scholarly journals Association of Predicted Lean Body Mass and Fat Mass With Incident Diabetic Nephropathy in Participants With Type 2 Diabetes Mellitus: A Post Hoc Analysis of ACCORD Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel Nyarko Hukportie ◽  
Fu-Rong Li ◽  
Rui Zhou ◽  
Meng-Chen Zou ◽  
Xiao-Xiang Wu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Nephropathy ◽  
Lean Body Mass ◽  
Body Mass ◽  
Fat Mass ◽  
Accord Study ◽  
Increased Risk ◽  
Specific Association ◽  
Post Hoc

BackgroundLean body mass (LBM) and fat mass (FM) have been shown to have different associations with several chronic diseases but little is known about the sex-specific association of LBM and FM with diabetic nephropathy (DN) risk among participants with diabetes.MethodsParticipants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was used in a post hoc analysis to examine the association of predicted LBM index (LBMI) and FM index (FMI) with incident DN risk (defined as a composite outcome of three types of predefined DN). Because of sex differences in body composition, analyses were conducted separately using sex-specific quartiles of predicted LBMI and FMI.ResultsOf the 9,022 participants with type 2 diabetes (5,575 men and 3,447 women) included in this study, 5,374 individuals developed DN (3,396 in men and 1,978 in women). Higher quartiles of LBMI were associated with a reduced risk of DN while higher quartiles of FMI were associated with an increased higher risk of DN among men but not women. Compared with the lowest quartile, the fully adjusted hazard ratios (HRs) and 95% confidence intervals (CIs)for the highest quartile of predicted LBMI and FMI were respectively 0.83 (95% CI 1.71 – 0.96) and 1.23 (95% CI 1.06-1.43) among men; and 0.92 (95% CI 0.63 – 1.33) and 1.14 (95% CI 0.79 – 1.63) among women.ConclusionsAmong participants with diabetes, predicted LBMI was inversely associated with risk of DN while predicted FMI was positively associated with an increased risk of incident DN among men but not women. Trial registration: ClinicalTrials.gov., no. NCT00000620.

DIABETES OR OBESITY; MAJOR EFFECTOR OF ALTERED LEVELS OF GHRELIN AND LEPTIN

2021 ◽  
pp. 55-59
Author(s):  
Lakshmi G.L ◽  
Shruti Dasgupta ◽  
Mohammed Salman ◽  
Sanjay K. R
Keyword(s):  
Type 2 Diabetes ◽  
Lean Body Mass ◽  
Body Mass ◽  
Fat Mass ◽  
Postprandial Glucose ◽  
Independent Effect ◽  
Mass Percentage ◽  
Obesity And Diabetes ◽  
Obese Subjects

Background: Ghrelin and leptin are the key hormones involved in the energy homeostasis and plays a relevant role in regulating hunger and satiety stimuli afferent to the brain. Abnormalities in the levels of ghrelin and leptin are often associated with the obesity and type 2 diabetes complications. However, there are no studies clarifying whether ghrelin and leptin levels have stronger association with obesity or Type 2 diabetes (T2DM). Aims:To evaluate and compare the independent effect of major dening factors of obesity and diabetes on ghrelin and leptin concentrations. Materials And Methods: Anthropometric measures such as height, weight, waist (WC) and hip circumference (HC), Body mass index (BMI), Basal metabolic rate (BMR), fat percentage, lean body mass, were taken. Assessed daily physical activity and energy intake. Biochemical parameters such as fasting glucose, postprandial glucose, HBA1c, ghrelin, leptin and insulin levels were measured. Statistical Analysis: One-way analysis of variance (ANOVA), Chi-square (χ2) test Pearson's correlation coefcients, Multiple stepwise linear regression model analysis were performed. Result: The diabetic subjects irrespective of obesity showed signicantly higher waist to hip ratio, HOMAIR levels of fasting blood glucose, postprandial glucose and signicantly lower levels of Ghrelin than non-diabetics. Similarly, obese subjects irrespective of diabetes have signicantly higher BMR and higher levels of Leptin than non-diabetics. Asignicantly higher BMI, fat mass percentage and lower lean body mass percentage were observed in obese subjects irrespective of diabetes than non-obese subjects. Among non-obese, diabetics have higher BMI, Fat mass percentage and lower lean body mass percentage. The levels of insulin were signicantly higher in diabetic obese subjects. HOMAIR (P≤0.0001) and Postprandial glucose (P≤0.05) showed negative independent effect and QUICKI (P≤0.0001) showed positive independent effect on the levels of ghrelin. BMI (P≤0.05) showed a positive effect and lean body mass percentage (P≤0.0001) showed an inverse effect on levels of leptin. Conclusion: It is evident from the study that low levels of ghrelin are predominantly associated with diabetes parameters when compared to parameters of obesity and on the contrary increased leptin levels have much stronger association with measures of obesity than diabetes. Evidence of altered leptin and ghrelin levels in these disorders infers vice versa, their respective roles in obesity and lean diabetes.

