In this study, indirect methods including fasting blood sugar (FBS), fasting insulin (FI), FBS/FI ratio, and quantitative insulin sensitivity check index (QUICKI) were compared with the homeostasis model assessment of insulin resistance (HOMA-IR) as a standard technique. The association of IR to sex hormone-binding globulin (SHBG) and several hormones was also analyzed.

Materials and Methods

This cross-sectional study was performed on 74 PCOS women. Sensitivity and specificity of each IR method was calculated based on HOMA-IR. Hormonal profiles of the patients were compared between the groups with defined normal and abnormal values of IR.

Results

Triglyceride levels had a positive association with FBS and HOMA-IR (p = 0.002 and p = 0.01, respectively) with a negative association to QUICKI and SHBG (p = 0.02 and p = 0.02, respectively). SHBG showed a significant negative association with FBS (p = 0.001). Dehydroepiandrosterone sulfate showed a positive association with FI (p = 0.002). Seven PCOS women showed abnormal SHBG levels (< 36 nmol/L) while expressed normal values of the rest of the studied variables. FI and QUICKI had the highest sensitivity while FBS/FI and QUICKI had the highest specificity when HOMA-IR was applied as a standard test.

Conclusion

SHBG and triglyceride had a significant negative and positive association with IR, respectively. HOMA-IR followed by FI and QUICKI is the most sensitive test for the detection of IR. SHBG levels can be a helpful biomarker for the diagnosis of PCOS.

Dietary and lifestyle inflammatory scores and risk of incident diabetes: a prospective cohort among participants of Tehran lipid and glucose study

Background

Inflammation is a precursor of chronic disease, which is affected by lifestyle and dietary habits. Recently empirical dietary inflammatory patterns (EDIP), dietary inflammation scores (DIS), and lifestyle inflammation scores (LIS) were developed to indicate lifestyle and dietary contributions in systemic inflammation. The current study aimed to investigate the associations between these indices and the incidence of diabetes among Tehranian adults.

Methods

A total of 4624 individuals, aged 20–75 years, who were free of diabetes at baseline (2008–2011), were followed for 5.71 years (2014–2017) to ascertain incident diabetes. Dietary intakes were collected at baseline using the food frequency questionnaire. The hazard ratio (HR) of diabetes was calculated by Cox proportional hazards regression across quartiles of EDIP, DIS, and LIS, adjusted for potential confounders.

Results

The mean ± SD for the age and BMI of the study population (45.1% male) were 40.8 ± 12.7 years and 27.1 ± 4.1 Kg.m2, respectively. At the end of the follow-up, 329 (7.1%) diabetes cases were identified. In the multivariable-adjusted model, individuals in the highest compared to the lowest quartile of EDIP (HR = 0.83; 95%CI:0.59–1.15, p for trend = 0.286), and LIS (HR = 2.41; 95%CI:1.61–3.60, P for trend < 0.001) had increased risk of diabetes. However, no significant associations were found between the score of DIS and diabetes incidents (HR = 0.83; 95%CI:0.59–1.15, p for trend = 0.286).

Conclusion

Greater adherence to EDIP and LIS scores was associated with a higher risk of diabetes, while no significant association was found between the DIS score and diabetes incident.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11327-1.

Long-term (52-week) efficacy and safety of dapagliflozin as an adjunct to insulin therapy in Japanese patients with type 1 diabetes: Subgroup analysis of the DEPICT-2 study

AIM

To examine the long-term efficacy and safety of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor used to treat type 1 diabetes, in the Japanese subpopulation of the DEPICT-2 study.

MATERIALS AND METHODS

Patients with type 1 diabetes were randomized to dapagliflozin 5 mg (n = 55), dapagliflozin 10 mg (n = 41) or placebo (n = 58) plus insulin for a 24-week, double-blind period followed by a 28-week, single-blind extension phase.

RESULTS

From baseline to 24 weeks, dapagliflozin reduced HbA1c compared with placebo (mean change of -0.58% and -0.80% for 5 and 10 mg, respectively), and an HbA1c reduction was observed up to 52 weeks. Compared with placebo, dapagliflozin 5 and 10 mg increased the proportion of patients achieving HbA1c reductions of 0.5% or more without severe hypoglycaemia events and reduced glycaemic variability assessed via continuous glucose monitoring. Both dapagliflozin doses decreased body weight and total daily insulin dose at 24 weeks compared with placebo; these reductions were maintained up to 52 weeks. Diabetic ketoacidosis occurred in both dapagliflozin groups (one and two cases, respectively) but not with placebo.

