Postchallenge hyperglycemia and mortality in a national sample of U.S. adults

Effects of hyperglycemia on the TGF-β pathway in trabecular meshwork cells

BACKGROUND

Hyperglycemia, which can lead to apoptosis, hypertrophy, fibrosis, and induces hyperinflammation in diabetic vascular complications due to oxidative stress. In order to elucidate the potential dual roles and regulatory signal transduction of TGF-β1 and TGF-β2 in human trabecular meshwork cells (HTMCs), we established an oxidative cell model in HTMCs using 5.5, 25, 50, and 100 mM d-glucose-supplemented media and characterized the TGF-β-related oxidative stress pathway.

METHODS

Further analysis was conducted to investigate oxidative damage and protein alterations in the HTMC caused by the signal transduction. This was done through a series of qualitative cell function studies, such as cell viability/apoptosis analysis, intracellular reactive oxygen species (ROS) detection, analysis of calcium release concentration, immunoblot analysis to detect the related protein expression alteration, and analysis of cell fibrosis to study the effect of different severities of hyperglycemia. Also, we illustrated the role of TGF-β1/2 in oxidative stress-induced injury by shRNA-mediated knockdown or stimulation with recombinant human TGF-β1 protein (rhTGF-β1).

RESULTS

Results from the protein expression analysis showed that p-JNK, p-p38, p-AKT, and related SMAD family members were upregulated in HTMCs under hyperglycemia. In the cell functional assays, HTMCs treated with rhTGFβ-1 (1 ng/mL) under hyperglycemic conditions showed higher proliferation rates and lower ROS and calcium levels.

CONCLUSIONS

To summarize, mechanistic analyses in HTMCs showed that hyperglycemia-induced oxidative stress activated TGF-β1 along with its associated pathway.

GENERAL SIGNIFICANCE

While at low concentrations, TGF-β1 protects cells from antioxidation, whereas at high concentrations, it accumulates in the extracellular matrix, causing further HTMC dysfunction.

Pharmacokinetics, pharmacodynamics, and safety of prandial oral insulin (N11005) in healthy subjects

Aims

To verify whether the oral insulin N11005 is administered as a prandial insulin by assessing the pharmacokinetics (PK), pharmacodynamics (PD), and safety profiles of N11005 with a short-acting biosynthetic human insulin (Novolin R) as reference.

Methods

This was a randomized, open-label, single-dose, crossover hyperinsulinemic-euglycemic clamp study in healthy Chinese male subjects. A total of 12 subjects were enrolled in the test (T) group (N11005, 300 IU, p.o.) and the reference (R) group (Novolin R, 0.1 IU/Kg, i.h.) with a washout period of 14 days. All subjects were administered on the same day of the clamp study. Glucose Infusion Rates (GIR), serum insulin, and C-peptide concentration were determined during every 8-hour clamp cycle. Trial registration: Clinicaltrials.gov identifier NCT04975022.

Results

After administration, the ratios of mean serum C-peptide concentration to baseline concentration in both T and R groups were lower than 50%, which confirmed the stability of the clamp platform. T group (N11005) showed a more rapid onset of action (tGIR10%max≈11 min) and a comparable duration of action to the R group, which was basically in line with the characteristics of prandial insulins. No adverse events (AEs) occurred throughout the study, which demonstrated that N11005 and Novolin R are safe and well-tolerated.

Conclusions

The PD profiles of the single-dose N11005 in the human body are similar to those of prandial insulins, with an excellent safety profile.

Clinical trial registration

Clinicaltrials.gov, identifier NCT04975022.

Are HOMA-IR and HOMA-B good predictors for diabetes and pre-diabetes subtypes?

BACKGROUND

To investigate the association between the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Homeostasis Model Assessment of Beta-cell function (HOMA-B) with the incidence of diabetes and pre-diabetes subtypes.

METHODS

A total of 3101 normoglycemic people aged 20-70 years were included in the 6-year follow-up study. Multinomial logistic regression was used to calculate the incidence possibility of isolated Impaired Fasting Glucose (iIFG), isolated Impaired Glucose Tolerance (iIGT), Combined impaired fasting glucose & impaired glucose tolerance (CGI), and Diabetes Mellitus (DM) per standard deviation (SD) increment in HOMA-IR and HOMA-B in the crude and multivariable model.

RESULTS

In the multivariate model, an increase in one SD change in HOMA-IR was associated with a 43, 42, 75, and 92% increased risk of iIFG, iIGT, CGI, and DM, respectively. There was a positive correlation between the increase in HOMA-B and the incidence of iIGT; however, after adjusting the results for metabolic syndrome components, it was inversely correlated with the incidence of iIFG [Odds Ratio = 0.86(0.75-0.99)].

CONCLUSIONS

HOMA-IR is positively correlated with diabetes and pre-diabetes subtypes' incidence, and HOMA-B is inversely correlated with the incidence of iIFG but positively correlated with iIGT incidence. However, none of these alone is a good criterion for predicting diabetes and pre-diabetes.

The role of age on the risk relationship between prediabetes and major morbidities and mortality: Analysis of the Hong Kong diabetes surveillance database of 2 million Chinese adults

BACKGROUND

Intensive lifestyle modification showed variable success in the prevention of major clinical events and mortality among people with prediabetes. We propose that age may partly explain the heterogeneity and that health hazards related to prediabetes are age-specific.

METHODS

We conducted a retrospective analysis of a territory-wide diabetes surveillance dataset from the Hong Kong Hospital Authority between 2000 and 2019. Prediabetes was defined according to the American Diabetes Association criteria. Proportional Cox regression was performed, stratified by baseline age categories (20-39, 40-59, 60-79 and ≥80 years).

FINDINGS

1,630,942 individuals were included in the analysis. Compared with normoglycaemia, prediabetes was associated with greater hazards for cardiovascular disease (CVD) and all-cause mortality in most age groups but the effect size attenuated with ascending age (p value for trend <0·05). In the youngest and in the oldest age categories, the respective hazard ratios (95% confidence interval) of prediabetes vs normoglycaemia were 1·79 (1·59, 2·01) and 1·00 (0·95, 1·05) for CVD, and 1·36 (1·20, 1·55) and 0·99 (0·97, 1·02) for all-cause mortality. Similar associations were found for chronic kidney disease, end-stage kidney disease, all-site cancer, all-site infection, subtypes of CVD, and cause-specific mortality. The associations became attenuated but remained after excluding people who later developed diabetes and adjusting for metabolic factors. Similar associations were observed in prediabetes defined by impaired fasting glucose, but not HbA1c.

INTERPRETATION

Prediabetes is associated with higher risk of major clinical events, even excluding subsequent development of diabetes and adjusting for metabolic factors. The risk relationships are stronger in young than older people.

FUNDING

This study did not receive any specific funding.

