scholarly journals Comparison of oral glucose tolerance test and HbA1c in detection of disorders of glucose metabolism in patients with acute stroke

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Karl Matz ◽  
Jaakko Tuomilehto ◽  
Yvonne Teuschl ◽  
Alexandra Dachenhausen ◽  
Michael Brainin
Keyword(s):  
Glucose Metabolism ◽  
Detection Rate ◽  
Glucose Tolerance Test ◽  
Controlled Trial ◽  
Relative Difference ◽  
Tolerance Test ◽  
Secondary Outcome ◽  
Outcome Analysis ◽  
Oral Glucose ◽  
Randomized Controlled

Abstract Background Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients. Design Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS). Methods A total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after 1 year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared. Results By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After 1 year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference). The study intervention led to a more favourable evolution of glycemic status after 1 year. Conclusion The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes. Trial registrationhttp://clinicaltrials.gov. Unique identifier: NCT01109836.

scholarly journals Comparison of oral glucose tolerance test and HbA1c in detection of disorders of glucose metabolism in patients with acute stroke

2020 ◽  
Author(s):  
Karl Matz ◽  
Jaakko Tuomilehto ◽  
Yvonne Teuschl ◽  
Alexandra Dachenhausen ◽  
Michael Brainin
Keyword(s):  
Glucose Metabolism ◽  
Detection Rate ◽  
Controlled Trial ◽  
Relative Difference ◽  
Tolerance Test ◽  
Secondary Outcome ◽  
Outcome Analysis ◽  
Oral Glucose ◽  
Randomized Controlled ◽  
One Year

Abstract Background: Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients. Design: Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS). Methods: A total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after one year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared.Results: By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After one year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference).The study intervention led to a more favourable evolution of glycemic status after one year.Conclusion: The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes.

scholarly journals Comparison of oral glucose tolerance test and HbA1c in detection of disorders of glucose metabolism in patients with acute stroke

2020 ◽  
Author(s):  
Karl Matz ◽  
Jaakko Tuomilehto ◽  
Yvonne Teuschl ◽  
Alexandra Dachenhausen ◽  
Michael Brainin
Keyword(s):  
Glucose Metabolism ◽  
Detection Rate ◽  
Controlled Trial ◽  
Relative Difference ◽  
Tolerance Test ◽  
Secondary Outcome ◽  
Outcome Analysis ◽  
Oral Glucose ◽  
Randomized Controlled ◽  
One Year

Abstract Background: Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients.Design: Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS).Methods: A total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after one year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared.Results: By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After one year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference).The study intervention led to a more favourable evolution of glycemic status after one year.Conclusion: The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes.

scholarly journals Comparison of Oral Glucose Tolerance Test and HbA1c in Detection of Disorders of Glucose Metabolism in Patients With Acute Stroke

2020 ◽  
Author(s):  
Karl Matz ◽  
Yvonne Teuschl ◽  
Jaakko Tuomilehto ◽  
Alexandra Dachenhausen ◽  
Michael Brainin
Keyword(s):  
Glucose Metabolism ◽  
Acute Stroke ◽  
Detection Rate ◽  
Controlled Trial ◽  
Relative Difference ◽  
Tolerance Test ◽  
Secondary Outcome ◽  
Outcome Analysis ◽  
Oral Glucose ◽  
One Year

Abstract Background: Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have accurate assessment of glycaemia in stroke patients.Design: Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS).Methods: a total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after one year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared.Results: By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range . The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After one year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference). The study intervention led to a more favourable evolution of glycemic status after one year.Conclusions: Many patients with acute stroke have unrecognised diabetes or prediabetes. The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognised glycemic disorders in patients with acute stroke with an at least 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes. Measuring HbA1c alone will lead to a false assurance of normal glycemic status in many stroke patients.

scholarly journals Plant Based Foods to Improve Metabolic Health in Prediabetics – Protocol for a Randomized Controlled Trial

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1278-1278
Author(s):  
Sumanto Haldar ◽  
Long Hui Wong ◽  
Alvin Suriya Tjahyo ◽  
Farhana Osman ◽  
Shia Lyn Tay ◽  
...  
Keyword(s):  
Weight Loss ◽  
Randomized Controlled Trial ◽  
Dietary Intervention ◽  
Glucose Tolerance Test ◽  
Controlled Trial ◽  
Tolerance Test ◽  
Metabolic Health ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Randomized Controlled

