RESUMEN
Subjects who have ischemia with non-obstructive coronary arteries (INOCA) experience angina pectoris with evidence of myocardial ischemia but without coronary stenosis. Few studies have investigated factors associated with its survival, especially insulin resistance. In this study, subjects with angina pectoris, without known diabetes mellites (DM), and with non-invasive tests showing myocardial ischemia were admitted for coronary angiography (CAG). Those whose CAG did not reveal stenosis and agreed to receive an oral glucose tolerance test (OGTT) 2 weeks after hospital discharge were enrolled for analysis. All-cause mortality was recorded, which served as the outcome of the study. A total of 587 subjects with INOCA, without known DM, and with OGTT data were analyzed. After OGTT and HbA1c tests, 86 subjects (14.7%) were newly diagnosed with DM and 59.8% had pre-DM. The median duration of follow-up was 7.03 years. Thirty-nine subjects died during the follow-up period. The incidence rate of mortality was 9.9 /1000 person-year. Those who died had a higher fasting glucose (101 ± 17 vs. 94 ± 13 mg/dl, p = 0.003) but a lower estimated glomerular filtration rate (eGFR) (54 ± 22 vs. 87 ± 30 ml/min, p < 0.001). In the Cox survival analysis, a higher fasting glucose (hazard ratio 1.053, p = 0.007) was associated with worse mortality for INOCA without DM (N = 501). On the contrary, a higher eGFR (hazard ratio 0.967, p = 0.012) was protective of better survival for non-diabetic INOCA (N = 501). In conclusion, for non-diabetic INOCA, higher fasting glucose was associated with worse mortality and higher eGFR was protective for better survival.
Asunto(s)
Glucemia , Ayuno , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Femenino , Glucemia/análisis , Glucemia/metabolismo , Persona de Mediana Edad , Ayuno/sangre , Anciano , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/sangre , Angiografía Coronaria , Vasos Coronarios/patología , Vasos Coronarios/metabolismo , Tasa de Filtración Glomerular , Diabetes Mellitus/mortalidad , Resistencia a la InsulinaRESUMEN
BACKGROUND: Glycemic control is crucial in peritoneal dialysis (PD) patients with diabetes. Although fasting blood glucose (FBG) is the most commonly used index to measure blood glucose levels, there is currently no evidence supporting the association between FBG level and mortality risk in PD patients. METHODS: A total of 3548 diabetic PD patients between 2002 and 2018 were enrolled from the National Health Insurance Service database of Korea. We investigated the association between FBG levels and the risk of all-cause and cause-specific mortality. RESULTS: Patients with FBG levels 80-99 mg/dL exhibited the highest survival rates, whereas those with FBG levels ≥180 mg/dL had the lowest survival rates. Compared with FBG levels 80-99 mg/dL, the adjusted hazard ratios and 95% confidence interval for all-cause mortality significantly increased as follows: 1.02 (0.87-1.21), 1.41 (1.17-1.70), 1.44 (1.18-2.75), and 2.05 (1.73-2.42) for patients with FBG 100-124 mg/dL, FBG 125-149 mg/dL, FBG 150-179 mg/dL, and FBG ≥180 mg/dL, respectively. The risk for all-cause mortality also showed an increasing pattern in patients with FBG levels <80 mg/L. The risk of cardiovascular death significantly increased as FBG levels exceeded 125 mg/dL. However, the risk of infection-related and malignancy-related deaths did not show a significant increase with increasing FBG levels. CONCLUSION: There was an increase in the risk of all-cause mortality as FBG levels exceeded 125 mg/dL in PD patients with diabetes, and the risk of cardiovascular death showed a strong correlation with FBG levels compared with other causes of death.
Asunto(s)
Glucemia , Causas de Muerte , Ayuno , Diálisis Peritoneal , Humanos , Masculino , Femenino , Diálisis Peritoneal/mortalidad , Persona de Mediana Edad , Glucemia/análisis , Ayuno/sangre , República de Corea/epidemiología , Anciano , Factores de Riesgo , Adulto , Tasa de Supervivencia , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Diabetes Mellitus/mortalidad , Diabetes Mellitus/sangreRESUMEN
Gestational diabetes mellitus (GDM) adversely affects offspring glucose homeostasis and risk of developing obesity. Here, we examined the association between glycemia in pregnant women with overweight or obesity without GDM and offspring metabolic health. Maternal fasting glucose concentrations and glucose 2-h after an oral glucose tolerance test (OGTT) were measured in 208 women with a pre-pregnancy body mass index (BMI) of 28-45 kg/m2 without GDM. Offspring outcomes were collected at birth, 3, and 5 years of age. Linear mixed models with time as fixed factor and subject ID as random effects were used for analysis. No associations were found between maternal fasting or 2-h glucose concentrations with offspring glucose and insulin concentrations from birth to 5 years of age. However, maternal fasting glucose in GW 28 and 36, and 2-h OGTT glucose in GW 28 were positively associated with C-peptide concentration at birth. Maternal fasting glucose concentrations in GW 28 and 36 were positively associated with weight-for-length, and maternal fasting glucose in GW 36 was associated with BMI z-score at birth. In summary, blood glucose in pregnant women with overweight or obesity is positively associated with offspring C-peptide concentration, weight-for-length, and BMI z-score at birth, even in the absence of GDM.
