1
|
Bonaventura A, Montecucco F. The STOP DIABETES study: when prevention works. Acta Diabetol 2019; 56:501-504. [PMID: 30826915 DOI: 10.1007/s00592-019-01309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/18/2019] [Indexed: 11/25/2022]
Abstract
Although many drugs are now available, a large effort is still needed to prevent diabetes. The STOP DIABETES study evaluated individuals at risk for type 2 diabetes (T2D) by a 2-h 75-g oral glucose tolerance test (OGTT). Based on the three main defective physiological responses, subjects were stratified as at low, intermediate, or high risk, and treated accordingly with lifestyle modifications and drugs. Participants at intermediate and high risk experienced the greatest reduction of T2D conversion. Interestingly, a group of individuals developing T2D presented a normal glucose tolerance at baseline, but a 1-h plasma glucose concentration > 155 mg/dL. These results are critical as prediabetes can increase the incidence of cardiovascular disease. Considering the timeframe between the first defects in glucose metabolism and the manifestation of diabetes complications, the effort to tackle the glycemic impairment as soon as possible represents an outstanding task to reduce the incidence of diabetes. Ideally, the earlier glycemic alterations are recognized, the lesser armamentarium needs to be used, and the lower is the expense in terms of drugs, complications, and related events and costs. Finally, a wealth of studies clearly demonstrated the importance of 1-h plasma glucose concentration, which has been proposed as an adjunctive diagnostic tool to detect prediabetes earlier. In conclusion, by an OGTT, a lot of individuals at risk for T2D may be detected when the central role for the 1-h plasma glucose concentration is also considered. Consequently, these subjects would be treated early and with less drugs and delay T2D complications.
Collapse
Affiliation(s)
- Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy.
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy
| |
Collapse
|
2
|
Bergman M, Manco M, Sesti G, Dankner R, Pareek M, Jagannathan R, Chetrit A, Abdul-Ghani M, Buysschaert M, Olsen MH, Nilsson PM, Medina JL, Roth J, Groop L, Del Prato S, Raz I, Ceriello A. Petition to replace current OGTT criteria for diagnosing prediabetes with the 1-hour post-load plasma glucose ≥ 155 mg/dl (8.6 mmol/L). Diabetes Res Clin Pract 2018; 146:18-33. [PMID: 30273707 DOI: 10.1016/j.diabres.2018.09.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 02/08/2023]
Abstract
Many individuals with prediabetes, as presently defined, will progress to diabetes (T2D) despite the considerable benefit of lifestyle modification. Therefore, it is paramount to screen individuals at increased risk with a more sensitive method capable of identifying prediabetes at an even earlier time point in the lengthy trajectory to T2D. This petition reviews findings demonstrating that the 1-hour (1-h) postload plasma glucose (PG) ≥ 155 mg/dl (8.6 mmol/L) in those with normal glucose tolerance (NGT) during an oral glucose tolerance test (OGTT) is highly predictive for detecting progression to T2D, micro- and macrovascular complications and mortality in individuals at increased risk. Furthermore, the STOP DIABETES Study documented effective interventions that reduce the future risk of T2D in those with NGT and a 1-h PG ≥ 155 mg/dl (8·6 mmol/L). The 1-h OGTT represents a valuable opportunity to extend the proven benefit of diabetes prevention to the sizeable and growing population of individuals at increased risk of progression to T2D. The substantial evidence provided in this petition strongly supports redefining current diagnostic criteria for prediabetes with the elevated 1-h PG level. The authors therefore advocate a 1-h OGTT to detect prediabetes and hence, thwart the global diabetes epidemic.
Collapse
Affiliation(s)
- Michael Bergman
- NYU School of Medicine, Department of Medicine and of Population Health, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, USA.