Assessment of lipid profile with HbA1c in type 2 diabetic Iraqi patients

Insulin-induced hyperglycemia is the hallmark of diabetes mellitus (DM), including various metabolic disorders. Diabetic people are more likely to develop dyslipidemia, hypertension, and obesity. Type 2 diabetes ‎(T2DM), the most common illness, is generally asymptomatic in its early stages and can go misdiagnosed for years. Diabetes screening may be beneficial in some cases since early identification and treatment can lessen the burden of diabetes and its consequences.‎ This study aimed to find the relationship between Glycated hemoglobin (HbA1c) ‎and lipid profile components in T2DM‎ patients. Methods: This descriptive-analytical and cross-sectional study was performed on the control group and T2DM patients in ‎Medical City in Baghdad between March and June 2021‎. A total of 90 patients with T2DM and ‎‎45 healthy control were included in this study. In the control group, healthy volunteer individuals participated. For all subjects, HbA1c, fasting blood sugar/FBS, and lipid profile (Total Cholesterol/TC, Triglyceride/TG, High-density Lipoprotein/HDL, Low-density Lipoprotein/LDL, and Very Low-density Lipoprotein/VLDL) were assessed. Among T2DM patients, 62.22% (n= 56) were male, and 37.78% (n= ‎‎34) were female. Mean ± SD levels of HbA1c, TC, TG, LDL, VLDL, HDL, and FBS were 7.33±0.56 ‎‎% (168.21±9.23, 146.10±9.64, 137.23±8.32, 41.05±5.86, 43.85±6.17, and ‎‎208.81±52.1) mg/dl respectively in the T2DM group. In the control group, ‎the Mean ± SD results of the same parameters were 4.91±0.27%, ‎‎(171.20±3.57, 116.60±8.25, 105.05±2.11, 41.83±4.92, 44.04±5.54, ‎‎96.20±7.8) mg/dl respectively. Results demonstrated statistically significant ‎‎differences between T2DM patients and control groups in HbA1c ‎‎(p equal to 0.0025), TG ‎(p equal to 0.015), LDL ‎ ‎(p=0.0029),‎ and FBS ‎(p=0.02‎). Pearson correlation analysis of HbA1c with other variables showed a significant ‎positive correlation with serum TC, TG, LDL, and ‎FBS ‎(r=0.573, P<0.01; ‎r=0.655, P <0.001; r=0.498, P<0.05‎; r=0.691, ‎P<‎0.001‎; ‎‏respectively). At the same time, the data showed a negative connection between HbA1c and HDL (r= - 0.562, P<0.01). The findings of this study reveal that diabetic people do not have a satisfactory HbA1c level. Furthermore, HbA1c shows a significant correlation with TC, TG, LDL, and VLDL, whereas it has a significant negative correlation with HDL. The study's findings showed that HbA1c might be a useful marker for predicting dyslipidemia in T2DM patients. Keywords: T2DM, Lipid profile, HbA1c.

Assessment of lipid profile with HbA1c in type 2 diabetic Iraqi patients

Insulin-induced hyperglycemia is the hallmark of diabetes mellitus (DM), including various metabolic disorders. Diabetic people are more likely to develop dyslipidemia, hypertension, and obesity. Type 2 diabetes ‎(T2DM), the most common illness, is generally asymptomatic in its early stages and can go misdiagnosed for years. Diabetes screening may be beneficial in some cases since early identification and treatment can lessen the burden of diabetes and its consequences.‎ This study aimed to find the relationship between Glycated hemoglobin (HbA1c) ‎and lipid profile components in T2DM‎ patients. This descriptive-analytical and cross-sectional study was performed on the control group and T2DM patients in ‎Medical City in Baghdad between March and June 2021‎. A total of 90 patients with T2DM and ‎‎45 healthy control were included in this study. In the control group, healthy volunteer individuals participated. For all subjects, HbA1c, fasting blood sugar/FBS, and lipid profile (Total Cholesterol/TC, Triglyceride/TG, High-density Lipoprotein/HDL, Low-density Lipoprotein/LDL, and Very Low-density Lipoprotein/VLDL) were assessed. Among T2DM patients 62.22% (n= 56) were male and 37.78% (n= ‎‎34) were female. Mean ± SD levels of HbA1c, TC, TG, LDL, VLDL, HDL, and FBS were 7.33±0.56 ‎‎% (168.21±9.23, 146.10±9.64, 137.23±8.32, 41.05±5.86, 43.85±6.17, and ‎‎208.81±52.1) mg/dl respectively in the T2DM group. In the control group, ‎the Mean ± SD results of the same parameters were 4.91±0.27%, ‎‎(171.20±3.57, 116.60±8.25, 105.05±2.11, 41.83±4.92, 44.04±5.54, ‎‎96.20±7.8) mg/dl respectively. Results demonstrated statistically significant ‎‎differences between T2DM patients and control groups in HbA1c ‎‎(p equal to 0.0025), TG ‎(p equal to 0.015), LDL ‎ ‎(p=0.0029),‎ and FBS ‎(p=0.02‎). Pearson correlation analysis of HbA1c with other variables showed a significant ‎positive correlation with serum TC, TG, LDL, and ‎FBS ‎(r=0.573, P<0.01; ‎r=0.655, P <0.001; r=0.498, P<0.05‎; r=0.691, ‎P<‎0.001‎; ‎‏respectively). While the data showed a negative connection between HbA1c and HDL (r= - 0.562, P<0.01) The findings of this study reveal that diabetic people do not have a satisfactory HbA1c level. Furthermore, HbA1c shows a significant correlation with TC, TG, LDL, and VLDL, whereas it has a significant negative correlation with HDL. The study showed that HbA1c might be useful for predicting dyslipidemia in T2DM patients. Keywords: T2DM, Lipid profile, HbA1c.

Genetic Connection between Hyperglycemia and Carotid Atherosclerosis in Hyperlipidemic Mice

Type 2 diabetes (T2D) is a major risk for atherosclerosis and its complications. Apoe-null (Apoe^−/−) mouse strains exhibit a wide range of variations in susceptibility to T2D and carotid atherosclerosis, with the latter being a major cause of ischemic stroke. To identify genetic connections between T2D and carotid atherosclerosis, 145 male F2 mice were generated from LP/J and BALB/cJ Apoe^−/− mice and fed 12 weeks of a Western diet. Atherosclerotic lesions in the carotid arteries, fasting, and non-fasting plasma glucose levels were measured, and genotyping was performed using miniMUGA arrays. Two significant QTL (quantitative trait loci) on chromosomes (Chr) 6 and 15 were identified for carotid lesions. The Chr15 QTL coincided precisely with QTL Bglu20 for fasting and non-fasting glucose levels. Carotid lesion sizes showed a trend toward correlation with fasting and non-fasting glucose levels in F2 mice. The Chr15 QTL for carotid lesions was suppressed after excluding the influence from fasting or non-fasting glucose. Likely candidate genes for the causal association were Tnfrsf11b, Deptor, and Gsdmc2. These results demonstrate a causative role for hyperglycemia in the development of carotid atherosclerosis in hyperlipidemic mice.

Associations of impaired glucose tolerance and sleep disorders with mortality among the US general population

INTRODUCTION

Sleep disorders and short sleep duration are common symptoms among people with diabetes. However, the evidence is limited about the associations of post-challenge hyperglycemia and sleep quality or quantity with all-cause mortality in the US general population.

