BACKGROUND Cardiovascular disease(CVD)is a leading cause of morbidity and mortality worldwide,the global burden of which is rising.It is still unclear the extent to which prediabetes contributes to the risk of CVD in ...BACKGROUND Cardiovascular disease(CVD)is a leading cause of morbidity and mortality worldwide,the global burden of which is rising.It is still unclear the extent to which prediabetes contributes to the risk of CVD in various age brackets among adults.To develop a focused screening plan and treatment for Chinese adults with prediabetes,it is crucial to identify variations in the connection between prediabetes and the risk of CVD based on age.AIM To examine the clinical features of prediabetes and identify risk factors for CVD in different age groups in China.METHODS The cross-sectional study involved a total of 46239 participants from June 2007 through May 2008.A thorough evaluation was conducted.Individuals with prediabetes were categorized into two groups based on age.Chinese atherosclerotic CVD risk prediction model was employed to evaluate the risk of developing CVD over 10 years.Random forest was established in both age groups.SHapley Additive exPlanation method prioritized the importance of features from the perspective of assessment contribution.RESULTS In total,6948 people were diagnosed with prediabetes in this study.In prediabetes,prevalences of CVD were 5(0.29%)in the younger group and 148(2.85%)in the older group.Overall,11.11%of the younger group and 29.59% of the older group were intermediate/high-risk of CVD for prediabetes without CVD based on the Prediction for ASCVD Risk in China equation in ten years.In the younger age group,the 10-year risk of CVD was found to be more closely linked to family history of CVD rather than lifestyle,whereas in the older age group,resident status was more closely linked.CONCLUSION The susceptibility to CVD is age-specific in newly diagnosed prediabetes.It is necessary to develop targeted approaches for the prevention and management of CVD in adults across various age brackets.展开更多
BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not be...BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.展开更多
Diabetes,one of the world's top ten diseases,is known for its high mortality and complication rates and low cure rate.Prediabetes precedes the onset of diabetes,during which effective treatment can reduce diabetes...Diabetes,one of the world's top ten diseases,is known for its high mortality and complication rates and low cure rate.Prediabetes precedes the onset of diabetes,during which effective treatment can reduce diabetes risk.Prediabetes risk factors include high-calorie and high-fat diets,sedentary lifestyles,and stress.Consequences may include considerable damage to vital organs,including the retina,liver,and kidneys.Interventions for treating prediabetes include a healthy lifestyle diet and pharmacological treatments.However,while these options are effective in the short term,they may fail due to the difficulty of long-term implementation.Medications may also be used to treat prediabetes.This review examines prediabetic treatments,particularly metformin,glucagon-like peptide-1 receptor agonists,sodium glucose cotransporter 2 inhibitors,vitamin D,and herbal medicines.Given the remarkable impact of prediabetes on the progression of diabetes mellitus,it is crucial to intervene promptly and effectively to regulate prediabetes.However,the current body of research on prediabetes is limited,and there is considerable confusion surrounding clinically relevant medications.This paper aims to provide a comprehensive summary of the pathogenesis of prediabetes mellitus and its associated therapeutic drugs.The ultimate goal is to facilitate the clinical utilization of medications and achieve efficient and timely control of diabetes mellitus.展开更多
BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes...BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention.The weight change in patients with prediabetes has not attracted much attention.AIM To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.METHODS We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance(NGT),and collected clinical data and follow-up results of all patients.Based on natural blood glucose outcomes,we classified 66 patients with progression to T2DM into the disease progression(DP)group,and 170 patients without progression to T2DM into the disease outcome(DO)group.We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression.A general linear model(univariate)was used to analyze the interaction between body weight and independent influencing factors.RESULTS There were 98 cases of impaired fasting glucose(IFG),90 cases of impaired glucose tolerance(IGT),and 48 cases of coexistent IFG and IGT.The body weight,waist circumference,body mass index,fasting blood glucose,and 2 h plasma glucose of patients with IFG,IGT,and coexistent IFG and IGT were higher than those in patients with NGT(P<0.05).Logistic regression analysis showed that body weight,glycosylated hemoglobin,uric acid,fasting insulin,and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905[95%confidence interval(CI):0.863-0.948],which was greater than that predicted by each indicator alone.Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1,the odds ratio(95%CI)of body weight 3 was 1.399(1.142-2.126)(P=0.033).There was a multiplicative interaction between body weight and uric acid(β=1.953,P=0.005).CONCLUSION High body weight in patients with prediabetes is an independent risk factor for progression to T2DM,and the risk of progression is increased when coexisting with high uric acid level.展开更多
