Correct homeostasis model assessment (HOMA) evaluation uses the computer program

Effect of prehabilitation on cardiopulmonary fitness and insulin sensitivity before pancreatic surgery

BACKGROUND

Pancreatic surgery is associated with significant morbidity. Cardiopulmonary fitness can predict postoperative outcomes. Similarly, poor insulin sensitivity is associated with postoperative complications. Supervised exercise training can improve cardiorespiratory fitness and insulin sensitivity. Immunonutrition may work synergistically with exercise. The study aimed to assess the impact of a 4-week multimodal prehabilitation programme on cardiopulmonary fitness and insulin sensitivity in patients awaiting pancreatic surgery, compared to a control group receiving standard postoperative care.

METHODS

In this prospective, non-randomised pilot study, we recruited patients with benign or malignant pathology, listed for pancreatic resection. Subjects underwent a baseline cardiopulmonary exercise test. We measured insulin sensitivity using the gold standard technique, the hyperinsulinaemic-euglycaemic clamp. The 4-week intervention comprised: resistance and high intensity interval training (ten sessions) plus daily omega-3 fatty supplements (2g) and extra virgin olive oil (30 ml). Cardiopulmonary exercise tests and clamps were repeated after four weeks. These were compared with contemporaneous non-randomised controls.

RESULTS

Of 21 recruited patients, 12 out of 12 (prehabilitation) and 6 out of 9 (control) completed the study. Prehabilitation led to an improvement in oxygen uptake at anaerobic threshold (+2.0 (95 per cent CI 0.1 to 4.0) ml kg-1 min-1) and peak exercise (+3.0 (95 per cent CI 0.7 to 5.3) ml kg-1 min-1), compared to controls. Within the prehabilitation group, there were significant improvements in peak power (P = 0.001), oxygen uptake at anaerobic threshold (P = 0.017) and peak exercise (P = 0.002). Cardiopulmonary fitness parameters were unchanged amongst controls. Insulin sensitivity did not change in either group.

CONCLUSION

Prehabilitation resulted in a significant improvement in cardiopulmonary fitness, before pancreatic surgery. The potential benefits of improved cardiopulmonary fitness must be balanced against the oncological and metabolic consequences of delay.

Evaluating indices of insulin resistance and estimating the prevalence of insulin resistance in a large biobank cohort

Introduction

Insulin resistance (IR) is involved in the pathogenesis of various metabolic disorders. Several surrogate indices of IR have been proposed. We assessed the performance of seven clinically relevant indirect measures of IR and estimated the prevalence of IR in a large population-based cohort.

Methods

The study was conducted on fasting individuals from the Qatar biobank (QBB) participants (n = 7,875). Individuals were considered insulin sensitive (IS) if lean, not diagnosed with diabetes, no hypertriglyceridemia, and not on lipid-lowering drugs, while individuals with Type 2 diabetes (T2D) were considered insulin resistant (IR). Cut-offs were determined as the top or lowest quartile values in the IS participants. The performance of IR indices was based on area under the curve (AUC), sensitivity and specificity.

Results

The cut-off for HOMA-IR was determined at 1.878, HOMA2-IR (insulin); 1.128, HOMA2-IR (C-peptide); 1.307, QUICKI; 0.347, TyG; 8.281, McAi; 7.727 and 1.718 for TG/HDL. All IR indices analyzed yielded AUC values ranging from 0.83 to 0.92. TyG was the most robust measure for IR (AUC = 0.92, Sensitivity = 0.90, Specificity = 0.79). The overall prevalence of IR in Qatar was estimated at ~51 - 65%.

Conclusions

TyG index was the most robust index for determining IR in the Qatari population. The proposed cut-offs could serve as a reference in Middle Eastern populations for IR screening.

One-carbon metabolism, insulin resistance, and fecundability in a Singapore prospective preconception cohort study

BACKGROUND

One-carbon metabolism, which consists of the folate cycle, methionine cycle, and trans-sulphuration pathway, is associated with nucleotide synthesis. However, the association between one-carbon metabolites, metabolic status, and reproductive health remains poorly understood.

OBJECTIVES

We examined the association between the one-carbon cycle plasma metabolites and fecundability and determined whether it is modified by metabolic health status, as assessed by insulin resistance (IR).

METHODS

This prospective cohort study utilized data from the Singapore PREconception Study of long-Term maternal and child Outcomes. Fasting blood samples were collected, and one-carbon cycle metabolites were measured. Fecundability was measured by time to pregnancy in menstrual cycles within a year of enrollment. We identified patterns in plasma one-carbon cycle metabolites using principal component (PC) analysis. We estimated fecundability ratios (FRs) and confidence intervals (CIs), with confounder adjustment using discrete-time proportional hazards models. IR was determined using the Homeostatic Model Assessment 2 Insulin Resistance score, classified into lower IR (<0.65) and higher IR (≥0.65). The role of IR was examined through interaction tests and stratification.

RESULTS

We identified 3 one-carbon cycle PCs. PC1, characterized by higher folate and lower homocysteine concentrations; PC2, characterized by higher concentrations of dimethylglycine, choline, methionine, and betaine; and PC3, characterized by higher concentrations of vitamins B2, B12, and B6. Each z-score increase in PC1 was associated with a 17% increase in fecundability (FR: 1.17; 95% CI: 1.03, 1.33). The association between PC1 and fecundability was more evident in women with lower IR (FR: 1.30; 95% CI: 1.08, 1.57) but was attenuated in those with higher IR (FR: 1.09; 95% CI: 0.92, 1.30), with a P-for-interaction of 0.127. PC2 and PC3 were not associated with fecundability.

CONCLUSIONS

Our findings suggest that higher folate and lower homocysteine concentrations, which reflected the interlinked folate and methionine cycles, were associated with higher fecundability in preconception women with lower IR but less so in those with higher IR.

CLINICAL TRIAL REGISTRATION

This trial was registered at ClinicalTrials.gov as NCT03531658 (https://www.

CLINICALTRIALS

gov/study/NCT03531658).

Associations of personal care product use during pregnancy and the postpartum period with markers of postpartum glycemic control - Results from the ERGO Study

BACKGROUND

Personal care products frequently contain endocrine disrupting chemicals (EDCs) including parabens and phthalates, which can alter glucose metabolism. The postpartum period is a time of rapid metabolic change, but whether EDC-associated product use impacts postpartum glucose metabolism is unknown.

METHODS

We included 270 participants from the Boston, MA-based Environmental Reproductive and Glucose Outcomes (ERGO) pregnancy cohort with data on self-reported personal care product use at ≤4 pregnancy visits (median: 11, 19, 26, 36 weeks of gestation) and 1 postpartum visit (median: 9 weeks). We quantified postpartum hemoglobin A1c (HbA1c), fasting insulin, fasting- and 2-h glucose post-75-g oral glucose tolerance test, and calculated homeostatic model assessment for insulin sensitivity (HOMA2-S) and beta-cell function (HOMA2-B). Using covariate-adjusted linear regression, we estimated visit-specific associations of product use with postpartum glycemic outcomes.

RESULTS

Associations of product use with postpartum glycemic measures were mixed. Users of certain hair products had lower postpartum insulin sensitivity compared to non-users (e.g., Visit1 hair gel/spray: 22.8% difference [95% CI: 39.2, -1.9] in mean HOMA2-S). Conversely, users of products like deodorant, liquid- and bar soap, had higher insulin sensitivity and lower glucose levels (e.g., postpartum deodorant: 32.1% difference [95% CI: 7.0, 63.1] in mean HOMA2-S; -3.1 mg/dL [95% CI: 6.3, -0.04] mean fasting glucose). Associations with other products were inconsistent across timepoints or null.

CONCLUSION

Use of certain personal care products during the perinatal period was associated with altered postpartum glucose metabolism. Larger studies are needed to understand the impacts of product use patterns on glycemic outcomes.

Developing CGMap: Characterizing Continuous Glucose Monitoring Data in Patients with Type 2 Diabetes

Objectives: This study will characterize continuous glucose monitoring (CGM) data in patients with type 2 diabetes in China, and assess the relationship between CGM-derived indicators and diabetes-related clinical parameters. Methods: The data for this study were collected from a randomized trial in China (ChiCTR2000039424) from February 2020 to July 2022 in which patients wore a CGM device for 14 days. Glycemia risk index (GRI), coefficient of variation (CV), standard deviation (SD), mean amplitude of glycemic excursions (MAGE), time in range (TIR), time above range (TAR), time below range (TBR), and estimate glycated hemoglobin (eA1c) were analyzed. Ordinary least square linear regression and the Spearman method were used to test the relationship between CGM-derived indicators and diabetes-related clinical parameters. Results: In all, 528 patients with type 2 diabetes from a randomized controlled trial were analyzed. It was shown that CV, SD, and MAGE increased with age and diabetes duration, but decreased with an increase in body mass index. Higher fasting plasma glucose, higher baseline HbA1c, and higher insulin resistance levels were associated with higher GRI, SD, MAGE, TAR, and eA1c, and they were associated with lower TIR. In addition, higher HOMA-2β was associated with higher TIR and TBR, and with lower TAR and eA1c. Hemoglobin had positive correlations to SD, TAR, and eA1c. Conclusions: It was found that glucose variability increased with age and the duration of diabetes. However, glucose variability decreased with increased BMI. Meanwhile, greater glycemic variability was associated with worse islet function, higher baseline glucose level, and higher hemoglobin.

Associations of >1-h compared with 1-h meal timing variability (eating jetlag) with plasma glycemic parameters and continuous glucose monitoring measures among pregnant females: a prospective cohort study

BACKGROUND

Eating jetlag (EJL), the difference in eating times between weekdays and weekends, disrupts circadian alignment and may affect metabolic health. However, its influence on glucose tolerance and continuous glucose monitoring (CGM) during pregnancy remains unknown.

OBJECTIVES

We aimed to investigate the associations between EJL and glycemic parameters during pregnancy.

METHODS

This secondary analysis was conducted on a cohort of 248 healthy pregnant females from Singapore. EJL, derived from 4-d food diaries at 20-wk of gestation, was the absolute difference in average meal times between weekdays and weekends for the first (EJLfirst) and last (EJLlast) meals and categorized as ≤1-h (reference) or >1-h. Primary outcomes at 25-wk of gestation included results from the 75-g oral glucose tolerance test, fasting insulin, homeostasis model assessment of insulin resistance (HOMA2-IR), and β-cell function (HOMA2-%B). Secondary outcomes at 20-wk of gestation included glycemic control and variability measured over 10-d using CGM. Skewed glycemic variables were log-transformed for normality, and associations between EJL and glycemic outcomes were analyzed using multivariable regressions.

RESULTS

After adjusting for baseline sociodemographic, lifestyle, and dietary factors, EJLlast >1-h was associated with higher fasting insulin [geometric mean ratio (95% confidence intervals): 1.21 (1.05, 1.39)], HOMA2-IR [1.21 (1.05, 1.39)], HOMA2-%B [1.11 (1.01, 1.22)], and CGM-based measures, including mean glucose [1.05 (1.00, 1.09)], J-index [1.11 (1.01, 1.22)], and glucose management indicator [1.03 (1.00, 1.06)]. EJLfirst >1-h was associated with higher CGM-based mean amplitude of glycemic excursions (MAGE) [1.09 (1.01, 1.19)]. For CGM-based glycemic variability outcomes (standard deviation, coefficient of variation [CV], MAGE), there were interactions between EJLfirst and 1) diet quality [adherence to Dietary Approaches to Stop Hypertension (DASH)] (P-interactions = 0.06-0.09), and 2) prepregnancy body mass index (BMI) (P-interaction=0.07 for CV). In females with a prepregnancy BMI ≥23 kg/m2 and low diet quality (DASH score ≤median), EJLfirst >1 h was associated with higher CGM-based glycemic variability.