Asunto(s)
Glucemia , Índice de Masa Corporal , Prueba de Tolerancia a la Glucosa , Homeostasis , Obesidad , Sobrepeso , Humanos , Femenino , Embarazo , Adulto , Glucemia/metabolismo , Obesidad/metabolismo , Obesidad/sangre , Sobrepeso/metabolismo , Sobrepeso/sangre , Diabetes Gestacional/metabolismo , Diabetes Gestacional/sangre , Recién Nacido , Preescolar , Insulina/sangre , Insulina/metabolismo , Péptido C/sangre , Ayuno/sangre , Complicaciones del Embarazo/metabolismo , Complicaciones del Embarazo/sangreRESUMEN
BACKGROUND: A persistent redox state and excessive reactive species involved in carbohydrate and lipid metabolism lead to oxidative damage in the liver, however, how fasting plasma concentrations of lipids and glucose are associated with fasting blood levels of alanine transaminase (ALT) and aspartate transaminase (AST) remains to be evaluated in large-scale population. METHODS: A cross-sectional study with 182,971 residents aged 18 to 92 years; multidimensional stratified analyses including quantile linear regression analysis and sex stratification were adopted to improve the quality of the evidence. RESULTS: The associations between the concentrations of non-HDL-C and triglyceride and ALT levels were positive, stronger in males in each quantile of ALT levels and the coefficients expanded with increasing ALT levels at slopes of 3.610 and 5.678 in males and 2.977 and 5.165 in females, respectively. The associations between the HDL-C concentrations and ALT levels were negative, also stronger in males in each quantile and the coefficients expanded with increasing ALT levels at slopes of -7.839 in females and - 5.797 in males. The associations between glucose concentrations and ALT levels were positive, but stronger in females in each quantile and the coefficients expanded with increasing ALT levels at slopes of 1.736 in males and 2.177 in females, respectively. Similar pattern consist of relatively weaker coefficients and slops were observed between concentrations of non-HDL-C, triglyceride and glucose and AST levels. The associations between albumin concentration and concentrations of blood lipids and glucose were relatively steady across all quantiles. CONCLUSIONS: The dose dependent effect between blood concentrations of lipids and glucose and liver function changes suggests that excessive carbohydrate and lipid metabolism may cause subclinical liver damage. Long term sustained primary and secondary inflammatory factors produced in the liver might be transmitted to adjacent organs, such as the heart, kidneys, and lungs, to cause and/or exacerbate pathological changes in these visceral organs.
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Alanina Transaminasa , Aspartato Aminotransferasas , Glucemia , Ayuno , Triglicéridos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Alanina Transaminasa/sangre , Adulto , Glucemia/metabolismo , Ayuno/sangre , Anciano , Adolescente , Triglicéridos/sangre , Estudios Transversales , Anciano de 80 o más Años , Aspartato Aminotransferasas/sangre , Adulto Joven , Lípidos/sangre , HDL-Colesterol/sangreRESUMEN
BACKGROUND: Cardiovascular disease represents a significant risk factor for mortality in individuals with type 2 diabetes mellitus (T2DM). High-density lipoprotein (HDL) is believed to play a crucial role in maintaining cardiovascular health through its multifaceted atheroprotective effects and its capacity to enhance glycemic control. The impact of dietary interventions and intermittent fasting (IF) on HDL functionality remains uncertain. The objective of this study was to assess the effects of dietary interventions and IF as a strategy to safely improve glycemic control and reduce body weight on functional parameters of HDL in individuals with T2DM. METHODS: Before the 12-week intervention, all participants (n = 41) of the INTERFAST-2 study were standardized to a uniform basal insulin regimen and randomized to an IF or non-IF group. Additionally, all participants were advised to adhere to dietary recommendations that promoted healthy eating patterns. The IF group (n = 19) followed an alternate-day fasting routine, reducing their calorie intake by 75% on fasting days. The participants' glucose levels were continuously monitored. Other parameters were measured following the intervention: Lipoprotein composition and subclass distribution were measured by nuclear magnetic resonance spectroscopy. HDL cholesterol efflux capacity, paraoxonase 1 (PON1) activity, lecithin cholesterol acyltransferase (LCAT) activity, and cholesterol ester transfer protein (CETP) activity were assessed using cell-based assays and commercially available kits. Apolipoprotein M (apoM) levels were determined by ELISA. RESULTS: Following the 12-week intervention, the IF regimen significantly elevated serum apoM levels (p = 0.0144), whereas no increase was observed in the non-IF group (p = 0.9801). ApoM levels correlated with weight loss and fasting glucose levels in the IF group. Both groups exhibited a robust enhancement in HDL cholesterol efflux capacity (p < 0.0001, p = 0.0006) after 12 weeks. Notably, only the non-IF group exhibited significantly elevated activity of PON1 (p = 0.0455) and LCAT (p = 0.0117) following the 12-week intervention. In contrast, the changes observed in the IF group did not reach statistical significance. CONCLUSIONS: A balanced diet combined with meticulous insulin management improves multiple metrics of HDL function. While additional IF increases apoM levels, it does not further enhance other aspects of HDL functionality. TRIAL REGISTRATION: The study was registered at the German Clinical Trial Register (DRKS) on 3 September 2019 under the number DRKS00018070.
