Abstract P124: The Impact of Combined Prediabetes and Prehypertension on Cardiovascular Morbidity

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Annie Sjöli ◽  
Bledar Daka ◽  
Ulf Lindblad ◽  
Margareta Hellgren
Keyword(s):  
Cardiovascular Risk ◽  
Glucose Tolerance ◽  
Treatment Strategies ◽  
Normal Glucose Tolerance ◽  
Full Model ◽  
Hazard Ratios ◽  
Normal Glucose ◽  
Definition Of ◽  
The Impact

Introduction: Cardiovascular disease (CVD) is often preceded by prediabetes (pre-DM) and/or prehypertension (pre-HT), but few studies have investigated the effect of concurrent pre-DM and pre-HT on cardiovascular risk. Hypothesis: We assessed the hypothesis that concurrent pre-DM and pre-HT increases the risk of CVD. Furthermore, we examined if the estimated cardiovascular risk differs with sex and with the definition of pre-DM. Methods: In 2002-2005, 2816 randomly selected individuals from two Swedish municipalities were enrolled in a health survey. The participants’ cardiometabolic profiles, including blood pressure (BP) and glucose tolerance, were examined. Individuals with diabetes mellitus and/or hypertension were excluded, leaving 2330 persons for analyses. Out of these, 150 had co-existing pre-DM (IFG and/or IGT) and pre-HT (WHO 2013 criteria), while 1250 had simultaneous normal glucose tolerance (NGT) and optimal BP (< 120/80 mmHg). Outcomes were assessed in 2011 using national Swedish registers. Hazard ratios (HR) for CVD were calculated for pre-DM, pre-HT and pre-HT combined with pre-DM, all versus NGT/optimal BP. Analyses were adjusted for age, BMI, sex, smoking and earlier CVD. Results: A total of 80 CVD events occurred during 8.1±0.9 years of follow-up. The unadjusted HR for CVD for combined pre-DM/pre-HT was 22.5. The association was attenuated after adjustments but persisted in the full model, see Figure 1. A test for interaction between combined pre-DM/pre-HT and sex on the outcome of CVD was non-significant (p = 0.6). IFG/pre-HT predicted CVD in all adjustment models (HR 3.2, p = 0.005) while IGT/pre-HT did not. Conclusions: Combined pre-DM and pre-HT substantially increases the risk of CVD. Those with pre-DM defined by IFG might be at particularly high risk, while the risk is likely the same in both sexes. Intensified treatment strategies should be considered in those with concomitant pre-DM and pre-HT.

Impact of Glucose Metabolism Disorders on IGF-1 Levels in Patients with Acromegaly

2018 ◽  
Vol 50 (05) ◽  
pp. 408-413 ◽  
Author(s):  
Sema Dogansen ◽  
Gulsah Yalin ◽  
Seher Tanrikulu ◽  
Sema Yarman
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Glucose Metabolism ◽  
Glucose Tolerance ◽  
Normal Glucose Tolerance ◽  
Glucose Metabolism Disorders ◽  
Insulin Resistant ◽  
Normal Glucose ◽  
Resistant Group ◽  
The Impact

AbstractIn this study, we aimed to evaluate the presence of glucose metabolism abnormalities and their impact on IGF-1 levels in patients with acromegaly. Ninety-three patients with acromegaly (n=93; 52 males/41 females) were included in this study. Patients were separated into three groups such as; normal glucose tolerance (n=23, 25%), prediabetes (n=38, 41%), and diabetes mellitus (n=32, 34%). Insulin resistance was calculated with homeostasis model assessment (HOMA). HOMA-IR > 2.5 or ≤2.5 were defined as insulin resistant or noninsulin resistant groups, respectively. Groups were compared in terms of factors that may be associated with glucose metabolism abnormalities. IGF-1% ULN (upper limit of normal)/GH ratios were used to evaluate the impact of glucose metabolism abnormalities on IGF-1 levels. Patients with diabetes mellitus were significantly older with an increased frequency of hypertension (p<0.001, p=0.01, respectively). IGF-1% ULN/GH ratio was significantly lower in prediabetes group than in normal glucose tolerance group (p=0.04). Similarly IGF-1% ULN/GH ratio was significantly lower in insulin resistant group than in noninsulin resistant group (p=0.04). Baseline and suppressed GH levels were significantly higher in insulin resistant group than in noninsulin resistant group (p=0.024, p<0.001, respectively). IGF-1% ULN/GH ratio is a useful marker indicating glucose metabolism disorders and IGF-1 levels might be inappropriately lower in acromegalic patients with insulin resistance or prediabetes. We suggest that IGF-1 levels should be re-evaluated after the improvement of insulin resistance or glycemic regulation for the successful management of patients with acromegaly.

