A Higher Serum Anion Gap Is Associated with the Risk of Progressing to Impaired Fasting Glucose and Diabetes

Impaired fasting glucose (IFG) is a reversible intermediate hyperglycemia stage with an increasing risk of diabetes and related complications. Our study was designed to identify the relationship between the serum anion gap and the risk of progressing to impaired fasting glucose and diabetes. Here, we performed a prospective, population-based study among 1191 Chinese individuals aged 22–87 years who took health examinations annually between 2006 and 2012 including clinical features and plasma metabolites. All of the participants had no history of diabetes or related chronic complications. Logistic regression analysis was designed to examine the associations between clinical and metabolomic factors and the risk of developing IFG or diabetes. Among them, 58 subjects whose fasting glucose were between 6.1 and 7 mmol/L were diagnosed as IFG or diabetes. After adjusting for age, sex, body mass index (BMI), high-density lipoprotein (HDL), low-density lipoprotein (LDL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), systolic blood pressure (SBP), diastolic blood pressure (DBP), potassium, and albumin at baseline, the participants in the upper tertiles of serum anion gap (SAG) had higher odds of progressing to IFG or diabetes than those in the lower tertiles. A receiver operating characteristic (ROC) curve was analyzed, and the optimal cutoff level for the anion gap to predict incident IFG or diabetes was 13.76 mmol/L, and the area under the ROC curve (AUC) was 0.623. Our data demonstrate that a higher serum anion gap is associated with the risk of developing IFG or diabetes.

Undiagnosed diabetes mellitus and associated factors among adults in Ethiopia: a systematic review and meta-analysis

Diabetes has become a major public health problem, with 4.6 million deaths annually. The number of people living with undiagnosed diabetes is on the rise and has a diverse prevalence. Thus, this systematic review and meta-analysis was aimed to synthesize the pooled estimate prevalence of undiagnosed diabetes mellitus, impaired fasting glucose and its associated factors in Ethiopia. The databases Medline, Hinari, Google Scholar, and Google search were used to find potential studies published from January 2013 until January 2021. Extracted data were entered into the excel spreadsheet. The random effects model with Der Simonian-Laird weights was used to assess the pooled estimate of prevalence of undiagnosed diabetes, impaired fasting glucose, and its associated factors. The Cochrane Q-test and I2 statistics were used to screen for statistical heterogeneity. A funnel plot and Egger's statistical test were also used to search for any publication bias (small study effect). After extensive searching of articles on different databases, a total of nine studies were included for this systematic review and meta-analysis. In random effects model, the pooled prevalence of undiagnosed diabetes mellitus and impaired fasting glucose was 5.75%, 95% CI (3.90–7.59%), and 8.94%, 95% CI (2.60–15.28%), respectively. Regarding the associated factors, participants family history of diabetes was significantly associated with diabetes status. The pooled odds of developing diabetes mellitus among participants with a family history of diabetes mellitus were about 3.56 times higher than those without a family history of diabetes mellitus (OR = 3.56, 95% CI (2.23, 5.68)). In this review, the higher prevalence of undiagnosed diabetes mellitus and impaired fasting glucose was observed among adults in Ethiopia. Family history of diabetes was found to have an association with increased risk of diabetes mellitus. Our finding highlights the need of screening at the community level, with special focus on adults with family history of diabetes mellitus.

Related Factors for Impaired Fasting Glucose in Korean Adults: A Population Based Study