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Biomarcadores , Glucemia , Diabetes Mellitus Tipo 2 , Ayuno , Obesidad , Fosfatidilcolina-Esterol O-Aciltransferasa , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Ayuno/sangre , Fosfatidilcolina-Esterol O-Aciltransferasa/sangre , Resultado del Tratamiento , Obesidad/sangre , Obesidad/diagnóstico , Obesidad/dietoterapia , Obesidad/fisiopatología , Obesidad/terapia , Glucemia/metabolismo , Factores de Tiempo , Biomarcadores/sangre , Restricción Calórica , Arildialquilfosfatasa/sangre , HDL-Colesterol/sangre , Proteínas de Transferencia de Ésteres de Colesterol/sangre , Pérdida de Peso , Anciano , Adulto , Dieta Saludable , Hipoglucemiantes/uso terapéutico , Insulina/sangre , Ayuno IntermitenteRESUMEN
BACKGROUND: This study aimed to investigate the effects of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), 2-hours postprandial blood glucose (2hPBG), and fasting insulin (FINS) levels on pregnancy outcomes and their predictive value in patients with gestational diabetes mellitus (GDM). METHODS: A total of 109 pregnant women with GDM (GDM group) were included and assayed for serum FBG, 2hPBG, HbA1c, and FINS levels. The incidence of adverse pregnancy outcomes was recorded. GDM patients were divided into the poor pregnancy outcome group and the favorable pregnancy outcome group and analyzed for HbA1c, FBG, 2hPBG, and FINS. The predictive value of serum index combined detection on GDM pregnancy outcome was assessed, and the effect of serum indices on pregnancy outcome was evaluated in GDM patients with logistic regression. RESULTS: In the GDM group, there were 8 cases of premature membranes breaking (7.34%), 6 cases of premature delivery (5.50%), 3 cases of hyperamniotic fluid (2.75%), 2 cases of neonatal asphyxia (1.83%), 5 cases of fetal growth restriction (4.59%), and 3 cases of low-birth-weight infants (2.75%). The total incidence of adverse preg-nancy outcomes was 24.77% (27/109). HbA1c, FBG, 2hPBG, and FINS in the poor pregnancy outcome group were higher than those in the favorable pregnancy outcome group. The AUC value of blood biochemical indicators combined detection in predicting pregnancy outcome in GDM patients was higher than of HbA1c, FBG, 2hPBG, and FINS alone detection. HbA1c ≥ 6.94%, FBG ≥ 7.18 mmol/L, 2hPBG ≥ 9.36 mmol/L, and FINS ≥ 13.07 U/L were the risk factors affecting pregnancy outcomes in GDM patients. CONCLUSIONS: The changes of HbA1c, FBG, 2hPBG, and FINS levels in GDM patients are associated with adverse pregnancy outcomes, and the combined detection of serum indicators has predictive value for pregnancy outcomes in GDM patients.
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Glucemia , Diabetes Gestacional , Hemoglobina Glucada , Valor Predictivo de las Pruebas , Resultado del Embarazo , Humanos , Embarazo , Femenino , Diabetes Gestacional/sangre , Diabetes Gestacional/diagnóstico , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Resultado del Embarazo/epidemiología , Adulto , Glucemia/análisis , Glucemia/metabolismo , Insulina/sangre , Ayuno/sangreRESUMEN
Intermittent religious fasting increases the risk of hypo- and hyperglycemia in individuals with diabetes, but its impact on those without diabetes has been poorly investigated. The aim of this preliminary study was to examine the effects of religious Bahá'í fasting (BF) on glycemic control and variability and compare these effects with time-restricted eating (TRE). In a three-arm randomized controlled trial, 16 subjects without diabetes were assigned to a BF, TRE, or control group. Continuous glucose monitoring and food intake documentation were conducted before and during the 19 days of the intervention, and the 24 h mean glucose and glycemic variability indices were assessed. The BF and TRE groups, but not the control group, markedly reduced the daily eating window while maintaining macronutrient composition. Only the BF group decreased caloric intake (-677.8 ± 357.6 kcal, p = 0.013), body weight (-1.92 ± 0.95 kg, p = 0.011), and BMI (-0.65 ± 0.28 kg, p = 0.006). Higher maximum glucose values were observed during BF in the within-group (+1.41 ± 1.04, p = 0.039) and between-group comparisons (BF vs. control: p = 0.010; TRE vs. BF: p = 0.022). However, there were no alterations of the 24 h mean glucose, intra- and inter-day glycemic variability indices in any group. The proportions of time above and below the range (70-180 mg/dL) remained unchanged. BF and TRE do not exhibit negative effects on glycemic control and variability in subjects without diabetes.