Prediabetes,the precursor of type 2 diabetes mellitus,is an intermediate stage between normal glucose homeostasis and overt diabetes.This asymptomatic metabolic state is increasingly prevalent in pediatric population ...Prediabetes,the precursor of type 2 diabetes mellitus,is an intermediate stage between normal glucose homeostasis and overt diabetes.This asymptomatic metabolic state is increasingly prevalent in pediatric population and is very difficult to detect without appropriate screening.Studies have shown that a certain proportion of children with prediabetes will develop diabetes in a few years.Even more alarming is the evidence that youth-onset diabetes has a more aggressive clinical course with progressive beta-cell decline and accelerated endorgan damage.Despite its importance,several aspects involving prediabetes in childhood are disputed or unknown.This review presents the latest insights into this challenging entity and outlines a simplified screening approach to aid clinical practice.In summary,childhood prediabetes is an important clinical condition indicating the need for proper screening and timely intervention.展开更多
Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. While, the diagnostic criteria of prediabetes are not uniform across various international ...Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. While, the diagnostic criteria of prediabetes are not uniform across various international professional organizations, it remains a state of high risk for developing diabetes with yearly conversion rate of 5%-10%. Observational evidence suggests as association between prediabetes and complications of diabetes such early nephropathy, small fiber neuropathy, early retinopathy and risk of macrovascular disease. Several studies have shown efficacy of lifestyle interventions with regards to diabetes prevention with a relative risk reduction of 40%-70% in adults with prediabetes. While there is increasing evidence to prove the efficacy of pharmacotherapy in prevention of diabetes in adults with prediabetes, pharmaceutical treatment options other than metformin are associated with adverse effects that limit their use for prediabetes. There are no reports of systematic evaluation of health outcomes related to prediabetes in children. The effects of pharmacotherapy of prediabetes on growth and pubertal development in children remains unknown. Secondary intervention with pharmacotherapy with metformin is advocated for high-risk individuals but criteria for such consideration benefit of early intervention, long term cost effectiveness of such interventions and the end point of therapy remain unclear. Pharmacotherapy must be used with caution in children with prediabetes. Prediabetes is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It is considered to be an at risk state, with high chances of developing diabetes. While, prediabetes is commonly an asymptomatic condition, there is always presence of prediabetes before the onset of diabetes. The elevation of blood sugar is a continuum and hence prediabetes can not be considered an entirely benign condition. This aim of this review is to describe the challenges associated with diagnosis of prediabetes, the possible adverse medical outcomes associated with prediabetes and the treatment options and rationale for their use in context of prediabetes.展开更多
Progression of normal glucose tolerance(NGT) to overt diabetes is mediated by a transition state called impaired glucose tolerance(IGT). Beta cell dysfunction and insulin resistance are the main defects in type 2 diab...Progression of normal glucose tolerance(NGT) to overt diabetes is mediated by a transition state called impaired glucose tolerance(IGT). Beta cell dysfunction and insulin resistance are the main defects in type 2 diabetes mellitus(type 2 DM) and even normoglycemic IGT patients manifest these defects. Beta cell dysfunction and insulin resistance also contribute to the progression of IGT to type 2 DM. Improving insulin sensitivity and/or preserving functions of beta-cells can be a rational way to normalize the GT and to control transition of IGT to type 2 DM. Loosing weight, for example, improves whole body insulin sensitivity and preserves beta-cell function and its inhibitory effect on progression of IGT to type 2 DM had been proven. But interventions aiming weight loss usually not applicable in real life. Pharmacotherapy is another option to gain better insulin sensitivity and to maintain beta-cell function. In this review, two potential treatment options(lifestyle modification and pharmacologic agents) that limits the IGT-type 2 DM conversion in prediabetic subjects are discussed.展开更多