CONCLUSIONS

EJL was associated with unfavorable glycemic parameters during pregnancy. Dietary interventions could promote consistent meal timing, especially in higher risk groups with suboptimal nutritional status. This trial was registered at clinicaltrials.gov as NCT03803345.

β-Cell Dedifferentiation in HOMA-βlow and HOMA-βhigh Subjects

CONTEXT

β-Cell dedifferentiation ratio is increased in type 2 diabetes; but its direct link to in vivo β-cell function in human remains unclear.

OBJECTIVE

The present study was designed to investigate whether β-cell dedifferentiation in situ was closely associated with β-cell function in vivo and to identify targets crucial for β-cell dedifferentiation/function in human.

METHODS

We acquired homeostasis model assessment of β-cell function (HOMA-β) values, calculated the number of hormone-negative endocrine cells, and evaluated important markers and novel candidates for β-cell dedifferentiation/function on paraneoplastic pancreatic tissues from 13 patients with benign pancreatic cystic neoplasm or intrapancreatic accessory spleen.

RESULTS

Both the β-cell dedifferentiation ratio and the dedifferentiation marker (Aldh1a3) were inversely related to in vivo β-cell function (HOMA-β) and in situ β-cell functional markers Glut2 and Ucn3 in humans. Moreover, the islets from HOMA-βlow subjects were manifested as (1) increased β-cell dedifferentiation ratio, (2) enriched dedifferentiation maker Aldh1a3, and (3) lower expression of Glut2 and Ucn3 compared with those from HOMA-βhigh subjects. We found that basic leucine zipper transcription factor 2 (Bach2) expression was significantly induced in islets from HOMA-βlow patients and was positively correlated with the ratio of β-cell dedifferentiation in humans.

CONCLUSION

Our findings emphasize the contribution of β-cell dedifferentiation to β-cell dysfunction in humans. Bach2 induction in β-cells with higher frequency of dedifferentiation observed in HOMA-βlow subjects reinforces its distinctive role as a pharmaceutical target of β-cell dedifferentiation for the treatment of people with diabetes.

The effects of obesity on thyroid function in a metabolically healthy high-fat, high-carbohydrate diet-induced obese rat model

Introduction

Obesity is a recognized exacerbator of thyroid dysfunction due to its detrimental effects on energy homeostasis, appetite regulation, basal metabolic rate, thermogenesis, and metabolism. However, almost all the reported findings on obesity-related thyroid dysfunction are based on models of metabolically unhealthy obesity (MUO) in the presence of insulin resistance. There are currently no reported studies using a metabolically healthy obesity (MHO) model characterized by the absence of insulin resistance to investigate thyroid dysfunction. Hence, this study aimed to investigate the association between thyroid dysfunction and obesity in a metabolically healthy high-fat high-carbohydrate diet-induced obese rat model.

Materials and methods

Male Sprague Dawley rats were randomly divided into either the control diet or the high-fat high-carbohydrate diet group (HFHC) (n=9, per group). During the 5-month induction period, the control group did not develop obesity while consuming a standard diet with water. The HFHC diet group consumed the HFHC diet and water for the same duration and was diagnosed with obesity. Post-obesity confirmation, the animals continued with the respective diets for a further 7 months to maintain the obese state. Caloric intake, fasting blood glucose (FBG) and BMI were measured once a month for the duration of the experiment. Glucose homeostasis and thyroid functional parameters were assessed terminally, accompanied by satiety and pro-inflammatory markers.

Results

The HFHC diet group presented with higher BMI, caloric intake and FBG, and elevated insulin, HOMA-IR, Hb1Ac, leptin and IL-6 levels compared to the control diet group. The HFHC diet group presented with significantly elevated levels of TSH, fT3 and fT4. These observations suggest that thyroid homeostasis is disturbed in the obese state. However, the reported elevated glycemic status indicators and IL-6 concentrations in the HFHC diet group did not satisfy the minimum criteria to be characterized as MUO.

Conclusion

The HFHC diet has induced MHO in male Sprague Dawley rats. This warrants using this model to investigate the homeostatic changes that occur during the metabolically healthy obese state. This can open new avenues for developing preventative measures to avoid progressing to MUO.

Postnatal Cardiometabolic Health After Metformin Use in Gestational Diabetes: A Secondary Analysis of the EMERGE Trial

AIM

Women with gestational diabetes mellitus (GDM) display adverse lifetime cardiometabolic health. We examined whether early metformin in GDM could impact cardiometabolic risk factors postpartum.

METHODS

EMERGE, a double-blind, placebo-controlled trial, randomized pregnancies 1:1 to placebo or metformin at GDM diagnosis and followed participants from randomization until 12 ± 4 weeks postpartum. In total, 478 pregnancies were available for postpartum maternal assessment, 237 and 241 assigned to metformin and placebo respectively. Weight (kg), body mass index (BMI) (kg/m2), waist circumference (cm), and blood pressure (mmHg) were measured, infant feeding method documented, and blood specimens drawn for a 75-gram oral glucose tolerance test, fasting insulin, C-peptide, and lipid analysis.

RESULTS

Despite similar weight and BMI at trial randomization, participants receiving metformin had significantly lower weight (79.5 ± 15.9 vs 82.6 ± 16.9 kg; P = .04) and BMI (29.3 [5.6] vs 30.5 [5.4]; P = .018) at the postpartum visit. However, no difference in weight change from randomization to 12 weeks postpartum was observed between metformin and placebo groups. Overall, 29% (n = 139) of the cohort met criteria for prediabetes or diabetes, with no positive impact with metformin. There were also no differences in measurements of insulin resistance, blood pressure, or lipids between groups.

CONCLUSION

Early metformin use in GDM did not impact important cardiometabolic parameters in the early postpartum period despite significant benefits in weight gain and insulin use in pregnancy.

Lifestyle Modification in Prediabetes and Diabetes: A Large Population Analysis

Background/Aims: Diabetes mellitus is a major cause of atherosclerotic cardiovascular disease (ASCVD). We examined a large population and tested the efficacy of a voluntary lifestyle program in prediabetic and diabetic subjects. Methods: Of 133,764 subjects, 56.3% were healthy, 36.2% were prediabetic, and 7.5% were diabetic. Fasting serum measurements of glucose, insulin, adiponectin, glycosylated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), glycated serum protein (GSP), fibrinogen, myeloperoxidase (MPO), lipoprotein-associated phospholipase A2 (LpPLA2), as well as standard lipids, direct low-density lipoprotein cholesterol (LDL-C), and small dense LDL-C (sdLDL-C) were performed using standard automated assays. Follow-up sampling at 6-12 months occurred in 20.1% of the prediabetic and 22.2% of the diabetic subjects; of these, 12.2% of the prediabetic and 9.7% of the diabetic subjects participated in a voluntary, real-world, digital dietitian-directed lifestyle-modification program with a 10-year diabetes risk being calculated using a biochemical model (Framingham). Results: Prediabetic and diabetic subjects had significantly elevated triglycerides, sdLDL-C, and hs-CRP and decreased HDL-C. They were insulin resistant as compared to healthy subjects, but only diabetics had significant reductions in insulin production. Lifestyle modification significantly reduced diabetes risk by 45.6% in prediabetics and significantly increased (2.4-fold) the percentage of diabetics that were in remission at follow-up (8.2% versus 3.4%) with increased weight loss (6.5 versus 2.0 pounds). Lifestyle intervention resulted in significant favorable effects on many metabolic markers. Conclusions: The measurement of fasting glucose and insulin is essential for the detection of decreased insulin production in diabetics. A digital lifestyle program can have favorable effects on ASCVD risk factors and diabetic status.

Insulin Sensitivity and Beta-Cell Function Following Tirzepatide in Japanese Patients with Type 2 Diabetes: A SURPASS J-mono Analysis

INTRODUCTION

The objective of this work was to assess the association of tirzepatide with changes in insulin sensitivity and beta-cell function in Japanese patients with type 2 diabetes (T2D).

METHODS

This was a prespecified analysis of SURPASS J-mono, a multicenter, randomized, double-blind, active-controlled phase 3 study in Japanese participants with T2D. Participants were randomly assigned to receive tirzepatide 5, 10, 15 mg, or dulaglutide 0.75 mg once weekly for 52 weeks. Changes from baseline in homeostatic model assessment (HOMA2) parameters were assessed by a mixed model for repeated measures. Post hoc subgroup analyses were conducted based on high and low baseline C-peptide categories (cutoff: median 1.86 µg/l).

RESULTS

This analysis included 636 participants (tirzepatide 5 mg: n = 159; 10 mg: n = 158; 15 mg: n = 160; dulaglutide 0.75 mg: n = 159). Fasting insulin and C-peptide levels were significantly reduced from baseline at week 52 at all three tirzepatide doses compared with dulaglutide 0.75 mg (estimated treatment differences [ETDs] for tirzepatide 5, 10, and 15 mg, respectively: insulin, - 22.6%, - 29.8%, and - 31.0%; C-peptide, - 14.2%, - 21.5%, and - 20.7%; p < 0.001 all comparisons). Insulin sensitivity and beta-cell function indices significantly increased in all tirzepatide groups compared with the dulaglutide 0.75-mg group (ETDs for tirzepatide 5, 10, and 15 mg, respectively: HOMA2-%S [insulin], 31.8%, 43.2%, and 49.9%; HOMA2-%S [C-peptide], 24.8%, 33.9%, and 38.2%; HOMA2-%B [insulin], 27.3%, 34.9%, and 40.6%; HOMA2-%B [C-peptide], 31.6%, 40.1%, and 46.7%; p < 0.001 all comparisons). Regardless of baseline C-peptide level, the tirzepatide groups showed significant improvement in glycated hemoglobin at week 52 compared with the dulaglutide group (C-peptide < 1.86 µg/l: - 2.31% to - 2.75% vs. - 1.45%; ≥ 1.86 µg/l: - 2.43% to - 2.89% vs. - 1.12%; p < 0.001).

CONCLUSIONS

In these prespecified and post hoc analyses, tirzepatide was associated with improved insulin sensitivity and insulin secretion in Japanese participants with T2D, which may result in reduced fasting insulin levels.

CLINICALTRIALS

GOV: NCT03861052.

Non-invasive liver fibrosis markers are increased in obese individuals with non-alcoholic fatty liver disease and the metabolic syndrome

The need for early non-invasive diagnostic tools for chronic liver fibrosis is growing, particularly in individuals with obesity, non-alcoholic fatty liver disease (NAFLD), and the metabolic syndrome (MetS) since prevalence of these conditions is increasing. This case-control study compared non-invasive liver fibrosis markers in obesity with NAFLD and MetS (NAFLD-MetS, n = 33), in obese (n = 28) and lean (n = 27) control groups. We used MRI (T1 relaxation times (T1) and liver stiffness), circulating biomarkers (CK18, PIIINP, and TIMP1), and algorithms (FIB-4 index, Forns score, FNI, and MACK3 score) to assess their potential in predicting liver fibrosis risk. We found that T1 (892 ± 81 ms vs. 818 ± 64 ms, p < 0.001), FNI (15 ± 12% vs. 9 ± 7%, p = 0.018), CK18 (166 ± 110 U/L vs. 113 ± 41 U/L, p = 0.019), and MACK3 (0.18 ± 0.15 vs. 0.05 ± 0.04, p < 0.001) were higher in the NAFLD-MetS group compared with the obese control group. Moreover, correlations were found between CK18 and FNI (r = 0.69, p < 0.001), CK18 and T1 (r = 0.41, p < 0.001), FNI and T1 (r = 0.33, p = 0.006), MACK3 and FNI (r = 0.79, p < 0.001), and MACK3 and T1 (r = 0.50, p < 0.001). We show that liver fibrosis markers are increased in obese individuals with NAFLD and MetS without clinical signs of liver fibrosis. More studies are needed to validate the use of these non-invasive biomarkers for early identification of liver fibrosis risk.