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Glucemia , Ayuno , Humanos , Ayuno/sangre , Glucemia/metabolismo , Masculino , Femenino , Adulto , Persona de Mediana Edad , Control Glucémico/métodos , Ingestión de Energía , Factores de Tiempo , ReligiónRESUMEN
BACKGROUND: Dyslipidemia increases cardiovascular disease risk, the leading cause of death worldwide. Under time-restricted feeding (TRF), wherein food intake is restricted to a consistent window of <12 hours, weight gain, glucose intolerance, inflammation, dyslipidemia, and hypercholesterolemia are all reduced in mice fed an obesogenic diet. LDLR (low-density lipoprotein receptor) mutations are a major cause of familial hypercholesterolemia and early-onset cardiovascular disease. METHODS: We subjected benchmark preclinical models, mice lacking LDLR-knockout or ApoE knockout to ad libitum feeding of an isocaloric atherogenic diet either ad libitum or 9 hours TRF for up to 13 weeks and assessed disease development, mechanism, and global changes in hepatic gene expression and plasma lipids. In a regression model, a subset of LDLR-knockout mice were ad libitum fed and then subject to TRF. RESULTS: TRF could significantly attenuate weight gain, hypercholesterolemia, and atherosclerosis in mice lacking the LDLR-knockout mice under experimental conditions of both prevention and regression. In LDLR-knockout mice, increased hepatic expression of genes mediating ß-oxidation during fasting is associated with reduced VLDL (very-low-density lipoprotein) secretion and lipid accumulation. Additionally, increased sterol catabolism coupled with fecal loss of cholesterol and bile acids contributes to the atheroprotective effect of TRF. Finally, TRF alone or combined with a cholesterol-free diet can reduce atherosclerosis in LDLR-knockout mice. However, mice lacking ApoE, which is an important protein for hepatic lipoprotein reuptake do not respond to TRF. CONCLUSIONS: In a preclinical animal model, TRF is effective in both the prevention and regression of atherosclerosis in LDLR knockout mice. The results suggest TRF alone or in combination with a low-cholesterol diet can be a lifestyle intervention for reducing cardiovascular disease risk in humans.
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Aterosclerosis , Modelos Animales de Enfermedad , Hígado , Ratones Noqueados para ApoE , Receptores de LDL , Animales , Receptores de LDL/genética , Receptores de LDL/deficiencia , Aterosclerosis/prevención & control , Aterosclerosis/genética , Aterosclerosis/metabolismo , Aterosclerosis/etiología , Hígado/metabolismo , Masculino , Ratones Endogámicos C57BL , Factores de Tiempo , Ayuno/sangre , Ratones , Hipercolesterolemia/genética , Hipercolesterolemia/metabolismo , Hipercolesterolemia/complicaciones , Dieta Aterogénica , Aumento de Peso , Ratones Noqueados , Enfermedades de la Aorta/prevención & control , Enfermedades de la Aorta/genética , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/metabolismo , Lípidos/sangre , Apolipoproteínas ERESUMEN
This study aimed to investigate and analyze the medication use, fasting blood glucose control, and associated risk factors among residents with type 2 diabetes at the grassroots level in Xinjiang Production and Construction Corps. A multi-stage cluster sampling method was employed to conduct a questionnaire survey among residents aged 45 and above in battalions (communities) as the smallest unit. The medication use was recorded, and fasting blood glucose control was considered as the dependent variable. Logistic regression analysis was performed to identify the risk factors influencing fasting blood glucose control among different population characteristics. A total of 2316 participants were included in the study, of which 1072 were male (45.12%), 1418 were aged 65 and above (61.23%), 2031 were Han Chinese (87.69%), and 1551 were from the surrounding areas of Urumqi (66.97%). The main medications used among the top three classes were metformin, insulin, and α-glucosidase inhibitors. The treatment rate for type 2 diabetes was 71.80%, and the fasting blood glucose control rate was 27.98%. Multivariate analysis identified living outside the Urumqi surrounding area, age 65 and above, body mass indexâ ≥â 24, abnormal blood lipids, and untreated hypertension as independent risk factors for poor fasting blood glucose control, while treatment was a protective factor for achieving blood glucose control. The treatment rate and fasting blood glucose control rate among grassroots residents with type 2 diabetes in Xinjiang Production and Construction Corps need improvement. Efforts should be made to enhance patient medication adherence and health management awareness through education. Targeted interventions should be implemented for high-risk populations with identified risk factors to reduce or delay the occurrence of diabetes and its complications, ultimately aiming to reduce mortality rates and improve quality of life.
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Glucemia , Diabetes Mellitus Tipo 2 , Control Glucémico , Hipoglucemiantes , Humanos , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Anciano , Femenino , Factores de Riesgo , Glucemia/análisis , China/epidemiología , Hipoglucemiantes/uso terapéutico , Control Glucémico/métodos , Ayuno/sangre , Metformina/uso terapéutico , Insulina/uso terapéutico , Encuestas y Cuestionarios , Factores de Edad , Estudios Transversales , Índice de Masa CorporalRESUMEN
OBJECTIVES: To determine how age affects insulin resistance during the menstrual cycle and insulin resistance-associated indices: the Triglyceride-glucose and Triglyceride-glucose-BMI indexes. METHODS: This prospective observational study used fasting plasma glucose, fasting insulin, triglycerides, body mass index (BMI), and days since the start of the menstrual period collected from the NHANES dataset (1999-2006). Insulin resistance was determined using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The participants were categorized as young (16-34 years) or older (>35 years). Rhythmicity during the menstrual cycle was analyzed using the Cosinor and Cosinor2 packages for R. MAIN OUTCOME MEASURES: Cosine fit curves for insulin resistance during the menstrual cycle and age-associated effects on rhythmicity. RESULTS: Using 1256 participants, rhythmicity was observed for fasting insulin and HOMA-IR (p < 0.05) but not for fasting plasma glucose, the Triglyceride-glucose index, or the Triglyceride-glucose-BMI index. Significant amplitudes for fasting insulin and HOMA-IR were observed when age was considered. Acrophases for fasting insulin and HOMA-IR were significant only for the younger group, and the differences between these groups were significant, suggesting that the changes in scores for insulin resistance for the younger and older groups occur at different times of their menstrual cycle. CONCLUSIONS: Insulin resistance does fluctuate during the menstrual cycle, and it is at a maximum at different times for younger and older women. Since these results are unadjusted, this study is preliminary and further investigation is required.