Abstract Objectives The study will investigate the effectiveness of an Asian food based intervention to improve metabolic health, notably glucose homeostasis in a prediabetic population. Methods A parallel design randomized controlled trial will be conducted in Chinese prediabetics aged 45–75 years, BMI 19.5–32 kg/m2. Prediabetes defined according to the American Diabetes Association guideline: fasting blood glucose 5.6–6.9 mmol/l or hemoglobin A1c 5.7–6.4% or 2-hr oral glucose tolerance test 7.8–11.0 mmol/l. Major exclusion criteria were: smoking, food allergies or intolerances to common food ingredients, dietary restrictions, sustained hypertension (>160/95 mmHg), history of metabolic, cardiac, liver or kidney disorders, thyroid dysfunction and recent weight loss. The dietary intervention will last for 16 weeks, where volunteers will consume 2 specially formulated main meals per day, provided as pre-cooked, frozen, ready-meals (approximately 400 kcal each). The treatment group (TG) meals will be prepared with legumes, low GI rice or noodles, blended vegetable oil and added mixed herbs and spices. The control group (CG) meals, isocaloric, will consist of a portion of chicken, a portion of vegetables, medium to high GI rice or noodles and negligible herbs and spices. The male volunteers will be provided additional 100 kcal snacks containing either wholegrain cereals and nuts/seeds (TG) or refined cereal snack products (CG). The daily meals and snacks for rest of the day will be chosen freely, while a dietitian limits the total average calorie consumption to ensure around 5% weight loss in both groups. The effects of dietary interventions on metabolic health will be assessed at every 4 week intervals. The primary outcome measures will include several markers of glucose homeostasis (including HbA1c, fasting glucose, fasting insulin and a 2-hr oral glucose tolerance test [OGTT]). The secondary outcomes will include lipid profile, fructosamine, adiponectin, markers of oxidative stress and chronic inflammation. Results The recruitment for the study has been completed (n = 256 screened, n = 123 suitable). The dietary intervention will commence in March 2021 and expected to be completed in July 2021. Conclusions N/A. Funding Sources Jointly funded by the National University of Singapore, Agency of Science Technology and Research, Singapore, and Wilmar International Limited.

scholarly journals Use of carnosine in the prevention of cardiometabolic risk factors in overweight and obese individuals: study protocol for a randomised, double-blind placebo-controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043680
Author(s):  
Kirthi Menon ◽  
James D Cameron ◽  
Maximilian de Courten ◽  
Barbora de Courten
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Glucose Metabolism ◽  
Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Controlled Trial ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Double Blind

IntroductionCarnosine, an over the counter food supplement, has been shown to improve glucose metabolism as well as cardiovascular risk factors in animal and human studies through its anti-inflammatory, antioxidative, antiglycating and chelating properties. The aim of this study is to establish if carnosine supplementation improves obesity, insulin sensitivity, insulin secretion, cardiovascular risk factors including arterial stiffness and endothelial function, and other risk factors related to diabetes and cardiovascular disease in the overweight and obese population.Methods and analysisFifty participants will be recruited to be enrolled in a double-blind randomised controlled trial. Eligible participants with a body mass index (BMI) between 25 and 40 kg/m2 will be randomly assigned to the intervention or placebo group. Following a medical review and oral glucose tolerance test to check eligibility, participants will then undergo testing. At baseline, participants will have anthropometric measurements (BMI, dual X-ray absorptiometry and peripheral quantitative CT scan), measurements of glucose metabolism (oral glucose tolerance test, intravenous glucose tolerance test and euglycaemic hyperinsulinaemic clamp), cardiovascular measurements (central blood pressure, endothelial function and arterial stiffness), a muscle and fat biopsy, physical activity measurement, liver fibroscan, cognitive function and questionnaires to assess dietary habits, sleep quality, depression, and quality of life. Following baseline assessments, participants will be randomised to either 2 g carnosine or placebo for 15 weeks. In the 15th week, all assessments will be repeated. The preplanned outcome metric is the change between baseline and follow-up measures.Ethics and disseminationThis study is approved by the Human Research Ethics Committee of Monash Health and Monash University, Australia.Trial registration numberNCT02686996.

