Relationship between the level of fasting plasma glucose and beta cell functions in Chinese with or without diabetes

Background Type 2 diabetes is a chronic disease characterized by a progressive loss of beta cell functions. However, the evaluation of beta cell functions is either expensive or inconvenient for clinical practice. We aimed to elucidate the association between the changes of insulin responsiveness and the fasting plasma glucose （FPG） during the development of diabetes. Methods A total of 1192 Chinese individuals with normal blood glucose or hyperglycemia were enrolled for the analysis. The early insulinogenic index （△I30/△G30）, the area under the curve of insulin （AUC-Ⅰ）, and homeostasis model assessment were applied to evaluate the early phase secretion, total insulin secretion, and insulin resistance respectively. Polynomial regression analysis was performed to estimate the fluctuation of beta cell functions. Results The △I30/△G30 decreased much more rapidly than the AUC-Ⅰ accompanying with the elevation of FPG. At the FPG of 110 mg/dl （a pre-diabetic stage）, the AI30/AG30 lost 50% of its maximum while the AUC-Ⅰ was still at a compensated normal level. The AUC-Ⅰ exhibited abnormal and decreased gradually at the FPG of from 130 mg/dl to higher （overt diabetes）, while the △I30/△G30 almost remained at 25% of its maximum value. When hyperglycemia continuously existed at 〉 180 mg/dl, both the AI30/AG30 and AUC-Ⅰ were totally lost. Conclusion The increased fasting plasma glucose reflects progressive decompensation of beta cell functions, and could be used to guide the strategy of clinical treatments.

Performance of Fasting Plasma Glucose and Postprandial Urine Glucose in Screening for Diabetes in Chinese High-risk Population

Background： The conventional approaches to diabetes screening are potentially limited by poor compliance and laboratory demand. This study aimed to evaluate the performance of fasting plasma glucose （FPG） and postprandial urine glucose （PUG） in screening for diabetes in Chinese high-risk population. Methods： Nine hundred and nine subjects with high-risk factors of diabetes underwent oral glucose tolerance test after an overnight fast. FPG, hemoglobin A 1 c, 2-h plasma glucose （2 h-PG）, and 2 h-PUG were evaluated. Diabetes and prediabetes were defined by the American Diabetes Association criteria. The area under the receiver operating characteristic （ROC） curve was used to evaluate the diagnostic accuracy of 2 h-PUG, and the optimal cut-off determined to provide the largest Youden index. Spearman correlation was used for relationship analysis. Results： Among 909 subjects, 33.4% （304/909） of subjects had prediabetes, and 17.2% （156/909） had diabetes. The 2 h-PUG was positively related to FPG and 2 h-PG （r = 0.428 and 0.551, respectively, both P 〈 0.001）. For estimation of 2 h-PG 〉 7.8 mmol/L and 2 h-PG ≥ 11.I mmol/L using 2 h-PUG, the area under the ROC curve were 0.772 （95% confidence interval [CI]： 0.738-0.806） and 0.885 （95% CI：0.850-0.921 ）, respectively. The corresponding optimal cut-offs for 2 h-PUG were 5.6 mmol/L and 7.5 retool/L, respectively. Compared with FPG alone, FPG combined with 2 h-PUG had a higher sensitivity fbr detecting glucose abnormalities （84.1% vs. 73.7%, P〈 0.001） and diabetes （82.7% vs. 48.1%, P〈 0.001）. Conclusion： FPG combined with 2 h-PUG substantially improves the sensitivity in detecting prediabetes and diabetes relative to FPG alone, and may represent an efficient layperson-oriented diabetes screening method.

Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks

BACKGROUND The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus(PLWH)who accepted primary treatment with the efavirenz(EFV)plus lamivudine(3TC)plus tenofovir(TDF)(EFV+3TC+TDF)regimen are unclear and warrant investigation.AIM To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV+3TC+TDF regimen for 156 wk.METHODS This study was designed using a follow-up design.Sixty-one male treatmentnaive PLWH,including 50 cases with normal glucose tolerance and 11 cases with prediabetes,were treated with the EFV+3TC+TDF regimen for 156 wk.The glucose metabolism dynamic characteristics,the main risk factors and the differences among the three CD4+count groups were analyzed.RESULTS In treatment-naive male PLWH,regardless of whether glucose metabolism disorder was present at baseline,who accepted treatment with the EFV+3TC+TDF regimen for 156 wk,a continuous increase in the fasting plasma glucose(FPG)level,the rate of impaired fasting glucose(IFG)and the glycosylated hemoglobin(HbA1c)level were found.These changes were not due to insulin resistance but rather to significantly reduced isletβcell function,according to the homeostasis model assessment ofβcell function(HOMA-β).Moreover,the lower the baseline CD4+T-cell count was,the higher the FPG level and the lower the HOMA-βvalue.Furthermore,the main risk factors for the FPG levels were the CD3+CD8+cell count and viral load(VL),and the factors contributing to the HOMA-βvalues were the alanine aminotransferase level,VL and CD3+CD8+cell count.CONCLUSION These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased isletβcell function during antiretroviral therapy with the EFV+3TC+TDF regimen for long-term application.

A cohort study on the association between fasting plasma glucose level over 5. 3 mmol / L and risks of abnormal glucose metabolism and cardiovascular diseases in the elderly

Objective To evaluate the association of fasting plasma glucose(FPG)level over 5.3 mmol/L with the development of abnormal glucose metabolism and cardiovascular disease(CVD).Methods This was a retrospec-tive cohort study with 1 064 non-diabetic subjects(980males;84 females)aged 60 or over,who carried out annual health check-up in Chinese PLA General

Gender differences in the relationship between plasma lipids and fasting plasma glucose in non-diabetic urban Chinese popula- tion： a cross-section study

The association between dyslipidemia and elevated fasting glucose in type 2 diabetes is well known. In non-diabetes, whether this association still exists, and whether dyslipidemia is an independent risk factor for high fasting plasma glucose （FPG） levels are not clear. This cross-sectional study recruited 3460 non-diabetic Chinese subjects （1027 men, and 2433 women, aged 35-75 years old） who participated in a health survey. Men and women were classified into tertiles by levels of plasma lipids respectively. In women, the prevalence of impaired fasting glucose （IFG） was decreased with increased HDL-C. A stepwise increase in HDL-C was associated with decreasing FPG levels （lowest tertiles, FPG： 5.376 ± 0.018; middle tertiles, 5.324± 0.018; highest tertiles, 5.276±0.018mmol/L; P = 0.001）. Reversely, FPG levels increased from lowest tertiles to highest tertiles of LDL-C, TC, and TG. we found that women in the first tertile with lower HDL-C level had a 1.75-fold increase in risk of IFG compared with non-diabetic women in the third tertile with higher HDL-C level （OR： 1.75; 95% CI： 1.20-2.56）. In men, no significant association was found. We took age, BMI, waist/hip ratio, education, smoking, alcohol drinking, and physical exercise as adjusted variables. In Chinese non-diabetic women, dyslipidemia is independently associated with high levels of FPG; TG, HDL-C, and LDL-C are predictors of IFG independent of BMI and waist/hip ratio.