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Glucemia , Índice de Masa Corporal , Resistencia a la Insulina , Insulina , Ciclo Menstrual , Triglicéridos , Humanos , Femenino , Adulto , Triglicéridos/sangre , Ciclo Menstrual/sangre , Glucemia/metabolismo , Adulto Joven , Adolescente , Insulina/sangre , Estudios Transversales , Estudios Prospectivos , Factores de Edad , Encuestas Nutricionales , Ayuno/sangre , Persona de Mediana Edad , HomeostasisRESUMEN
OBJECTIVE: We aimed to evaluate the heterogeneity of gestational diabetes mellitus (GDM) patients diagnosed with various screening criteria. METHODS: We stratified pregnant women using consecutive fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (2hPPG) intervals of 0.2 mmol/L. The incidence of abnormal neonatal birthweight and birth-related adverse outcomes was compared with that of pregnant women without GDM. RESULTS: The study included 39,988 pregnant women (18-45 years, mean [SD], 31.5 [4.7] years) in Ningbo, China. The means (SDs) of FPG and 2hPPG within 24-28 weeks of gestation were 4.5 (0.5) and 6.8 (1.3) mmol/L, respectively. A total of 3025 (7.6%) women had 5.1-6.9 mmol/L FPG and 4560 (11.4%) had 8.5-11.0 mmol/L 2hPPG. The incidence of GDM according to the two combination criteria was 17.3% (6908 cases). The relative risk (RR) for < 10th percentile birthweight (< 10th WT) was 0.82 (95% CI, 0.74-0.91, p < 0.001) by 5.1 mmol/L FPG criterion and 1.14 (95% CI, 1.06-1.23, p < 0.001) by 8.5 mmol/L 2hPPG criterion, while the RRs for > 90th percentile birthweight (> 90th WT) were 1.48 (95% CI, 1.35-1.63, p < 0.001) and 0.95 (95% CI, 0.86-1.04, p = 0.29) according to the corresponding criteria. The FPG criterion was more strongly associated with maternal hypertension than the 2hPPG criterion. Both criteria did not show a distinct association with other composite adverse outcomes. CONCLUSION: High FPG is significantly associated with high birth weight, whereas high 2hPPG is slightly associated with low birth weight. Our findings highlight the heterogeneity of patients with GDM diagnosed by different criteria.
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Peso al Nacer , Glucemia , Diabetes Gestacional , Ayuno , Periodo Posprandial , Humanos , Femenino , Diabetes Gestacional/sangre , Diabetes Gestacional/epidemiología , Diabetes Gestacional/diagnóstico , Embarazo , Adulto , Ayuno/sangre , Glucemia/análisis , China/epidemiología , Adulto Joven , Adolescente , Resultado del Embarazo/epidemiología , Recién Nacido , Prueba de Tolerancia a la Glucosa , Persona de Mediana Edad , IncidenciaRESUMEN
OBJECTIVE: This study aimed to determine the likelihood of hyperglycemia postpartum in women with gestational diabetes mellitus (GDM) and to identify the predictors. METHODS: The retrospective cohort study involved 1 527 GDM patients who delivered at Peking University First Hospital from 1 January 2021, to 31 December 2021. According to the blood glucose level of postpartum oral glucose tolerance test (OGTT), women were divided into a normal glucose tolerance (NGT) group and a hyperglycemia group, and their characteristics and risk factors of hyperglycemia were compared. RESULTS: The prevalence of hyperglycemia was 33.9% (184/543) at 6-12 weeks postpartum. Compared with the NGT group, the fasting plasma glucose (FPG) of hyperglycemia group increased significantly during pregnancy and postpartum, the OGTT 1h postprandial glucose (PG) and 2hPG increased in the second trimester of pregnancy, the triglyceride (TG) increased in the first trimester of pregnancy and postpartum, the triglyceride glucose (TyG) index increased in the first trimester of pregnancy and postpartum, and the total cholesterol (TCHO) and low density lipoprotein cholesterol (LDL-C) decreased in the second trimester (p < 0.05). Fasting plasma glucose (FPG) in the first trimester [odds ratio (OR) = 3.583, p < 0.001], OGTT 2hPG in the second trimester (OR = 1.604, p < 0.001), the TyG index in the first trimester (OR = 1.863, p = 0.045) and FPG in third trimester (OR = 1.985, p = 0.024) were independent risk factors for postpartum hyperglycemia. CONCLUSIONS: Approximately one-third of women with GDM have hyperglycemia 6-12 weeks after delivery. FPG and the TyG index in the first trimester, OGTT 2hPG in the second trimester and FPG in third trimester are risk factors for postpartum hyperglycemia.