Diabetes Mellitus Risk Prediction in the Framingham Offspring Study and Large Population Analysis

Background: Diabetes mellitus is a major cause of death and a significant risk factor for cardiovascular disease, kidney failure, neuropathy, and retinopathy. Our objectives were to develop a diabetes risk model and apply it to a large population. Methods: Non-diabetic adults in the Framingham Offspring Study (n = 2416) were followed for 10 years for new diabetes. At baseline, the fasting serum glucose, adiponectin, insulin, glycated albumin, total cholesterol, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were measured using standardized automated assays. Standard health information was collected. Diabetes risk prediction models were developed using logistic regression analysis and applied to a large population (n = 133,764). Results: In this prospective study, 166 subjects (6.9%) developed new-onset diabetes. Glucose, body mass index (BMI), log adiponectin, % log glycated albumin, parental diabetes, TG, and the use of cholesterol-lowering medications entered the model (C statistic: 0.924; 0.898, biochemical variables: 0.898, and fasting glucose: only 0.876). In the population in non-diabetic subjects (56.3) and prediabetic subjects (36.2%), the predicted 10-year diabetes risk rates were 0.4% and 5.5% with the biochemical model, respectively. Prediabetic and diabetic subjects were insulin-resistant compared to non-diabetic subjects, but only those with diabetes had significant reductions in their insulin production. Conclusions: The 10-year risk of diabetes can be accurately predicted and applied to large populations. Fasting glucose alone is diagnostic for diabetes and is an excellent predictor of future diabetes, with having prediabetes increasing the risk 6-fold. Insulin and C-peptide measurements are useful in diabetic subjects to detect decreased insulin production and the need for insulin therapy.

Metabolic factors modulate effort-based decision-making in major depressive disorder

BACKGROUND

Abnormalities in effort-based decision-making have been consistently reported in major depressive disorder (MDD). Evidence indicates that metabolic factors, such as insulin resistance and dyslipidemia, which are highly prevalent in MDD, are independently associated with reward disturbances. Herein, we investigate the moderating effect of metabolic factors on effort-based decision-making in individuals with MDD.

METHODS

Forty-nine adults with MDD completed the Effort Expenditure for Rewards Task (EEfRT). Anthropometric and laboratorial parameters were assessed in all participants. We conducted a factor analysis to identify combinations of correlated metabolic variables, and reduce the number of comparisons.

RESULTS

Proxy markers of elevated insulin resistance (OR: 0.816, p < 0.001) and hyperglycemia (OR: 0.898, p = 0.021) were associated with a lower willingness to exert physical effort for rewards in the EEfRT. In contrast, elevated HDL (OR: 1.165, p = 0.004), and elevated non-HDL cholesterol and triglycerides (OR: 1.184, p < 0.001) were associated with increased frequency of hard task choices. These associations were independent of age, sex, depressive symptoms severity and medication use. Computational modeling revealed that the insulin resistance (β = 0.275, p = 0.035) and cholesterol factors (β = 0.565, p < 0.001) were independently associated with increased effort discounting.

LIMITATIONS

Post-hoc analysis using a relatively small sample of convenience.

CONCLUSIONS

Metabolic factors significantly and independently modulated effort-based decision-making in patients with MDD. These results have implications for our understanding of reward disturbances in MDD, and offer insights for further mechanistic investigations.

Changes in pancreatic levodopa uptake in patients with obesity and new-onset type 2 diabetes: an 18F-FDOPA PET-CT study

Introduction

Levodopa (L-3,4-dihydroxyphenylalanine)g, a dopamine precursor that circulates in the peripheral region, is involved in pancreatic glycemic control. Although previous animal studies have shown that peripheral levodopa is correlated with insulin secretion in pancreatic beta cells, the mechanism by which the pancreas uses levodopa differently in humans with obesity and type 2 diabetes remains unknown. Our study aimed to observe how the pancreas uptakes and utilizes levodopa differently under obese and diabetic conditions.

Materials and method

18F-fluoro-L-dopa positron emission tomography-computed tomography (18F-FDOPA PET-CT) was used to visualize how the human body uses levodopa under obese and diabetic conditions and presented its clinical implications. 10 patients were divided into 3 groups: 1) Group A, normal weight without type 2 diabetes; 2) Group B, obese without type 2 diabetes; and 3) Group C, obese with new-onset type 2 diabetes. All patients' lifestyle modification was conducted prior to 18F-FDOPA PET-CT, and plasma samples were collected to confirm changes in amino acid metabolites.

Results

Pancreatic levodopa uptake increased in obese patients with insulin resistance, whereas it decreased in obese patients with new-onset type 2 diabetes [standardized uptake value (SUV) mean in participants with normal weight, 2.6 ± 0.7; SUVmean in patients with obesity, 3.6 ± 0.1; SUVmean in patients with obesity and new-onset type 2 diabetes, 2.6 ± 0.1, P = 0.02].

Conclusions

This suggested that the alterations in the functional capacity of pancreatic beta cells to take up circulating levodopa are potentially linked to the insulin resistance and the pathogenesis of type 2 diabetes. The differences in the uptake values between the groups implied that pancreatic levodopa uptake could be an early indicator of type 2 diabetes.

Change in carbohydrate intake one year after Roux-en-Y gastric bypass: A prospective study

Background and objectives: To investigate the effect of carbohydrate intake before laparoscopic Roux-en-Y gastric bypass (LRYGB) on body weight, body composition and glycaemic status after surgery. Methods: In a tertiary centre cohort study, dietary habits, body composition and glycaemic status were evaluated before and 3, 6 and 12 months after LRYGB. Detailed dietary food records were processed by specialized dietitians on the basis of a standard protocol. The study population was subdivided according to relative carbohydrate intake before surgery. Results: Before surgery, 30 patients had a moderate relative carbohydrate intake (26%-45%, M-CHO), a mean body mass index (BMI) of 40.4 ± 3.9 kg/m² and a mean glycated haemoglobin A1c (A1C) of 6.5 ± 1.2% compared to 20 patients with a high relative carbohydrate intake (> 45%, H-CHO), mean BMI of 40.9 ± 3.7 kg/m² (non-significant, NS) and a mean A1C of 6.2% (NS). One year after surgery, body weight, body composition and glycaemic status were similar in the M-CHO (n = 25) and H-CHO groups (n = 16), despite less caloric intake in the H-CHO group (1317 ± 285 g vs. 1646 ± 345 g in M-CHO, p < 0.01). Their relative carbohydrate intake converged to 46% in both groups, but the H-CHO group reduced the absolute total carbohydrate consumption more than the M-CHO group (190 ± 50 g in M-CHO vs. 153 ± 39 g in H-CHO, p < 0.05), and this was especially pronounced for the mono- and disaccharides (86 ± 30 g in M-CHO vs. 65 ± 27 g in H-CHO, p < 0.05). Conclusion: A high relative carbohydrate intake before LRYGB, did not influence the change in body composition or diabetes status after surgery, despite a significantly lower total energy intake and less mono- and disaccharide consumption after surgery.

Effect of broccoli sprout extract and baseline gut microbiota on fasting blood glucose in prediabetes: a randomized, placebo-controlled trial

More effective treatments are needed for impaired fasting glucose or glucose intolerance, known as prediabetes. Sulforaphane is an isothiocyanate that reduces hepatic gluconeogenesis in individuals with type 2 diabetes and is well tolerated when provided as a broccoli sprout extract (BSE). Here we report a randomized, double-blind, placebo-controlled trial in which drug-naive individuals with prediabetes were treated with BSE (n = 35) or placebo (n = 39) once daily for 12 weeks. The primary outcome was a 0.3 mmol l-1 reduction in fasting blood glucose compared with placebo from baseline to week 12. Gastro-intestinal side effects but no severe adverse events were observed in response to treatment. BSE did not meet the prespecified primary outcome, and the overall effect in individuals with prediabetes was a 0.2 mmol l-1 reduction in fasting blood glucose (95% confidence interval -0.44 to -0.01; P = 0.04). Exploratory analyses to identify subgroups revealed that individuals with mild obesity, low insulin resistance and reduced insulin secretion had a pronounced response (0.4 mmol l-1 reduction) and were consequently referred to as responders. Gut microbiota analysis further revealed an association between baseline gut microbiota and pathophysiology and that responders had a different gut microbiota composition. Genomic analyses confirmed that responders had a higher abundance of a Bacteroides-encoded transcriptional regulator required for the conversion of the inactive precursor to bioactive sulforaphane. The abundance of this gene operon correlated with sulforaphane serum concentration. These findings suggest a combined influence of host pathophysiology and gut microbiota on metabolic treatment response, and exploratory analyses need to be confirmed in future trials. ClinicalTrials.gov registration: NCT03763240 .

Type 2 diabetes pathway-specific polygenic risk scores elucidate heterogeneity in clinical presentation, disease progression and diabetic complications in 18,217 Chinese individuals with type 2 diabetes

AIMS/HYPOTHESIS

Type 2 diabetes is a complex and heterogeneous disease and the aetiological components underlying the heterogeneity remain unclear in the Chinese and East Asian population. Therefore, we aimed to investigate whether specific pathophysiological pathways drive the clinical heterogeneity in type 2 diabetes.

METHODS

We employed newly developed type 2 diabetes hard-clustering and soft-clustering pathway-specific polygenic risk scores (psPRSs) to characterise individual genetic susceptibility to pathophysiological pathways implicated in type 2 diabetes in 18,217 Chinese patients from Hong Kong. The 'total' type 2 diabetes polygenic risk score (PRS) was summed by genome-wide significant type 2 diabetes signals (n=1289). We examined the associations between psPRSs and cardiometabolic profile, age of onset, two glycaemic deterioration outcomes (clinical requirement of insulin treatment, defined by two consecutive HbA1c values ≥69 mmol/mol [8.5%] more than 3 months apart during treatment with two or more oral glucose-lowering drugs, and insulin initiation), three renal (albuminuria, end-stage renal disease and chronic kidney disease) outcomes and five cardiovascular outcomes.

RESULTS

Although most psPRSs and total type 2 diabetes PRS were associated with an earlier and younger onset of type 2 diabetes, the psPRSs showed distinct associations with clinical outcomes. In particular, individuals with normal weight showed higher psPRSs for beta cell dysfunction and lipodystrophy than those who were overweight. The psPRSs for obesity were associated with faster progression to clinical requirement of insulin treatment (adjusted HR [95% CI] 1.09 [1.05, 1.13], p<0.0001), end-stage renal disease (1.10 [1.04, 1.16], p=0.0007) and CVD (1.10 [1.05, 1.16], p<0.0001) while the psPRSs for beta cell dysfunction were associated with reduced incident end-stage renal disease (0.90 [0.85, 0.95], p=0.0001) and heart failure (0.83 [0.73, 0.93], p=0.0011). Major findings remained significant after adjusting for a set of clinical variables.

