A Randomized Controlled Clinical Trial of Lifestyle Intervention and Pioglitazone for Normalization of Glucose Status in Chinese with Prediabetes

Aims. Prediabetes has been proved as an important risk factor of both diabetes and cardiovascular disease (CVD). Previous studies have shown that both lifestyle intervention and pioglitazone may delay the development of diabetes in patients with prediabetes. However, no study has ever explored whether these interventions could revert prediabetes to normal glycemic status as the primary outcome. Interventions that may revert prediabetes back to normal glucose status would be of great clinical importance. Materials and Methods. We conducted a randomized, multicenter, 2 × 2 factorial designed study to examine whether intensive lifestyle intervention and/or pioglitazone could revert prediabetes to normal glucose tolerance. The participants were followed up for three years unless they reverted to normal glucose state or developed diabetes at the annual oral glucose tolerance test (OGTT). Reversion to normal glucose tolerance was confirmed on the basis of the results of OGTT. Results. In our study, 1945 eligible patients were ultimately randomized into four groups. In this three-year follow-up study, overall, 60.0%, 50.3%, 56.6% and 65.1% reverted back to normoglycemic state over 3 years of follow-up in the conventional lifestyle intervention plus placebo, intensive lifestyle intervention plus placebo, conventional lifestyle intervention plus pioglitazone, and intensive lifestyle intervention plus pioglitazone groups, respectively. Compared to the conventional lifestyle intervention plus placebo group, all the other three groups did not show any significant benefit in terms of reverting back to normoglycemic state. Conclusion. In our study, for patients with prediabetes, neither intensive lifestyle intervention nor pioglitazone had led to a higher reversion rate to normal glucose state. Trail registration.http://www.chictr.org.cn: ChiCTR-PRC-06000005.

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Rationale, Design, and Baseline Characteristics of Beijing Prediabetes Reversion Program: A Randomized Controlled Clinical Trial to Evaluate the Efficacy of Lifestyle Intervention and/or Pioglitazone in Reversion to Normal Glucose Tolerance in Prediabetes

Journal of Diabetes Research ◽

10.1155/2017/7602408 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Yingying Luo ◽

Sanjoy K. Paul ◽

Xianghai Zhou ◽

Cuiqing Chang ◽

Wei Chen ◽

...

Keyword(s):

Glucose Tolerance ◽

Lifestyle Intervention ◽

Lifestyle Modification ◽

Intervention Group ◽

Normal Glucose Tolerance ◽

Controlled Clinical Trial ◽

Prediabetic State ◽

Metabolic Markers ◽

Intensive Lifestyle Intervention ◽

Normal Glucose

Background. Patients with prediabetes are at high risk for diabetes and cardiovascular disease (CVD). No study has explored whether intervention could revert prediabetes to normal glycemic status as the primary outcome. Beijing Prediabetes Reversion Program (BPRP) would evaluate whether intensive lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia and improve the risk factors of CVD as well.Methods. BPRP is a randomized, multicenter, 2 × 2 factorial design study. Participants diagnosed as prediabetes were randomized into four groups (conventional/intensive lifestyle intervention and 30 mg pioglitazone/placebo) with a three-year follow-up. The primary endpoint was conversion into normal glucose tolerance. The trial would recruit 2000 participants (500 in each arm).Results. Between March 2007 and March 2011, 1945 participants were randomized. At baseline, the individuals were53±10years old, with median BMI 26.0 (23.9, 28.2) kg/m2and HbA1c 5.8 (5.6, 6.1)%. 85% of the participants had IGT and 15% had IFG. Parameters relevant to glucose, lipids, blood pressure, lifestyle, and other metabolic markers were similar between conventional and intensive lifestyle intervention group at baseline.Conclusion. BPRP was the first study to determine if lifestyle modification and/or pioglitazone could revert prediabetic state to normoglycemia in Chinese population. Major baseline parameters were balanced between two lifestyle intervention groups. This trial is registered with www.chictr.org.cn:ChiCTR-PRC-06000005.