Triglyceride and Glucose Index (TyG) is a Reliable Biomarker to Predict Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a common liver disease worldwide. There is no specific biomarker for the diagnosis of NAFLD. Trigly-ceride and glucose index (TyG) may predict the subsequent occurrence of NAFLD in later life. This cross sectional study was aimed to evaluate the effectiveness of triglyceride and glucose index (TyG) as a possible biomarker of NAFLD. The study was conducted at the Department of Laboratory Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2019 to February 2020. A total of 124 subjects were taken as study population following selection criteria. Among them 62 were diagnosed patients of NAFLD and 62 were healthy subjects as control group. Fasting plasma glucose was measured by glucose oxidase method and serum triglyceride was measured by enzymatic-colorimetric method, while TyG index was calculated accordingly. The mean age was 39.5 ± 11.27 years in NAFLD patients and 37.10 ± 12.28 years in control subjects with male female ratio 1:1.7 and 1:1.8 respectively. Major portion of NAFLD patients (62.9%) were overweight (BMI ≥ 25). The mean fasting plasma glucose level was 5.73 ± 1.47 mmol/L in NAFLD patients and 5.27 ± 0.69 mmol/L in control group (p < 0.027). The mean serum triglyceride level was 237.19 ± 96.47 mg/dl in NAFLD patients and 117.32 ± 53.07 mg/dl in control group (p < 0.001). The triglyceride and glucose index (TyG) was 9.36 ± 0.47 in NAFLD group and 8.53 ± 0.42 in control group. TyG index was significantly higher in NAFLD patients in comparison to control group (p < 0.001). In ROC analysis, cut off value of TyG index was 8.85 with sensitivity 93.5% and specificity 79%. As a fast and effective method, TyG index can be used as a diagnostic tool to predict NAFLD.

Update on biomarkers of glycemic control

Attaining and maintaining good glycemic control is a cornerstone of diabetes care. The monitoring of glycemic control is currently based on the self-monitoring of blood glucose(SMBG) and laboratory testing for hemoglobin A1 c(HbA1 c),which is a surrogate biochemical marker of the average glycemia level over the previous 2-3 mo period. Although hyperglycemia is a key biochemical feature of diabetes, both the level of and exposure to high glucose, as well as glycemic variability, contribute to the pathogenesis of diabetic complications and follow different patterns in type 1 and type 2 diabetes. HbA1 c provides a valuable,standardized and evidence-based parameter that is relevant for clinical decision making, but several biological and analytical confounders limit its accuracy in reflecting true glycemia. It has become apparent in recent years that other glycated proteins such as fructosamine, glycated albumin, and the nutritional monosaccharide 1,5-anhydroglucitol, as well as integrated measures from direct glucose testing by an SMBG/continuous glucose monitoring system, may provide valuable complementary data, particularly in circumstances when HbA1 c results may be unreliable or are insufficient to assess the risk of adverse outcomes. Long-term associations of these alternative biomarkers of glycemia with the risk of complications need to be investigated in order to provide clinically relevant cut-off values and to validate their utility in diverse populations of diabetes patients.

The Expression of Resistin in Adipose Tissues of Patients with Polycystic Ovary Syndrome and Insulin Resistance

The relationship between the expression of resistin in polycystic ovary syndrome （PCOS） and insulin resistance was investigated. The plasma resistin concentrations in 35 patients with PCOS and 40 controls were measured by ELISA. Luteinizing hormone （LH）, follicle-stimulating hormone （FSH）, and fasting insulin （FIN） were tested by radioimmunoassay. Insulin resistance index （HOMA-IR） was calculated. Fasting plasma glucose （FPG） was determined by oxidase test. Western blot and reverse transcriptase PCR （RT-PCR） methods were used to detect the expression of resistin in adipose tissues. The levels of plasma resistin, LH, LH/FSH and FIN and HOMA-IR in patients with PCOS were significantly higher than those in control group （all P〈0.05）. Plasma resistin was correlated positively with FPG, FIN, HOMA-IR, LH and LH/FSH （r=0.56, 0.60, 0.65, 0.48, and 0.42 respectively）. Resistin protein and mRNA expression levels in patients with PCOS were significantly higher than those in normal tissues （all P〈0.01）. It was concluded that resistin might be involved in the pathogenesis of insulin resistance of PCOS.

Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy--the Kailuan Eye Study

AIM:To explore the influencing factors of diabetes type 2 patients with mild non-proliferative diabetic retinopathy(NPDR)in the Kailuan area of Tangshan,Hebei Province,China.METHODS:In this non-interventional,retrospective study,683 patients with type 2 diabetes were included in the Kailuan Diabetic Retinopathy Study involving participants with diabetes in the community-based longitudinal Kailuan Study.Based on the undilated ultrawide field(200°;UWF)images and partial dilated digital fundus images,the diabetic retinopathy(DR)of the surveyed population was graded.Interobserver agreement was estimated by using Cohen’s Kappa statistics.The main outcome indicators included gender,age,weight,height,body mass index,blood pressure,circumferences of neck,waist and hip,current smoking,levels of fasting plasma glucose(FPG),hypersensitive C-reactive protein,creatinine,and cholesterol,etc.According to different lesions’locations of patients with mild NPDR,logistic regression models were used to estimate the odds ratios(ORs)and their 95%Cls of each risk factor.RESULTS:The study group of 683 patients included 570 males and 113 females.The mean age of the patients was62.18±9.41 y.Compared with dilated fundus examinations,there was fair agreement with the level of DR identified on UWF images in 63.91%of eyes(k=0.369,95%CI,0.00-0.00).Detected by UWF images,there were 98 patients with mild NPDR having peripheral retinal lesions,35 patients with mild NPDR having posterior lesions,44 patients with mild NPDR whose lesions were detected both in and out the standard two fields area,and 336 patients with non obvious DR.Parameters that conferred a statistically significant increased risks for mild NPDR with having peripheral retinal lesions were neck circumstance(OR,1.124;95%CI,1.044-1.211),and with posterior lesions were FPG(OR,1.052;95%CI,1.007-1.099).CONCLUSION:UWF is an effectiveness means of DR screening.Moreover,it is necessary to evaluate peripheral diabetic retinal lesions which can help to estimate the severity of DR.The phenomenon that nonuniform and inhomogeneous distribution of DR lesions has been found.And the influencing factors in mild NPDR are differing by different lesions’locations.

Insulin Glargine 300 Units/mL Effectiveness in Patients with T2DM Uncontrolled by Basal Insulin in Real-Life Settings in the Czech Republic

Introduction: To evaluate the clinical effectiveness of Gla-300 units/mL (Gla-300) in the treatment of patients with type 2 diabetes (T2DM) uncontrolled by basal insulin in real-life clinical settings in the Czech Republic (TOPAZ study). Methods: TOPAZ was a prospective, multi-center, non-interventional, 6-month study. Of the 312 patients screened, 289 were evaluated at month 6. The primary objective was the change of HbA1c after 6 months. The proportion of patients with HbA1c < 7.0% DCCT (< 53 mmol/mol), and those with a decrease of at least 0.5% of HbA1c at month 6, change in FPG, body weight and insulin dose at month 3 and 6 were analysed as secondary objectives. Incidence of hypoglycemia, adverse events and patient treatment satisfaction were also assessed. Results: HbA1c decreased significantly after 6 months (mean change 0.9% ± 1.1% DCCT [−9.9 ± 11.6 mmol/mol], p < 0.0001). HbA1c target < 7.0% DCCT was achieved in 17.6% of patients, 66.1% of patients showed mean HbA1c decrease of 0.5% ± 0.8%. At month 6, FPG decreased (mean change from baseline −1.8 ± 3.1 mmol/L) as well as the incidence of hypoglycemia decreased by 49% (p < 0.0001) while no weight gain was observed. No significant safety signals were identified. Conclusion: In a real-life setting, switching to Gla-300 in T2DM patients uncontrolled with other basal insulin was associated with improved glycemic control and reduced risk of hypoglycemia without weight gain, while patients’ satisfaction with treatment increased.