CONCLUSIONS/INTERPRETATION

Beta cell dysfunction and lipodystrophy could be the driving pathological pathways in type 2 diabetes in individuals with normal weight. Genetic risks of beta cell dysfunction and obesity represent two major genetic drivers of type 2 diabetes heterogeneity in disease progression and diabetic complications, which are shared across ancestry groups. Type 2 diabetes psPRSs may help inform patient stratification according to aetiology and guide precision diabetes care.

The association between novel metabolic parameters and all-cause/cardiovascular mortality in patients with metabolic syndrome is modified by age

BACKGROUND

Triglyceride glucose index (TyG) serves as an effective parameter for assessing metabolic status. However, it remains uncertain whether TyG and other metabolic parameters can predict clinical outcomes in people with metabolic syndrome (MetS). We investigated the association of TyG, triglyceride glucose-waist to height ratio (TyG-WHtR), and metabolic score for insulin resistance (METS-IR) with all-cause and cardiovascular mortality in the MetS cohort and determined whether this association changes with age.

METHOD

Participants enrolled in the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 were selected and categorized into two groups: younger individuals (age < 65 years) and older individuals (age ≥ 65 years). Three new metabolic indices of TyG, TyG-WHtR, and METS-IR were constructed. The weighted Cox proportional hazards model and restricted cubic spline (RCS) models were employed to evaluate the relation between three indices and mortality outcomes. The time-dependent receiver operating characteristic (ROC) curve assessed the ability of different indices to predict mortality. Sensitivity analysis was conducted to evaluate the robustness and reliability of the findings.

RESULTS

The study comprised a total of 8271 participants, including 5456 younger participants and 2815 older participants, and 1407 deaths were observed over a median follow-up period of 8.3 years. Compared with the first quartile (Q1), the fourth quartile's (Q4) TyG, TyG-WHtR, and METS-IR were linked to an increased risk of all-cause mortality (HR 1.63, 95% CI 1.12-2.39; HR 2.78, 95% CI 1.68-4.61; HR 1.36, 95% CI 1.12-2.02, respectively) and cardiovascular mortality (HR 2.04, 95% CI 1.15-4.90; HR 4.99, 95% CI 1.76-14.11; HR 2.69, 95% CI 1.89-8.15, respectively) in the younger group but not in the older group. The RCS results showed no significant non-linear associations between TyG, TyG-WHtR, METS-IR, and all-cause (P = 0.082; P = 0.712; P = 0.062, respectively) or cardiovascular mortality (P = 0.176; P = 0.793; P = 0.482, respectively) in the older age group. TyG-WHtR demonstrated the highest area under the curve for predicting 3-year mortality in the younger age group, with values of 0.653 for all-cause mortality and 0.688 for cardiovascular mortality.

CONCLUSION

Our results highlight the predictive value of TyG, TyG-WHtR, and METS-IR in the MetS population, providing new evidence for medical practice and public health.

Relationship Between the Single Nucleotide Polymorphism A35C in the Cu/Zn-Superoxide Dismutase-1 Gene and Glycemic Control in Individuals with Type 2 Diabetes Mellitus

Hyperglycemia in type 2 diabetes mellitus (T2DM) increases oxidative stress. Furthermore, the presence of the single nucleotide polymorphism A35C (SNP A35C) in Cu/Zn-superoxide dismutase1 (SOD1) gene is closely related to this increase in oxidative stress and the development and progression of T2DM and its complications. This study aimed to evaluate the association between SNP A35C (rs2234694) genotypes and glycemic control in T2DM individuals. A total of 110 individuals were evaluated for anthropometric parameters, body composition, glycemic metabolism markers (fasting serum glucose, %HbA1c, insulin, C-peptide, and HOMA-IR, -%B, -%S), and SOD activity. Individuals were grouped according to SNP A35C genotypes. Variables of interest were assessed according to groups. The T-test for independent samples or the Mann-Whitney U test was used to analyze the differences in continuous variables between groups, and the chi-square test was performed for categorical variables. A binary logistic regression model was constructed, with p < 0.05 considered significant. Overweight was found in 81.8% of individuals with T2DM. Individuals with the AC genotype for SNP A35C had higher levels of fasting serum glucose (p = 0.018) and lower values of HOMA-%B (p = 0.044). The presence of the variant allele was positively associated with higher values of fasting serum glucose (OR: 11.340; 95%IC 1.173-109.649; p = 0.036) and HOMA-IR (OR: 9.987; 95%IC 1.127-88.506; p = 0.039). Individuals with the AC genotype of SNP A35C had poorer glycemic control than individuals with the AA genotype, and the presence of the variant allele was associated with poor glycemic control in T2DM individuals.

Lyophilized ash gourd (Benincasa hispida (Thunb.) Cogn.) juice alleviates diet-induced prediabetes in a rat model

Prediabetes is characterized by elevated blood sugar levels, indicating an increased risk of developing diabetes. This study evaluated the effects of ash gourd (AG), a tropical fruit from the Cucurbitaceae family, on prediabetes, as well as its phytochemical composition. A prediabetic rat model was developed in Sprague-Dawley (SD) rats by administering a high fat diet (HFD) for 16 weeks. This model exhibited reduced pancreatic function, heightened insulin resistance, and decreased insulin sensitivity compared to a standard diet group, leading to hyperglycemia and dyslipidemia, hallmarks of prediabetic conditions. Histological analysis of hepatic tissue revealed macro- and microvesicular fat accumulation and inflammatory changes, supporting these findings. This study highlights the utility of HFD-induced SD rats as a model for prediabetic conditions. Following this, lyophilized ash gourd juice (LAGJ) powder was administered to the prediabetic rat model to assess its potential for reversing prediabetic conditions. LAGJ administration resulted in a significant reduction in fasting blood sugar (FBS) levels, glucose intolerance, and insulin resistance. Additionally, LAGJ significantly mitigated fatty liver changes compared to the prediabetic untreated control (PUC) group. Histological examination of liver tissue in the LAGJ treated group showed a typical architecture similar to that of the normal control group. These findings indicate that LAGJ could be a promising intervention for individuals with prediabetes who are at risk of developing type 2 diabetes and fatty liver disease. Phytochemical analysis of AG pulp revealed the presence of stigmasterol, stigmasteryl β-glucoside, and 6'-O-palmitoyl stigmasteryl β-glucoside.

Associations of carbohydrate quality and cardiovascular risk factors vary among diabetes subtypes

BACKGROUND

Assess the intake of carbohydrate quality and their association with cardiovascular risk factors among diabetes subtypes.

METHODS

Participants of the German Diabetes Study (GDS) (recent-onset diabetes (n = 487) and 5-years thereafter (n = 209)) were allocated into severe autoimmune diabetes (SAID, 35%), severe insulin-deficient diabetes (SIDD, 3%), severe insulin-resistant diabetes (SIRD, 5%), mild obesity-related diabetes (MOD, 28%), and mild age-related diabetes (MARD, 29%). Dietary glycemic index (GI), glycemic load (GL), and intake of higher- (≥ 55) and low-GI (< 55) foods, dietary fiber, and total sugar were derived from a validated food frequency questionnaire and cross-sectionally associated with cardiovascular risk factors (blood lipids, subclinical inflammation, blood pressure, fatty liver index) using multivariable linear regression analysis for subtypes with prevalences ≥ 10%.

RESULTS

Intake of carbohydrate quality parameters was broadly comparable between the subtypes. Among SAID higher total sugar intake was associated with lower HDL-cholesterol (ß (95% CI) relative change per 1 SD increment: - 3.4% (- 6.7; - 0.1)). No clear associations were seen among MOD. Among MARD, a higher dietary GL and higher-GI carbohydrate intake were associated with higher serum triglycerides (10.9% (2.4; 20.1), 12.4% (3.9; 21.5)) and fatty liver index (absolute change: 0.18 (0.06; 0.31), 0.17 (0.05; 0.28)) and lower HDL-cholesterol (- 4.1% (- 7.6; - 0.4), - 4.4% (- 7.8; - 0.8)), whilst higher intake of low-GI carbohydrates and dietary fiber were associated with lower high-sensitivity C-reactive protein (- 16.0% (- 25.7; - 5.1), - 13.9% (- 24.2; - 2.2)).

CONCLUSIONS

Associations of carbohydrate quality parameters with blood lipids, subclinical inflammation, and fatty liver index differed between diabetes subtypes. However, evidence is too preliminary to derive subtype-specific recommendations.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT01055093.

Activation of the HPA Axis Does Not Explain Nonresponsiveness to GLP-1R Agonist Treatment in Individuals With Type 2 Diabetes

ARTICLE HIGHLIGHTS

It is unclear why some individuals with type 2 diabetes are unresponsive to treatment with glucagon-like peptide 1 receptor (GLP-1R) agonists, but hypothalamic-pituitary-adrenal (HPA) axis activation could play a role. We used [68Ga]Ga-NODAGA-exendin-4 positron emission tomography/computed tomography to compare pituitary GLP-1R expression between responders and nonresponders to treatment with GLP-1R agonists. Pituitary GLP-1R expression and HPA axis activation did not differ between responders and nonresponders to GLP-1R agonist treatment. In addition, pituitary radiolabeled exendin uptake was markedly higher in men than in women. Further study is required to explain treatment differences and understand sex differences in pituitary radiolabeled exendin uptake.

Study protocol of the PRINCESS trial-PReoperative INtermittent fasting versus CarbohydratE loading to reduce inSulin resiStance versus standard of care in orthopaedic patients: a randomised controlled trial

INTRODUCTION

Surgical trauma induces a metabolic stress response, resulting in reduced insulin sensitivity and hyperglycaemia. Postoperative insulin resistance (IR) is associated with postoperative complications, and extended preoperative fasting may further aggravate the postoperative metabolic stress response. Nutritional strategies, such as carbohydrate loading (CHL), have been successfully used to attenuate postoperative IR. Recent evidence suggests that time-restricted feeding (TRF), a form of intermittent fasting, improves IR in the general population, even after a short period of TRF. We hypothesise that TRF, as well as CHL, improve postoperative IR.

METHODS AND ANALYSIS

This open-label, single-centre, randomised controlled trial will compare the effect of short-term preoperative TRF, CHL and standard preoperative fasting on perioperative IR. A total of 75 orthopaedic patients presenting for elective intermediate to major surgery at a Dutch academic hospital will be randomly assigned to a control group (standard preoperative fasting), a TRF group or a CHL group. The primary outcome is postoperative IR, based on the updated homeostasis model assessment of IR, on the first day after surgery. Statistical analyses are performed using Student's t-tests or Mann-Whitney U tests.

ETHICS AND DISSEMINATION

The local medical ethics committee of the Amsterdam UMC, the Netherlands, approved the trial protocol in January 2023 (NL81556.018.22). No publication restrictions apply, and the results of the study will be disseminated through a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05760339.

Data-driven Cluster Analysis Reveals Increased Risk for Severe Insulin-deficient Diabetes in Black/African Americans

CONTEXT

Diabetes is a heterogenic disease and distinct clusters have emerged, but the implications for diverse populations have remained understudied.

OBJECTIVE

Apply cluster analysis to a diverse diabetes cohort in the US Deep South.