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A Clinic-based Approach to Diagnosis and Management of Prediabetes in High-risk Children and Adolescents

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa008 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Chelsea Lawson ◽

S Naseeruddin Ahmed ◽

Cassandra Brady ◽

Ashley H Shoemaker

Keyword(s):

High Risk ◽

Glucose Tolerance ◽

Best Practice ◽

Fasting Glucose ◽

Retrospective Chart Review ◽

Normal Glucose Tolerance ◽

Oral Glucose ◽

Oral Glucose Tolerance Testing ◽

Normal Glucose

Abstract Background Type 2 diabetes (T2D) in youth is increasing in prevalence. Diabetes screening is recommended for at-risk youth but best-practice strategies for management of pediatric prediabetes are unknown. This study leverages a pediatric prediabetes clinic to assess identification of high-risk patients, the rate of clinic follow-up and progression to T2D in youth over time. Methods Retrospective chart review of children referred to a single center for evaluation of prediabetes over a 3-year period. Measurements included hemoglobin A1c (HbA1C) and oral glucose tolerance testing. Patients were classified as normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or T2D based on 2019 American Diabetes Association criteria. Patients classified as IGT/T2D were prescribed metformin. Results Of the 254 patients included; 25.6% had IGT and 6.7% had T2D. The IGT/T2D groups were older and more obese than the NGT group. There was a moderate correlation between HbA1C and fasting glucose (r = 0.59, P < 0.001); HbA1C and 2-hour glucose (r = 0.63, P < 0.001). Over the 3-year study, 52 of 82 patients with IGT/T2D (63%) returned for follow-up. Four patients regained NGT; 3 of those had isolated impaired fasting glucose (100 to 102 mg/dL). Three patients (4.6%) progressed from IGT to T2D over an average of 13 ± 6.2 months. In those patients, body mass index had increased 1.7 ± 2.3 kg/m2 from baseline. Conclusions A pediatric prediabetes clinic may allow for identification of high-risk youth but lost to follow-up rates are high. Continued weight gain is a risk factor for progression to T2D and effective weight management programs are needed.

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Abnormal Regulation of Venous Alanine after Glucose Ingestion in Myotonic Dystrophy

Clinical Science ◽

10.1042/cs0680151 ◽

1985 ◽

Vol 68 (2) ◽

pp. 151-157 ◽

Cited By ~ 8

Author(s):

Richard T. Moxley ◽

William Kingston ◽

Robert C. Griggs

Keyword(s):

Amino Acids ◽

Glucose Tolerance ◽

Myotonic Dystrophy ◽

Normal Glucose Tolerance ◽

Oral Glucose ◽

Oral Glucose Tolerance Testing ◽

Glucose Ingestion ◽

Normal Glucose ◽

Normal Males ◽

Slight Rise

1. The concentration of amino acids in whole blood was measured before and during standard 5 h oral glucose tolerance testing in six male patients with myotonic dystrophy and five normal males. The plasma levels of insulin and glucose were also determined. 2. From 90 to 240 min after glucose ingestion there was a striking decline in venous alanine concentration in the patients with myotonic dystrophy in contrast to a slight rise in alanine in the normal group. 3. The patients displayed normal glucose tolerance, and there was a sustained fall in the venous concentration of the insulin-sensitive amino acids comparable with that seen in the normal controls. However, the patients showed a threefold increase of plasma insulin after glucose. 4. These data indicate an abnormal regulation of alanine in myotonic dystrophy which may be the result of an alteration in muscle synthesis of this amino acid. This defect in alanine synthesis may be due to a decreased availability of intracellular pyruvate caused by the insulin resistance that exists in these patients.