scholarly journals Association of predicted lean body mass and fat mass with cardiovascular events in patients with type 2 diabetes mellitus

2019 ◽  
Vol 191 (38) ◽  
pp. E1042-E1048 ◽  
Author(s):  
Zhenhua Xing ◽  
Liang Tang ◽  
Jian Chen ◽  
Junyu Pei ◽  
Pengfei Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lean Body Mass ◽  
Body Mass ◽  
Fat Mass ◽  
Cardiovascular Events

scholarly journals Frequency of Genital Infections According to Body Mass Index in Dapagliflozin-treated Patients with Type 2 Diabetes Mellitus

2017 ◽  
Vol 04 (01) ◽  
pp. e1-e4
Author(s):  
Gottfried Rudofsky ◽  
Tanja Haenni ◽  
John Xu ◽  
Eva Johnsson
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
The Body ◽  
Baseline Body Mass Index ◽  
Obese Patients ◽  
Genital Infections ◽  
Increased Risk ◽  
Three Body

Abstract Genital infections are associated with sodium glucose co-transporter 2 inhibitors such as dapagliflozin. Since patients with Type 2 diabetes are at increased risk of genital infections, and obesity is a risk factor for infections, obese patients with Type 2 diabetes could be more susceptible to genital infections when treated with sodium glucose co-transporter 2 inhibitors. This pooled dataset assessed the frequency of genital infections according to baseline body mass index in patients treated with dapagliflozin 10 mg. Data were pooled from 13 studies of up to 24 weeks’ duration (dapagliflozin N=2 360; placebo N=2 295). Frequency of genital infections was compared between three body mass index subgroups (<30, ≥30−< 35 and ≥35 kg/m2). Genital infections were reported in 130 (5.5%) patients receiving dapagliflozin and 14 (0.6%) patients receiving placebo; none of which were serious. Genital infections were more common in women (84/130 [64.6%]) than in men (46/130 [35.4%]) treated with dapagliflozin. In the body mass index < 30, ≥ 30−< 35 and ≥ 35 kg/m2 dapagliflozin-treated subgroups, 38/882 (4.3%), 47/796 (5.9%) and 45/682 (6.6%) patients presented with genital infections, respectively. Although the frequency was low overall and relatively similar between subgroups, there was a trend towards an increase in genital infections in patients with a higher body mass index. This trend is unlikely to be clinically relevant or to affect suitability of dapagliflozin as a treatment option for obese patients with Type 2 diabetes, but rather should influence advice and counselling of overweight patients on prevention and treatment of genital infections.

scholarly journals A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study

Diabetologia ◽  
2021 ◽  
Author(s):  
Simon R. Heller ◽  
Milan S. Geybels ◽  
Ahmed Iqbal ◽  
Lei Liu ◽  
Lily Wagner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Severe Hypoglycaemia ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Post Hoc Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Post Hoc