Background Individuals with impaired fasting glucose (IFG) who have poor health behaviors are at a greater risk for various health outcomes. This study compared the health behaviors and health literacy between individuals with non-IFG and IFG; factors that were associated with IFG were identified by sex. Methods This study was an observational study with a cross-sectional design based on data from the Korea National Health and Nutrition Examination Survey (KNHANES) that used a stratified, multi-stage, cluster-sampling design to obtain a nationally representative sample. This study analyzed the KNHANES Health Examination Survey and Health Behavior Survey from 2016 to 2018 (N=9919). Multiple logistic regression analysis was employed to compute the odds ratios of health behaviors and health literacy to identify the risk factors for IFG. Results The prevalence of IFG among the total was 29.0% (weighted n=2826, 95% CI 27.8–30.2). In the IFG group, 63.6% were male and 36.4% were female (X2=320.57, p<.001). In multiple logistic regression by sex, the factors associated with IFG in male were as follows: age (50s; OR=2.36, 95% CI 1.79–3.13), high BMI (OR=2.27, 95% CI 1.78–2.90), frequent drinking (OR=1.83, 95% CI 1.23–2.72), and using nutrition fact labels (OR=1.35, 95% CI 1.05–1.75). Low economic status (OR=4.18, 95% CI 1.57–11.15) and high BMI (OR=2.35, 95% CI 1.29–4.28) were the affecting factors in female. On the other hand, employment status, perceived stress, and job type were not related to IFG in both male and female. Conclusions Strategies should be targeted to improve health behaviors and health literacy for those in their 40s and 60s, male in shift work, those who frequently dine out, overweight male, female with low economic statuses, and frequent drinkers. Moreover, healthcare providers should understand the barriers to health behaviors and literacy to effectively deliver healthcare service.

Trajectories of energy intake distribution and subsequent risk of hyperglycemia among Chinese adults: findings from the China Health and Nutrition Survey (1997–2018)

Aims Few studies have examined the secular trend of the energy intake distribution, and its effect on future risk of hyperglycemia. This study aims to describe trajectories of energy intake distribution over 12 years and relate them to subsequent risk of hyperglycemia over 9 years of follow-up. Methods Our study used ten waves of data from the CHNS survey, a population-based longitudinal survey in China, ongoing since 1989. We examined a cohort of adult participants who were free from diabetes but had at least three waves of dietary data from 1997 to 2009. We assessed energy intake using three consecutive 24 h recalls. We used these data to identify trajectory groups of energy intake distribution by multi-trajectory model based on energy intake proportions of breakfast, lunch, and dinner. We followed up participants for hyperglycemia, diabetes, and impaired fasting glucose for 9 years from 2009 to 2018. Outcomes were ascertained with fasting glucose, serum HbA1c, and self-report of diabetes and/or glucose-lowering medication. We estimated relative risk (RR) for hyperglycemia, diabetes, and impaired fasting glucose by identified trajectory groups using multilevel mixed-effects modified Poisson regression with robust (sandwich) estimation of variance. Gender difference was additionally examined. Results A total of 4417 participants were included. Four trajectory groups were identified, characterized and labeled by “Energy evenly distributed with steady trend group” (Group 1), “Dinner and lunch energy dominant with relatively steady trend group” (Group 2), “Dinner energy dominant with increasing trend and breakfast energy with declining trend group” (Group 3), and “breakfast and dinner energy dominant with increasing trend group” (Group 4). During 48,091 person-years, 1053 cases of incident hyperglycemia occurred, 537 cases of incident diabetes occurred, and 516 cases of impaired fasting glucose occurred. Compared with Group 1, Group 3 was associated with higher subsequent risk of incident hyperglycemia in 9 years of follow-up (RR = 1.28, 95% CI = 1.02, 1.61). No association was found for incident diabetes and impaired fasting glucose. Among males, Group 3 was associated with higher risk of incident hyperglycemia in 9 years of follow-up (RR = 1.44, 95% CI = 1.07, 1.94). No relationship was found in females. Conclusions Energy intake distribution characterized by over 40% of energy intake from dinner with a rising trend over years was associated with higher long-term risk of hyperglycemia in Chinese adults.

Impaired fasting glucose: a risk factor for atrial fibrillation and heart failure