RESEARCH DESIGN AND METHODS

Our study included 8795 adults from the National Health and Nutrition Examination Survey 2005-2014. Mortality data were ascertained through 2015. Multivariable Cox proportional-hazards models were used to estimate adjusted HRs (aHRs) for all-cause mortality according to 2-hour plasma glucose levels during the 75 g oral glucose tolerance test-normal glucose tolerance (NGT), <140 mg/dL; impaired glucose tolerance (IGT), 140-199 mg/dL; and diabetes, ≥200 mg/dL. We then examined the associations of glucose tolerance status and self-reported physician-diagnosed sleep disorders (yes vs no) or sleep duration (<7 vs ≥7 hours) with all-cause mortality.

RESULTS

During follow-up (median, 5.6 years), the diabetes group had a higher risk of all-cause mortality compared with the NGT group (aHR (95% CI)=1.93 (1.41 to 2.64)), but not the IGT group (aHR (95% CI)=1.19 (0.90 to 1.59)). When we categorized participants according to glucose tolerance status and sleep disorders, the IGT group with sleep disorders had a higher risk of all-cause mortality (aHR (95% CI)=2.03 (1.24 to 3.34)) compared with the NGT group without sleep disorders. Both diabetes groups with and without sleep disorders also showed high mortality risks. The results were consistent when we used sleep duration instead of sleep disorders.

CONCLUSIONS

Using the most updated US national data, we found a high risk of all-cause mortality among individuals with IGT having sleep disorders or short sleep duration as well as those with diabetes. Future investigations are needed to identify whether and what kind of sleep management is beneficial for people with impaired glucose metabolism to prevent early death.

Comparative effects of insulin glulisine and lispro on postprandial plasma glucose and lipid profile in Japanese patients with type 2 diabetes mellitus

Objective

The control of postprandial plasma glucose (PPG) excursions is critical in the prevention of diabetic complications. Controversy remains on the differences in postprandial actions of insulin glulisine and lispro. The aim of this study was to define the differences in the efficacy of these two insulin analogues on PPG.

Methods

The study subjects were 20 in-hospital patients with type 2 diabetes mellitus (T2DM). Plasma glucose (PG) was tightly controlled with basal insulin and insulin glulisine or lispro, and then glulisine or lispro were switched to the other insulin analog every other day for 6 study days. PG was measured before breakfast and 0.5-, 1-, and 2 h-postprandial during the study. Postprandial plasma C-peptide and lipids were analyzed in the first 2 days of the study. Postprandial increments in each parameter were compared between glulisine and lispro.

Results

Whereas the median value of 0.5 h-Δ-PPG was comparable in glulisine and lispro, the 1 h-Δ-PPG was significantly lower with lispro than with glulisine (41 vs 53 mg/dl, respectively, p = 0.03). Similarly, the 2 h-Δ-PPG with lispro was 10 mg/dl lower than that with glulisine (35 vs 45 mg/dl, respectively, p = 0.05). In parallel with PPG, Δ-C-peptide at 1- and 2 h-postprandial were significantly lower with lispro than glulisine (0.50 vs 0.75 ng/ml, respectively, and 0.55 vs 0.75 ng/ml, respectively). The increment in LDL-C and HDL-C was significantly lower with lispro than with glulisine at 0.5 h-postprandial.

Conclusion

Insulin lispro seems superior to glulisine in the control of PPG in Japanese patients with T2DM.

Barriers in translating preclinical rodent exercise metabolism findings to human health

Physical inactivity and low aerobic capacity are primary drivers of chronic disease pathophysiology and are independently associated with all-cause mortality. Conversely, increased physical activity and exercise are central to metabolic disease prevention and longevity. Although these relationships are well characterized in the literature, what remains incompletely understood are the mechanisms by which physical activity/exercise prevents disease. Given methodological constraints of clinical research, investigators must often rely on preclinical rodent models to investigate these potential underlying mechanisms. However, there are several key barriers to applying exercise metabolism findings from rodent models to human health. These barriers include housing temperature, nutrient metabolism, exercise modality, exercise testing, and sex differences. Increased awareness and understanding of these barriers will enhance the ability to impact human health through more appropriate experimental design and interpretation of data within the context of these factors.

The Role of Transforming Growth Factor-Beta in Retinal Ganglion Cells with Hyperglycemia and Oxidative Stress

A characteristic of diabetes mellitus is hyperglycemia, which is considered with an emphasis on the diabetic retinopathy of progressive neurodegenerative disease. Retinal ganglion cells (RGCs) are believed to be important cells affected in the pathogenesis of diabetic retinopathy. Transforming growth factor-beta (TGF-β) is a neuroprotective protein that helps to withstand various neuronal injuries. To investigate the potential roles and regulatory mechanisms of TGF-β in hyperglycemia-triggered damage of RGCs in vitro, we established RGCs in 5.5, 25, 50, and 100 mM D-glucose supplemented media and focused on the TGF-β-related oxidative stress pathway in combination with hydrogen peroxide (H₂O₂). Functional experiments showed that TGF-β1/2 protein expression was upregulated in RGCs with hyperglycemia. The knockdown of TGF-β enhanced the accumulation of reactive oxygen species (ROS), inhibited the cell proliferation rate, and reduced glutathione content in hyperglycemia. Furthermore, the results showed that the TGF-β-mediated enhancement of antioxidant signaling was correlated with the activation of stress response proteins and the antioxidant pathway, such as aldehyde dehydrogenase 3A1 (ALDH3A1), heme oxygenase-1 (HO-1), nuclear factor erythroid 2-related factor (Nrf2), and hypoxia-inducible factor (HIF-1α). Summarizing, our results demonstrated that TGF-β keeps RGCs from hyperglycemia-triggered harm by promoting the activation of the antioxidant pathway, suggesting a potential anti-diabetic therapy for the treatment of diabetic retinopathy.

Sitagliptin improves plasma apolipoprotein profile in type 2 diabetes: A randomized clinical trial of sitagliptin effect on lipid and glucose metabolism (SLIM) study

AIM

This study aims to evaluate the effect of dipeptidyl peptidase-4 inhibitors on lipid metabolism in patients with type 2 diabetes mellitus (T2D).

METHODS

This is a multicenter, open-labeled, randomized controlled study. T2D patients with HbA1c 6.9-8.9% (52-74 mmol/mol) who were under treatment with sulfonylurea were randomly allocated to either the sitagliptin group or the non-sitagliptin group. Glucose and lipid metabolism parameters including apolipoproteins (apo), sterols, and urinary albumin were assessed at baseline, 3, and 6 months of the treatment.

RESULTS

A total of 164 patients completed the 6-month observation (n = 81 for sitagliptin and n = 83 for non-sitagliptin). HbA1c decreased in the sitagliptin group but not in the non-sitagliptin group. Serum TG and total, LDL and HDL cholesterol levels did not change in either group. Apo B-48, apo CII, and apo CIII levels decreased in the sitagliptin group, but not in the non-sitagliptin group. The change in urinary albumin was significantly different between the groups with a preferable change in the sitagliptin group. There were no changes in serum sterols levels in the two groups.

CONCLUSIONS

The treatment of sitagliptin for 6 months improves the metabolism of glucose and chylomicron and reduces plasma levels of atherogenic lipoproteins in patients with T2D.