Evaluation of Insulin Resistance Indices in Type 2 Diabetic Patients Treated with Different Anti-Diabetic Drugs

Clinically, determination of insulin resistance is important for diabetic patients. We evaluated the relationship among 20/(fasting C-peptide × fasting plasma glucose), HOMA-IR and QUICKI indices in type 2 diabetic patients. The study included 40 patients with type 2 diabetes. Patients divided into three groups based on their medication: metformin, metformin + glibenclamide and metformin + glitazone. Fasting blood sugar, and lipid profile were measured by enzymatic method, serum insulin, and C-peptide were measured by ELISA method. Insulin resistance was calculated by using of 20/(fasting C-peptide × fasting plasma glucose), HOMA-IR and QUICKI indices. There was no significant relationship between 20/(fasting C-peptide × fasting plasma glucose) index and other parameters in all studied groups except QUICKI in metformin group showed a significant correlation with 20/(fasting C-peptide × fasting plasma glucose) index (r = 0.56 and p = 0.03). There was a significant correlation between HOMA-IR and QUICKI indices in all studied groups. There was no significant relationship between 20/(fasting C-peptide × fasting plasma glucose) index with other clinical parameters. On the other hand, our data strongly suggested a significant correlation between HOMA-IR and QUICKI indices in studied subjects with type 2 diabetes.

The role of oral glucose tolerance test in screening for diabetes mellitus in the elderly of Harbin, China

Though diabetes is common worldwide, the proportion of cases diagnosed is not high. Nearly fifty percent of patients with diabetes mellitus (DM) in US are undiagnosed.~1 The ratio might be higher in China. It has been suggested that diabetes may be present 4 to 7 years before diagnosis.~2 (Many of) the complications appear to be present at the time of diagnosis of the diabetic status.~1 (Screening for) diabetes in early stage of diabetes is thus a worthwhile exercise.

不同性别FPG正常人群的糖代谢相关因素聚类分析及2型糖尿病发病风险评估

目的基于糖代谢相关因素,对空腹血糖(fasting plasma glucose,FPG)正常的男性和女性分别进行聚类分析,并评价不同聚类组与2型糖尿病(type 2 diabetes mellitus,T2DM)发病风险的关系。方法选取句容市队列研究基线FPG<6.1 mmol/L的研究对象,分别对2857名男性和4398名女性进行层次K-means(hierarchical K-means,HK-means)聚类分析,聚类变量包括年龄、FPG、稳态模型评估胰岛素分泌指数与抵抗指数、三酰甘油、上颈围、腰围身高比及体力活动指数。采用Kaplan-Meier曲线和Cox比例风险回归模型分析评估聚类组的T2DM绝对和相对发病风险。结果男女人群分别被分为具有不同表型特征及T2DM发病风险的5个聚类组(cluster)。男性cluster 1体质指数(body mass index,BMI)水平最低和年龄最高,cluster 2体力活动指数最高,cluster 3 BMI水平最高且体力活动指数最低,cluster 4表现出高胰岛素抵抗且胰岛β细胞代偿分泌的特征,cluster 5年龄最低但血脂异常。女性cluster 1、2和4与男性特征相似,cluster 3年龄最低,cluster 5体力活动指数最低且肥胖伴随血脂异常。与男性cluster 1相比,cluster 3和4的T2DM发病风险增加了1.28和0.87倍(均P<0.05);调整协变量后,HR(95%CI)分别为1.651(0.927~2.939)与1.516(0.779~2.950),差异均无统计学意义(均P>0.05)。相比于女性cluster 1,cluster 3 T2DM发病风险较低,调整后HR(95%CI)为0.380(0.205~0.704);Cluster 5 T2DM的发病风险较高(P<0.05),调整协变量后差异无统计学意义(HR=1.172,95%CI:0.717~1.916)。结论FPG正常的人群在未诊断为糖尿病时即存在生理代谢异质性,其聚类表型特征呈现出一定的男女性别差异。基于糖代谢相关因素在非糖尿病人群中进行聚类,有助于提高高危亚组的早期筛查和防控干预。