CONCLUSIONS

Efficacy and safety results from the Japanese subpopulation of the DEPICT-2 study were generally consistent with those from the overall population, indicating that long-term dapagliflozin adjunct to insulin therapy improves glycaemic control without an increased risk of hypoglycaemia but with a risk of diabetic ketoacidosis in Japanese patients with type 1 diabetes.

The association of insulinemic potential of diet and lifestyle with the risk of insulin-related disorders: a prospective cohort study among participants of Tehran Lipid and Glucose Study

BACKGROUND

We aim to assess the association of empirical dietary (EDIH) and lifestyle (ELIH) index for hyperinsulinemia with the risk of insulin resistance, hyperinsulinemia, insulin sensitivity, and β-cell dysfunction in Iranian adults.

METHODS

In this prospective study, a total of 1244 men and women aged ≥ 20 years were selected among participants of the Tehran lipid and glucose study and followed for 3.2 years. Dietary intakes were assessed using a valid semi-quantitative food frequency questionnaire. Dietary and lifestyle insulinemic potential indices were calculated using dietary intake, body mass index, and physical activity information. Multivariable logistic regression was used to estimate the associated risk of a 3-year incidence of insulin-related disorders.

RESULTS

The mean ± SD age and BMI of all eligible participants (42.7% males) were 43.0 ± 13.0 and 27.4 ± 4.9 in the study's baseline. After adjusting for all potential confounders, participants in the highest tertile of ELIH score had a greater risk of developing hyperinsulinemia (OR:2.42, 95%CI:1.52-3.86, P for trend =  < 0.001), insulin resistance (OR:2.71, 95%CI:1.75-4.18, P for trend =  < 0.001) and insulin insensitivity (OR:2.65, 95%CI: 1.72-4.10, P for trend =  < 0.001) compared with those in the lowest tertile. However, the risk of incident β-cell dysfunction was lower in individuals with a higher score of ELIH in comparison to those with the lowest score (OR:0.30, 95%CI:0.19-0.45, P for trend =  < 0.001).

CONCLUSIONS

Empirical lifestyle index for hyperinsulinemia was directly associated with insulin resistance, insulin insensitivity, and hyperinsulinemia and was inversely associated with β-cells dysfunction.

Excessive Intake of High-Fructose Corn Syrup Drinks Induces Impaired Glucose Tolerance

The number of patients with diabetes was approximately 463 million worldwide in 2019, with almost 57.6% of this population concentrated in Asia. Asians often develop type 2 diabetes (T2D), even if they are underweight and consume a smaller amount of food. Soft drinks contain large amounts of sweeteners, such as high-fructose corn syrup (HFCS). Excessive intake of HFCS drinks is considered to be one of the causes of T2D. In the present study, we investigated the effect of excessive consumption of HFCS-water on glucose tolerance and obesity under conditions of controlled caloric intake using a mouse model. Three-week-old male ICR mice were divided into two groups and given free access to 10% HFCS-water or deionized water. The caloric intake was adjusted to be the same in both groups using a standard rodent diet. The excess HFCS-water intake did not lead to obesity, but led to impaired glucose tolerance (IGT) due to insulin-secretion defect. It affected glucose and fructose metabolism; for example, it decreased the expression of glucokinases, ketohexokinase, and glucose transporter 2 in the pancreas. These results suggest that excessive consumption of HFCS drinks, such as soft drinks, without a proper diet, induces nonobese IGT due to insulin-secretion defect.

Dietary and lifestyle inflammatory scores are associated with increased risk of metabolic syndrome in Iranian adults

BACKGROUND

In the current study, we aimed to investigate the association of dietary inflammation scores (DIS) and lifestyle inflammation scores (LIS) with the risk of metabolic syndrome (MetS) in a prospective population-based study.

METHODS

A total of 1625 participants without MetS were recruited from among participants of the Tehran Lipid and Glucose Study(2006-2008) and followed a mean of 6.1 years. Dietary data of subjects were collected using a food frequency questionnaire at baseline to determine LIS and DIS. Multivariable logistic regression models, were used to calculate the odds ratio (ORs) and 95 % confidence interval (CI) of MetS across tertiles of DIS and LIS.

RESULTS

Mean ± SD age of individuals (45.8 % men) was 37.5 ± 13.4 years. Median (25-75 interquartile range) DIS and LIS for all participants was 0.80 (- 2.94, 3.64) and 0.48 (- 0.18, - 0.89), respectively. During the study follow-up, 291 (17.9 %) new cases of MetS were identified. Based on the age and sex-adjusted model, a positive association was found between LIS (OR = 7.56; 95% CI 5.10-11.22, P for trend < 0.001) and risk of MetS, however, the association of DIS and risk of MetS development was not statistically significant (OR = 1.30;95% CI 0.93-1.80, P for trend = 0.127). In the multivariable model, after adjustment for confounding variables, including age, sex, body mass index, physical activity, smoking, and energy intake, the risk of MetS is increased across tertiles of DIS (OR = 1.59; 95% CI 1.09-2.33, P for trend = 0.015) and LIS(OR = 8.38; 95% CI 5.51-12.7, P for trend < 0.001).