Short-term time-restricted feeding is safe and feasible in non-obese healthy midlife and older adults

Chronic calorie restriction (CR) improves cardiovascular function and several other physiological markers of healthspan. However, CR is impractical in non-obese older humans due to potential loss of lean mass and bone density, poor adherence, and risk of malnutrition. Time-restricted feeding (TRF), which limits the daily feeding period without requiring a reduction in calorie intake, may be a promising alternative healthspan-extending strategy for midlife and older adults; however, there is limited evidence for its feasibility and efficacy in humans. We conducted a randomized, controlled pilot study to assess the safety, tolerability, and overall feasibility of short-term TRF (eating <8 h day^-1 for 6 weeks) without weight loss in healthy non-obese midlife and older adults, while gaining initial insight into potential efficacy for improving cardiovascular function and other indicators of healthspan. TRF was safe and well-tolerated, associated with excellent adherence and reduced hunger, and did not influence lean mass, bone density, or nutrient intake. Cardiovascular function was not enhanced by short-term TRF in this healthy cohort, but functional (endurance) capacity and glucose tolerance were modestly improved. These results provide a foundation for conducting larger clinical studies of TRF in midlife and older adults, including trials with a longer treatment duration.

Potential therapeutic applications of exosomes in different autoimmune diseases

Autoimmune diseases are caused by self-immune responses to autoantigens, which damage body tissues and severely affect the patient's quality of life. Therapeutic drugs are associated with adverse side effects and their beneficial effects are limited to specific populations. Evidence indicates that exosomes which are small vesicles secreted by most cell types and body fluids, and may play roles in both immune stimulation and tolerance since they are involved in many processes such as immune signaling, inflammation and angiogenesis. Exosomes have also emerged as promising tools for therapeutic delivery, given their intrinsic features such as stability, biocompatibility and a capacity for stealth. In this review, we summarize existing literature regarding the production, efficacy, action mechanism, and potential therapeutic uses of exosomes in the contexts of autoimmune diseases such as type 1 diabetes mellitus, multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.

Cause-specific risk of major adverse cardiovascular outcomes and hypoglycemic in patients with type 2 diabetes: a multicenter prospective cohort study

PURPOSE

Glycated hemoglobin A1_c (HbA1_c) and fasting plasma glucose (FPG) was identified to account for the risk of cardiovascular diseases in type 2 diabetic patients, but no study evaluated the risk based on both HbA1_c and FPG levels. We described the risk of major adverse cardiovascular events (MACE) and hypoglycemic in type 2 diabetic patients according to both HbA1_c and FPG levels.

METHODS

With the usage of databases of Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE), 1815 patients from 61 centers in China was identified and grouped according to the criterion value of HbA1_c and FPG: Good glycemic control (HbA1_c < 6.5%, FPG < 6.1 mmol/L); Insufficient glycemic control (HbA1_c < 6.5%, FPG ≥ 6.1 mmol/L or HbA1_c ≥ 6.5%, FPG < 6.1 mmol/L); Poor glycemic control (HbA1_c ≥ 6.5%, FPG ≥ 6.1 mmol/L). Time-varying multivariable Cox proportional hazards models were employed.

RESULTS

Average age was 64.8 ± 5.8 years, with a median of 4.8 years of follow-up. Overall, the incidence rates of MACE were 20.6 per 1000-person-years in Good glycemic control compared with 45.9 per 1000-person-years in Insufficient glycemic control (adjusted hazard ratio (aHR): 1.99; 95% CI 1.11-3.56; p = 0.02) and 54.7 per 1000-person-years in Poor glycemic control (aHR: 2.46; 95% CI 1.38-4.40; p = 0.002), respectively. The risk of hypoglycemic was highest in Insufficient glycemic control; 67.3 per 1000-person-years compared with 46.3 per 1000-person-years in Good glycemic control (aHR: 1.62; 95% CI 1.03-2.56; p = 0.04). Apart from this, we also observed that both MACE (aHR:1.41; 95% CI 1.13-1.77; p = 0.003) and hypoglycemic episodes (aHR: 1.82; 95% CI 1.48-2.24; p < 0.001) were sufficiently more frequent in the insulin-exposed group than the non-exposed group. In a post-hoc analysis, the risk of MACE (aHR:1.43; 95% CI 1.09-1.86; p = 0.01) and hypoglycemic (aHR: 1.99; 95% CI 1.46-2.69; p < 0.001) were more pronounced in Insufficient glycemic control with insulin exposure.

CONCLUSIONS

We observed a significant association of cause-specific risk of MACE and hypoglycemic with Insufficient glycemic control, particularly with insulin exposure.

Positive Association Between Small Dense Low-Density Lipoprotein Cholesterol Concentration and Biomarkers of Inflammation, Thrombosis, and Prediabetes in Non-Diabetic Adults

Aims: Recent studies suggest elevated levels of small dense low-density lipoprotein cholesterol (sdLDL-C) can predict the risk of incident coronary heart disease (CHD), even in individuals considered to be at low risk for cardiovascular disease(CVD) based on their LDL-C levels. This study aims to prospectively investigate the association between sdLDL-C concentration and traditional and nontraditional CHD risk markers to explore the underlying roles of sdLDL-C in atherogenic processes.

Methods: Between 2009 and 2011, 594 healthy volunteers aged 35–65 years were recruited as control subjects in a study of work-related risk factors and acute CHD. All participants fasted for 12–14 h, and venous blood samples were collected in the morning to measure serum lipid profiles and other CHD-related markers. A standard oral glucose tolerance test was performed on all participants to assess their subclinical diabetes and prediabetes status.

Results: There were significantly positive associations between sdLDL-C concentration and traditional (age, smoking and alcohol drinking habit, blood pressure, body mass index (BMI), serum lipid profiles, and diabetes status) and nontraditional risk factors (complete blood counts, (CBC), fibrinogen, high-sensitivity C-reactive protein, and subclinical diabetes status) for CVD. After adjusting for confounding variables which include age, gender, BMI, hypertension, household income, and smoking and alcohol drinking habits, all atherosclerotic risk markers except D-dimer were significantly and positively associated with sdLDL-C.

Conclusions: Our data indicated sdLDL-C is strongly associated with atherosclerotic risk markers, such as inflammation, thrombosis, hematological markers, and prediabetes. This study supports the hypothesis that sdLDL-C is a promising CVD risk biomarker.

Diabetes based on 2-h plasma glucose among those classified as having prediabetes based on fasting plasma glucose or A1c

OBJECTIVE

Determine the prevalence of diabetes using 2-h plasma glucose among people who otherwise would be categorized as having prediabetes based on A1c and fasting glucose, and to determine whether those people were more likely to have cardiometabolic risk factors.

METHODS

Among 3644 adults with prediabetes based on A1c and fasting glucose in the 2005-2014 National Health and Nutrition Examination Survey, a cross-sectional survey of the US general population, we estimated the percentage who would be categorized as having diabetes based on having a 2-h plasma glucose ⩾200 mg/dL. We calculated odds ratios of cardiometabolic risk factors associated with having 2-h plasma glucose ⩾200 mg/dL.

