WHO and ADA criteria for the diagnosis of diabetes mellitus in relation to body mass index. Insulin sensitivity and secretion in resulting subcategories of glucose tolerance

Although there is now substantial evidence linking low birthweight with impaired glucose tolerance and type 2 diabetes in adult life, the extent to which reduced fetal growth is associated with impaired insulin sensitivity, defective insulin secretion, or a combination of both factors is not clear. We have therefore examined the relationships between birth size and both insulin sensitivity and insulin secretion as assessed by an intravenous glucose tolerance test with minimal model analysis in 163 men and women, aged 20 yr, born at term in Adelaide, South Australia. Birth size did not correlate with body mass index or fat distribution in men or women. Men who were lighter or shorter as babies were less insulin sensitive ( P = 0.03 and P = 0.01, respectively), independently of their body mass index or body fat distribution. They also had higher insulin secretion ( P = 0.007 and P = 0.006) and increased glucose effectiveness ( P = 0.003 and P = 0.003). Overall glucose tolerance, however, did not correlate with birth size, suggesting that the reduced insulin sensitivity was being compensated for by an increase in insulin secretion and insulin-independent glucose disposal. There were no relationships between birth size and insulin sensitivity or insulin secretion in women. These results show that small size at birth is associated with increased insulin resistance and hyperinsulinemia in young adult life but that these relationships are restricted to the male gender in this age group.

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Impaired Insulin Secretion in the Turner Metabolic Syndrome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2004-0122 ◽

2004 ◽

Vol 89 (7) ◽

pp. 3516-3520 ◽

Cited By ~ 84

Author(s):

Vladimir K. Bakalov ◽

Margaret M. Cooley ◽

Michael J. Quon ◽

Mei Lin Luo ◽

Jack A. Yanovski ◽

...

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Insulin Secretion ◽

Insulin Sensitivity ◽

Body Mass ◽

Cell Function ◽

Insulin Response ◽

Area Under The Curve ◽

Oral Glucose ◽

Glucose Challenge

Abstract An increased prevalence of impaired glucose homeostasis (IGH) and diabetes mellitus is reported in monosomy X, or Turner syndrome (TS). To determine whether IGH is an intrinsic feature of this syndrome, independent of obesity or hypogonadism, we compared results of a standard oral glucose challenge in age- and body mass index-matched women with TS and with karyotypically normal premature ovarian failure (POF). Fasting glucose levels were normal in both groups, but glucose values after oral glucose challenge were higher in TS [2-h glucose, 135 ± 36 mg/dl (7.5 ± 2.0 mmol/liter) in TS and 97 ± 18 mg/dl (5.4 ± 1.0 mmol/liter) in POF; P < 0.0001]. Glucose-stimulated insulin secretion was lower in TS; e.g. the initial insulin response (ΔI/ΔG30) was decreased by 60% compared with POF (P < 0.0001). We also compared responses to a standard iv glucose tolerance test in women with TS and in age- and body mass index-matched normal women and found that the insulin area under the curve was 50% lower in women with TS (P = 0.003). Insulin sensitivity measured by the quantitative insulin sensitivity check index was higher in women with TS compared with both control groups. Thus, IGH is not secondary to obesity or hypogonadism in TS, but it is a distinct entity characterized by decreased insulin secretion, suggesting that haploinsufficiency for X-chromosome gene(s) impairs β-cell function and predisposes to diabetes mellitus in TS.

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The effects of three-week fasting diet on blood pressure, lipid profile and glucoregulation in extremely obese patients

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0708440b ◽

2007 ◽

Vol 135 (7-8) ◽

pp. 440-446 ◽

Cited By ~ 3

Author(s):

Biljana Beleslin ◽

Jasmina Ciric ◽

Milos Zarkovic ◽

Zorana Penezic ◽

Svetlana Vujovic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Body Mass Index ◽