Background Dysglycaemia is associated with overall cardiovascular disease even at prediabetes levels. The aim of this study was to explore the association between glucose levels and future risk of developing atrial fibrillation and heart failure, respectively. Methods In this prospective cohort study subjects from the Swedish AMORIS-cohort with fasting glucose from health examinations 1985–1996 without previous cardiovascular disease (N = 294,057) were followed to 31 December 2011 for incident atrial fibrillation or heart failure. Cox proportional hazard models with attained age as timescale and adjustments for sex, cholesterol, triglycerides, and socioeconomic status were used to estimate hazard ratios by glucose categorized groups (normal glucose 3.9–6.0 mmol/L, impaired fasting glucose; 6.1–6.9 mmol/L, undiagnosed diabetes ≥ 7.0 mmol/L, and diagnosed diabetes). Results During a mean follow-up time of 19.1 years 28,233 individuals developed atrial fibrillation and 25,604 developed heart failure. The HR for atrial fibrillation was 1.19 (95% confidence interval 1.13–1.26) for impaired fasting glucose, 1.23 (1.15–1.32) for undiagnosed diabetes and 1.30 (1.21–1.41) for diagnosed diabetes. Corresponding figures for heart failure were; 1.40 (1.33–1.48), 2.11 (1.99–2.23), 2.22 (2.08–2.36) respectively. In a subset with BMI data (19%), these associations were attenuated and for atrial fibrillation only remained statistically significant among subjects with diagnosed diabetes (HR 1.25; 1.02–1.53). Conclusions Fasting glucose at prediabetes levels is associated with development of atrial fibrillation and heart failure. To some extent increased BMI may drive this association.

Effect of Breastfeeding and Its Duration on Impaired Fasting Glucose and Diabetes in Perimenopausal and Postmenopausal Women: Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2019

Background and Objectives: To examine the effect of maternal breastfeeding on the subsequent risk of diabetes in parous Korean women aged >50 years. Materials and Methods: A total of 14,433 participants from the Korea National Health and Nutrition Examination Survey (KNHANES) were included. The subjects were divided into three groups: normal, impaired fasting glucose, and diabetes. The adjusted odds ratios (ORs) for impaired fasting glucose (IFG) and diabetes were assessed using multivariate logistic regression. Results: A total of 2301 (15.94%) women were classified as having diabetes, and 3670 (25.43%) women were classified as having impaired fasting glucose. Breastfeeding was associated with an OR for diabetes of 0.76 (95% confidence interval (CI): 0.61, 0.95) compared with non-breastfeeding after adjustment for possible confounders in the multivariable logistic regression analysis. Breastfeeding for 13–24 months was associated with an OR of 0.68 (95% CI, 0.5, 0.91), and breastfeeding for 25–36 months was associated with an OR of 0.68 (95% CI, 0.52, 0.87) for diabetes compared with breastfeeding for <1 month in the multivariable logistic regression analysis. Conclusions: Our results suggest that long-term breastfeeding, particularly breastfeeding for 13–36 months, may be associated with a lower risk for diabetes later in life.

Association of Impaired Fasting Glucose with Cardiovascular Disease in the Absence of Risk Factor

Background The association between impaired fasting glucose (IFG) and cardiovascular disease (CVD) in participants without atherosclerotic cardiovascular disease (ASCVD) risk factors based on current definitions is unclear. The study aimed to examine the association of fasting glucose levels with CVD and its subtypes in persons without ASCVD risk factors. Methods This study included 38,297 participants (men, 62.1%; mean age, 47.9 [12.9] years) who were free of a history of CVD, absent of ASCVD risk factors, and had a fasting plasma glucose (FPG) level between 70 to 125 mg/dl at baseline from Kailuan Study during 2006 to 2007, participants were followed up until new-onset CVD event, death or December 31, 2017. Cox proportional hazards models were performed to evaluate the associations. Results During a median follow-up of 11.0 years (interquartile range, 10.7-11.2 years), we observed 1,217 incident CVD events. Compared with participants with FPG 70 to 99 mg/dl, the multivariable adjusted hazard ratios for CVD among participants with FPG 100 to 109 mg/dl and 110 to 125 mg/dl were 1.18 (95% confidence interval [CI], 1.02-1.38) and 1.27 (95%CI, 1.03-1.55), respectively. Multivariable-adjusted spline regression model showed a J-shaped association between FPG and the risk of CVD. Conclusions We found that among individuals without diabetes or other traditional ASCVD risk factors, there is an increased risk of incident CVD with increasing abnormal FPG levels. These results highlight the importance of primordial prevention for FPG level increases along with other traditional ASCVD risk factors.