RESULTS

A total of 6.9% would be categorized as having diabetes based on 2-h plasma glucose. The adjusted odds ratios (95% confidence interval) associated with having 2-h plasma glucose ⩾200 mg/dL were significant for total hypertension (2.06, 1.35-3.14), high triglycerides (1.64, 1.10-2.44), low high-density lipoprotein cholesterol (1.55, 1.01-2.39), albuminuria (2.05, 1.33-3.14) and elevated alanine aminotransferase (1.78, 1.09-2.91), but not for other cardiometabolic risk factors.

CONCLUSION

A total of 6.9% of people categorized as having prediabetes based on A1c and fasting glucose would be categorized as having diabetes based on 2-h plasma glucose. They were more likely to have hypertension, high triglycerides, low high-density lipoprotein cholesterol, albuminuria and elevated alanine aminotransferase.

Effect of a single bout of aerobic exercise on high-fat meal-induced inflammation

BACKGROUND AND AIMS

Chronic low-grade inflammation is involved in the development of metabolic disorders including atherosclerosis, type 2 diabetes (T2D) and metabolic syndrome. Aerobic exercise has been shown to be anti-inflammatory and attenuate postprandial blood lipids, however, the effect of exercise on postprandial inflammation remains unclear. The aim of this study was to determine the protective effect of a single bout of aerobic exercise against postprandial lipemia and peripheral blood mononuclear cell (PBMC) inflammation and to evaluate associations with changes in the energy-sensing enzyme, AMP-activated protein kinase (AMPK).

MATERIALS AND METHODS

Healthy male subjects (n=12, age=23±2, %Fat=19±2) reported to the laboratory following an overnight fast (12-14h) on two separate occasions for consumption of a high-fat meal (HFM). Participants completed an acute bout of aerobic exercise the afternoon prior to one of the HFM visits.

RESULTS AND CONCLUSION

Results indicate that the single bout of moderate aerobic exercise increased AMPK signaling in PBMCs, as shown by increased phosphorylated acetyl-CoA carboxylase (p-ACC). This may be due to decreases in the AMPK inhibitory kinases PKD and GSK3β. Additionally, prior moderate intensity exercise decreased postprandial lipemia (PPL) and some mediators of the inflammatory pathway, such as p-NF-κB. These findings that acute aerobic exercise improves AMPK and NF-κB signaling in human PBMCs contribute support to the anti-inflammatory roles of exercise.

One bout of exercise alters free-living postprandial glycemia in type 2 diabetes

PURPOSE

Elevated postprandial glycemic (PPG) excursions are significant risk factors for cardiovascular disease in type 2 diabetes patients. In this study, we tested if and for how many meals a single bout of exercise would reduce PPG responses to subsequent meals in type 2 diabetes (T2D) patients using a continuous glucose monitor system (CGMS).

METHODS

We recruited nine sedentary (<30 min·wk(-1) of exercise) individuals with T2D (mean ± SD; body mass index = 36.0 ± 1.1 kg·m(-2), age = 60.3 ± 1.0 yr, HbA1c = 6.3% ± 0.2%). The subjects consumed a eucaloric diet (51% carbohydrate, 31% fat, and 18% protein) consisting of three meals, identical in composition, for a 2-d period while wearing a continuous glucose monitor system in two different conditions (exercise [EX], one 60-min bout at 60%-75% of heart rate reserve performed before breakfast), vs a sedentary [SED] condition). We quantified 24-h average glucose, PPG area under the curve (AUC; 4-h glucose AUC after meals), and PPG-2 h (2 h postprandial glucose).

RESULTS

EX significantly reduced average [glucose] during the first 24-h period (P = 0.03). EX caused a reduction in PPG-AUC (P = 0.02) for all of the meals during the 2 d (main effect between conditions). A comparison between the EX and the SED conditions at each meal revealed that EX reduced PPG-AUC after the second meal of day 1 (lunch) (P = 0.04). PPG-2 h was not significantly different between EX and SED.

CONCLUSIONS

Although a single EX bout does lower 24-h average [glucose], it only significantly lowered PPG-AUC at the second meal after the bout, suggesting that daily exercise may be needed to most effectively improve PPG at the advent of exercise training in T2D patients.

Hyperglycemia-Mediated Oxidative Stress Increases Pulmonary Vascular Permeability

OBJECTIVE

Hyperglycemia in diabetes mellitus is associated with endothelial dysfunction as evidenced by increased oxidative stress and vascular permeability. Whether impaired glucose control in metabolic syndrome impacts pulmonary vascular permeability is unknown. We hypothesized that in metabolic syndrome, hyperglycemia increases lung vascular permeability through superoxide.

METHODS

Lung capillary Kf and vascular superoxide were measured in the isolated lungs of LZ and OZ rats. OZ were subjected to 4 weeks of metformin treatment (300 mg/kg/day orally) to improve insulin sensitivity. In a separate experiment, lung vascular permeability and vascular superoxide were measured in LZ exposed to acute hyperglycemia (30 mM).

RESULTS

As compared to LZ, OZ had impaired glucose and insulin tolerance and elevated vascular superoxide which was associated with an elevated lung Kf. Chronic metformin treatment in OZ improved glucose control and insulin sensitivity which was associated with decreased vascular oxidative stress and lung Kf. Acute hyperglycemia in isolated lungs from LZ increased lung Kf, which was blocked with the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor, apocynin (3 mM). Apocynin also decreased baseline Kf in OZ.

CONCLUSIONS

These data suggest that hyperglycemia in metabolic syndrome exacerbates lung vascular permeability through increases in vascular superoxide, possibly through NADPH oxidase.

Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis

OBJECTIVES

 To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality.

DESIGN

 Meta-analysis of prospective cohort studies.

DATA SOURCES

 Electronic databases (PubMed, Embase, and Google Scholar).

SELECTION CRITERIA

 Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovascular disease, coronary heart disease, stroke, all cause mortality, and prediabetes.

REVIEW METHODS

 Two authors independently reviewed and selected eligible studies, based on predetermined selection criteria. Prediabetes was defined as impaired fasting glucose according to the criteria of the American Diabetes Association (IFG-ADA; fasting glucose 5.6-6.9 mmol/L), the WHO expert group (IFG-WHO; fasting glucose 6.1-6.9 mmol/L), impaired glucose tolerance (2 hour plasma glucose concentration 7.8-11.0 mmol/L during an oral glucose tolerance test), or raised haemoglobin A_1c (HbA_1c) of 39-47 mmol/mol : (5.7-6.4%) according to ADA criteria or 42-47 mmol/mol (6.0-6.4%) according to the National Institute for Health and Care Excellence (NICE) guideline. The relative risks of all cause mortality and cardiovascular events were calculated and reported with 95% confidence intervals.