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Glucemia , Diabetes Gestacional , Prueba de Tolerancia a la Glucosa , Hiperglucemia , Periodo Posparto , Triglicéridos , Humanos , Femenino , Embarazo , Diabetes Gestacional/sangre , Diabetes Gestacional/diagnóstico , Adulto , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/epidemiología , Estudios Retrospectivos , Glucemia/análisis , Glucemia/metabolismo , Triglicéridos/sangre , Periodo Posparto/sangre , Ayuno/sangre , Factores de Riesgo , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: A high triglyceride-glucose index (TyG) is associated with a higher risk of incident heart failure. However, the effects of longitudinal patterns of TyG index on the risk of heart failure remain to be characterized. Therefore, in the present study, we aimed to characterize the relationship between the trajectory of TyG index and the risk of heart failure. METHODS: We performed a prospective study of 56,149 participants in the Kailuan study who attended three consecutive surveys in 2006-2007, 2008-2009, and 2010-2011 and had no history of heart failure or cancer before the third wave survey (2010-2011). The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2], and we used latent mixture modeling to characterize the trajectory of the TyG index over the period 2006-2010. Additionally, Cox proportional risk models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for incident heart failure for the various TyG index trajectory groups. RESULTS: From 2006 to 2010, four different TyG trajectories were identified: low-stable (n = 13,554; range, 7.98-8.07), moderate low-stable (n = 29,435; range, 8.60-8.65), moderate high-stable (n = 11,262; range, 9.31-9.30), and elevated-stable (n = 1,898; range, 10.04-10.25). A total of 1,312 new heart failure events occurred during a median follow-up period of 10.04 years. After adjustment for potential confounders, the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident heart failure for the elevated-stable, moderate high-stable, and moderate low-stable groups were 1.55 (1.15, 2.08), 1.32 (1.08, 1.60), and 1.17 (0.99, 1.37), respectively, compared to the low-stable group. CONCLUSIONS: Higher TyG index trajectories were associated with a higher risk of heart failure. This suggests that monitoring TyG index trajectory may help identify individuals at high risk for heart failure and highlights the importance of early control of blood glucose and lipids for the prevention of heart failure.
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Glucemia , Insuficiencia Cardíaca , Triglicéridos , Humanos , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/diagnóstico , Triglicéridos/sangre , Femenino , Masculino , Persona de Mediana Edad , Glucemia/metabolismo , Glucemia/análisis , Estudios Prospectivos , Anciano , Factores de Riesgo , Modelos de Riesgos Proporcionales , China/epidemiología , Adulto , Ayuno/sangreRESUMEN
Background: Currently ischemic stroke poses a serious disease burden globally, and high fasting plasma glucose is one of the important risk factors. The aim of this study was to investigate the disease burden of ischemic stroke due to fasting glucose during 1990-2019 in China, to estimate the effect of age, period, and cohort on the trend of ischemic stroke disease burden, and to predict the disease burden of ischemic stroke in 2020-2030. Methods: Ischemic stroke burden data were obtained by screening from the Global Burden of Disease Study 2019 (GBD 2019) database for high-risk populations in China. Annual average percentage change (AAPC) was calculated using the Joinpoint regression model to assess the trend of ischemic stroke burden between 1990 and 2019. Age-period-cohort models were introduced to estimate the independent effects of age, period, and cohort on ischemic stroke burden, and to predict the ischemic stroke burden in 2020-2030 based on Bayesian age-period-cohort models. Results: From 1990 to 2019, the number of ischemic stroke deaths due to high fasting plasma glucose in China continued to increase with an AAPC of 3.61. Trends in age-standardized incidence rates did not show statistical significance. In the age-period-cohort analysis, the age effect of ischemic stroke burden showed a continuously increasing trend over the study period. The period effect showed an overall favorable trend over the study period. The overall and cohort effects for males showed an overall increasing trend, whereas the cohort effect for females showed a decreasing trend after a decreasing trend for the 1945 birth cohort. Conclusions: This study found that ischemic stroke due to high fasting plasma glucose in China has generally fluctuated between 1990 and 2019, with a decreasing trend in recent years, and projections also suggest that it will continue to show a decreasing trend in the future. Age and period of birth were the main elements influencing the burden of disease, especially among the elderly and men. Policies should be used to promote the prevention of known risk factors and to strengthen health management for key populations.
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Glucemia , Ayuno , Carga Global de Enfermedades , Accidente Cerebrovascular Isquémico , Humanos , China/epidemiología , Masculino , Persona de Mediana Edad , Glucemia/análisis , Glucemia/metabolismo , Femenino , Ayuno/sangre , Anciano , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/sangre , Adulto , Factores de Riesgo , Carga Global de Enfermedades/tendencias , Incidencia , Estudios de Cohortes , Anciano de 80 o más Años , Adulto JovenRESUMEN
INTRODUCTION: High blood glucose levels in individuals with diabetes mellitus (DM) can lead to various complications, highlighting the need for adequate management. Diabetes Self-Management Education has been proven effective in controlling glycaemic events and preventing DM complications. Telenursing is a promising method for educating DM patients. This study aimed to determine the effectiveness of cell phone-based telenursing on fasting blood glucose (FBG) levels of people with DM. MATERIALS AND METHODS: This study used a quasiexperimental on 84 participants with DM, which was randomised into intervention (n=42) and control (n=42) groups. The intervention group was provided with health education through booklets and cell phone-based telenursing for four sessions and four sessions of follow-up, while the control group was given health education according to standards from the health centre (Puskesmas). All respondents had their FBG levels checked before, one month, and two months follow-up. The data were analysed using paired sample t-tests, independent samples t-test, and repeated ANOVA. RESULTS: The mean FBG measurements in the intervention group prior to treatment were 210.88mg/dL, decreased to 173.21mg/dL in the first month, and 177.48mg/dL in the second month (follow-up), while the control group started at 206.36mg/dL, decreased to 182.55mg/dL in the first month, and 191.64mg/dL in the second month. The difference between the two groups was not significant in both the intervention and control groups, p=0.181. CONCLUSION: Health education through mobile phone-based telenursing and standard health centres both affect FBG levels of people with DM.
