Four-Year Follow-Up of Glucose Tolerance and Beta-Cell Function in Nondiabetic Cystic Fibrosis Patients

Abstract Aim To assess the order of severity of the defects of three direct determinants of glucose regulation, i.e., beta-cell function, insulin clearance and insulin sensitivity, in patients with CF categorized according their glucose tolerance status, including early elevation of mid-OGTT glucose values (>140 and < 200 mg/dL), named AGT140. Methods Two hundred and thirty-two CF patients aged 10-25 underwent OGTT. Beta-cell function and insulin clearance were estimated by OGTT mathematical modelling and OGTT-derived biomarkers of insulin secretion and sensitivity were calculated. The association between five glucose tolerance stages [NGT, AGT140, Indeterminate glucose Tolerance (INDET), impaired glucose tolerance (IGT), Cystic fibrosis related diabetes (CFRD)] and glucometabolic variables was assessed with general linear model. Results Beta-cell function and insulin sensitivity progressively worsened across glucose tolerance stages (p<0.001) with AGT140 patients significantly differing from NGT (all p<0.01). AGT140 and INDET showed a degree of beta-cell dysfunction similar to IGT and CFRD, respectively (all p<0.01). Insulin clearance was not significantly associated with glucose tolerance stages (p=0.162). Each class of glucose tolerance was uniquely identified by a specific combination of defects of the direct determinants of glucose regulation. Conclusions In CF patients each of the five glucose tolerance stages shows a unique pattern of defects of the direct determinants of glucose regulation, with AGT140 patients significantly differing from NGT and being similar to IGT. These findings suggest to recognize AGT 140 as a distinct glucose tolerance class and to reconsider the grade of glucometabolic deterioration across glucose tolerance stages in CF.

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Investigation of the progress in the women with gestational diabetes mellitus postpartum

Vietnam Journal of Diabetes and Endocrinology ◽

10.47122/vjde.2020.40.8 ◽

2021 ◽

pp. 45-51

Author(s):

Thi To Nhu Phan ◽

Trung Vinh Hoang

Keyword(s):

Diabetes Mellitus ◽

Logistic Regression ◽

Glucose Tolerance ◽

Beta Cell ◽

Glucose Intolerance ◽

Beta Cell Function ◽

Cell Function ◽

Postpartum Women ◽

Matsuda Index ◽

History Of

Aims: Our aim was to evaluate the uptake of postpartum screening, the prevalence and the risk factors for glucose intolerance in women with a recent history of gestational diabetes mellitus (GDM). Methods: All women with a history of GDM are advised to undergo a 75g oral glucose tolerance test (OGTT) around 6 - 12 weeks postpartum. Indices of insulin sensitivity (the Matsuda index and the reciprocal of the homeostasis model assessment of insulin resistance, HOMA-IR) and an index of beta-cell function, the Insulin Secretion-Sensitivity Index-2 (ISSI-2) were calculated based on the OGTT postpartum. Multivariable logistic regression was used to some factors. Results: Of all women (135) who received an OGTT postpartum, 42.2% (57) had glucose intolerance (11.8% impaired fasting glucose, 24.4% impaired glucose tolerance and 6.0% both impaired fasting and impaired glucose tolerance) and 1.5% (2) had overt diabetes. Compared to women with a normal OGTT postpartum, women with glucose intolerance and diabetes were older (32.5 ± 4.3 vs. 30.8 ± 4.8 years, p = 0.049), were more often obese (34.5% vs. 17.3%, p = 0.023). In the multivariable logistic regression, an EM background [OR = 2.76 (1.15 - 6.62), p = 0.023] and the HbA1c level at the time of the OGTT in pregnancy [OR = 4.78 (1.19 - 19.20), p = 0.028] remained significant predictors for glucose intolerance postpartum. Women with glucose intolerance and diabetes postpartum had a similar insulin sensitivity [Matsuda index 0.656 (0.386 - 1.224) vs. 0.778 (0.532 - 1.067), p = 0.709; HOMA-IR 0.004 (0.002 - 0.009) vs. 0.064 (0.003 - 0.007), p = 0.384] but a lower beta-cell function compared to women with a normal OGTT postpartum, remaining significant after adjustment for confounders [ISSI-2 1.6 (1.2 - 2.1) vs. 1.9 (1.7 - 2.4), p = 0.002]. Conclusions: Glucose intolerance is very frequent in early postpartum in women with GDM these women have an impaired beta-cell function. Nearly one third of women did not attend the scheduled OGTT postpartum and these women have an adverse risk profile. More efforts are needed to engage and stimulate women with GDM to attend the postpartum OGTT.