| | - Melania Manco
- Research Unit for Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children Hospital, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Rachel Dankner
- The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, USA; Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Manan Pareek
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark; Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Ram Jagannathan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 18, Atlanta, GA, USA
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University, Clinic Saint-Luc, Brussels, Belgium
| | - Michael H Olsen
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark; Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Peter M Nilsson
- Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Jesse Roth
- The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, USA
| | - Leif Groop
- Lund University, Lund University Diabetes Centre, Malmö, Sweden
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Itamar Raz
- Diabetes Unit at Hadassah University Hospital, Hadassah Center for the Prevention of Diabetes, Diabetes Clinical Research Center, Jerusalem, Israel
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi I Sunyer and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain; Department of Cardiovascular and Metabolic Diseases, Istituto Ricerca Cura Carattere Scientifico Multimedica, Sesto, San Giovanni, MI, Italy
| |
Collapse
|
3
|
Wu X, Chen H, Wang Y, Li H. The relationship between coronary risk factors and elevated 1-h postload plasma glucose levels in patients with established coronary heart disease. Clin Endocrinol (Oxf) 2013; 78:67-72. [PMID: 22324971 DOI: 10.1111/j.1365-2265.2012.04362.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/05/2012] [Accepted: 01/24/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Recent studies have shown that an elevated 1-h postload plasma glucose (1hPG) is able to identify subjects with normal glucose tolerance (NGT) at high risk for future type 2 diabetes and atherosclerotic cardiovascular disease. However, clinical studies about the characteristics of coronary heart disease (CHD) patients with elevated 1hPG are lacking. The aim of this study was to analyse the 1hPG level in CHD patients with NGT. METHODS A total of 204 CHD patients with NGT were recruited. Subjects underwent an oral glucose tolerance test, echocardiography and coronary angiography. Demographic data were recorded and blood samples obtained. According to the 1hPG cut-off point of 8.6 mm, patients were divided into two groups: 1hPG ≥ 8.6 mm (n = 65) and 1hPG < 8.6 mm (n = 139). RESULTS Compared with the 1hPG < 8.6 mm group, subjects with 1hPG ≥ 8.6 mm had a worse metabolic profile, exhibiting significantly higher body mass index, systolic blood pressure, triglyceride level and lower HDL-cholesterol level. Plasma high-sensitivity CRP (hsCRP) levels were higher in the 1hPG ≥ 8.6 mm group than in the 1hPG < 8.6 mm group. Coronary angiography revealed that single-vessel changes were more frequent in the 1hPG < 8.6 mm group, but there were no significant differences in the Gensini score. CONCLUSIONS Patients with CHD with 1hPG ≥ 8.6 mm have a worse metabolic profile, higher levels of hsCRP and multi-vessel coronary atherosclerosis. These findings suggest that, in patients with CHD, elevated 1hPG increases coronary risk factors and may be a marker for early-stage glucose intolerance.
Collapse
Affiliation(s)
- Xing Wu
- Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | | | | |
Collapse
|
4
|
Qin CM, Wang R, Yin FZ, Liu B, Ma CM, Lu Q. The change in one-hour postload plasma glucose levels, and an analysis of its related factors in abdominally obese Han Chinese men with normal glucose tolerance. J Diabetes Complications 2012; 26:536-9. [PMID: 22739800 DOI: 10.1016/j.jdiacomp.2012.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 04/25/2012] [Accepted: 05/26/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study was to observe the difference in one-hour postload plasma glucose levels and analyze its related factors in abdominally obese men with normal glucose tolerance (NGT). DESIGN This case-control study included 36 abdominally obese men (waist circumference ≥90 cm) and 31 non-abdominally obese men (waist circumference <90 cm) aged 20-50 years with NGT. Cases and controls were matched in age. All subjects underwent oral glucose tolerance test with 75 g of oral anhydrous glucose. RESULTS 0.5 and 1-h postload plasma glucose levels were higher in abdominally obese group than in non-abdominally obese group (P<.05). Fasting plasma glucose (FPG), 2 and 3-h postload plasma glucose were similar in the two groups (P>.05). 1-h postload plasma glucose was positively correlated with body mass index (r=0.454), waist circumference (WC) (r=0.519), systolic blood pressure (r=0.456), diastolic blood pressure (r=0.338), triglycerides (r=0.439), and negatively correlated with high density lipoprotein cholesterol (r=-0.391), 1/fasting insulin (r=-0.459), insulinogenic index (r=-0.357) and disposition index (r=-0.602) (P<.01). In multiple regression analysis, 1-h postload plasma glucose maintained an independent association with disposition index (β=-1.367, P=.000), WC (β=0.103, P=.000) and triglycerides (β=0.185, P=.017). CONCLUSIONS The present study demonstrated that the level of one-hour postload plasma glucose was elevated in abdominally obese men with NGT. Besides FPG and 2-h postload plasma glucose, we must also pay attention to the measurement of one-hour postload plasma glucose. Disposition index, WC and triglycerides were independently related factors for elevated one-hour postload plasma glucose.
Collapse
Affiliation(s)
- Chun-Mei Qin
- Department of Endocrinology, The First Hospital of Qinhuangdao, Hebei Medical University, Qinhuangdao, 066000, Hebei Province, China
| | | | | | | | | | | |
Collapse
|
5
|
Chen G, Zou X, Yao J, Jiang Q, Zhang Y, Tu M, Yang S, Xu S, Lin W, Huang H, Liang J, Li L, Lin L. The correlation between the oral glucose tolerance test 30-minutes plasma glucose and risk factors for diabetes and cardiovascular diseases: a cross-sectional epidemiological study of diabetes in Fujian Province in the South-East of China. J Endocrinol Invest 2011; 34:e115-20. [PMID: 20935449 DOI: 10.1007/bf03347470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the correlation between abnormal oral glucose tolerance test (OGTT) 30-min plasma glucose (PG) and risk factors and metabolic abnormalities of diabetes and cardiovascular diseases (CVD). METHODS Participants (no.=2457) underwent a physical examination, blood biochemistry examination, OGTT, and a 12-lead electrocardiogram. We measured fasting PG (FPG) and PG at 30 min (30minPG) and 1 h (1hPG) of the OGTT. The association between an increase in 30minPG (by 1 SD) and the metabolic abnormalities of diabetes and CVD such as hypertension, overweight and obesity, central obesity, and hyperlipidemia; osteoporosis was assessed by logistic regression analysis after controlling for FPG and 2hPG. RESULTS This analysis showed that an increase of 30minPG by 1 SD (1.92 mmol/l) significantly increased the risk of chronic metabolic abnormalities in diabetes and CVD such as hypertension, overweight, and obesity, central obesity, hyperlipidemia, and osteoporosis. Stepwise multiple regression analysis also showed that 30minPG was significantly correlated with male gender, smoking, FPG, 2hPG, total cholesterol, waist/hip ratio, and blood pressure. CONCLUSIONS An elevation of 30minPG increased the risk of diabetes and CVD. The increased risk was independent of FPG, 2hPG, age, sex, and smoking status.