DESIGN

Retrospective hierarchical cluster analysis of electronic health records from 89 875 patients diagnosed with diabetes between January 1, 2010, and December 31, 2019, at the Kirklin Clinic of the University of Alabama at Birmingham, an ambulatory referral center.

PATIENTS

Adult patients with International Classification of Diseases diabetes codes were selected based on available data for 6 established clustering parameters (glutamic acid decarboxylase autoantibody; hemoglobin A1c; body mass index; diagnosis age; HOMA2-B; HOMA2-IR); ∼42% were Black/African American.

MAIN OUTCOME MEASURE(S)

Diabetes subtypes and their associated characteristics in a diverse adult population based on clustering analysis. We hypothesized that racial background would affect the distribution of subtypes. Outcome and hypothesis were formulated prior to data collection.

RESULTS

Diabetes cluster distribution was significantly different in Black/African Americans compared to Whites (P < .001). Black/African Americans were more likely to have severe insulin-deficient diabetes (OR, 1.83; 95% CI, 1.36-2.45; P < .001), associated with more serious metabolic perturbations and a higher risk for complications (OR, 1.42; 95% CI, 1.06-1.90; P = .020). Surprisingly, Black/African Americans specifically had more severe impairment of β-cell function (homoeostatic model assessment 2 estimates of β-cell function, C-peptide) (P < .001) but not being more obese or insulin resistant.

CONCLUSION

Racial background greatly influences diabetes cluster distribution and Black/African Americans are more frequently and more severely affected by severe insulin-deficient diabetes. This may further help explain the disparity in outcomes and have implications for treatment choice.

The 13C Glucose Breath Test Accurately Identifies Insulin Resistance in People With Type 1 Diabetes

OBJECTIVE

This study investigated whether the delta-over-baseline of exhaled 13CO2 (Δ13CO2), generated from a 13C glucose breath test (13C-GBT), measured insulin resistance (IR) in people with type 1 diabetes, using the hyperinsulinemic-euglycemic clamp (HEC) as a reference method. The secondary objective was to compare the 13C-GBT with the estimated glucose disposal rate (eGDR).

METHODS

A 40 mU/m2/min HEC and 2 separate 13C-GBTs (euglycemic with insulin bolus and hyperglycemic without bolus) were consecutively performed in 44 adults with type 1 diabetes with varying body compositions. eGDR was calculated based on hemoglobin A1c (HbA1c), presence of hypertension, and waist circumference.

RESULTS

The mean glucose disposal rate (M-value) was 5.9 ± 3.1 mg/kg/min and mean euglycemic Δ13CO2 was 6.4 ± 2.1 δ‰, while median eGDR was 5.9 [4.3-9.8] mg/kg/min. The hyperglycemic Δ13CO2 did not correlate with the M-value, while the euglycemic Δ13CO2 and the M-value correlated strongly (r = 0.74, P < .001). The correlation between M-value and eGDR was more moderate (Spearman's rho = 0.63, P < .001). Linear regression showed an association between Δ13CO2 and M-value, adjusted for age, sex, and HbA1c ]adjusted R² = 0.52, B = 1.16, 95% confidence interval (CI) .80-1.52, P < .001]. The area under the receiver-operator characteristics curve for Δ13CO2 to identify subjects with IR (M-value < 4.9 mg/kg/min) was 0.81 (95% CI .68-.94, P < .001). The optimal cut-off for Δ13CO2 to identify subjects with IR was ≤ 5.8 δ‰.

CONCLUSION

Under euglycemic conditions, the 13C-GBT accurately identified individuals with type 1 diabetes and concurrent IR, suggesting its potential as a valuable noninvasive index. Clinical Trial Identifier: NCT04623320.

Cardiometabolic Health Intervention Using Music and Exercise (CHIME) Delivered via Telehealth to Wheelchair Users: Protocol for a Randomized Controlled Trial

BACKGROUND

Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality.

OBJECTIVE

The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos.

METHODS

This study's design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3×/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded.

RESULTS

Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission.

CONCLUSIONS

The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57423.

Nomogram for Predicting Suboptimal Weight Loss at Three Years after Roux-en-Y Gastric Bypass Surgery in Chinese Patients with Obesity and Type 2 Diabetes

INTRODUCTION

Strategies to address suboptimal weight loss after Roux-en-Y gastric bypass (RYGB) can be developed if at-risk patients are identified in advance. This study aimed to build a pre-surgery prediction nomogram for early prediction of insufficient weight loss (IWL) or weight regain (WR) after bariatric surgery in Chinese patients.

METHODS

In this retrospective study, 187 patients with obesity and type 2 diabetes who underwent laparoscopic RYGB were followed yearly for 3 years. Suboptimal weight loss included IWL and WR. IWL was defined as a total weight loss percentage of <25% at 1 year postoperatively, and WR was defined as a maximum weight loss percentage of >20% at 3 years postoperatively. Multivariate logistic regression was performed to identify independent predictors and to establish a nomogram to predict the occurrence of suboptimal weight loss.

RESULTS

Multivariate logistic regression revealed that male sex (OR 4.268, 95% CI: 1.413-12.890), body mass index (OR 0.816, 95% CI: 0.705-0.946), and glycated hemoglobin (OR 1.493, 95% CI: 1.049-2.126) were independent predictors of IWL/WR. The AUC value of the nomogram constructed from the above three factors was 0.781. The Hosmer-Lemeshow test showed that the model had a good fit (p = 0.143). The calibration curve of the nomogram is close to an ideal diagonal line. Furthermore, the decision curve analysis demonstrated the good net benefits of the model.

CONCLUSIONS

A nomogram based on pre-surgery factors was developed to predict postoperative IWL/WR. This provides a convenient and useful tool for predicting suboptimal weight loss before surgery.

Insulin resistance, cognition, and functional brain network topology in older adults with obesity

Objective

Cross-sectional data from a sample of older adults with obesity was used to determine how peripheral and neuronal insulin resistance (IR) relate to executive function and functional brain network topology.

Methods

Older adults (n=71) with obesity but without type 2 diabetes were included. Peripheral IR was quantified by HOMA2-IR. Neuronal IR was quantified according to a proposed neuron-derived exosome-based method (NDE-IR). An executive function composite score, summed scores to the Auditory Verbal Learning Test (AVLT) trials 1-5, and functional brain networks generated from resting-state functional magnetic resonance imaging were outcomes in analyses. We used general linear models and a novel regression framework for brain network analysis to identify relationships between IR measures and brain-related outcomes.

Results

HOMA2-IR, but not NDE-IR, was negatively associated with executive function. Neither IR measure was associated with AVLT score. Peripheral IR was also related to hippocampal network topology in participants who had undergone functional neuroimaging. Neither peripheral nor neuronal IR were significantly related to network topology of the central executive network.

Conclusions

Cognitive and functional imaging effects were observed from HOMA2-IR, but not NDE-IR. The hippocampus may be particularly vulnerable to effects of peripheral IR.

Risk Evaluation of Progression of Proteinuria and Renal Decline Based on a Novel Subgroup Classification in Chinese Patients with Type 2 Diabetes

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is a highly heterogeneous disease with a varying risk of complications. The recent novel subgroup classification using cluster analysis contributed to the risk evaluation of diabetic complications. However, whether the subgroup classification strategy could be adopted to predict the risk of onset and progression of diabetic kidney disease (DKD) in Chinese individuals with T2DM remains to be elucidated.

METHODS

In this retrospective study, 612 Chinese patients with T2DM were enrolled, and the median follow-up time was 3.5 years. The T2DM subgroups were categorized by a two-step cluster analysis based on five parameters, including age at onset of diabetes, body mass index (BMI), glycosylated hemoglobin (HbA1c), homeostasis model assessment 2 of insulin resistance (HOMA2-IR), and homeostasis model assessment 2 of β-cell function (HOMA2-β). Clinical characteristics across subgroups were compared using t-tests and chi-square tests. Furthermore, multivariate logistic regression models were adopted to assess the risk of albuminuria progression and renal function decline among different subgroups.

RESULTS

The cohort was categorized into four groups: severe insulin-deficient diabetes (SIDD), with 146 patients (23.9%); mild insulin resistance (MIRD), with 81 patients (13.2%); moderate glycemic control diabetes (MGCD), with 211 patients (34.5%); and moderate weight insulin deficiency diabetes (MWIDD), with 174 patients (28.4%). The MIRD group exhibited an increased risk of progression from non-albuminuria to albuminuria as compared with the MWIDD group, with an adjusted odds ratio (OR) and 95% confidence interval (CI) of 2.92 (1.06, 8.04). The SIDD group had a higher risk of progression from micro-albuminuria to macro-albuminuria as compared with the MGCD group, with an adjusted OR and 95% CI of 3.39 (1.01, 11.41). There was no significant difference in the glomerular filtration rate (GFR) decline among all groups.

CONCLUSION

The present study offered the first evidence for risk evaluation of the development of DKD in the novel cluster-based T2DM Chinese subgroups. It suggested that the MIRD subgroup had a higher risk of DKD onset than the MWIDD subgroup. Meanwhile, the SIDD subgroup showed a higher risk of progression of albuminuria than the MGCD subgroup. This novel classification system could be effective in predicting the risk of DKD in Chinese patients with T2DM, which could facilitate the implementation of personalized therapeutic strategies.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2300077183).

Copper Deficiency Associated with Glycemic Control in Individuals with Type 2 Diabetes Mellitus

Adequate copper (Cu) status has been associated with improved glycemic control, partly because of its role in reducing oxidative stress through superoxide dismutase (SOD) activity. Thus, the aim was to investigate the relationship between plasma Cu concentration and markers associated with glycemic control in individuals with type 2 diabetes mellitus (T2DM). This observational and cross-sectional study was conducted in individuals with T2DM of both sexes, aged between 19 and 59 years. Plasma Cu levels were analyzed using inductively coupled plasma optical emission spectrometry (ICP-OES). Fasting glucose and insulin concentrations, C-peptide levels, SOD activity, and glycated hemoglobin (%HbA1c) were measured. Homeostatic model assessments (HOMA%B, HOMA%S, and HOMA-IR) were also performed. Additionally, %body fat and waist circumference were measured, and body mass index was calculated. Participants were categorized based on their plasma Cu concentrations (< 70 µg/dL and ≥ 70 µg/dL). The associations between variables were analyzed using chi-squared or Fisher's test and binary logistic regression models. Statistical significance was set at P < 0.05. Of the 97 participants (74.2% women), 85.5% had Cu deficiency. Cu-deficient individuals showed elevated C-peptide concentrations and HOMA%B values compared to those with adequate Cu levels (2.8 ng/mL vs. 1.8 ng/mL, P = 0.011; and 71.4 vs. 31.0, P = 0.003), respectively. Cu deficiency was associated with insulin resistance (P = 0.044) and decreased likelihood of exceeding the target serum glucose level (OR = 0.147, P = 0.013). However, no significant association was found between SOD activity and plasma Cu concentration. Consequently, Cu deficiency was linked to improved glycemic control, although it was not associated with the other markers.

Retinal and Choroidal Phenotypes Across Novel Subtypes of Type 2 Diabetes Mellitus

PURPOSE

To investigate longitudinal changes in choroidal thickness (CT) and ganglion cell-inner plexiform layer thickness (GC-IPLT) across distinct phenotypes of type 2 diabetes mellitus (T2DM) patients.

DESIGN

Prospective cohort study.

METHODS

T2DM patients were categorized into 5 groups (SAID, SIDD, SIRD, MOD, and MARD) using K-means clustering based on β-cell function and insulin resistance. Swept-source optical coherence tomography measured baseline and 4-year follow-up CT and GC-IPLT. Linear mixed-effects models assessed absolute and relative changes in CT and GC-IPLT across subtypes.