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Glucemia , Diabetes Mellitus , Teleenfermería , Humanos , Masculino , Femenino , Persona de Mediana Edad , Glucemia/análisis , Adulto , Diabetes Mellitus/sangre , Diabetes Mellitus/terapia , Ayuno/sangre , Teléfono Celular , Anciano , Educación del Paciente como AsuntoRESUMEN
The relationship of adipose tissue insulin resistance (AT-IR, a product of fasting insulin and free fatty acids) and homeostasis-model assessment-insulin resistance (HOMA-IR) to ß-cell function was studied cross-sectionally in the setting of subtle glucose dysregulation. Associations of AT-IR and HOMA-IR with fasting and post-glucose glycemia and ß-cell function inferred from serum insulin kinetics during a 75 g oral glucose tolerance test were studied in 168 young female Japanese students. ß-cell function was evaluated by disposition index calculated as a product of the insulinogenic index (IGI) and Matsuda index. AT-IR, not HOMA-IR, showed positive associations with post-glucose glycemia and area under the glucose response curve although both indices were associated with fasting glycemia. HOMA-IR, not AT-IR, was associated positively with log IGI whereas both indices were inversely associated with Matsuda index. AT-IR, not HOMA-IR, showed inverse associations with log disposition index. Associations of adipose tissue insulin resistance with ß-cell function (inverse) and glucose excursion in young Japanese women may suggest that lipotoxicity to pancreatic ß-cells for decades may be associated with ß cell dysfunction found in Japanese patients with type 2 diabetes. Positive association of HOMA-IR with insulinogenic index may be associated with compensatory increased insulin secretion.
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Tejido Adiposo , Glucemia , Prueba de Tolerancia a la Glucosa , Resistencia a la Insulina , Células Secretoras de Insulina , Insulina , Humanos , Femenino , Células Secretoras de Insulina/metabolismo , Tejido Adiposo/metabolismo , Glucemia/metabolismo , Adulto Joven , Adulto , Japón , Insulina/sangre , Insulina/metabolismo , Estudios Transversales , Ayuno/sangre , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Fluorine-18 fluorodeoxyglucose (FDG) with positron emission tomography (PET) is the standard for detecting myocardial inflammation in cardiac sarcoidosis, requiring preparation with the ketogenic diet (KD) to achieve myocardial glucose suppression. Despite this, incomplete myocardial glucose suppression remains a significant issue, and strategies to reduce myocardial glucose uptake (MGU) and identify incomplete myocardial glucose suppression are required. This study sought to understand the relationship between point-of-care beta-hydroxybutyrate (BHB) and different patterns of MGU and between KD and fasting duration with MGU in patients undergoing evaluation for cardiac sarcoidosis. METHODS: We prospectively included 471 outpatients who underwent FDG-PET for cardiac sarcoidosis evaluation, followed the KD for 1 (n=100), 2 (n=29), and ≥3 days (n=342), fasted for at least 12 hours, and had BHB levels measured immediately before FDG injection. Images were classified as (1) no MGU (negative), (2) focal/multifocal (positive), (3) diffuse (nondiagnostic), or (4) nonspecific uptake (NS-MGU). RESULTS: Cardiac FDG-PET scans were interpreted as the following: 376 (79.83%) negative; 61 (12.95%) positive; 14 (2.97%) diffuse; and 20 (4.25%) NS-MGU. There was a strong negative relationship between BHB levels and MGU (P<0.0001). BHB levels increased significantly with KD duration (P<0.0001) and fasting time (P=0.0067). The combined rate of diffuse, NS-MGU, and positive scans (34%, 28%, 16%) decreased inversely with KD duration (1, 2, and ≥3 days, respectively). However, MGU was not different across different fasting times (P=0.6). Blood glucose levels were not associated with MGU (P=0.17) and only weakly associated with BHB levels (R2=0.03; P<0.001). CONCLUSIONS: We observed a strong inverse relationship between ketosis and patterns of MGU. Longer KD and fasting durations are associated with higher ketosis. However, only KD duration was associated with lower rates of MGU. Measurement of BHB levels before FDG-PET using point-of-care testing is feasible and may facilitate the management of patients referred for myocardial inflammation.