Body Weight ◽

Insulin Sensitivity ◽

Lipid Profile ◽

Body Mass ◽

Glucose Intolerance ◽

The Body ◽

Obese Patients

Introduction Obesity is often accompanied by a number of complications including diabetes mellitus and cardiovascular diseases. Elevated blood pressure and lipids, as well as deterioration of glucoregulation are attributed, as the most significant factors, to development of diabetes mellitus and cardiovascular complications in obese patients. Objective The aim of our study was to evaluate the effects of a fasting diet on blood pressure, lipid profile and glucoregulatory parameters. Method We included 110 patients (33 male and 77 female; mean age 35?1 years, body weight 131.7?2.6 kg, body mass index 45.4?0.8 kg/m2) who were hospitalized for three weeks for the treatment of extreme obesity with the fasting diet. At the beginning, during, and at the end of this period, we evaluated changes in blood pressure, lipid profile, as well as parameters of glucoregulation including glycaemia, insulinaemia, and insulin sensitivity by HOMA. Oral glucose tolerance test (OGTT) was performed in all patients at the beginning and at the end of the fasting diet. Results During the fasting diet, the body weight decreased from 131.7?2.6 kg to 117.7?2.4 kg (p<0.001), the body mass index decreased from 45.4?0.8 kg/m2 to 40.8?0.8 kg/m2 (p<0.001), and both systolic and diastolic blood pressure significantly declined (143?2 vs. 132?2 mm Hg, p<0.001; 92?2 vs. 85?2 mm Hg, p<0.001). In addition, the fasting diet produced a significant decrease in total cholesterol, LDL cholesterol, triglycerides, as well as basal glycaemia and insulinaemia (p<0.001) Before the fasting diet, OGTT was normal in 76% of patients, whereas 21% of patients showed glucose intolerance, and 4% of patients diabetes mellitus. After the fasting diet, OGTT was normal in 88% of patients, whereas 12% of patients still had signs of glucose intolerance (p<0.05). In addition, insulin resistance significantly (p<0.05) increased from 54?6% to 89?13% after the fasting diet. Conclusion The three-week fasting diet in extremely obese patients produced a significant decrease and normalization of blood pressure, decrease in lipids, and improvement in glucoregulation including the increase in insulin sensitivity.

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Variations over four decades in body mass index trajectories prior to diagnosis of diabetes mellitus: The Manitoba Follow-up Study, 1948–2007

Can J Public Health ◽

10.17269/cjph.106.4641 ◽

2015 ◽

Vol 106 (3) ◽

pp. e95-e100 ◽

Cited By ~ 1

Author(s):

Dessalegn Y. Melesse ◽

Shiva S. Halli ◽

Robert B. Tate

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Body Mass ◽

Follow Up Study ◽

Body Mass Index Trajectories ◽

Diagnosis Of Diabetes Mellitus

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Type 2 Diabetes Mellitus, Impaired Glucose Tolerance and Associated Comorbidities in Children During 2002–2013 in Children’s Clinical University Hospital, Latvia

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2018-0037 ◽

2018 ◽

Vol 72 (6) ◽

pp. 322-326

Author(s):

Jurgita Gailite ◽

Agnese Mikilpa-Mikgelba ◽

Ieva Siliņa ◽

Ināra Kirillova ◽

Una Lauga-Tuņina ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Type 2 Diabetes Mellitus ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Body Mass ◽

University Hospital ◽

Complication Risk

Abstract The world has seen a rise of type 2 diabetes mellitus in children during the last 20 years. It is proposed that this increase is due to unhealthy eating habits, increasing obesity, especially among teenagers, and better diagnostics. The main risks associated with diabetes are microvascular and macrovascular complications, which can lead to early disability and premature death. The aim of our study was to identify children with type 2 diabetes mellitus or impaired glucose tolerance and investigate associated comorbidities at the time of diagnosis in the Children’s Clinical University Hospital in Latvia. A retrospective analysis was performed of all children with type 2 diabetes mellitus or glucose tolerance impairment from 2002 till 2013, who were treated in Children’s Endocrinology Centre. According to inclusion criteria, 57 patients were selected of whom 24 (42%) had type 2 diabetes mellitus and 33 (58%) had impaired glucose tolerance. Body mass index was analysed according to percentile and all patients were found to have excess weight. In children with type 2 diabetes mellitus, all patients had body mass index over the 99th percentile. Arterial hypertension was found in 66.7% and dyslipidemia in 54.2% type 2 diabetes mellitus patients. From all type 2 diabetes mellitus patients, 71% (n = 17) were girls and they had statistically significantly higher total cholesterol (p = 0.02) and low-density lipoprotein (p = 0.003) levels. Considering, that girls with type 2 diabetes mellitus have high cardiovascular risk in adulthood, it is very important not only to achieve normal glucose levels early, but also to treat comorbidities, to reduce further microvascular and macrovascular complication risk.

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Glucose Tolerance and Insulin Secretion patterns by Body Mass Index(BMI) in Offspring of Parents with Non-Insulin Dependent Diabetes Mellitus

The Journal of Nurses Academic Society ◽

10.4040/jnas.1997.27.3.694 ◽

1997 ◽

Vol 27 (3) ◽

pp. 694

Author(s):

Young Im Moon ◽

Hye Ja Park ◽

Young Ae Chang

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Insulin Secretion ◽

Glucose Tolerance ◽

Body Mass ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Insulin Dependent

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Haplotypes of PPARGC1A are associated with glucose tolerance, body mass index and insulin sensitivity in offspring of patients with type 2 diabetes

Diabetologia ◽

10.1007/s00125-005-1800-9 ◽

2005 ◽

Vol 48 (7) ◽

pp. 1331-1334 ◽

Cited By ~ 18

Author(s):

J. Pihlajamäki ◽

M. Kinnunen ◽

E. Ruotsalainen ◽

U. Salmenniemi ◽

I. Vauhkonen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Body Mass Index ◽

Insulin Sensitivity ◽

Glucose Tolerance ◽

Body Mass

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Leitliniengerechte Therapie der Adipositas

