scholarly journals The Diagnosis of Prediabetes in Adolescents/Dijagnoza Predijabetesa Kod Adolescenata

2014 ◽  
Vol 34 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Vera Zdravković ◽  
Silvija Sajić ◽  
Jadranka Mitrović ◽  
Igor Stefanović ◽  
Polina Pavićević ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Normal Glucose Tolerance ◽  
Normal Weight ◽  
Insulinogenic Index ◽  
Obese Patients ◽  
Obese Adolescents ◽  
Glucose Levels

Summary Background: Prediabetes is characterized by isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), and combined IFG/IGT. This study aimed to establish the prevalence of prediabetes and examine possible contributory factors in a cohort of obese adolescents. Methods: In this prospective study, we recruited 85 obese patients from the Obesity Clinic at the University Children’s Hospital and 17 normal weight controls. All patients were of Caucasian origin, 60 males/42 females, aged 7.4-18.3 years, with at least Tanner 2 stage of puberty. Results: Depending on criteria we used, insulin resistance was confirmed in 62-100% of obese patients, predominantly in the group with BMI SDS > 3. oGTT revealed isolated impaired fasting glucose (IFG) in 13.9%, impaired glucose tolerance (IGT) in 20.8% and combined IFG and IGT only in 2.8% of the obese patients. Patients in the prediabetes group were older (14±2.4 vs 12.8±2.5 p=0.04) and had higher glucose levels (p<0.001) during the whole oGTT compared to normal glucose tolerance (NGT) group. There was no difference between groups in respect to family history, BMI, lipids and fasting insulin. Insulinogenic index, WBISI and HOMA%B were significantly lower in the prediabetes group compared to the NGT group (p=0.07, 0.01 and 0.04 respectively). HbA1c level was measured in 58% of patients and was significantly higher in the prediabetes group (5.4±0.3 vs 5.7±0.4, p=0.002). Conclusion: Prediabetes occurrence was fairly high in our obese adolescents. Further studies should establish what would be the most appropriate screening test to diagnose these patients at risk for type 2 diabetes and initiate treatment without delay.

scholarly journals Identification of factors differentially associated with isolated impaired fasting glucose and isolated post-load impaired glucose tolerance: the Hong Kong Cardiovascular Risk Factor Study

2006 ◽  
Vol 155 (4) ◽  
pp. 623-632 ◽  
Author(s):  
G Neil Thomas ◽  
C Mary Schooling ◽  
Sarah M McGhee ◽  
Sai-Yin Ho ◽  
Bernard M Y Cheung ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Glucose Intolerance ◽  
Impaired Fasting Glucose ◽  
Early Life ◽  
Fasting Glucose ◽  
Oral Glucose ◽  
Hip Circumference ◽  
Glucose Levels

Background: The use of fasting and post-prandial glucose levels in the classification of hyperglycaemic states often identifies distinct subjects, but the factors determining these intermediate-isolated glucose intolerant states are yet to be clearly elucidated in Chinese subjects. Methods: Representative subjects (n = 2769) were randomly recruited from the Hong Kong Chinese population and glycaemic status was determined using both fasting and 2h 75 g oral glucose tolerance test glucose levels. The relationship between the groups with isolated glucose intolerance and vascular risk factors was investigated using ANOVA and logistic regression analyses. Results: Using either criterion, diabetes was identified in 265 (9.6%) subjects and glucose intolerance in 568 (20.5%) subjects. Of those 568, isolated impaired glucose tolerance (IGT) using the post-load criterion was identified in 49.5% and isolated impaired fasting glucose (IFG) in 30.5%. Ageing and hyperinsulinaemia were common determinants of IGT and IFG; with small hip circumference a marker of poorer early life development and being born in China rather than Hong Kong, a possible low birth weight marker was also associated with IFG. Hypertension, hypertriglyceridaemia and poor education were also associated with IGT. When we looked for factors differentially associated with these glucose intolerant states, female sex, greater hip circumference, high triglyceride levels, low fasting insulin levels, and not being born in China were independently associated with isolated IGT compared with isolated IFG. Conclusion: Despite common antecedents to the glucose intolerant states, isolated IFG appeared to be particularly associated with early life development, and isolated IGT was more strongly associated with obesity-related determinants such as hypertriglyceridaemia.

scholarly journals Impaired fasting glucose with or without impaired glucose tolerance: progressive or parallel states of prediabetes?