RESULTS

Over a median 4.11-year follow-up, CT and GC-IPLT decreased significantly across all groups. Choroidal thinning rates were most pronounced in SIDD (-6.5 ± 0.53 µm/year and -3.5 ± 0.24%/year) and SAID (-6.27 ± 0.8 µm/year and -3.19 ± 0.37%/year), while MARD showed the slowest thinning rates (-3.63 ± 0.34 µm/year and -1.98 ± 0.25%/year). SIRD exhibited the greatest GC-IPLT loss (-0.66 ± 0.05 µm/year and -0.91 ± 0.07%/year), with the least in SIDD (-0.36 ± 0.05 µm/year and -0.49 ± 0.07%/year), all statistically significant (all P < 0.001). Adjusted for confounding variables, SIDD and SAID groups showed faster CT thinning than MARD [-2.57 µm/year (95% CI: -4.16 to -0.97; P = 0.002) and -2.89 µm/year (95% CI: -4.12 to -1.66; P < 0.001), respectively]. GC-IPLT thinning was notably accelerated in SIRD versus MARD, but slowed in SIDD relative to MARD [differences of -0.16 µm/year (95% CI: -0.3 to -0.03; P = 0.015) and 0.15 µm/year (95% CI: 0.03 to 0.27; P = 0.015), respectively].

CONCLUSIONS

Microvascular damage in the choroid is associated with SIDD patients, whereas early signs of retinal neurodegeneration are evident in SIRD patients. All these changes may precede the onset of DR.

Comparisons of Post-Load Glucose at Different Time Points for Identifying High Risks of MASLD Progression

Background: The 1-h post-load plasma glucose was proposed to replace the current OGTT criteria for diagnosing prediabetes/diabetes. However, it remains unclear whether it is superior in identifying progressive metabolic dysfunction-associated steatotic liver disease (MASLD), and thus we aimed to clarify this issue. Methods: Consecutive Asian participants (non-MASLD, n = 1049; MASLD, n = 1165) were retrospectively enrolled between June 2012 and June 2024. CT was used to quantify liver steatosis, while the serum liver fibrotic marker was used to evaluate liver fibrosis. Results: Compared with those with normal levels of both 1-h post-glucose (1hPG) and 2-h post-glucose (2hPG), patients with MASLD showed a significant positive association between elevated 1hPG levels and moderate to severe liver steatosis (odds ratio [OR] = 2.19, 95% confidence interval [CI]: 1.13-4.25, p = 0.02]. Elevated levels of both 1hPG and 2hPG were associated with an increased risk of liver injury (OR = 2.03, 95% CI: 1.44-2.86, p < 0.001). Elevated 2hPG levels with or without elevated 1hPG levels were associated with liver fibrosis (OR = 1.99, 95% CI: 1.15-3.45, p < 0.001; OR = 2.72, 95% CI: 1.79-4.11, p < 0.001, respectively). Additionally, either 1hPG or 2hPG levels were associated with atherosclerosis, revealing significant dose-dependent associations between glucose status and atherosclerosis risk (OR = 2.77, 95% CI: 1.55-4.96, p < 0.001 for elevated 1hPG; OR = 2.98, 95% CI = 1.54-5.78, p = 0.001 for elevated 2hPG; OR = 2.41, 95% CI = 1.38-4.21, p = 0.001 for elevated levels of both 1hPG and 2hPG). The areas under the ROC for predicting steatosis, liver injury, liver fibrosis, and atherosclerosis were 0.64, 0.58, 0.58, and 0.64 for elevated 1hPG (all p < 0.05) and 0.50, 0.60, 0.56, and 0.62 for elevated 2hPG (all p < 0.05), respectively. Conclusions: These findings underscore the necessity for clinicians to acknowledge that the screening and management of MALSD requires the monitoring of 1hPG levels.

Association between HOMA2 based beta-cell function or insulin resistance and long-term outcomes in kidney transplant recipients with type 2 diabetes

Type 2 diabetes (T2D) is a common comorbidity in kidney transplant recipients, representing a significant proportion of the candidate pool. Post-kidney transplantation management of T2D remains challenging, leading to inferior long-term outcomes compared to non-diabetic recipients. This study aimed to assess the association between Homeostatic Model Assessment 2 (HOMA2) derived insulin resistance and beta-cell function on kidney graft outcomes in T2D kidney transplant recipients. We conducted a monocentric retrospective study at the University Hospital of Lille, including all consecutive adult T2D patients who underwent kidney transplantation between January 2007 and December 2018. HOMA2 indexes (HOMA2 IR for insulin resistance and HOMA2 B for beta-cell function) were calculated at one-year post-transplantation. Primary endpoint was graft survival and secondary endpoints were death-censored graft survival, patient survival and post-transplant metabolic control. Among 1620 kidney transplant recipients, 138 patients with T2D were included, with a median follow-up of 1837 days [1283-2726]. HOMA2 IR was significantly associated with an increased risk of kidney graft failure or death (HR per unit = 1.11 (1.02-1.21). Beta-cell function was not associated with graft prognosis, but decreased beta-cell function was associated with poorer metabolic control over time. This study highlights the significance of insulin resistance as a potential determinant of long-term outcomes in T2D kidney transplant recipients.

The adipose tissue melanocortin 3 receptor is targeted by ghrelin and leptin and may be a therapeutic target in obesity

OBJECTIVE

Obesity is linked to perturbations in energy balance mechanisms, including ghrelin and leptin actions at the hypothalamic circuitry of neuropeptide Y (NPY) and melanocortin. However, information about the regulation of this system in the periphery is still scarce. Our objective was to study the regulation of the NPY/melanocortin system in the adipose tissue (AT) and evaluate its therapeutic potential for obesity and type 2 diabetes.

METHODS

The expression of the NPY/melanocortin receptors' levels was assessed in the visceral AT of individuals with obesity and altered metabolism. Protein levels of these receptors were evaluated in cultured adipocytes incubated with ghrelin (30 and 100 ng/mL) and leptin (1 and 10 nM) and in the AT of an animal model with a mutation in the leptin receptor (ZSF1 rat), to understand their regulation by leptin and ghrelin. The vertical sleeve gastrectomy animal model was used to evaluate the putative therapeutic potential of the NPY/melanocortin system.

RESULTS

In this study, we unravelled that leptin (1 nM and 10 nM) selectively reduced the levels of NPY5R and MC3R but no other NPYR/MCRs in cultured adipocytes. In turn, acylated ghrelin (100 ng/mL) significantly increased NPY1R, but the inhibition of its receptor also abrogates MC3R levels. However, in the Lepr-deficient ZSF1 rat, both NPY5R and MC3R levels were reduced, along with other NPYRs and MCRs, suggesting that leptin resistance negatively affects NPY and melanocortin signalling. In human adipose tissue, we found a downregulation of genes encoding the NPY and melanocortin receptors in the visceral AT of individuals with obesity and insulin resistance, being correlated with genes regulating metabolic activity. Additionally, diabetic obese rats submitted to vertical sleeve gastrectomy showed increased levels of NPY, melanocortin, ghrelin, and leptin receptors in the AT, including MC3R, suggesting it may constitute a therapeutic target in obesity.

CONCLUSIONS

Our results suggest that the AT NPY/melanocortin system, particularly the MC3R, may be involved in the neuroendocrine regulation of adipocyte metabolism. Altogether, our work shows MC3R is under the control of the ghrelin/leptin duo, is reduced in patients with obesity and prediabetes, and may constitute a therapeutic target in obesity.

Increasing plant protein in the diet induces changes in the plasma metabolome that may be beneficial for metabolic health. A randomized crossover study in males

BACKGROUND & AIM

Dietary shifts replacing animal protein (AP) with plant protein (PP) sources have been associated with lowering cardiometabolic risk (CMR), but underlying mechanisms are poorly characterized. This nutritional intervention aims to characterize the metabolic changes induced by diets containing different proportions of AP and PP sources in males at CMR.

DESIGN

This study is a 4-week, crossover, randomized, controlled-feeding trial in which 19 males with CMR followed two diets providing either 36 % for the control diet (CON-D) or 64 % for the flexitarian diet (FLEX-D) of total protein intake from PP sources. Plasma nontargeted metabolomes (LC-MS method) were measured in the fasted state and after a high-fat challenge meal at the end of each intervention arm. Lipogenesis and protein synthesis fluxes, flow-mediated dilatation (FMD) and gluco-lipidic responses were assessed after the challenge meal. Data were analyzed with mixed models, and univariate and multivariate models for metabolomics data.

RESULTS

In both arms CMR improved with time, with decreased body weight (-0.9 %), insulin resistant (-34 %, HOMA-IR, Homeostatic Model Assessment for Insulin Resistance) and low-density lipoproteins (LDL)-cholesterol (-11 %). Diet had no effect on FMD or metabolic fluxes, but a trend (0.05

CONCLUSIONS

Despite little changes in risk factors after 4 wk, this study evidenced subtle metabolic adaptations in amino acids and lipid metabolism and gut microbiota activity occurring after higher PP source intake that may be beneficial to CMR.

CLINICALTRIALS

GOV STUDY IDENTIFIER

NCT04236518.

CLINICAL TRIAL REGISTRY

NCT04236518 on ClinicalTrials.gov.

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Key Words

• Branched-chain amino acids
• Hypertriglyceridemic waist phenotype
• Plant proteins
• Plant-based diet
• Postprandial response
• Trimethylamine-oxide

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MESH Headings

• Adult
• Humans
• Male
• Middle Aged
• Young Adult
• Blood Glucose/metabolism
• Cardiometabolic Risk Factors
• Cross-Over Studies
• Fasting/blood
• Insulin Resistance
• Metabolome/physiology
• Postprandial Period/physiology
• Plant Proteins, Dietary/administration & dosage

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Affiliation(s)

Gaïa Lépine Université Clermont Auvergne, INRAE, UNH, 63000, Clermont-Ferrand, France; Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 91120, Palaiseau, France
François Mariotti Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 91120, Palaiseau, France
Marie Tremblay-Franco Toxalim - Research Centre in Food Toxicology, Toulouse University, INRAE, ENVT, INP-Purpan, UT3, F-31300, Toulouse, France; MetaboHUB-MetaToul, National Infrastructure of Metabolomics and Fluxomics, Toulouse, 31077, France
Marion Courrent CHU Clermont-Ferrand, Inserm CIC 1405, France
Marie-Anne Verny Université Clermont Auvergne, INRAE, UNH, 63000, Clermont-Ferrand, France
Jérémie David Université Clermont Auvergne, INRAE, UNH, 63000, Clermont-Ferrand, France
Véronique Mathé Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 91120, Palaiseau, France
Patrick Jame Universite Claude Bernard Lyon 1, CNRS, ISA, UMR5280, 5 rue de la Doua, F-69100 Villeurbanne, France
Anthony Anchisi Universite Claude Bernard Lyon 1, CNRS, ISA, UMR5280, 5 rue de la Doua, F-69100 Villeurbanne, France
Catherine Lefranc-Millot Roquette Frères, Lestrem, France
Caroline Perreau Roquette Frères, Lestrem, France
Laetitia Guérin-Deremaux Roquette Frères, Lestrem, France
Céline Chollet CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), MetaboHUB, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
Florence Castelli CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), MetaboHUB, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
Emeline Chu-Van CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), MetaboHUB, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
Jean-François Huneau Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 91120, Palaiseau, France
Didier Rémond Université Clermont Auvergne, INRAE, UNH, 63000, Clermont-Ferrand, France
Gisèle Pickering CHU Clermont-Ferrand, Inserm CIC 1405, France
Hélène Fouillet Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 91120, Palaiseau, France.
Sergio Polakof Université Clermont Auvergne, INRAE, UNH, 63000, Clermont-Ferrand, France.