AIM To determine the predictive role of body mass index(BMI) and waist circumference(WC) for diabetes and prediabetes risk in future in total sample as well as in men and women separately. METHODS In a population base...AIM To determine the predictive role of body mass index(BMI) and waist circumference(WC) for diabetes and prediabetes risk in future in total sample as well as in men and women separately. METHODS In a population based cohort study, 1765 with mean ± SD age: 42.32 ± 6.18 healthy participants were followed up from 2003 till 2013(n = 960). Anthropometric and biochemical measures of participants were evaluated regularly during the follow up period. BMI and WC measures at baseline and diabetes and prediabetes status of participants at 2013 were determined. Multivariable logistic regression analysis was used for determining the risk of diabetes and prediabetes considering important potential confounding variables. Receiver operatingcharacteristic curve analysis was conducted to determine the best cut of values of BMI and WC for diabetes and prediabetes. RESULTS At 2013, among participants who had complete data, 45 and 307 people were diabetic and prediabetic, respectively. In final fully adjusted model, BMI value was a significant predictor of diabetes(RR = 1.39, 95%CI: 1.06-1.82 and AUC = 0.68, 95%CI: 0.59-0.75; P < 0.001) however not a significant risk factor for prediabetes. Also, WC was a significant predictor for diabetes(RR = 1.2, 95%CI: 1.05-1.38 and AUC = 0.67, 95%CI: 0.6-0.75) but not significant risk factor for prediabetes. Similar results were observed in both genders.CONCLUSION General and abdominal obesity are significant risk factors for diabetes in future.展开更多
Objective To study the association between metal exposure and risk of diabetes and prediabetes among Chinese workers exposed to metals.Methods We used data obtained from the baseline survey of the Jinchang Cohort Stud...Objective To study the association between metal exposure and risk of diabetes and prediabetes among Chinese workers exposed to metals.Methods We used data obtained from the baseline survey of the Jinchang Cohort Study of workers in Jinchang Industry,the largest nickel production company in China.A total of 42,122 workers ≥20 years of age were included in the study.A standardized,structured questionnaire was used to collect epidemiological information.Physical examinations and laboratory tests were conducted to evaluate the health status of the participants and to measure various biomarkers including blood sugar,lipids,and urinary metal concentrations.Logistic regression was used to study the association between occupational groups categorized according to the measured metal levels(office workers,low-level;mining/production workers,mid-level;and smelting/refining workers,high-level)and risk of diabetes and prediabetes.Results The overall prevalence of diabetes and prediabetes was 7.5% and 16.8%,respectively.The adjusted odds ratios for diabetes among mining/production workers and smelting/refining workers compared to office workers were 1.5(95% CI:1.3,1.7)and 3.8(95% CI:3.4,4.3),respectively.No association was observed between these occupational groups and prediabetes in this study.Conclusion Occupations associated with higher levels of metal exposure were associated with an increased risk of diabetes in this cohort.More studies are needed to confirm this observed association.展开更多
BACKGROUND The risk of developing prediabetes based on the metabolic/obesity phenotypes has been poorly investigated. AIM To examine the association of baseline metabolic/obesity phenotypes and their changes over time...BACKGROUND The risk of developing prediabetes based on the metabolic/obesity phenotypes has been poorly investigated. AIM To examine the association of baseline metabolic/obesity phenotypes and their changes over time with the risk of prediabetes development. METHODS In a population-based cohort study, 1741 adults (aged > 19 years) with normal blood glucose were followed for 14 years. Anthropometric and biochemical measures were evaluated regularly during the follow-up period. According to body mass index and metabolic health status, participants were categorized into four groups: Metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Multivariable Cox regression analysis was used to measure the risk of prediabetes according to the baseline metabolic/obesity phenotype and their changes during the follow-up. RESULTS In the whole population with a mean (95CCI for mean) follow up duration of 12.7 years (12.6-12.9), all three MUNW, MHO, MUO groups were at higher risk for developing prediabetes compared to the MHNW group (P = 0.022). The MUNW group had the highest risk for developing prediabetes (hazard ratio (HR): 3.84, 95%CI: 1.20, 12.27). In stratified analysis by sex, no significant association was found in men, while women in the MUNW group were at the greatest risk for prediabetes (HR: 6.74, 95%CI: 1.53, 29.66). Transforming from each phenotype to MHNW or MHO was not related to the risk of prediabetes development, whereas transforming from each phenotype to MUO was associated with an increased risk of prediabetes (HR > 1;P < 0.05). CONCLUSION Our findings indicate that MHO is not a high risk, unless it transforms into MUO over time. However, people in the MUNW group have the greatest risk for developing prediabetes, and therefore, they should be screened and treated.展开更多