2008 ◽  
Vol 295 (2) ◽  
pp. E428-E435 ◽  
Author(s):  
Leigh Perreault ◽  
Bryan C. Bergman ◽  
Mary C. Playdon ◽  
Chiara Dalla Man ◽  
Claudio Cobelli ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Impaired Fasting Glucose ◽  
Insulin Action ◽  
Low Dose ◽  
Fasting Glucose ◽  
Normal Glucose Tolerance ◽  
Β Cell ◽  
Cell Dysfunction ◽  
Normal Glucose

Our objective was to determine whether defects underlying impaired fasting glucose (IFG) are maintained and additive when combined with impaired glucose tolerance (IGT) (representing a progressive form of prediabetes) or are distinct in IFG/IGT (reflecting a parallel form of prediabetes). Volunteers with IFG ( n = 10), IFG/IGT ( n = 14), or normal glucose tolerance (NGT; n = 15) were matched for demographics and anthropometry. Insulin secretion was assessed using the glucose step-up protocol and insulin action through the use of a two-stage hyperinsulinemic euglycemic clamp with infusion of [6,6-2H2]glucose. Modeling of insulin secretory parameters revealed similar basal (Φb) but diminished dynamic (Φd) components in both IFG and IFG/IGT ( P = 0.05 vs. NGT for both). Basal glucose rate of appearance (Ra) was higher in IFG compared with NGT ( P < 0.01) and also, surprisingly, with IFG/IGT ( P < 0.04). Moreover, glucose Ra suppressed more during the low-dose insulin clamp in IFG ( P < 0.01 vs. NGT, P = 0.08 vs. IFG/IGT). Insulin-stimulated glucose uptake [glucose rate of disappearance (Rd)] was similar in IFG, IFG/IGT, and NGT throughout the clamp. We conclude that nuances of β-cell dysfunction observed in IFG were also noted in IFG/IGT. A trend for additional insulin secretory defects was observed in IFG/IGT, possibly suggesting progression in β-cell failure in this group. In contrast, basal glucose Ra and its suppressability with insulin were higher in IFG, but not IFG/IGT, compared with NGT. Together, these data indicate that IFG/IGT may be a distinct prediabetic syndrome rather than progression from IFG.

scholarly journals The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

Diabetologia ◽  
2020 ◽  
Author(s):  
Aikaterini Eleftheriadou ◽  
Scott Williams ◽  
Sarah Nevitt ◽  
Emily Brown ◽  
Rebecca Roylance ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Normal Glucose Tolerance ◽  
Risk Of Bias ◽  
Cardiac Autonomic Neuropathy ◽  
Prevalence Data ◽  
Normal Glucose

Abstract Aims/hypothesis Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Considering the exponential rise of prediabetes, we aimed to determine the prevalence of CAN through a systematic literature review. Methods This systematic review was registered with PROSPERO (CRD42019125447). An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, Scopus and Cochrane databases. Published full text, English language articles that provide CAN prevalence data of studies in individuals with prediabetes and aged over 18 years were included. Prevalence data for normal glucose tolerance and diabetes were also extracted from the selected articles, if present. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using a critical appraisal tool. Results Database searches found 4500 articles; subsequently, 199 full text articles were screened, 11 of which fulfilled the inclusion criteria (4431 total participants, 1730 people with prediabetes, 1999 people with normal glucose tolerance [NGT] and 702 people with predominantly type 2 diabetes). Six of the selected studies reported definite CAN prevalence data (9–39%). Only a single large population-based study by Ziegler et al (KORA S4 study, 1332 participants) determined definite CAN based on two or more positive autonomic function tests (AFTs), with a mean prevalence of 9% in all prediabetes groups (isolated impaired glucose tolerance 5.9%; isolated impaired fasting glucose 8.1%; impaired fasting glucose plus impaired glucose tolerance 11.4%), which was higher than NGT (4.5%). This study is most likely to provide a reliable population-specific estimate of CAN in prediabetes. There was a higher than expected prevalence of CAN in prediabetes (9–38%) when compared with normal glucose tolerance (0–18%) within the same studies (n = 8). There was a wide prevalence of possible CAN based on one positive AFT (n = 5). There was heterogeneity between the studies with variations in the definition of CAN, methodology and characteristics of the populations, which likely contributed to the diversity of prevalence estimates. The overall risk of bias was low. Conclusions/interpretation There is a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition.

scholarly journals Insulin Secretory Defect and Insulin Resistance in Isolated Impaired Fasting Glucose and Isolated Impaired Glucose Tolerance

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Sae Aoyama-Sasabe ◽  
Mitsuo Fukushima ◽  
Xin Xin ◽  
Ataru Taniguchi ◽  
Yoshikatsu Nakai ◽  
...  
Keyword(s):  
Insulin Sensitivity ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Impaired Fasting Glucose ◽  
Plasma Glucose ◽  
Clinical Characteristics ◽  
Fasting Glucose ◽  
Insulinogenic Index ◽  
Initial Examination ◽  
The Relationship