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HbA1 and beta cell function in cystic fibrosis (CF)

Pediatric Research ◽

10.1203/00006450-198112000-00194 ◽

1981 ◽

Vol 15 (12) ◽

pp. 1567-1567

Author(s):

J Sack ◽

T Bistritzer ◽

A Eshkol ◽

D Katznelson

Keyword(s):

Cystic Fibrosis ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function

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Review for "Combination Therapy with Pioglitazone/Exenatide Improves Beta Cell Function and Produces Superior Glycemic Control Compared to Basal/Bolus Insulin in Poorly Controlled T2DM : 3‐Year Follow‐up of the Qatar Study"

10.1111/dom.14153/v1/review5 ◽

2020 ◽

Keyword(s):

Glycemic Control ◽

Combination Therapy ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Bolus Insulin ◽

Basal Bolus

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Sustained Improvements in Glucose Metabolism Late After Roux-En-Y Gastric Bypass Surgery in Patients with and Without Preoperative Diabetes

Scientific Reports ◽

10.1038/s41598-019-51516-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Nils B. Jørgensen ◽

Kirstine N. Bojsen-Møller ◽

Carsten Dirksen ◽

Christoffer Martinussen ◽

Maria S. Svane ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Gastric Bypass ◽

Glucose Metabolism ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Relative Change

Abstract To describe glucose metabolism in the late, weight stable phase after Roux-en-Y Gastric Bypass (RYGB) in patients with and without preoperative type 2 diabetes we invited 55 RYGB-operated persons from two existing cohorts to participate in a late follow-up study. 44 (24 with normal glucose tolerance (NGT)/20 with type 2 diabetes (T2D) before surgery) accepted the invitation (median follow-up 2.7 [Range 2.2–5.0 years]). Subjects were examined during an oral glucose stimulus and results compared to preoperative and 1-year (1 y) post RYGB results. Glucose tolerance, insulin resistance, beta-cell function and incretin hormone secretion were evaluated. 1 y weight loss was maintained late after surgery. Glycemic control, insulin resistance, beta-cell function and GLP-1 remained improved late after surgery in both groups. In NGT subjects, nadir glucose decreased 1 y after RYGB, but did not change further. In T2D patients, relative change in weight from 1 y to late after RYGB correlated with relative change in fasting glucose and HbA1c, whereas relative changes in glucose-stimulated insulin release correlated inversely with relative changes in postprandial glucose excursions. In NGT subjects, relative changes in postprandial nadir glucose correlated with changes in beta-cell glucose sensitivity. Thus, effects of RYGB on weight and glucose metabolism are maintained late after surgery in patients with and without preoperative T2D. Weight loss and improved beta-cell function both contribute to maintenance of long-term glycemic control in patients with type 2 diabetes, and increased glucose stimulated insulin secretion may contribute to postprandial hypoglycemia in NGT subjects.

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A Systematic Review of Beta Cell Function in Adults of Black African Ethnicity

Journal of Diabetes Research ◽

10.1155/2019/7891359 ◽

2019 ◽

Vol 2019 ◽

pp. 1-17 ◽

Cited By ~ 1

Author(s):

M. Ladwa ◽

O. Hakim ◽

S. A. Amiel ◽

L. M. Goff

Keyword(s):

Insulin Secretion ◽

Glucose Tolerance ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Normal Glucose Tolerance ◽

Qualitative Synthesis ◽

Intravenous Glucose ◽

Black African

Background. Understanding ethnic differences in beta cell function has important implications for preventative and therapeutic strategies in populations at high risk of type 2 diabetes (T2D). The existing literature, largely drawn from work in children and adolescents, suggests that beta cell function in black African (BA) populations is upregulated when compared to white Europeans (WE). Methods. A systematic literature search was undertaken in June 2018 to identify comparative studies of beta cell function between adults (>age 18 years) of indigenous/diasporic BA and WE ethnicity. All categories of glucose tolerance and all methodologies of assessing beta cell function in vivo were included. Results. 41 studies were identified for inclusion into a qualitative synthesis. The majority were studies in African American populations (n=30) with normal glucose tolerance (NGT)/nondiabetes (n=25), using intravenous glucose stimulation techniques (n=27). There were fewer studies in populations defined as only impaired fasting glucose/impaired glucose tolerance (IFG/IGT) (n=3) or only T2D (n=3). Although BA broadly exhibited greater peripheral insulin responses than WE, the relatively small number of studies which measured C-peptide to differentiate between beta cell insulin secretion and hepatic insulin extraction (n=14) had highly variable findings. In exclusively IGT or T2D cohorts, beta cell insulin secretion was found to be lower in BA compared to WE. Conclusions. There is inconsistent evidence for upregulated beta cell function in BA adults, and they may in fact exhibit greater deficits in insulin secretory function as glucose intolerance develops.

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