CONCLUSIONS

The findings of the current study showed that greater adherence to LIS and DIS, determined to indicate the inflammatory potential of diet and lifestyle, are associated with increased the risk of MetS.

Sex differences in the association between fatty liver and type 2 diabetes incidence in non-obese Japanese: A retrospective cohort study

Aims/Introduction

Asians develop type 2 diabetes at a lower body mass index (BMI) compared with other races, which is partly because of Asian‐specific fat depots. Sex plays a role in fat deposition, regardless of race. This retrospective cohort study aimed to investigate the association among fatty liver, sex and type 2 diabetes in non‐obese Japanese.

Materials and Methods

The participants in this study (13,596 men and 6,037 women) were aged 30–64 years, and had undergone health checkups between 2013 and 2015, in Aichi, Japan. Baseline BMI was categorized as follows: <18.5, 18.5–19.9, 20–22.9, 23–24.9, 25–27.4 and ≥27.5 kg/m². Fatty liver was diagnosed by abdominal ultrasonography. The joint effect of BMI and fatty liver on the incidence of type 2 diabetes was assessed, stratified by sex.

Results

During follow up, 738 men and 138 women developed type 2 diabetes. Compared with the BMI of 20–22.9 kg/m² without fatty liver group, the BMI of 20–22.9 kg/m² with fatty liver was associated with a higher risk of type 2 diabetes in men, but not in women. Furthermore, men with a BMI of 23–24.9 and 25–27.4 kg/m² without fatty liver had no significant type 2 diabetes risk, whereas women with a BMI of 23–24.9 and 25–27.4 kg/m², regardless of fatty liver, had an increased risk.

Conclusions

These results suggest the association between fatty liver and type 2 diabetes in non‐obese Asians is different by sex; fatty liver increases diabetes risk among male, not female, non‐obese Asians.

The Relationship between Body Mass Index and Incident Diabetes Mellitus in Chinese Aged Population: A Cohort Study

OBJECTIVES

Previous studies reported that overweight older adults had a lower mortality after cardiovascular diseases attack, indicating being thinner might not always be better. However, there is an ongoing debate about what is the optimal range of body mass index (BMI) for the aged population. We aimed to evaluate the value of BMI for the prediction of incident diabetes mellitus (DM) in the Chinese elderly population.

METHODS

A total number of 6,911 Chinese elderly people (4,110 men and 2,801 women, aged 71 ± 6.0 years) were included in this cohort study. BMI was measured at baseline (Jan 1, 2014, to Dec 31, 2014). All the participants were further classified into six groups: <18.5 kg/m², 18.5 to <22.5 kg/m², 22.5 to <25.0 kg/m², 25.0 to <27.5 kg/m², 27.5 to <30.0 kg/m², and ≥30.0 kg/m². Fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) were annually measured during follow-up (Jan 1, 2015-May 31, 2019). DM was confirmed if either FBG ≥ 7.0 mmol/L or HbA1c ≥ 6.5%. We used the Cox proportional hazard regression model to evaluate the association between BMI and the prediction of incident DM.

RESULTS

Comparing individuals with a BMI range of 18.5 to <22.5 kg/m² (reference), the hazard ratio for incident DM was 2.13 (95% CI: 1.54~2.95), 2.14 (95% CI: 1.53~3.00), 3.17 (95% CI: 2.19~4.59), 3.15 (95% CI: 1.94~5.09), and 3.14 (95% CI: 1.94~5.09) for the group with a BMI range of 22.5 to <25.0 kg/m², 25.0 to <27.5 kg/m², 27.5 to <30.0 kg/m², and ≥30.0 kg/m² after adjusting for baseline age, sex, blood pressure, lipid profiles, and eGFR (P trend < 0.001), after adjusting for the abovementioned confounders. The association tended to be closer in men and young participants, compared with their counterparts.

CONCLUSIONS

High BMI was associated with a high risk of developing DM in the Chinese aged population. Thus, it is optimal for the aged population to maintain their body weight within a reasonable range to prevent chronic diseases.

Mild obesity does not affect the forearm muscle microvascular responses to hyperglycemia

INTRODUCTION

Mild obesity has been associated with postprandial brachial artery vascular dysfunction. However, direct assessment of these effects within the forearm skeletal muscle microcirculation remains unclear. Thus, this study aimed to investigate the effects of mild obesity on the arm micro- and macrovascular responses to glucose ingestion.