RESULTS

 53 prospective cohort studies with 1 611 339 individuals were included for analysis. The median follow-up duration was 9.5 years. Compared with normoglycaemia, prediabetes (impaired glucose tolerance or impaired fasting glucose according to IFG-ADA or IFG-WHO criteria) was associated with an increased risk of composite cardiovascular disease (relative risk 1.13, 1.26, and 1.30 for IFG-ADA, IFG-WHO, and impaired glucose tolerance, respectively), coronary heart disease (1.10, 1.18, and 1.20, respectively), stroke (1.06, 1.17, and 1.20, respectively), and all cause mortality (1.13, 1.13 and 1.32, respectively). Increases in HBA_1c to 39-47 mmol/mol or 42-47 mmol/mol were both associated with an increased risk of composite cardiovascular disease (1.21 and 1.25, respectively) and coronary heart disease (1.15 and 1.28, respectively), but not with an increased risk of stroke and all cause mortality.

CONCLUSIONS

 Prediabetes, defined as impaired glucose tolerance, impaired fasting glucose, or raised HbA_1c, was associated with an increased risk of cardiovascular disease. The health risk might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA_1c of 39 mmol/mol.

Sitting Less and Moving More: Improved Glycaemic Control for Type 2 Diabetes Prevention and Management

Epidemiological evidence indicates that excessive time spent in sedentary behaviours (too much sitting) is associated with an increased risk of type 2 diabetes (T2D). Here, we highlight findings of experimental studies corroborating and extending the epidemiological evidence and showing the potential benefits for T2D of reducing and breaking up sitting time across the whole day. We also discuss future research opportunities and consider emerging implications for T2D prevention and management. This new evidence is stimulating an expansion of diabetes-related physical activity guidelines-suggesting that in addition to moderate-vigorous physical activity, reducing and regularly interrupting prolonged sitting time is likely to have important and varied benefits across the spectrum of diabetes risk.

Effect of nateglinide and glimepiride in reducing postprandial hyperglycaemia in patients with type 2 diabetes mellitus

Aim — The purpose of this study was to compare the effect of nateglinide on two-hour post-meal glucose levels with that of glimepiride in patients with type 2 diabetes mellitus. Methods — Glucose and insulin levels were measured during 14-hour profiles (comprising three meal challenges) and intravenous glucose tolerance tests performed before and after five-weeks of treatment with nateglinide (120 mg, a.c.) or glimepiride (1 mg, o.d.) in a randomised, two-centre, double-blind, crossover study in 26 patients with type 2 diabetes and fasting initial glucose levels < 13.9 mmol/L. Results — Mean two-hour postprandial glucose levels were significantly lower during nateglinide treatment than during glimepiride treatment (9.46 vs. 10.00 mmol/L, respectively; p<0.05). The 14-hour incremental glucose area under the curve was -2.2 mmol•h/L during nateglinide treatment and +6.2 mmol•h/L during glimepiride treatment (p<0.01). Nateglinide improved both the early insulin response during meals and the acute insulin response during intravenous glucose tolerance tests, restoring the biphasic insulin secretion pattern. Both insulin secretagogues improved intravenous glucose tolerance relative to the pre-treatment period, but only nateglinide restored a biphasic insulin profile. Conclusions — By restoring a more physiological post-load insulin response, nateglinide is more effective than glimepiride in controlling postprandial glucose excursions.

Review: Pre-diabetes: clinical relevance and therapeutic approach

Type 2 diabetes mellitus is epidemic in most developed and many developing countries. The associated morbidity, mortality and high costs of care, make type 2 diabetes an important global public health challenge and target for prevention. Patients at high risk for type 2 diabetes can be diagnosed by fasting glucose levels or responses to an oral glucose tolerance test (OGTT). Such patients are also at increased risk for cardiovascular disease (CVD). Since obesity and physical inactivity are important risk factors for type 2 diabetes, lifestyle interventions, emphasising modest weight loss and increases in physical activity, should be recommended for most patients with pre-diabetes. Such interventions are safe and effective and also reduce risk factors for CVD. Several oral antidiabetic agents have been shown to be effective at delaying onset of type 2 diabetes. Thiazolidinediones (TZDs) reduced incident diabetes by ~60%, whilst metformin, acarbose and orlistat are only about half as effective as the TZDs. Pharmacological interventions may be appropriate for patients at particular risk for developing diabetes, but the benefits of treatment need to be balanced against the safety and tolerability of the intervention. If pharmacological treatment is warranted, metformin should be considered first because of its favourable overall safety, tolerability, efficacy, and cost profile.

Understanding Post-Prandial Hyperglycemia in Patients with Type 1 and Type 2 Diabetes: A Web-based Survey in Germany, the UK, and USA

INTRODUCTION

To explore how patients with diabetes experience post-prandial hyperglycemia (PPH) or elevated blood glucose (BG) following a meal.

METHODS

A web-based survey of patients with type 1 or type 2 diabetes using bolus insulin in Germany, the USA, and the UK was conducted.

RESULTS

A total of 906 respondents completed the survey. PPH was a frequent occurrence among patients with type 1 and type 2 diabetes; 61.9% of respondents had experienced PPH in the past week, and differences by diabetes type were not significant. More than half of the respondents reported that they knew they were experiencing PPH because they had measured their BG (64.8%) and/or because they "just didn't feel right" (51.9%). The most frequently reported reasons given for PPH were eating more fat/sugar than estimated (31.2%) and over-eating in terms of their calculated bolus insulin dose (30.4%). The most common situations/factors contributing to PPH were stress (27.4%), eating at a restaurant (24.9%), being busy (21.1%), and/or feeling tired (19.2%). The most frequent corrective actions respondents took following PPH were testing BG and taking bolus insulin based on the reading (62.0%), and/or eating less/more carefully at their next meal or snack (18.8%). Additionally, significant differences in the reasons and contributing factors given for PPH and corrective actions following PPH, as well as emotions experienced when taking bolus insulin, were found by diabetes type.

CONCLUSION

These findings shed light on how patients with diabetes experience and manage PPH on a day-to-day basis and have implications for improving diabetes self-management. Clinicians and diabetes educators should help patients address eating habits and lifestyle issues that may contribute to PPH.

FUNDING

This study was sponsored by Novo Nordisk.

The Economic Burden of Post-prandial Hyperglycemia (PPH) Among People with Type 1 and Type 2 Diabetes in Three Countries

INTRODUCTION

Post-prandial hyperglycemia (PPH) among people with diabetes is a well-known clinical challenge to diabetes management. While the economic burden of diabetes is well studied, little is known about economic costs specific to PPH. The purpose of this study was to investigate costs of PPH related to work, diabetes management, and use of healthcare resources among people with diabetes taking bolus insulin.

METHODS

Data were collected in a web survey of 906 adults with type 1 (39%) and type 2 (61%) diabetes taking bolus insulin in Germany (34%), the UK (26%), and the USA (40%).

RESULTS

Sixty-two percent of respondents experienced PPH in the past week, and respondents averaged 1.7 episodes per week. Working respondents indicated that PPH affected their work productivity: 27% missed work time and 71% experienced work productivity issues while at work due to a recent episode of PPH. In terms of diabetes management, respondents with PPH in the past week measured their blood glucose (BG) more frequently than those without PPH (3.7 vs. 2.5 times/day, P < 0.001). PPH was also significantly associated with greater use of healthcare resources. Compared to those without PPH, respondents with PPH reported greater contact with healthcare professionals related to diabetes in the past year (5.5 vs. 4.4 visits, P < 0.001; 2.7 vs. 1.4 calls/emails, P < 0.001) and were more likely to report medical complications related to diabetes (72% vs. 55%, P < 0.001). Average annual costs associated with PPH due to missed work time, additional BG test strips, and physician visits were estimated to be $1239 USD per employed person in the USA.