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Younger-onset compared with later-onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow-up (UKPDS 92)

BACKGROUND

Younger-onset type 2 diabetes is associated with accelerated complications. We assessed whether complications and mortality rates differed for younger age compared with older age at diagnosis over 30 years of follow-up.

METHODS

In this study, we used data from the UKPDS, collected between 1977 and 2007, of participants aged 25-65 years with newly diagnosed type 2 diabetes with younger-onset (younger than 40 years) or later-onset (40 years or older), and without diabetes autoantibodies. We analysed standardised mortality ratios (SMR) using UK general population data, and incidence rates of prespecified outcomes by 10-year age intervals at diagnosis.

FINDINGS

Of 4550 participants testing negative to all measured autoantibodies, 429 (9·4%) had younger-onset type 2 diabetes. 2704 (59·4%) were male, and mean HbA1c was 76 mmol/mol (SD 24·6). The median follow-up was 17·5 years (IQR 12·7-20·8). SMR for younger-onset type 2 diabetes was higher (3·72 [95% CI 2·98-4·64]) compared with later-onset type 2 diabetes (1·54 [1·47-1·61]). The incidence rate was higher for all outcomes in later-onset type 2 diabetes, except for microvascular disease (younger-onset 14·5 (11·9-17·7) vs later-onset 12·1 (11·3-13·0) per 1000 person-years). However, at any given age, the 5-year incidence of any diabetes-related endpoint, all-cause mortality, microvascular disease, and myocardial infarction was higher with younger age at diagnosis. Annual mean HbA1c was higher in the first 20 years in younger-onset compared with later-onset type 2 diabetes. Among participants randomised to intensive versus conventional glycaemic control, we observed no interactions by subgroup of younger-onset versus later-onset type 2 diabetes for any outcome.

INTERPRETATION

The risk of dying relative to the general population is even greater for people diagnosed with type 2 diabetes at younger ages. The increased risk of complications and poorer glycaemic control in younger-onset type 2 diabetes calls for the development of services to identify and manage these individuals.

FUNDING

National Institute of Health and Care Research's Biomedical Research Centre.

Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy

BACKGROUND

Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile distributions in women with normal (non-IR and non-GDM) and suboptimal glycemic status (IR and/or GDM).

METHODS

CGM measurements were taken for 3-10 days at 18-24 weeks' gestation, followed by fasting serum insulin and oral glucose tolerance testing at 24-28 weeks' gestation. IR and GDM were determined by the updated Homeostasis Model Assessment of IR score of ≥ 1.22 and 2013 World Health Organization criteria, respectively. Risks of IR and GDM were estimated using modified Poisson models, and hourly interstitial glucose centiles determined using Generalized Additive Models for Location, Scale and Shape.

RESULTS

This prospective cohort study involved 167 pregnant women in Singapore, with a mean age of 31.7 years, body mass index of 22.9 kg/m2, and gestation of 20.3 weeks. 25% of women exhibited IR and 18% developed GDM. After confounders adjustment, women with suboptimal glycemic control, indicated by higher mean daily glucose (risk ratio 1.42; 95% confidence interval 1.16, 1.73), glucose management indicator (1.08; 1.03, 1.12), and J-index (1.04; 1.02, 1.06), as well as those with greater glycemic variability, indicated by higher standard deviation (1.69; 1.37, 2.09), coefficient of variation (1.03; 1.00, 1.06), and mean amplitude of glycemic excursions (1.4; 1.14, 1.35) derived from CGM in early gestation were associated with higher risks of developing IR in later gestation. These associations were similarly observed for the development of GDM. Centile curves showed that, compared to those with normal glycemic status, women with suboptimal glycemic status had higher glucose levels, with greater fluctuations throughout 24 h.

CONCLUSIONS

In pregnant women who subsequently developed IR and GDM, interstitial glucose levels assessed by CGM were elevated and varied greatly. This supports the potential use of CGM to screen for glycemic changes early in pregnancy.

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.

Reducing the mitochondrial oxidative burden alleviates lipid-induced muscle insulin resistance in humans

Preclinical models suggest mitochondria-derived oxidative stress as an underlying cause of insulin resistance. However, it remains unknown whether this pathophysiological mechanism is conserved in humans. Here, we used an invasive in vivo mechanistic approach to interrogate muscle insulin action while selectively manipulating the mitochondrial redox state in humans. To this end, we conducted insulin clamp studies combining intravenous infusion of a lipid overload with intake of a mitochondria-targeted antioxidant (mitoquinone). Under lipid overload, selective modulation of mitochondrial redox state by mitoquinone enhanced insulin-stimulated glucose uptake in skeletal muscle. Mechanistically, mitoquinone did not affect canonical insulin signaling but augmented insulin-stimulated glucose transporter type 4 (GLUT4) translocation while reducing the mitochondrial oxidative burden under lipid oversupply. Complementary ex vivo studies in human muscle fibers exposed to high intracellular lipid levels revealed that mitoquinone improves features of mitochondrial bioenergetics, including diminished mitochondrial H2O2 emission. These findings provide translational and mechanistic evidence implicating mitochondrial oxidants in the development of lipid-induced muscle insulin resistance in humans.

Identifying subtypes of type 2 diabetes mellitus based on real-world electronic medical record data in China

AIMS

To replicate the European subtypes of type 2 diabetes mellitus (T2DM) in the Chinese diabetes population and investigate the risk of complications in different subtypes.

METHODS

A diabetes cohort using real-world patient data was constructed, and clustering was employed to subgroup the T2DM patients. Kaplan-Meier analysis and the Cox models were used to analyze the association between diabetes subtypes and the risk of complications.

RESULTS

A total of 2,652 T2DM patients with complete clustering data were extracted. Among them, 466 (17.57 %) were classified as severe insulin-deficient diabetes (SIDD), 502 (18.93 %) as severe insulin-resistant diabetes (SIRD), 672 (25.34 %) as mild obesity-related diabetes (MOD), and 1,012 (38.16 %) as mild age-related diabetes (MARD). The risk of chronic kidney disease (CKD) and diabetic retinopathy (DR) were different in the four subtypes. Compared with MARD, SIRD had a higher risk of CKD (HR 2.40 [1.16, 4.96]), and SIDD had a higher risk of DR (HR 2.16 [1.11, 4.20]). The risk of stroke and coronary events had no difference.

CONCLUSIONS

The European T2DM subtypes can be replicated in the Chinese diabetes population. The risk of CKD and DR varied among different subtypes, indicating that proper interventions can be taken to prevent specific complications in different subtypes.

Trajectories of Inflammation in Youth and Risk of Mental and Cardiometabolic Disorders in Adulthood

Importance

Research suggests that low-grade, nonresolving inflammation may predate adult mental and physical illness. However, evidence to date is largely cross-sectional or focuses on single disorder outcomes.

Objectives

To examine trajectories of inflammation as measured by C-reactive protein (CRP) levels in a large sample of children and adolescents, and to explore associations between different identified trajectories and mental and related cardiometabolic health outcomes in early adulthood.

Design, Setting, and Participants

In a longitudinal cohort study using data from the large UK-based Avon Longitudinal Study of Parents and Children (ALSPAC), latent class growth analysis (LCGA) was used to explore different trajectories of inflammation, with logistic regression exploring association with mental and physical health outcomes. Participants with measurable CRP data and associated mental and cardiometabolic health outcomes recorded were included in the analysis. Data analysis was performed from May 1, 2023, to March 30, 2024.

Exposures

Inflammation was assessed via CRP levels at ages 9, 15, and 17 years. LCGA was used to identify different trajectories of inflammation.

Main Outcomes and Measures

Outcomes assessed at age 24 years included psychotic disorders, depressive disorders, anxiety disorders, hypomania, and, as a measure of insulin resistance, Homeostasis Model Assessment (HOMA2) score.

Results

A total of 6556 participants (3303 [50.4%] female) were included. Three classes of inflammation were identified: persistently low CRP levels (reference class, n = 6109); persistently raised CRP levels, peaking at age 9 years (early peak, n = 197); and persistently raised CRP levels, peaking at age 17 years (late peak, n = 250). Participants in the early peak group were associated with a higher risk of psychotic disorder (odds ratio [OR], 4.60; 95% CI, 1.81-11.70; P = .008), a higher risk of severe depression (OR, 4.37; 95% CI, 1.64-11.63; P = .02), and higher HOMA2 scores (β = 0.05; 95% CI, 0.01-0.62, P = .04) compared with participants with persistently low CRP. The late peak group was not associated with any outcomes at age 24 years.

Conclusions and Relevance

Low-grade systemic inflammation peaking in midchildhood was associated with specific mental and cardiometabolic disorders in young adulthood. These findings suggest that low-grade persistent inflammation in early life may be an important shared common factor for mental-physical comorbidity and so could be relevant to future efforts of patient stratification and risk profiling.

The Effect of the Oral Contraceptive Pill on Acute Glycaemic Response to an Oral Glucose Bolus in Healthy Young Women: A Randomised Crossover Study

Background/Objective: The oral contraceptive pill (OCP) is widely used by women worldwide, yet the influence of the OCP on carbohydrate metabolism remains under-investigated, with existing studies being few and largely cross-sectional. The study objective was to assess, for the first time, the effect of the combined OCP on postprandial glycaemic response to an oral glucose bolus, using a randomised crossover design. Methods: The effect of a combined monophasic OCP phase on glucose homeostasis and metabolic profile was investigated in 21 healthy young women, who were regular users of either androgenic or anti-androgenic OCP formulations. Plasma glycaemic markers (glucose, insulin and C-peptide) were assessed prior to a 60 g glucose drink (fasting) and for a further 4 h postprandially; once during the "active" (hormone-containing) pill phase and once during the "inactive" (hormone-free) pill phase of the OCP usage cycle. Results: Despite no change in fasting values, in androgenic pill users, postprandial glucose and insulin responses to an oral glucose bolus were ~100% and ~50% greater, respectively, during the active versus inactive phase. In contrast, in anti-androgenic pill users there was no significant change in response between the two OCP usage cycle phases. Conclusions: These findings highlight an acute, but potentially detrimental, influence of the combined OCP on glucose homeostasis, particularly in users of formulations containing androgenic progestogens. Given the high global prevalence of OCP use and increasingly common prolonged active pill regimens, which may continue for months, years or even decades, potential cumulative effects of such changes on metabolic risk demand further investigation.

Association Between Mycobacterium tuberculosis Sensitization and Insulin Resistance Among US Adults Screened for Type 2 Diabetes Mellitus

Background

Type 2 diabetes mellitus (T2DM) may be a long-term sequela of infection with Mycobacterium tuberculosis (Mtb) by mechanisms that remain to be fully explained. We evaluated the association between Mtb sensitization and T2DM and, via mediation analysis, the extent to which it is mediated by insulin resistance and/or β-cell failure.