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Changes in Glucose Tolerance over Time in Women with Polycystic Ovary Syndrome: A Controlled Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2004-1843 ◽

2005 ◽

Vol 90 (6) ◽

pp. 3236-3242 ◽

Cited By ~ 185

Author(s):

Richard S. Legro ◽

Carol L. Gnatuk ◽

Allen R. Kunselman ◽

Andrea Dunaif

Keyword(s):

Type 2 Diabetes ◽

Glucose Tolerance ◽

Polycystic Ovary ◽

Normal Glucose Tolerance ◽

Ovary Syndrome ◽

Normal Glucose ◽

Pcos Group ◽

Over Time

We performed this study to access the changes in glucose tolerance over time in a group of women with polycystic ovary syndrome (PCOS) (n = 71) and control women (n = 23) with regular menstrual cycles and baseline normal glucose tolerance. Mean follow-up was between 2 and 3 yr for both groups (PCOS 2.5 ± 1.7 yr; controls 2.9 ± 2.1 yr). Based on World Health Organization glucose tolerance categories, there was no significant difference in the prevalence of glucose intolerance at follow-up in the PCOS group. In the PCOS group, 25 (37%) had impaired glucose tolerance (IGT) and seven (10%) had type 2 diabetes mellitus at baseline, compared with 30 (45%) and 10 (15%), respectively, at follow-up. There were also no differences within groups (PCOS or control) or between groups (PCOS vs. control) in the oral glucose tolerance test-derived measure of insulin sensitivity, but in the women with PCOS who converted to either IGT or type 2 diabetes mellitus, there was a significant decrease (P < 0.0001). At the follow-up visit, the mean glycohemoglobin level was 6.1 ± 0.9% in women with PCOS vs. 5.3 ± 0.7% in the control women (P < 0.001). Women with PCOS and baseline IGT had a low conversion risk of 6% to type 2 diabetes over approximately 3 yr, or 2% per year. The effect of PCOS, given normal glucose tolerance (NGT) at baseline, is more pronounced with 16% conversion to IGT per year. Our study supports that women with PCOS (especially with NGT) should be periodically rescreened for diabetes due to worsening glucose intolerance over time, but this interval may be over several years and not annually.

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Glucose Tolerance in Patients with Cystic Fibrosis – Results from the German Cystic Fibrosis Registry

Klinische Pädiatrie ◽

10.1055/a-1117-3771 ◽

2020 ◽

Vol 232 (04) ◽

pp. 210-216

Author(s):

Nicole Prinz ◽

Julia Wosniok ◽

Doris Staab ◽

Manfred Ballmann ◽

Christian Dopfer ◽

...

Keyword(s):

Cystic Fibrosis ◽

Glucose Tolerance ◽

Real World ◽

Normal Glucose Tolerance ◽

Oral Glucose ◽

Real World Data ◽

Clinical Registries ◽

Normal Glucose ◽

Multivariable Regression ◽

Adjusted Model

Abstract Background Oral glucose tolerance (OGT) deteriorates progressively in cystic fibrosis (CF). Clinical registries provide a unique basis to study real-world data. Patients & methods OGT tests (OGTTs) documented in the German CF-registry in 2016 were classified according WHO, modified by ADA: normal glucose tolerance (NGT), indeterminate glycaemia (INDET), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT, diabetes mellitus (DM). To study the association with lung function, multivariable regression adjusted for age, sex, and CFTR mutation was performed. Results Overall, OGTT screening was done in 35% of CF patients ≧10 years. Of the 996 patients (46.4% females; median age (IQR): 19 (14–27) years) with evaluable OGTTs, 56.2% had either NGT or INDET, whereas 34% had a pre-diabetic OGTT (IFG; IGT; IFG+IGT) and 9.8% a diabetic OGTT. 7 patients had glucose tolerance abnormalities <10 years. DM was more common in females or patients with F508del homozygote mutation, whereas IFG was more frequent in males (all p<0.05). Nearly 75% of patients after transplantation and about half with enteral/parental nutrition and/or steroid use had either a pre-diabetic or diabetic glucose tolerance. In the adjusted model, age (p<0.001) and OGTT category (p=0.013) had both a significant impact on %FEV1. Conclusion Our data of the German CF-registry highlights incidence of glucose tolerance abnormalities in second decade of life in CF patients. However, it also underlines the need for improvement of the documentation and/or performance of OGTT screening in real-world CF care.