METHODS

This cross-sectional study combined NIRS assessments of forearm skeletal muscle (FDS) reactivity (reperfusion slope) with %FMD of conduit artery function (brachial artery) before (Pre), as well as 60 and 120 min after glucose ingestion in 10 lean (BMI 23.9 ± 1.8) and 10 obese (BMI 32.9 ± 1.9) individuals.

RESULTS

Both groups showed a significant increase in the reperfusion slope at 60 and 120 min after glucose ingestion compared with the pre-glucose ingestion measurements. Obese individuals showed a significant (p < .05) reduction in %FMD at 60 min after glucose ingestion, while no significant changes in postprandial %FMD were observed in lean participants.

CONCLUSION

Even though obese individuals showed impaired postprandial brachial artery function, the current findings suggest that mild obesity does not affect the forearm skeletal muscle responses to glucose ingestion.

Genetic predisposition in type 2 diabetes: A promising approach toward a personalized management of diabetes

Diabetes mellitus, also known simply as diabetes, has been described as a chronic and complex endocrine metabolic disorder that is a leading cause of death across the globe. It is considered a key public health problem worldwide and one of four important non-communicable diseases prioritized for intervention through world health campaigns by various international foundations. Among its four categories, Type 2 diabetes (T2D) is the commonest form of diabetes accounting for over 90% of worldwide cases. Unlike monogenic inherited disorders that are passed on in a simple pattern, T2D is a multifactorial disease with a complex etiology, where a mixture of genetic and environmental factors are strong candidates for the development of the clinical condition and pathology. The genetic factors are believed to be key predisposing determinants in individual susceptibility to T2D. Therefore, identifying the predisposing genetic variants could be a crucial step in T2D management as it may ameliorate the clinical condition and preclude complications. Through an understanding the unique genetic and environmental factors that influence the development of this chronic disease individuals can benefit from personalized approaches to treatment. We searched the literature published in three electronic databases: PubMed, Scopus and ISI Web of Science for the current status of T2D and its associated genetic risk variants and discus promising approaches toward a personalized management of this chronic, non-communicable disorder.

Acute and chronic diabetes complications associated with self-reported oral health: a retrospective cohort study

BACKGROUND

Oral health is associated with diabetes, but the chances of experiencing acute or chronic diabetes complications as per this association is unknown in Canada's most populous province, Ontario. This study assesses the impact of self-reported oral health on the likelihood of experiencing acute and chronic complications among a cohort of previously diagnosed diabetics.

METHODS

A retrospective cohort study was conducted of diabetics (n = 5183) who participated in the Canadian Community Health Survey 2003 and 2007-08. Self-reported oral health status was linked to health encounters in electronic medical records until March 31, 2016. Multinomial regression models determined the odds of the first acute or chronic complication after self-report of oral health status.

RESULTS

Thirty-eight percent of diabetics reporting "poor to fair" oral health experienced a diabetes complication, in comparison to 34% of those reporting "good to excellent" oral health. The odds of an acute or chronic complication among participants reporting "poor to fair" oral health status was 10% (OR 1.10; 95% CI 0.81, 1.51) and 34% (OR 1.34; 95% CI 1.11, 1.61) greater respectively, than among participants experiencing no complications and reporting "good to excellent" oral health.

CONCLUSION

Self-reporting "poor to fair" oral health status is associated with a greater likelihood of chronic complications than acute complications. Further research regarding the underlying causal mechanisms linking oral health and diabetes complications is needed.

Type 2 Diabetes Remission and Substantial Body Weight Reduction Achieved with Metformin and a Sodium-Glucose Cotransporter 2 Inhibitor

The overall goal in the treatment of type 2 diabetes mellitus (T2DM) is remission. However, the effects of a sodium-glucose cotransporter 2 inhibitor (SGLT2i) on remission of T2DM are unknown. We herein report a case involving an overweight 43-year-old man who completely recovered from T2DM after SGLT2i therapy (dapagliflozin at 5 mg/day). In the pretreatment period, he had a body mass index (BMI) of 26.0 kg/m², hemoglobin A1c (HbA1c) concentration of 10.3%, advanced insulin resistance, pancreatic β-cell dysfunction, and fatty liver. Eighteen months after comprehensive therapy, including the administration of an SGLT2i and metformin, his BMI had decreased to 21.3 kg/m² and his glycemic control was almost normal (HbA1c of 5.3%) despite discontinuation of all hypoglycemic medications. This report is the first to propose the usefulness of the combination therapy of SGLT2i and metformin for achieving normal body weight and remission of newly diagnosed T2DM in a real-world clinical situation.