Abstract Aims/hypothesis Hypoglycaemia is a common side effect of insulin and some other antihyperglycaemic agents used to treat diabetes. Severe hypoglycaemia has been associated with adverse cardiovascular events in trials of intensive glycaemic control in type 2 diabetes. The relationship between non-severe hypoglycaemic episodes (NSHEs) and severe hypoglycaemia in type 2 diabetes has been documented. However, an association between more frequent NSHEs and cardiovascular events has not been verified. This post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial aimed to confirm whether there is an association between NSHEs and severe hypoglycaemic episodes in individuals with type 2 diabetes. In addition, the possible association between NSHEs and major adverse cardiac events (MACE), cardiovascular death and all-cause mortality was investigated. Methods LEADER was a double-blind, multicentre, placebo-controlled trial that found that liraglutide significantly reduced the risk of MACE compared with the placebo. In this post hoc analysis, we explored, in all LEADER participants, whether the annual rate of NSHEs (defined as self-measured plasma glucose <3.1 mmol/l [56 mg/dl]) was associated with time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person), time to first MACE, time to cardiovascular death and time to all-cause mortality. Participants with <2 NSHEs per year were used as reference for HR estimates. Cox regression with a time-varying covariate was used. Results We demonstrate that there is an association between NSHEs (2–11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for. Additionally, while no association was found between participants with 2–11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]). Conclusions/interpretation The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes. Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs. Trial registration ClinicalTrials.gov (NCT01179048). Graphical abstract

Maternal Hypertension Increases Risk of Preeclampsia and Low Fetal Birthweight: Genetic Evidence From a Mendelian Randomization Study

Hypertension ◽  
2022 ◽  
Author(s):  
Maddalena Ardissino ◽  
Eric A.W. Slob ◽  
Ophelia Millar ◽  
Rohin K. Reddy ◽  
Laura Lazzari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Body Mass ◽  
Mendelian Randomization ◽  
European Ancestry ◽  
Increased Risk

Background: Maternal cardiovascular risk factors have been associated with adverse maternal and fetal outcomes. Given the difficulty in establishing causal relationships using epidemiological data, we applied Mendelian randomization to explore the role of cardiovascular risk factors on risk of developing preeclampsia or eclampsia, and low fetal birthweight. Methods: Uncorrelated single-nucleotide polymorphisms associated systolic blood pressure (SBP), body mass index, type 2 diabetes, LDL (low-density lipoprotein) with cholesterol, smoking, urinary albumin-to-creatinine ratio, and estimated glomerular filtration rate at genome-wide significance in studies of 298 957 to 1 201 909 European ancestry participants were selected as instrumental variables. A 2-sample Mendelian randomization study was performed with primary outcome of preeclampsia or eclampsia (PET). Risk factors associated with PET were further investigated for their association with low birthweight. Results: Higher genetically predicted SBP was associated increased risk of PET (odds ratio [OR] per 1-SD SBP increase 1.90 [95% CI=1.45–2.49]; P =3.23×10 −6 ) and reduced birthweight (OR=0.83 [95% CI=0.79–0.86]; P =3.96×10 −18 ), and this was not mediated by PET. Body mass index and type 2 diabetes were also associated with PET (respectively, OR per 1-SD body mass index increase =1.67 [95% CI=1.44–1.94]; P =7.45×10 −12 ; and OR per logOR increase type 2 diabetes =1.11 [95% CI=1.04–1.19]; P =1.19×10 −3 ), but not with reduced birthweight. Conclusions: Our results provide evidence for causal effects of SBP, body mass index, and type 2 diabetes on PET and identify that SBP is associated with reduced birthweight independently of PET. The results provide insight into the pathophysiological basis of PET and identify hypertension as a potentially modifiable risk factor amenable to therapeutic intervention.