scholarly journals Baseline Characteristics of Participants in a Randomized Controlled Trial of Metformin for Frailty Prevention

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 130-131
Author(s):  
Tiffany Cortes ◽  
Nicolas Musi ◽  
Chen-pin Wang ◽  
Joel Michalek ◽  
Sara Espinoza
Keyword(s):  
Randomized Controlled Trial ◽  
Glucose Tolerance ◽  
Physical Performance ◽  
Controlled Trial ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Double Blind ◽  
Randomized Controlled ◽  
Insulin Clamp ◽  
And Function

Abstract We are conducting a double-blind, randomized controlled trial of metformin for frailty prevention. Participants are adults aged 65+ years with pre-diabetes assessed by 2-hour oral glucose tolerance test (OGTT). Those who are frail (Fried criteria) are excluded. Participants are randomized to metformin (maximum dose of 2,000 mg/day) vs. placebo and followed for 2 years. The primary outcome is frailty (category and score); secondary outcomes are physical performance and function (short physical performance battery, 6-minute walk, lower extremity strength), systemic and skeletal muscle tissue inflammation, muscle insulin signaling, insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry). Safety assessments occur every 3 months; frailty, systemic inflammation, and OGTT are assessed at baseline and every 6 months, and insulin clamp with muscle biopsies are assessed at baseline and every 12 months. To date, 85 subjects have been randomized; 120 completers are planned. Mean age is 72.8 ± 5.7 years, 55.3% are male, and 43.5% were Hispanic. Mean BMI is 30.2±5.8 kg/m2, waist circumference is 104.4 ±15.5 cm, fasting glucose is 102.3 ± 10.0 mg/dL, Hemoglobin A1c is 5.8 ±0.3, and glucose at 2 hours during OGTT is 167.3 ± 17.8 mg/dL. Metformin is being examined in this study as a potential therapeutic agent to prevent frailty in older adults with pre-diabetes. Findings from this trial may have future implications for the screening and potential treatment of pre-diabetes in older patients with metformin for the prevention of frailty.

scholarly journals Metformin prevents metabolic side effects during systemic glucocorticoid treatment

2017 ◽  
Vol 176 (3) ◽  
pp. 349-358 ◽  
Author(s):  
Eleonora Seelig ◽  
Stefanie Meyer ◽  
Katharina Timper ◽  
Nicole Nigro ◽  
Martina Bally ◽  
...  
Keyword(s):  
Side Effects ◽  
Glucose Tolerance Test ◽  
Controlled Trial ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Oral Glucose Tolerance ◽  
Glucocorticoid Treatment ◽  
Metabolic Complications ◽  
Systemic Glucocorticoid

Objectives Patients receiving glucocorticoid treatment are prone to develop metabolic complications. In preclinical studies, metformin prevented the development of the metabolic syndrome during glucocorticoid excess. We herein investigated the metabolic effect of metformin during glucocorticoid treatment in non-diabetic patients. Methods In a double-blind, placebo-controlled trial, patients starting glucocorticoid treatment (prednisone, prednisolone or methylprednisolone) for four weeks were randomised to concomitantly receive metformin (850 mg once daily for one week followed by 850 mg twice daily for three weeks) or placebo. All patients underwent a standardised oral glucose tolerance test at baseline and after four weeks. The primary endpoint was change in the 2-h area under the curve (AUC) of glucose during the oral glucose tolerance test between baseline and four weeks. Results 29 of 34 randomised non-diabetic patients completed the trial (17 metformin and 12 placebo). In patients allocated to placebo, median glucose 2-h AUC increased from baseline to four weeks (836 (IQR 770–966) to 1202 (1009–1271) mmol/L per min; P = 0.01). In contrast, glucose levels remained similar to baseline in the metformin group (936 (869–1003) to 912 (825–1011) mmol/L per min; P = 0.83). This change within four weeks was different between both groups (P = 0.005). Glucocorticoid equivalent doses were similar in both groups (placebo: 980.0 (560.0–3259.8) mg/28 days; metformin: 683.0 (437.5–1970.5) mg/28 days; P = 0.26). Conclusions In this first randomised controlled trial of metformin targeting metabolic complications in patients needing glucocorticoid therapy, we observed a beneficial effect of metformin on glycaemic control. Metformin thus seems to be a promising drug for preventing metabolic side effects during systemic glucocorticoid treatment.

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