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Cardiomiopatías , Fluorodesoxiglucosa F18 , Miocardio , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Sarcoidosis , Humanos , Masculino , Femenino , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/metabolismo , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Persona de Mediana Edad , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/metabolismo , Estudios Prospectivos , Miocardio/metabolismo , Cetosis/metabolismo , Anciano , Ayuno/sangre , Dieta Cetogénica , Adulto , Valor Predictivo de las Pruebas , Ácido 3-Hidroxibutírico/sangre , Factores de Tiempo , Biomarcadores/sangreRESUMEN
CONTEXT: Glucagon plays a role in the development of type 2 diabetes, yet its role in prediabetes (preDM) remains uncertain. OBJECTIVE: To evaluate glucagon levels in the fasting state and its response to glucose inhibition in preDM through meta-analysis. METHODS: A systematic search across Pubmed, Embase, Web of Science, and Cochrane Library identified studies assessing glucagon levels during 75 g oral glucose tolerance test (OGTT) in both preDM and normal glucose tolerance (NGT) cohorts. Data on glucagon, glucose, and insulin were pooled using a random-effect model. RESULTS: Although glucagon levels decreased in both preDM and NGT groups upon glucose challenge, glucagon levels at 0 hours, 0.5 hours, 1 hour, and 1.5 hours in preDM were significantly higher compared to NGT, despite higher glucose levels at all time points and higher insulin levels at 0 hours, 1 hour, 1.5 hours, and 2 hours during OGTT. Subgroup analysis revealed that in studies using the radioimmunoassay method, glucagon levels in preDM were higher at 0.5 hours and 1 hour than NGT, while in studies using the ELISA method, glucagon levels were similar to those of the NGT group despite higher glucose in preDM compared to NGT. Fasting glucagon level was inadequately suppressed in both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Responsiveness to glucose inhibition was preserved in IFG, while glucagon level in IGT group at 0.5 hours after glucose intake was not suppressed and was higher than NGT. CONCLUSION: Glucagon was not adequately suppressed during OGTT in preDM. Glucagon dysregulation is a contributing mechanism underlying both IFG and IGT.
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Glucemia , Glucagón , Prueba de Tolerancia a la Glucosa , Estado Prediabético , Humanos , Glucagón/sangre , Estado Prediabético/sangre , Estado Prediabético/metabolismo , Glucemia/análisis , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/metabolismo , Insulina/sangre , Ayuno/sangreRESUMEN
BACKGROUND: The link between nonalcoholic fatty liver disease and type 2 diabetes has not been fully established. We investigated the temporal relationship between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D), quantitatively assessed the impact, and evaluated the related mediation effect. METHODS: This study involved participants from the China Multi-Ethnic Cohort Study and the UK Biobank. We performed cross-lagged path analysis to compare the relative magnitude of the effects between NAFLD and T2D using two-period biochemical data. Hepatic steatosis and fasting blood glucose elevation (FBG) represented NAFLD and T2D respectively. We fitted two separate Cox proportional-hazards models to evaluate the influence of hepatic steatosis on T2D. Furthermore, we applied the difference method to assess mediation effects. RESULTS: In cross-lagged path analyses, the path coefficients from baseline hepatic steatosis to first repeat FBG (ßCMEC = 0.068, ßUK-Biobank = 0.033) were significantly greater than the path coefficients from baseline FBG to first repeat hepatic steatosis (ßCMEC = 0.027, ßUK-Biobank = -0.01). Individuals with hepatic steatosis have a risk of T2D that is roughly three times higher than those without the condition (HR = 3.478 [3.314, 3.650]). Hepatic steatosis mediated approximately 69.514% of the total effect between obesity and follow-up T2D. CONCLUSIONS: Our findings contribute to determining the sequential relationship between NAFLD and T2D in the causal pathway, highlighting that the dominant pathway in the relationship between these two early stages of diseases was the one from hepatic steatosis to fasting blood glucose elevation. Individuals having NAFLD face a significantly increased risk of T2D and require long-term monitoring of their glucose status as well.
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Glucemia , Diabetes Mellitus Tipo 2 , Ayuno , Enfermedad del Hígado Graso no Alcohólico , Humanos , China/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Reino Unido/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/sangre , Femenino , Masculino , Persona de Mediana Edad , Glucemia/análisis , Estudios Longitudinales , Ayuno/sangre , Adulto , Anciano , Factores de Tiempo , Factores de Riesgo , Modelos de Riesgos ProporcionalesRESUMEN
Background: Diabetes mellitus (DM) is a global public health problem characterized by an elevated blood glucose level. Monitoring blood sugar levels is vital for effective diabetes management and preventing complications. However, the association between longitudinal biomarkers and the incidence of diabetic complications is often overlooked. Therefore, this study aimed to assess the incidence of diabetic retinopathy, predictors, and association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia. Methods: A multicenter retrospective follow-up study was carried out in referral hospitals in Amhara region, Ethiopia. A random sample of 462 newly diagnosed DM patients was selected. The proportional hazard assumption was checked for the survival sub-model, and for the longitudinal sub-model, the normality assumption was checked. Then the joint modeling with time-dependent lagged parameterizations was fitted. Model assumptions and comparisons were checked. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value<0.05 was used to identify predictors. Results: In this study, Overall, 54 patients developed DR, and the incidence rate was 2.33 per 1000 person-months over the follow-up period, with a 95% CI of [1.78, 3.05]. Rural residence (AHR = 2.21, 95% CI: [1.21, 4.05]), hypertension co-morbidity (AHR = 3.01, 95% CI: [1.85, 6.53]), and longer duration of DM (>5 years) (AHR = 2.28, 95% CI: [1.91, 5.15]) were important predictors for the incidence of DR. In addition, the incidence of DR was substantially correlated with the time-dependent lagged value of FBS change (AHR = 4.20, 95% CI [1.62, 10.85]). Conclusions: In this study, the incidence of diabetic retinopathy was somewhat high when compared to prior similar studies in Ethiopia. A joint model of longitudinal fasting blood sugar level changes was significantly associated with an increased risk of DR. Besides, being rural residence, hypertension co-morbidity, and a longer duration of DM were significant predictors for the incidence of DR. Therefore, public awareness, an integrated care approach, and prioritizing glycemic control are highly recommended.