Polymorphic variant rs4430796 at HNF1B gene: sex-specific, BMI-dependent associations with parameters of glucose metabolism, redox homeostasis and risk of type 2 diabetes

2021 ◽  
pp. 25-36
Author(s):  
Ю.Э. Азарова ◽  
Е.Ю. Клёсова ◽  
А.В. Полоников
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
Redox Homeostasis ◽  
Russian Population ◽  
Polymorphic Variant ◽  
Pancreatic Islets Of Langerhans ◽  
Increased Risk ◽  
First Time

Ожирение является важнейшим фактором риска развития сахарного диабета 2 типа (СД2). Гепатоцитарный ядерный фактор 1 β (HNF1B) контролирует глюкостатическую функцию островков Лангерганса поджелудочной железы и ассоциирован с развитием СД2 в европейской и азиатской популяциях. Однако исследований, оценивающих роль генетических вариантов HNF1B в формировании предрасположенности к СД2 в русской популяции, на сегодняшний день не проводилось. Целью настоящей работы стало изучение ассоциации полиморфного варианта rs4430796 (A>G) в интроне гена HNF1B с показателями гликемического профиля и редокс-гомеостаза, а также риском развития СД2 у жителей Центральной России, с учетом их пола и индекса массы тела. В исследование включено 3206 человек, из них 1579 больных СД2 и 1627 условно здоровых добровольцев. Генотипирование проводили с использованиеми технологии iPLEX на геномном времяпролетном масс-спектрометре MassArray 4 (Agena Bioscience). Впервые в русской популяции установлена взаимосвязь полиморфизма rs4430796 гена HNF1B с повышенным риском развития СД2 (OR 1,24, 95CI 1,05-1,47, р=0,011). Стратифицированный анализ по полу обнаружил, что выявленная ассоциация характерна только для женщин с избыточной массой тела (OR 1,54, 95CI 1,06-2,22, р=0,02) и ожирением (OR 2,07, 95CI 1,14-3,77, р=0,047) и отсутствует у лиц с нормальной массой тела вне зависимости от пола. Изучаемый SNP ассоциирован с повышенным содержанием перекиси водорода (р=0,012) и более низким уровнем общего глутатиона плазмы (р=0,041) у женщин, тогда как у мужчин с СД2 генотип G/G связан со снижением концентрации С-пептида (р=0,004) и повышением концентрации глюкозы крови (р=0,015). Биоинформатический анализ подтвердил отрицательный эффект аллеля G на экспрессию HNF1B, а также выявил его связь с гиперметилированием гена в различные периоды жизни, что обусловливает низкую экспрессию гена HNF1B у носителей минорного аллеля rs4430796-G. Таким образом, нами впервые установлено, что полиморфный вариант гена HNF1B rs4430796 ассоциирован с предрасположенностью к СД2 в русской популяции, при этом его связь с заболеванием имеет пол-специфический характер и зависит от индекса массы тела. Obesity is a critical risk factor for type 2 diabetes mellitus (T2D). Hepatic nuclear factor 1 β (HNF1B) controls the glucostatic function of pancreatic islets of Langerhans and is associated with the development of T2D in the European and Asian populations. However, studies evaluating the contribution of genetic variants at HNF1B to the pathogenesis of the disease in Russian population have not been conducted to date. The aim of this work was to study the association of the polymorphic variant rs4430796 (A>G) in the intron of the HNF1B gene with parameters of glycemic profile and redox homeostasis, as well as the risk of developing T2D in citizens of Central Russia, taking into account their gender and body mass index. The study included 3206 participants, 1579 patients with T2D and 1627 healthy volunteers. Genotyping was performed using iPLEX technology on a genomic time-of-flight mass spectrometer MassArray 4 (Agena Bioscience). For the first time in the Russian population, the relationship of the rs4430796 polymorphism at the HNF1B gene with an increased risk of developing T2D (OR 1,24, 95CI 1,05-1,47, p=0,011) was established. A gender-stratified analysis found that the association is characteristic only for females with overweight (OR 1,54, 95CI 1,06-2,22, p=0,02) and obesity (OR 2.07, 95CI 1,14-3,77, p=0.047) and is absent in individuals with normal body weight, regardless from the gender. The studied SNP is associated with an increased content of hydrogen peroxide (p=0,012) and a lower level of total plasma glutathione (p=0,041) in females, whereas in diabetic males the G/G genotype is associated with a decrease in the concentration of C-peptide (p=0,004) and an increase in blood glucose concentration (p=0,015). Bioinformatic analysis confirmed the negative effect of the alternative G allele on the expression of the HNF1B gene, as well as its relationship with hypermethylation of the gene at different periods of life, which leads to low expression of HNF1B in carriers of variant rs4430796. Conclusions: It was found for the first time that the polymorphic variant rs4430796 of the HNF1B gene is associated with a predisposition to T2D, whereas its relationship with the disease is sex-specific and depends on body mass index.