Objective.To investigate the characteristics of isolated impaired glucose tolerance (IGT) and isolated impaired fasting glucose (IFG), we analyzed the factors responsible for elevation of 2-hour postchallenge plasma glucose (2 h PG) and fasting plasma glucose (FPG) levels.Methods.We investigated the relationship between 2 h PG and FPG levels who underwent 75 g OGTT in 5620 Japanese subjects at initial examination for medical check-up. We compared clinical characteristics between isolated IGT and isolated IFG and analyzed the relationships of 2 h PG and FPG with clinical characteristics, the indices of insulin secretory capacity, and insulin sensitivity.Results.In a comparison between isolated IGT and isolated IFG, insulinogenic index was lower in isolated IGT than that of isolated IFG (0.43 ± 0.34 versus 0.50 ± 0.47, resp.;p<0.01). ISI composite was lower in isolated IFG than that of isolated IGT (6.87 ± 3.38 versus 7.98 ± 4.03, resp.;p<0.0001). In isolated IGT group, insulinogenic index showed a significant correlation with 2 h PG (r=-0.245,p<0.0001) and had the strongest correlation with 2 h PG (β=-0.290). In isolated IFG group, ISI composite showed a significant correlation with FPG (r=-0.162,p<0.0001) and had the strongest correlation with FPG (β=-0.214).Conclusions.We have elucidated that decreased early-phase insulin secretion is the most important factor responsible for elevation of 2 h PG levels in isolated IGT subjects, and decreased insulin sensitivity is the most important factor responsible for elevation of FPG levels in isolated IFG subjects.

scholarly journals From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Arianna Pani ◽  
Ilaria Gironi ◽  
Giacoma Di Vieste ◽  
Elena Mion ◽  
Federico Bertuzzi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Combination Therapy ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Polycystic Ovary ◽  
Ovary Syndrome ◽  
Glucose Levels

Aims. Despite the very clear association between polycystic ovary syndrome (PCOS) and dysglycemia, few studies have explored the continuum of glycemic alterations leading from minor glucose abnormalities to overt diabetes. The purpose of this review is to trace the natural history of glycemic alteration in women with PCOS. Methods. We performed a literature review without time limit until August 2019. Inclusion criteria were studies addressing the association between impaired glucose tolerance or impaired fasting glucose or type 2 diabetes (T2D) and PCOS with at least an English abstract. The exclusion criteria were no PCOS or impaired glucose tolerance or impaired fasting glucose or T2D as outcome. The outcomes of interest were the onset of impaired glucose tolerance, impaired fasting glucose, T2D, and the progression from impaired glucose tolerance or impaired fasting glucose to T2D. Results. Healthy diet and physical activity are the first-line therapy for PCOS. Treatment with metformin was associated with significant lower 2-hour postload glucose levels and with reduction in fasting glucose when compared to placebo. Thiazolidinediones were more effective in reducing fasting glucose levels compared to placebo. Metformin and pioglitazone treatments showed similar effects on fasting glucose levels. The sodium-glucose cotransporter-2 inhibitor empagliflozin did not show differences in metabolic parameters when compared to metformin. The combination therapy with metformin plus the glucagon-like peptide-1 receptor agonist liraglutide was associated with significant improvements in basal and postload glucose levels compared with only liraglutide. Likewise, a combination therapy with the dipeptidyl peptidase-4 inhibitor saxagliptin and metformin demonstrated superiority versus metformin in fasting glucose and oral glucose tolerance test normalization. Myo-inositol supplementation was associated with lower insulin levels, glucose levels, and insulin resistance when compared with placebo, metformin, or estrogen treatments. Conclusions. The use of insulin-sensitizing agents, such as metformin and inositols, along with lifestyle interventions may improve the metabolic profile in PCOS women.

Plasma glucose concentration 60 min post oral glucose load and risk of type 2 diabetes and cardiovascular disease: Pathophysiological implications

2019 ◽  
Vol 16 (4) ◽  
pp. 337-343
Author(s):  
Fahim Abbasi ◽  
Paul JW Tern ◽  
Gerald M Reaven
Keyword(s):  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Impaired Fasting Glucose ◽  
Plasma Glucose ◽  
Glucose Concentration ◽  
Fasting Glucose ◽  
Normal Glucose Tolerance ◽  
Plasma Glucose Concentration ◽  
Oral Glucose ◽  
Normal Glucose

Aim: The aim of this study was to gain insight into the pathophysiological significance of elevated plasma glucose concentrations (mmol/L) 60 min post oral glucose load in apparently healthy individuals. Methods: Comparison of resistance to insulin action and associated cardio-metabolic risk factors in 490 apparently healthy persons, subdivided into those with a plasma glucose concentration 60 min following a 75-g oral glucose challenge of <8.6 versus ⩾8.6. Results: Insulin resistance was significantly greater in persons with normal glucose tolerance whose 60-min glucose concentration was ⩾8.6, associated with higher blood pressure, plasma concentrations of glucose, insulin, triglyceride and lower high-density lipoprotein cholesterol concentrations. Similar differences were seen in persons with impaired fasting glucose, but not in those with impaired glucose tolerance or both impaired fasting glucose and impaired glucose tolerance. The group whose 60-min glucose was <8.6 ( n = 318) contained primarily persons with normal glucose tolerance (88%), whereas the majority of those whose 60-min value was ⩾8.6 ( n = 172) had prediabetes (59%) and in particular combined impaired fasting glucose and impaired glucose tolerance. Conclusion: Plasma glucose concentration of ⩾8.6 mmol/L 60 min post oral glucose identifies higher proportions of combined impaired fasting glucose and impaired glucose tolerance individuals as well as normal glucose tolerance and impaired fasting glucose individuals with a more adverse cardio-metabolic profile, contributing to observed increased overall risk of type 2 diabetes and other metabolic diseases.

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