CONCLUSION

Results indicate that PPH is associated with greater economic costs and that reducing the incidence of PPH would help mitigate such costs. Additional research is needed to better understand costs associated with PPH that may be more difficult to measure, as well as more long-term impacts and costs.

FUNDING

Novo Nordisk.

Association of 1,5-Anhydroglucitol With Cardiovascular Disease and Mortality

In diabetes, low concentrations of the biomarker 1,5-anhydroglucitol (1,5-AG) reflect hyperglycemic excursions over the prior 1-2 weeks. To the extent that hyperglycemic excursions are important in atherogenesis, 1,5-AG may provide independent information regarding cardiovascular risk. Nonetheless, few studies have evaluated associations of 1,5-AG with long-term cardiovascular outcomes in a population-based setting. We measured 1,5-AG in 11,106 participants in the Atherosclerosis Risk in Communities (ARIC) study without cardiovascular disease at baseline (1990-1992) and examined prospective associations with coronary heart disease (n = 1,159 events), ischemic stroke (n = 637), heart failure (n = 1,553), and death (n = 3,120) over 20 years of follow-up. Cox proportional hazards models were adjusted for demographic and cardiovascular risk factors. Compared with persons with 1,5-AG ≥6 μg/mL and no history of diabetes, persons with diabetes and 1,5-AG <6.0 μg/mL had an increased risk of coronary heart disease (HR 3.85, 95% CI 3.11-4.78), stroke (HR 3.48, 95% CI 2.66-4.55), heart failure (HR 3.50, 95% CI 2.93-4.17), and death (HR 2.44, 95% CI 2.11-2.83). There was a threshold effect, with little evidence for associations at "nondiabetic" concentrations of 1,5-AG (e.g., >10 μg/mL). Associations remained but were attenuated with additional adjustment for fasting glucose or HbA1c. These data add to the growing evidence for the prognostic value of 1,5-AG for long-term complications in the setting of diabetes.

Different glucose tolerance status and incident cardiovascular disease and all-cause mortality among elderly Iranians

AIMS

To determine the effect of different glucose categories on incident cardiovascular disease (CVD) and all-cause mortality in a population-based cohort.

METHODS

A total of 834 individuals aged 65 years and older without a history of CVD at baseline were stratified according to 2-h post-load glucose fasting glucose test into six categories including: (i) normal fasting glucose/normal glucose tolerance; (ii) prediabetes, (iii) isolated fasting hyperglycemia (IFH); (iv) isolated post-challenge hyperglycemia (IPH); (v) IPH and IFH; and (vi) known diabetes mellitus. The prognostic significance of these groups on CVD and total mortality were examined by Cox proportional hazard ratios in a multivariate adjusted model.

RESULTS

Over 9 years of follow up, 186 incidents of CVD and 218 deaths occurred (72 CVD mortality).Of the population, 45.2%, 30.7%, 1.2%, 6.1% 4.7%, and 11.9% were normal fasting glucose/normal glucose tolerance, prediabetes IFH, IPH, IFH and IPH, and known diabetes mellitus, respectively. Multivariate adjusted hazard ratios for CVD were 1.13 (95% CI 0.78-1.64), 1.03 (95% CI 0.25-4.22), 1.17 (95% CI 0.65-2.11), 2.52 (95% CI 1.43-4.42) and 2.39 (95% CI 1.55-3.69), and for CVD mortality were 0.59 (95% CI 0.27-1.30), 2.02 (95% CI 0.27-15.15), 1.26 (95% CI 0.51-3.16), 3.57 (95% CI 1.64-7.75), and 4.70 (95% CI 2.54-8.69) for prediabetes, IFH, IPH, IFH and IPH, and known diabetes mellitus phenotypes, respectively. Corresponding hazard ratios for all-cause mortality in multivariate model adjusted for prevalent CVD were 1.07 (95% CI 0.73-1.57), 0.59 (95% CI 0.08-4.30), 0.92 (95% CI 0.5-1.70), 2.31 (95% CI 1.33-4.01) and 3.88 (95% CI 2.70-5.55), respectively.

CONCLUSION

Among the elderly population with newly diagnosed diabetes, only the combined IFH and IPH phenotype, but not IFH or IPH alone, was a significant predictor of CVD and mortality events. Prediabetes was not associated with any risk. Geriatr Gerontol Int 2016; 16: 1263-1271.

Repetitive Glucose Spikes Accelerate Atherosclerotic Lesion Formation in C57BL/6 Mice

Background

A number of epidemiological studies demonstrated that postprandial hyperglycemia is a risk factor for cardiovascular disease in individuals with impaired glucose tolerance. Although several laboratory studies have addressed the plausible causal role of postprandial acute hyperglycemia (glucose spikes) in the development of atherosclerosis, there is little convincing evidence in vivo whether the atherosclerotic lesion formation can be accelerated solely by glucose spikes. Here, we assessed the effect of repetitive glucose spikes on atherosclerotic lesion formation in mice.

Methods

Female C57BL/6 mice were fed an atherogenic diet from 8 to 28 weeks of age. During the atherogenic diet feeding period, the mice orally received a glucose solution (50 mg glucose/mouse; G group) or water (W group) twice daily, 6 days a week. Atherosclerotic lesion formation in the aortic sinus was quantitatively analyzed in serial cross-sections by oil red O staining.

Results

G group mice showed transient increases in blood glucose level (~5 mmol/L above W group), and the levels returned to levels similar to those in W group mice within 60 min. No significant differences in glucose tolerance, insulin sensitivity, and plasma lipid profiles were observed after the 20-week repetitive administration between the 2 groups. G group mice showed an approximately 4-fold greater atherosclerotic lesion size in the aortic sinus than W group mice. Gene expression levels of Cd68 and Icam1 in the thoracic aorta were higher in G group mice than in W group mice.

Conclusions

These results indicate that glucose spikes can accelerate atherosclerotic lesion formation, with little influence on other metabolic disorders. Repetitive glucose administration in wild-type mice may serve as a simple and useful approach to better understanding the causal role of glycemic spikes in the development of atherosclerosis.

Guiding diabetes screening and prevention: rationale, recommendations and remaining challenges

Advances made in diabetes management are not sufficient to reduce morbidity, mortality and cost without making prevention efforts at various levels imperative for substantial impact. Research has demonstrated the efficacy of lifestyle intervention and medications in preventing type 2 diabetes among diverse high-risk groups commonly identified with oral glucose tolerance testing. Efficacy, sustainability and safety data are most comprehensive for lifestyle and metformin, with other medications also demonstrating efficacy and potential in the pharmacoprevention of diabetes. Subsequent implementation studies have demonstrated feasibility of lifestyle intervention programs at health centers, communities, and at local and national government levels. Challenges remain in widespread translation and reaching and engaging at-risk individuals and populations.

Effects of a Macro-Nutrient Preload on Type 2 Diabetic Patients

AIMS

Macro-nutrient preloads given 30 min before regular meals may improve metabolism. The aim was to investigate how type 2 diabetic patients react to a preload consisting of a blend of macro-nutrients with a low-glycemic index (Inzone Preload(®)).