Collapse
Affiliation(s)
- G Chen
- Department of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian, China.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Tian H, Pan C, Lu J, Li C, Zhong W, Cao X. A 7-year follow-up study of the features and transformations of elderly male patients with OGTT-1h hyperglycemia. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11684-008-0076-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
7
|
Hirsch IB, Bode BW, Childs BP, Close KL, Fisher WA, Gavin JR, Ginsberg BH, Raine CH, Verderese CA. Self-Monitoring of Blood Glucose (SMBG) in insulin- and non-insulin-using adults with diabetes: consensus recommendations for improving SMBG accuracy, utilization, and research. Diabetes Technol Ther 2008; 10:419-39. [PMID: 18937550 DOI: 10.1089/dia.2008.0104] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Current clinical guidelines for diabetes care encourage self-monitoring of blood glucose (SMBG) to improve glycemic control. Specific protocols remain variable, however, particularly among non-insulin-using patients. This is due in part to efficacy studies that neglect to consider (1) the performance of monitoring equipment under real-world conditions, (2) whether or how patients have been taught to take action on test results, and (3) the physiological, behavioral, and social circumstances in which SMBG is carried out. As such, a multidisciplinary group of specialists, including several endocrinologists, a health psychologist, a diabetes nurse practitioner, and a patient advocate (the Panel), discuss within this review article how the potential of SMBG might be fully realized in today's healthcare environment. The resulting recommendations cover technological, clinical, behavioral, and research considerations with the aim of achieving short- and long-term benefits, ranging from fewer hypoglycemic episodes to lower complication-related costs. The panel also made suggestions for designing future studies that increase the ability to discern optimal models of SMBG utilization for individuals with diabetes who may, or may not, use insulin.
Collapse
Affiliation(s)
- Irl B Hirsch
- Department of Medicine, University of Washington Medical Center-Roosevelt, Seattle, Washington 98105, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Ambady R, Chamukuttan S. Early diagnosis and prevention of diabetes in developing countries. Rev Endocr Metab Disord 2008; 9:193-201. [PMID: 18604647 DOI: 10.1007/s11154-008-9079-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
Abstract
Type 2 diabetes has an insidious onset with a long latent period of dysglycaemia. By the time the diagnosis of diabetes is made, diabetes-related tissue damage occurs in nearly half of the patients. Even after diagnosis, the glycaemic control is suboptimal in more than 50%, leading to the vascular complications. Evidences suggest that early detection of diabetes by appropriate screening methods, especially in subjects with high risk for diabetes will help to prevent or delay the vascular complications and thus reduce the clinical, social and economic burden of the disease. There are also evidences to show that intervention at the prediabetic stage is superior to diagnosis of diabetes.
Collapse
Affiliation(s)
- Ramachandran Ambady
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, 28, Marshall's Road, Egmore, Chennai-600 008, India.
| | | |
Collapse
|
9
|
Affiliation(s)
- Judith Fradkin
- From the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Griffin P. Rodgers
- From the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
10
|
Rhee MK, Ziemer DC, Kolm P, Phillips LS. Postchallenge glucose rises with increasing age even when glucose tolerance is normal. Diabet Med 2006; 23:1174-9. [PMID: 17054591 DOI: 10.1111/j.1464-5491.2006.01956.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Ageing increases the likelihood of developing diabetes, with associated cardiovascular disease. In a cross-sectional study, we sought to determine whether age is associated with an increase in glucose concentrations 1 h after an oral glucose challenge (1-h OGTT), even when glucose tolerance is normal (NGT). METHODS Among subjects in the NHANES II database, 2591 subjects with NGT and documented 1-h OGTT glucose concentrations were studied. The relationship between age and 1-h OGTT glucose concentrations was assessed in a multivariable linear regression analysis. RESULTS In a multivariable linear regression analysis, each 10-year increase in age conferred an additional 0.20 mmol/l increase in the 1-h OGTT glucose (P < 0.0001). Moreover, an interaction between age and gender was found such that 1-h OGTT glucose concentrations rose more rapidly with increasing age in men than in women. The impact of age on 1-h OGTT glucose was independent of both fasting and 2-h OGTT glucose concentrations. CONCLUSIONS One-hour OGTT glucose concentrations rise significantly with age even in subjects with NGT. Further investigation is warranted to explore the pathophysiological significance of such age-related impairment of glucose handling, which might increase the risk of cardiovascular disease even when patients do not meet criteria for the diagnosis of diabetes or prediabetes.
Collapse
Affiliation(s)
- M K Rhee
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Atlanta, GA 30303, USA.
| | | | | | | |
Collapse
|