Bone fragility has been recognized as a complication of diabetes,both type 1 diabetes (T1D) and type 2 diabetes (T2D),whereas the relationship between prediabetes and fracture risk is less clear.Fractures can deeply i...Bone fragility has been recognized as a complication of diabetes,both type 1 diabetes (T1D) and type 2 diabetes (T2D),whereas the relationship between prediabetes and fracture risk is less clear.Fractures can deeply impact a diabetic patient’s quality of life.However,the mechanisms underlying bone fragility in diabetes are complex and have not been fully elucidated.Patients with T1D generally exhibit low bone mineral density (BMD),although the relatively small reduction in BMD does not entirely explain the increase in fracture risk.On the contrary,patients with T2D or prediabetes have normal or even higher BMD as compared with healthy subjects.These observations suggest that factors other than bone mass may influence fracture risk.Some of these factors have been identified,including disease duration,poor glycemic control,presence of diabetes complications,and certain antidiabetic drugs.Nevertheless,currently available tools for the prediction of risk inadequately capture diabetic patients at increased risk of fracture.Aim of this review is to provide a comprehensive overview of bone health and the mechanisms responsible for increased susceptibility to fracture across the spectrum of glycemic status,spanning from insulin resistance to overt forms of diabetes.The management of bone fragility in diabetic patient is also discussed.展开更多
Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is more common in diabetic patients. There are limited studies on clinical, biochemical and histological features of NAFLD patients who are diabetic...Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is more common in diabetic patients. There are limited studies on clinical, biochemical and histological features of NAFLD patients who are diabetic. The aim of the study was to determine the prevalence of diabetes and prediabetes in a cohort of NAFLD patients and to compare anthropometry, biochemical and metabolic parameters and hepatic histology of diabetic NAFLD patients with non-diabetic NAFLD patients. Methods: 515 consecutive NAFLD patients diagnosed by abdominal ultrasound and 100 healthy controls were subjected to detailed anthropometric measurements and biochemical assays including blood sugars, LFT, lipid profile and HOMA. Diabetes and prediabetes were defined according to WHO criteria. Patients were categorized and compared according to the presence or absence of diabetes. Liver biopsy was performed in 240 NAFLD patients and the liver histology was also compared between the two groups. Statistical analysis was performed on SPSS 16. Results: 124 out of the 515 (24.08%) NAFLD patients were diabetics, 118 out of 515 (22.9%) were pre-diabetics, while only 3 out of 100 controls had impaired glucose tolerance. Diabetic patients were older. NAFLD patients with diabetes had significantly higher waist circumference [98.02 ± 12.01 vs 93.89 ± 8.8, p = 0.000] as compared to the NAFLD patients without diabetes. Fasting blood sugar [124 ± 46.3 vs 90.8 ± 10.2, p = 0.000], triglyceride level [218.4 ± 17.6 vs 192 ± 9, p = 0.03] and HOMA-IR [2.6 ± 0.36 vs 1.84 ± 0.2, p < 0.001] were significantly higher in NAFLD-diabetes group. Hypertension [35% vs 11.7%, p = 0.000] was commoner in diabetic NAFLD patients. Histopathology in the diabetic patients revealed steatosis alone in 34.2% cases, borderline NASH in 31.4% and definite NASH in 34.2%. Fatty change alone was noted in 16.5% cases, borderline NASH in 34.1%, while 49% had definite NASH on liver biopsy of NAFLD patients without diabetes. Fibrosis was noted in 31.4% in diabetic and 27% in non-diabetic patients. IR alone had a linear correlation with necroinflammatory activity. Conclusion: The prevalence of diabetes and prediabetes is six times more in NAFLD patients than in healthy controls. NAFLD patients with diabetes have higher metabolic risk factors such as large waistline, hypertension, high triglyceride levels and increased insulin resistance. Diabetes or pre diabetes patients per se do not have histologically severe disease, rather insulin resistance play an important role in increasing the severity of the disease.展开更多