METHODS

In a before-after study design, 30 subjects with type 2 diabetes mellitus (T2DM) were enrolled in a 12-week program. All subjects were given Inzone Preload (43% proteins, 29% carbohydrates, 10% lipids, and 9% fibers, 71 kcal), 30 min before each meal during 12 weeks. Fasting glucose and postprandial 2 h glucose were monitored every second week. Body weight (BW) and waist circumference were measured each month. Fasting plasma glucose, glycosylated hemoglobin, serum lipids, fasting insulin, C-reactive protein, and homeostasis model assessment were evaluated before and after the intervention. Subjective appetite was monitored using visual analogue scales after the Inzone Preload.

RESULTS

The dietary intervention significantly influenced several metabolic parameters compared to base line. Inzone Preload treatment reduced mean postprandial plasma glucose levels (12.2 ± 1.2 vs. 10.5 ± 2.0 mmol/L), HbA1c (7.4 ± 0.3 vs. 7.1 ± 0.2%), mean total cholesterol (4.8 ± 0.9 vs. 4.3 ± 0.8 mmol/L), low-density lipoprotein cholesterol (2.8 ± 0.6 vs. 2.5 ± 0.4 mmol/L), and CRP (1.5 ± 1.4 vs. 0.7 ± 0.7 mg/L). BW loss of more than 3% was seen in 13 participants (43%). Feelings of satiety were significantly higher after Inzone Preload than after habitual breakfast (p < 0.05). No significant changes in fasting blood glucose, high-density lipoprotein and total triacylglycerol, HOMA-IR, and HOMA-β were observed.

CONCLUSION

A macro-nutrient preload treatment reduces postprandial glucose, inflammatory markers, and serum lipids in patients with T2DM. Approximately half of the study group also displayed reduced BW.

Associations of prediabetes with all-cause and cardiovascular mortality: a meta-analysis

BACKGROUND

Reports on the association of prediabetes with all-cause mortality and cardiovascular mortality are inconsistent. Objective. To evaluate the risk of all-cause and cardiovascular mortality in association with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT).

METHODS

Prospective cohort studies with data on prediabetes and mortality were included. The relative risks (RRs) of all-cause and cardiovascular mortality were calculated and reported with 95% confidence intervals (95% CIs).

RESULTS

Twenty-six studies were included. The risks of all-cause and cardiovascular mortality were increased in participants with prediabetes defined as IFG of 110-125 mg/dL (IFG 110) (RR 1.12, 95% CI 1.05-1.20; and RR 1.19, 95% CI 1.05-1.35, respectively), IGT (RR 1.33, 95% CI 1.24-1.42; RR 1.23, 95% CI 1.11-1.36, respectively), or combined IFG 110 and/or IGT (RR 1.21, 95% CI 1.11-1.32; RR 1.21, 95% CI 1.07-1.36, respectively), but not when IFG was defined as 100-125 mg/dL (RR 1.07, 95% CI 0.92-1.26; and RR 1.16, 95% CI 0.94-1.42, respectively).

CONCLUSIONS

Prediabetes, defined as IFG 110, IGT, or combined IFG 110 and/or IGT, was associated with increased all-cause and cardiovascular mortality.

High-intensity interval training for improving postprandial hyperglycemia

High-intensity interval training (HIIT) has garnered attention in recent years as a time-efficient exercise option for improving cardiovascular and metabolic health. New research demonstrates that HIIT may be particularly effective for improving postprandial hyperglycemia in individuals with, or at risk for, type 2 diabetes (T2D). These findings have clinical relevance because elevated postprandial hyperglycemia is a significant risk factor for cardiovascular morbidity and mortality. This article summarizes the latest evidence demonstrating that HIIT can improve postprandial glucose control to highlight the potential application of HIIT in the prevention and management of T2D and associated cardiovascular complications.

A Chinese risk score model for identifying postprandial hyperglycemia without oral glucose tolerance test

BACKGROUND

The aim of the study is to develop a risk score model for identifying postprandial hyperglycemia without oral glucose tolerance tests (OGTT) in Chinese population, and minimize the number of subjects needing further OGTT.

METHODS

Multivariable stepwise logistic regression was used to develop risk score models in a derivation cohort (7953 participants without known diabetes). The developed models were verified in a validation cohort (another 1455 subjects without known diabetes). All subjects had completed questionnaires, physical examination and OGTT. Performances of the risk score models were estimated using receiver operating characteristic curves.

RESULTS

Two risk score models for screening postprandial hyperglycemia were developed. The simple model used non-invasive risk factors (age, height, weight, waist, systolic blood pressure, pulse, hypertension, dyslipidemia and family history of diabetes mellitus), and the full model contained additional variables [fasting blood glucose (FBG), triglyceride/high density lipoprotein cholesterol] obtainable by invasive laboratory tests. The area under receiver operating characteristic curve (AUC) of simple model was similar to FBG and glycated haemoglobin. The full model has the largest AUC [0.799 (0.789-0.809) and 0.730 (0.702-0.758)] in both derivation and validation cohorts (p < 0.001 compared with simple model, FBG, and glycated haemoglobin). At a cutoff point of 80, the sensitivity, specificity and percentage that needed subsequent OGTT were 75.97, 67.56 and 48.38%, respectively.

CONCLUSIONS

We developed a risk score model for screening postprandial hyperglycemia based on routine clinical information. It could effectively identify patients at high-risk for postprandial hyperglycemia and remarkably reduce the number of subjects requiring OGTT.

Lack of exercise is a major cause of chronic diseases

Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.

Isolated post-challenge hyperglycaemia and risk of cardiovascular events: Tehran Lipid and Glucose Study

OBJECTIVE

To evaluate the risk of cardiovascular events in diabetes defined by isolated post-challenge hyperglycaemia (IPH).

METHODS

We followed 3794 subjects aged ≥40 years without known history of diabetes or cardiovascular disease (CVD) at baseline for CVD events. Participants were categorized as subjects without diabetes [fasting plasma glucose (FPG) < 126 mg/dL and 2-h post-challenge plasma glucose (2-hPG) < 200 mg/dL], IPH (FPG < 126 mg/dL and 2-h PG ≥ 200 mg/dL) and fasting hyperglycaemia (fasting blood glucose (FBS) ≥ 126 mg/dL). Hazard ratios (HRs) were calculated with the use of Cox proportional-hazards regression models to evaluate the risk of CVD events.

RESULTS

At baseline, of 486 subjects with newly diagnosed diabetes, 190 (39%) had IPH. Over the next 8 years, age and sex-adjusted HR for incident CVD was 1.77 (95% confidence interval (CI): 1.19-2.64; p = 0.005) in subjects with IPH compared with subjects without diabetes. After further adjustment for potential confounders, the HR for CVD was not significant [1.32 (95% CI: 0.88-1.99; p = 0.2)].

CONCLUSIONS

IPH in middle-aged adults adds nothing for identifying CVD risks when other risk factors are taken into account. Associated metabolic risk factors seem to be more important than hyperglycaemia per se.