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

2005 ◽  
Vol 90 (6) ◽  
pp. 3236-3242 ◽  
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 &lt; 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 &lt; 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.

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

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 &lt; 0.001); HbA1C and 2-hour glucose (r = 0.63, P &lt; 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.

Insulin resistance and cardiovascular risk factors in women with PCOS who have normal glucose tolerance test

2012 ◽  
Vol 29 (2) ◽  
pp. 148-151 ◽  
Author(s):  
Ismail Cem Yildir ◽  
Faruk Kutluturk ◽  
Turker Tasliyurt ◽  
Berna Murat Yelken ◽  
Berat Acu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Cardiovascular Risk ◽  
Glucose Tolerance ◽  
Cardiovascular Risk Factors ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Normal Glucose Tolerance ◽  
Normal Glucose

scholarly journals Elevated 1‐h post‐load plasma glucose levels in Thai people with normal glucose tolerance associated with high diabetes and cardiovascular risk

2019 ◽  
Vol 37 (4) ◽  
pp. 705-706
Author(s):  
Y. Thewjitcharoen ◽  
A. Elizabeth Jones ◽  
S. Butadej ◽  
S. Nakasatien ◽  
P. Chotwanvirat ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Normal Glucose Tolerance ◽  
Glucose Levels ◽  
Normal Glucose ◽  
Thai People

scholarly journals Use of hemoglobin A1c to identify dysglycemia in cystic fibrosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250036
Author(s):  
Amy Darukhanavala ◽  
Filia Van Dessel ◽  
Jannifer Ho ◽  
Megan Hansen ◽  
Ted Kremer ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Glucose Tolerance ◽  
Hemoglobin A1c ◽  
Screening Tool ◽  
Normal Glucose Tolerance ◽  
Screening Methods ◽  
Oral Glucose ◽  
Screening Guidelines ◽  
Normal Glucose ◽  
The Impact

Background Cystic fibrosis (CF) leads to pancreatic endocrine dysfunction with progressive glycemic disturbance. Approximately 30%–50% of people with CF eventually develop CF–related diabetes (CFRD). Pre-CFRD states progress from indeterminant glycemia (INDET) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Screening guidelines recommend inconvenient annual 2-hour oral glucose tolerance tests (OGTTs), beginning at age 10 years. More efficient methods, such as hemoglobin A1C (HbA1c), have been evaluated, but only limited, relatively small studies have evaluated the association between HbA1c and pre-CFRD dysglycemic states. Objective To determine whether HbA1c is an appropriate screening tool for identifying patients with pre-CFRD dysglycemia to minimize the burden of annual OGTTs. Methods This retrospective review evaluated medical records data of all University of Massachusetts Memorial Health System CF patients with an HbA1c result within 90 days of an OGTT between 1997 and 2019. Exclusion criteria were uncertain CF diagnosis, other forms of diabetes, or incomplete OGTT. In total, 56 patients were included and categorized according to OGTT results (American Diabetes Association criteria): normal glucose tolerance, INDET, IFG, or IGT. Associations were evaluated between HbA1c and OGTT results and between HbA1c and pre-CFRD dysglycemic states. Results Mean HbA1c was not significantly different between patients with normal glucose tolerance and those in the INDET (p = 0.987), IFG (p = 0.690), and IGT (p = 0.874) groups. Analysis of variance confirmed the lack of association between HbA1c and glycemia, as mean HbA1c was not significantly different amongst the four categories (p = 0.250). Conclusion There is increasing awareness of the impact of pre-CFRD states, including reduced pulmonary function and nutritional status. Unfortunately, our results do not support using HbA1c as a screening tool for pre-CFRD dysglycemia, specifically INDET, IFG, and IGT. Further studies are warranted to evaluate more efficient screening methods to reduce the burden of annual OGTTs.

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