Abstract MP09: Sex Differences And Development Of Advanced Diabetic Nephropathy In Type 2 Diabetic Nephropathy Rats

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Denisha Spires ◽  
Oleg Palygin ◽  
Vladislav Levchenko ◽  
Sherif Khedr ◽  
Oksana Nikolaienko ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Nephropathy ◽  
Kidney Function ◽  
Male And Female ◽  
Sexual Dimorphisms ◽  
Glucose Levels ◽  
Age Related ◽  
Increased Risk ◽  
Type 2 Diabetic

Diabetic kidney disease (DKD) is a severe complication of diabetes, which causes an increased risk of cardiovascular diseases and end-stage renal failure. Recent clinical data have demonstrated distinct sexual dimorphisms in the pathogenesis of DKD in humans, which impacts both severity- and age-related risk factors. A type 2 diabetic nephropathy (T2DN) rat model characterized by spontaneous development of an advanced form of diabetic nephropathy (DN) was used here to study sexual dimorphisms in the development of type 2 diabetes with DN. Male and female T2DN rats at late stages of the disease were used to evaluate hyperglycemia, renal injury, and kidney function. During late stage DKD (>46 weeks), glucose tolerance tests (GTT) revealed higher glucose levels in males (378 ± 19 vs. 183 ± 48 mg/dL) compared to females. This was accompanied by pathological changes in kidney function including urinary nephrin shedding, albuminuria (11.8 ± 5.7 vs. 0.98 ± 0.64 Alb/Cre ratio), and glomerular damage. To test the role of the endocrine environment in the pathophysiology of type 2 diabetes with DKD, we performed gonadectomies on male and female T2DN rats at 9 to 10 weeks of age, and animals were monitored until the full development of DKD (>46 weeks). All T2DN rats (intact and gonadectomized) maintained their diabetic phenotype, which was verified by higher end point blood glucose levels following a GTT (intact vs gonadectomized, male and female, respectively; 404 ± 21 vs 466 ± 32 and 264 ± 20 vs 291 ± 25 mg/dL). Based on kidneys to body weight ratios, gonadectomized male T2DN rats had a significant reduction in kidney hypertrophy (intact vs gonadectomized; males and females, respectively: 9.9 ± 0.2 vs 7.4 ± 0.2 and 7.7 ± 0.2 vs 7.0 ± 0.2 ratio). Moreover, FITC-inulin based GFR measurements revealed gonadectomized males had improved GFRs, whereas the GFRs of gonadectomized females rats were worsened (7.5 ± 1.5 vs. 4.1 ± 0.7 for male and 4.1 ± 0.2 vs. 7.3 ± 1.3 for female μg/mL/min; gonadectomy vs intact, correspondingly). In conclusion, male T2DN rats develop more severe DKD compared to age-matched females, and this phenotype is partially attenuated by the absence of sex hormones in males and exacerbated by the absence of hormones in females.