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Effects of exercise and lack of exercise on glucose tolerance and insulin sensitivity

Journal of Applied Physiology ◽

10.1152/jappl.1983.55.2.512 ◽

1983 ◽

Vol 55 (2) ◽

pp. 512-517 ◽

Cited By ~ 195

Author(s):

G. W. Heath ◽

J. R. Gavin ◽

J. M. Hinderliter ◽

J. M. Hagberg ◽

S. A. Bloomfield ◽

...

Keyword(s):

Glucose Tolerance ◽

Insulin Response ◽

Insulin Binding ◽

Normal Glucose Tolerance ◽

Residual Effects ◽

Oral Glucose ◽

Glucose Load ◽

Plasma Insulin Concentration ◽

Normal Glucose ◽

Blood Glucose Concentrations

Physically trained individuals have a markedly blunted insulin response to a glucose load and yet have normal glucose tolerance. This phenomenon has generally been ascribed to long-term adaptations to training which correlate with maximal oxygen uptake (VO2max) and reduced adiposity. Our study was undertaken to test the hypothesis that residual effects of the last bouts of exercise play an important role in this phenomenon. Eight well-trained subjects stopped training for 10 days. There were no significant changes in VO2max (58.6 +/- 2.2 vs. 57.6 +/- 2.1 ml/kg), estimated percent body fat (12.5 +/- 0.7 vs. 12.5 +/- 0.8%), or body weight. The maximum rise in plasma insulin concentration in response to a 100-g oral glucose load was 100% higher after 10 days without exercise than when the subjects were exercising regularly. Despite the increased insulin levels, blood glucose concentrations were higher after 10 days without exercise. Insulin binding to monocytes also decreased with physical inactivity. One bout of exercise after 11 days without exercise returned insulin binding and the insulin and glucose responses to an oral 100-g glucose load almost to the initial “trained” value. These results support our hypothesis.

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Response of incretins (GIP and GLP-1) to an oral glucose load in female and male subjects with normal glucose tolerance

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2014.09.002 ◽

2014 ◽

Vol 106 (2) ◽

pp. e25-e29 ◽

Cited By ~ 3

Author(s):

Toshihiro Matsuo ◽

Yoshiki Kusunoki ◽

Tomoyuki Katsuno ◽

Takashi Ikawa ◽

Takafumi Akagami ◽

...

Keyword(s):

Glucose Tolerance ◽

Normal Glucose Tolerance ◽

Oral Glucose ◽

Oral Glucose Load ◽

Glucose Load ◽

Normal Glucose ◽

Male Subjects

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Urinary myo-inositol levels in Japanese schoolchildren with normal glucose tolerance

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0107 ◽

2016 ◽

Vol 29 (2) ◽

Author(s):

Eiichiro Satake ◽

Rie Matsushita ◽

Kazuteru Kitsuda ◽

Kohnosuke Ohtaka ◽

Eiko Nagata ◽

...

Keyword(s):

Early Detection ◽

Glucose Tolerance ◽

Normal Glucose Tolerance ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Normal Range ◽

Oral Glucose Tolerance Tests ◽

Normal Glucose ◽

Glucose Tolerance Tests ◽

The Difference

AbstractUrinaryIn Study 1 (328 schoolchildren), fasting and postprandial UMI were measured, with ΔUMI defined as the difference between fasting and postprandial UMI levels. In Study 2, oral glucose tolerance tests and UMI measurements were conducted in 18 children with suspected having diabetes.For Study 1, ΔUMI was observed [−0.65 (−3.9, 1.35) mg/g creatinine]. For Study 2, children with diabetes or impaired glucose tolerance had a significantly higher ΔUMI than children with normal glucose tolerance.These studies demonstrated the normal range of UMI in children and possibility of a novel biomarker for early detection of glucose intolerance in children.

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