Methods

Adults were assessed for T2DM by fasting plasma glucose, 2-hour oral glucose tolerance testing, and hemoglobin A1c; β-cell dysfunction and insulin resistance by homoeostasis model assessment 2; and Mtb sensitization by tuberculin skin testing. Associations between Mtb sensitization and T2DM were modeled with probit regression and decomposed into indirect effects of β-cell dysfunction and insulin resistance. Analyses were adjusted for sociodemographic, behavioral, and clinical characteristics.

Results

We included 1843 adults. Individuals with Mtb sensitization were older than those without Mtb (median [IQR], 54 [39-64] vs 47 [33-62] years). As compared with being uninfected, Mtb sensitization was associated with T2DM (adjusted absolute risk difference, 9.34% [95% CI, 2.38%-15.0%]; P < .001) and increased insulin resistance (adjusted median difference, 0.16 [95% CI, .03-.29]; P = .014) but not β-cell dysfunction (adjusted median difference, -3.1 [95% CI, -10.4 to 4.3]; P = .42). In mediation analyses, insulin resistance mediated 18.3% (95% CI, 3.29%-36.0%; P = .020) of the total effect of the association between Mtb sensitization and T2DM.

Conclusions

Definitive prospective studies examining incident T2DM following tuberculosis are warranted. Notwithstanding, our findings suggest that exposure to Mtb may be a novel risk factor for T2DM, likely driven by an increase in insulin resistance.

Time-course atherogenic blood lipid response to statin discontinuation in dyslipidemic adults

BACKGROUND AND AIMS

Half of dyslipidemic patients sometimes discontinue statin medication. It is unclear if blood atherogenic risk increases right after statin discontinuation or if there is a lingering protective effect. We sought to determine if a legacy effect prevented blood lipid increases during the first stages of statin cessation.

METHODS AND RESULTS

Atherogenic blood lipid profile was measured in 10 overweight (BMI 31 ± 3 kg m-2) middle-aged males (62 ± 7 years old), statin users, while fasted and postprandially. Trials were conducted before (i.e., Day 0) and after 4, 7, 15, and 30 days of statin withdrawal and 20 days after statins reloading (Day 50). Four days after statin discontinuation, blood fasting LDL-c, total cholesterol (CHOL), and triglyceride (TG) concentrations increased by 30%, 18%, and 17%, respectively (P < 0.05). The increases in LDL-c, CHOL, and TG peaked after 7-15 days at 79%, 48%, and 34% of basal levels (P < 0.001), respectively. There were no significant correlations between the increases in blood lipids and the dose or years under statin treatment (P = 0.156-0.575). Twenty days after resuming statins, blood LDL-c (2.79 ± 1.06 vs 2.20 ± 0.50 mmol L-1; P = 0.568), CHOL (4.85 ± 1.41 vs 4.25 ± 0.83 mmol L-1; P = 0.747), and TG (1.47 ± 0.60 vs 1.50 ± 0.68 mmol L-1; P = 0.782), returned to basal levels.

CONCLUSIONS

Our data does not support a statin lingering/legacy effect in blood lipids since they dangerously increased after only 4 days of statin withdrawal in every patient, regardless of dose and years under treatment. Reloading statins restored blood lipids, evidencing a reproducible biological effect at the whole-body level.

Association between O-GlcNAc levels and platelet function in obese insulin-resistant subjects

Obesity is an epidemic associated with platelet and vascular disorders. Platelet O-GlcNAcylation has been poorly studied in obese subjects. We aimed to evaluate O-linked N-acetyl-glucosamine (O-GlcNAc) levels and platelet activity in obese insulin-resistant (ObIR) subjects. Six healthy and six insulin-resistant obese subjects with a body mass index of 22.6 kg/m2 (SD ± 2.2) and 35.6 kg/m2 (SD ± 3.8), respectively, were included. Flow cytometry was used to measure markers of platelet activity, expression of P-selectin (CD62P antibody), glycoprotein IIb/IIIa (integrins αIIbβ3 binding to PAC-1 antibody), and thrombin stimulation. O-GlcNAc was determined in the platelets of all test subjects by cytofluometry, intracellular calcium, percentage of platelet aggregation, and immunofluorescence microscopy and Western blot were used to assess O-GlcNAc and OGT (O-GlcNAc transferase) in platelets. Platelets from ObIR subjects had on average 221.4 nM intracellular calcium, 81.89% PAC-1, 22.85% CD62P, 57.48% OGT, and 66.62% O-GlcNAc, while platelets from healthy subjects had on average 719.2 nM intracellular calcium, 4.99% PAC-1, 3.17% CD62P, 18.38% OGT, and 23.41% O-GlcNAc. ObIR subjects showed lower platelet aggregation than healthy subjects, 13.83% and 54%, respectively. The results show that ObIR subjects have increased O-GlcNAc, and increased intraplatelet calcium associated with platelet hyperactivity and compared to healthy subjects, suggesting that changes in platelet protein O-GlcNAcylation and platelet activity might serve as a possible prognostic tool for insulin resistance, prediabetes and its progression to type 2 diabetes mellitus.

Dissociation between liver fat content and fasting metabolic markers of selective hepatic insulin resistance in humans

OBJECTIVE

Fasting hyperglycemia and hypertriglyceridemia are characteristic of insulin resistance (IR) and rodent work has suggested this may be due to selective hepatic IR, defined by increased hepatic gluconeogenesis and de novo lipogenesis (DNL), but this has not been shown in humans.

DESIGN

Cross-sectional study in men and women across a range of adiposity.

METHODS

Medication-free participants (n = 177) were classified as normoinsulinemic (NI) or hyperinsulinemic (HI) and as having low (LF) or high (HF) liver fat content measured by magnetic resonance spectroscopy. Fractional gluconeogenesis (frGNG) and hepatic DNL were measured using stable isotope tracer methodology following an overnight fast.

RESULTS

Although HI and HF groups had higher fasting plasma glucose and triglyceride concentrations when compared to NI and LF groups respectively, there was no difference in frGNG. However, HF participants tended to have lower frGNG than LF participants. HI participants had higher DNL compared to NI participants but there was no difference observed between liver fat groups.

CONCLUSIONS

Taken together, we found no metabolic signature of selective hepatic IR in fasting humans. DNL may contribute to hypertriglyceridemia in individuals with HI but not those with HF. Glycogenolysis and systemic glucose clearance may have a larger contribution to fasting hyperglycemia than gluconeogenesis, especially in those with HF, and these pathways should be considered for therapeutic targeting.

Effect of probiotics on glycemic control and lipid profiles in patients with type 2 diabetes mellitus: a randomized, double blind, controlled trial

Introduction

This double-blind, placebo-controlled, randomized (1:1) clinical trial was conducted at the West China Hospital, Sichuan University, from March to September 2017.

Methods

Eligible participants included adults aged 18 years and older, living in the community, diagnosed with type 2 Diabetes Mellitus according to ADA guidelines, capable of self-managing their diabetes, and able to visit the study site for follow-up. The intervention group received 25 ml of a probiotic beverage containing with over 10^8 CFU/mL of Lactobacillus, administered four times daily. An equal volume of inactivated Lactobacillus was administered to the control group and the control group was administered the same volume of inactivated Lactobacillus. This study aimed to evaluate the effectiveness of probiotics on glycemic control and other diabetes-related outcomes in patients with type 2 diabetes patients. The primary outcomes were changes in HbA1c and FBG levels post-intervention. Investigators, participants, and study site personnel were blinded to the treatment allocation until the conclusion of the study. This double-blind, randomized, placebo-controlled clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR-POR-17010850).

Results

Of the 490 participants screened, 213 were randomized to either the probiotics group (n = 103) or the placebo group (n = 110). After 16 weeks of follow-up, the probiotic group showed reductions in HbA1c [-0.44 (-0.66 to -0.22)] and FBG [-0.97 (-1.49 to 0.46)] post-intervention, similar to the placebo group with reductions in HbA1c [-0.33 (-0.52 to -0.15)] and FBG [-0.90 (-1.32 to -0.47)], but these changes were not statistically significant in PP and ITT analyses (P>0.05). Adverse events were similarly distributed among groups, indicating comparable safety profiles.

Discussion

Overall, 16-week probiotic supplementation showed no beneficial effects on glycemic control, lipid profiles, or weight.

Clinical Trial Registration

https://www.chictr.org.cn/showproj.html?proj=18421, identifier ChiCTR-POR-17010850.

Using anthropometric parameters to predict insulin resistance among patients without diabetes mellitus

Anthropometric parameters are widely used in the clinical assessment of hypertension, type 2 diabetes, and cardiovascular disease. However, few studies have compared the association between different anthropometric parameters and insulin resistance (IR). This study was aimed at investigating the relationship between 6 indicators, including body mass index (BMI), calf circumference (CC), arm circumference (AC), thigh circumference (TC), waist circumference (WC), waist-height ratio (WHtR), and IR. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to measure IR. Weighted linear regression was used to assess the relationship between different parameters and IR. The receiver operating characteristic curve (ROC) was employed to compare the strength of the relationship between different anthropometric parameters and IR. A total of 8069 participants were enrolled in our study, including 4873 without IR and 3196 with IR. The weighted linear regression results showed that BMI, CC, AC, TC and WC were significantly correlated with IR, except WHtR. After adjusting for multiple confounding factors, we found that BMI, AC and WC were significantly positively correlated with IR, while TC was significantly negatively correlated with IR. Logistic regression results showed that a larger TC was associated with a decreased risk of IR. In addition, BMI and WC had similar areas under the curve (AUC: 0.780, 95% CI 0.770-0.790; AUC: 0.774, 95% CI 0.763-0.784, respectively), which were higher than TC and AC (AUC: 0.698, 95% CI 0.687-0.710, AUC: 0.746, 95% CI 0.735-0.757, respectively). To our knowledge, this is the first study to report a negative correlation between TC and IR among patients without diabetes mellitus. Therefore, TC may be a new tool to guide public health and a clinical predictor of IR in non-diabetic patients.

The relation of mTOR with diabetic complications and insulin resistance in patients with type 2 diabetes mellitus

BACKGROUND

Dysregulation of the mechanistic target of rapamycin (mTOR) has been related to several metabolic conditions, notably obesity and type 2 diabetes (T2DM). This study aimed to evaluate the role of mTOR in patients with T2DM, and its relationship with insulin resistance and microvascular complications.

METHODS

This case-control study was conducted on 90 subjects attending the Outpatient Internal Medicine Clinic in Damanhur Teaching Hospital. Subjects were divided into 3 groups, Group I: 20 healthy controls, Group II: 20 subjects with T2DM without complications, and Group III: 50 subjects with T2DM with microvascular complications. An Enzyme-linked immunosorbent assay was used to measure serum mTOR levels. T2DM and diabetic complications were defined according to the diagnostic criteria of the American Diabetes Association.

RESULTS

The results revealed significant positive correlations to HbA1c (r = 0.530, P < 0.001), fasting glucose (r = 0.508, P < 0.001), and HOMA- IR (r = 0.559, P < 0.001), and a significant negative correlation to eGFR (r=-0.370, P = 0.002). Multivariate analysis revealed an independent association of mTOR and HbA1c values with the presence of microvascular complications. The prediction of microvascular complications was present at a cutoff value of 8 ng/ml mTOR with a sensitivity of 100% and specificity of 95% with an AUC of 0.983 and a p-value < 0.001.

CONCLUSION

mTOR is a prognostic marker of diabetic microvascular and is associated with insulin resistance in patients with T2DM.

TRIAL REGISTRATION

The study was conducted following the Declaration of Helsinki, and approved by the Ethics Committee of Alexandria University (0201127, 19/7/2018).