scholarly journals Reduced Lean Body Mass and Cardiometabolic Diseases in Adult Males with Overweight and Obesity: A Pilot Study

2018 ◽  
Vol 15 (12) ◽  
pp. 2754 ◽  
Author(s):  
Shirine Khazem ◽  
Leila Itani ◽  
Dima Kreidieh ◽  
Dana El Masri ◽  
Hana Tannir ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Diseases ◽  
Lean Body Mass ◽  
Body Mass ◽  
Overweight And Obesity ◽  
Treatment Seeking ◽  
Adult Males ◽  
Body Composition Assessment ◽  
Cardiometabolic Diseases

Little is known about the reduction in lean body mass (LBM) and its health consequences in overweight and in obesity, especially in males. Therefore, we aimed to assess the prevalence of low LBM in treatment-seeking adult males with overweight and obesity and the association with cardiometabolic diseases, i.e., type 2 diabetes, cardiovascular diseases and dyslipidemia. A body composition assessment was conducted by a bio-impedance analyzer (InBody 170) among a total of 110 males, of whom 72 were overweight and obese and were referred to the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (BAU) in Lebanon, and 38 were normal-weight participants of similar ages. The participants with overweight and obesity were then categorized as being with or without low LBM. Of the sample of 72 participants, 50 (69.4%) met the criteria for reduced LBM and displayed a significantly higher prevalence of cardiometabolic diseases (i.e., type 2 diabetes, cardiovascular diseases and dyslipidemia) than those with normal LBM (36.0% vs. 9.1%; p = 0.019). Logistic regression analysis showed that low LBM increases the odds of having cardiometabolic diseases by nearly 550% (odds ratio (OR) = 5.46, 95% confidence interval (CI) = 1.31–26.39, p < 0.05) after adjusting for total fat and central adiposity. Treatment-seeking adult males with overweight and obesity displayed a great prevalence of reduced LBM, which seems to be strongly associated with cardiovascular and metabolic diseases.

scholarly journals Childhood Body Mass Index and Fasting Glucose and Insulin Predict Adult Type-2 Diabetes: The International Childhood Cardiovascular Cohort (i3C) Consortium

2020 ◽  
Author(s):  
Tian Hu ◽  
David R. Jacobs Jr. ◽  
Alan R. Sinaiko ◽  
Lydia A. Bazzano ◽  
Trudy L. Burns ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
Fasting Glucose ◽  
Self Report ◽  
Adult Type ◽  
Childhood Body Mass Index ◽  
Increased Risk ◽  
Design And Methods

Objective: To examine childhood body mass index (BMI), fasting glucose and insulin in relation to incident adult type-2 diabetes mellitus (T2DM). <p>Research Design and Methods: We used data from The International Childhood Cardiovascular Cohort Consortium. Data included childhood measurements (age 3-19) obtained during the 1970s-90s, a health questionnaire including self-report of adult T2DM (occurrence age, medication use) obtained at mean age 40 years, and a medical diagnosis registry (Finland). </p> <p>Results: The sample included 6,738 participants. Of these, 436 (6.5%) reported onset of T2DM between ages 20-59 (mean 40.8) years, and 86% of them reported use of a confirmed anti-diabetic medication. BMI and glucose (age- and sex-standardized) were associated with incident T2DM after adjustment for cohort, country, sex, race, age and calendar year of measurement. Increasing levels of childhood BMI and glucose were related to incrementally increased risk of T2DM beginning at age 30, beginning at cut points below the 95<sup>th</sup> percentile for BMI and below 100 mg/dL for glucose. Insulin was positively associated with adult T2DM after adjustment for BMI and glucose and added to T2DM discrimination. </p> <p>Conclusions: Childhood BMI and glucose are predictors of adult T2DM at levels previously considered to be within the normal range. These easy to apply measurements are appealing from a clinical perspective. Fasting insulin has the potential to be an additional predictor.</p>

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