Adipositas - Ursachen Folgeerkrankungen Therapie ◽

10.1055/s-0037-1618626 ◽

2008 ◽

Vol 02 (02) ◽

pp. 59-66

Author(s):

H. Hauner

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Body Mass ◽

Typ 2 Diabetes ◽

Typ 2 Diabetes Mellitus ◽

Chirurgische Maßnahmen ◽

Leitliniengerechte Therapie ◽

Strukturelle Voraussetzungen

ZusammenfassungAdipositas stellt eines der zentralen Gesundheitsprobleme dar. Der Phänotyp ist durch eine Vermehrung des Körperfetts charakterisiert, die mit einem erhöhten Morbiditätsund Mortalitätsrisiko einhergeht. Ab einem Body-Mass-Index (BMI) von 30 kg/m2 bzw. ab einem BMI von 25 kg/m2 bei gleichzeitigem Vorliegen von Begleiterkrankungen wie z. B. Typ-2-Diabetes mellitus ist daher eine gewichtssenkende Behandlung indiziert. Dafür steht ein breites Spektrum von evidenzbasierten Therapiemaßnahmen zur Verfügung, deren Einsatz auf die individuellen Bedürfnisse und Möglichkeiten des Patienten zugeschnitten werden muss. Die Primärbehandlung zielt auf eine langfristige Lebensstiländerung mit energieärmerer Kost und Steigerung der körperlichen Aktivität. Das Konzept der abgestuften Therapie beinhaltet auch sehr niedrig kalorische Diäten, gewichtssenkende Medikamente und, bei extremer therapieresistenter Adipositas, chirurgische Maßnahmen. Der Therapieerfolg hängt entscheidend von der Motivation des Patienten ab, die Eigenverantwortung für sein Gewichtsmanagement zu übernehmen. Bereits eine Senkung des Körpergewichts um fünf bis zehn Prozent führt zu einer signifikanten Besserung der Lebensqualität sowie zahlreicher Begleiterkrankungen. Eine wirksame Adipositastherapie ist im deutschen Gesundheitssystem bisher nicht möglich, da keine Kostenübernahme durch Krankenkassen stattfindet und deshalb auch viele strukturelle Voraussetzungen dafür fehlen. Daneben sind zusätzlich Aktivitäten zur Primärprävention der Adipositas auf gesamtgesellschaftlicher Ebene dringend erforderlich.

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Rolle der metabolischen Chirurgie bei Diabetes mellitus Typ 2 und NASH

Adipositas - Ursachen Folgeerkrankungen Therapie ◽

10.1055/s-0037-1618703 ◽

2010 ◽

Vol 04 (02) ◽

pp. 79-83

Author(s):

F. X. Felberbauer ◽

A. Bohdjalian ◽

F. Langer ◽

S. Shakeri-Leidenmühler ◽

B. Ludvik ◽

...

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Body Mass ◽

Bariatrische Chirurgie ◽

Diabetes Mellitus Typ 2 ◽

Metabolische Chirurgie ◽

Nichtalkoholische Steatohepatitis

Zusammenfassung Diabetes mellitus Typ 2 stellt bereits heute in ökonomischer, medizinischer und sozialer Hinsicht ein globales Problem dar, dessen Bedeutung in den nächsten zwei Jahrzehnten noch massiv zunehmen wird. Bariatrische Chirurgie ist zweifelsohne die wirkungsvollste Behandlung von morbider Adipositas, führt zu substantiellem, anhaltendem Gewichtsverlust, Verbesserung von Begleiterkrankungen und Reduktion von Mortalität. Metabolische Chirurgie führt bei 56 bis 95 % der morbid adipösen Typ-2-Diabetiker zur Diabetesremission. Jüngste Ergebnisse zeigen für Patienten mit einem Body-Mass-Index zwischen 30 und 40 kg/m2 ebenfalls exzellente Ergebnisse. Die Verbesserung der diabetischen Stoffwechsellage ist auch auf eine kalorische Restriktion und Änderung der gastrointestinalen Hormonsekretion zurückzuführen. Die Etablierung von Diabeteschirurgie verlangt ein besseres pathophysiologisches Verständnis der Erkrankung und der Operationsmethoden – diese Arbeit beschreibt den Einfluss etablierter Operationsmethoden auf die diabetische Stoffwechsellage und die Hormonsekretion des Gastrointestinaltrakts. NASH (nichtalkoholische Steatohepatitis) betrifft rund ein Drittel der morbid adipösen Patienten. Es werden Prävalenz, Diagnosestellung und Beeinflussung der Erkrankung durch metabolische Chirurgie diskutiert. Der Goldstandard zur Diagnosestellung ist nach wie vor die Leberbiopsie. In mehreren Publikationen konnte die positive Beeinflussung der NASH durch metabolische Chirurgie gezeigt werden – für morbid adipöse Patienten stellt metabolische Chirurgie die effektivste Therapie der NASH dar.

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