Background: Several recent studies have shown that treatment with therapeutic lifestyle changes, and/or several drugs retard progression of prediabetes to type 2 diabetes. However, none of these studies used a Sulfony...Background: Several recent studies have shown that treatment with therapeutic lifestyle changes, and/or several drugs retard progression of prediabetes to type 2 diabetes. However, none of these studies used a Sulfonylurea (SU), although in UKPDS, SUs delayed the progression of hyperglycemia and several subjects would have been categorized as having prediabetes by present diagnostic criteria. Thus, SUs may have delayed the progression in this group as well. Objective: Therefore, we examined comparative efficacy of glimepiride and metformin in progression to diabetes in subjects with prediabetes. Methods: Twenty men and 18 women ages 28 - 81 years with prediabetes were followed for 5 - 9 years. Prediabetes was diagnosed by impaired fasting glucose and HbA1Cbetween 5.7% - 6.4% with two consecutive determinations as recommended by American Diabetes Association. Twenty obese subjects were administered metformin 500 mg/day and 18 non obese subjects received glimepiride 0.5 mg/day, in addition to dietary and exercise counseling. Results: Mean duration of follow up was 5.8 ± 0.2 years. Fasting Plasma Glucose (FPG) and HbA1Cdeclined to <100 mg/dl and <5.7% in all subjects by 6 months. During the follow up period, 9 of 20 (45%) subjects receiving metformin and 5 of 18 (27%) in glimepiride group progressed to diabetes (p < 0.01) as determined by FPG ≥ 126 mg/dl and HbA1C≥ 6.5% (RR, 1.61 with Confidence Interval, 1.43 - 1.74 for metformin vs glimepiride;p < 0.01). The mean duration to progression was 32 ± 4 months in metformin group and 47 ± 5 months in subjects receiving glimepiride. FPG and HbA1clevels promptly returned to <100 mg/dl and <5.7% on increasing daily dose of both metformin (1000 - 1500 mg) and glimepiride (2 - 4 mg). The glycemic control was maintained till the end of observation period. None of the subjects in either group manifested a cardiovascular event nor any of the subjects died during the period of observation. Conclusion: Glimepiride may be more effective in delaying the progression of prediabetes to diabetes in non-obese subjects in comparison to metformin in obese subjects with no significant difference in cardiovascular morbidity or overall mortality.展开更多
[Objectives]To study the clinical effect of Zishenwan on elderly patients with prediabetes based on the method of Sweet-Bitter Therapeutic.[Methods]Total 64 elderly patients with prediabetes in Suzhou TCM Hospital Aff...[Objectives]To study the clinical effect of Zishenwan on elderly patients with prediabetes based on the method of Sweet-Bitter Therapeutic.[Methods]Total 64 elderly patients with prediabetes in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine from April,2020 to July,2021 were randomly divided into control group(32 cases)and Zishenwan group(32 cases).The control group received basic treatment(diet control and regular luck exercise),while the Zishenwan group was treated with Zishenwan on the basic treatment.[Results]The results of intragroup comparisons after treatment show that both of the groups improved plasma glucose,insulin,plasma lipid metabolism and other related indexes.The results of inter-group comparisons were as follows.(i)The FPG and 2hPG of the Zishenwan group were significantly lower than the control group(P<0.05).(ii)The FINS and HOMA-IR of the Zishenwan group were significantly lower than the control group(P<0.05).(iii)The LDL-C of the Zishenwan group were significantly lower than the control group(P<0.05).(iv)The ADP,hs-CRP,and GLP-1 of the Zishenwan group were significantly improved compared to those of the control group(P<0.05).Although there was no significant difference in other indicators,the improvement trend is better than that of the control group.[Conclusions]Zishenwan can further improve plasma glucose level of the elderly patients with prediabetes on the basis of basic treatment,and to a certain extent,reduce the plasma glucose to normal,which is beneficial to the benign outcome of the elderly patients with prediabetes.In addition,it can improve insulin secretion and reduce insulin resistance,which provides a basis for the disease control of elderly patients with prediabetes.It can also improve the lipid metabolism of elderly patients with prediabetes,and the effect on LDL-C is significant.It is speculated that its mechanism may be closely related to the changes of ADP,hs-CRP and GLP-1 in the body of elderly patients with prediabetes.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)has high morbidity and mortality worldwide,therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness.A s...BACKGROUND Type 2 diabetes mellitus(T2DM)has high morbidity and mortality worldwide,therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness.A strong correlation between severity of metabolic syndrome(MetS)and HbA1c,fasting insulin and insulin resistance has been reported.Accordingly,the MetS severity score(or MestS Zscore)can potentially be used to predict the risk of T2DM progression over time.AIM To evaluate the association the of MestS Z-score in first degree relatives(FDRs)of T2DM with the risk of prediabetes and type 2 diabetes in future.METHODS A prospective open cohort study was conducted between 2003-2018.At baseline,the sample comprised of 1766 FDRs of patients with T2DM who had a normal glucose tolerance test.Relative risk(RR)and 95%confidence interval were calculated based on logistic regression.The receiver-operator characteristic analysis and area under the curve based on MetS Z-score were used to evaluate the risk of prediabetes and diabetes among the FDR population.RESULTS Baseline MetS Z-scores were associated with the its latest values(P<0.0001).Compared with individuals who were T2DM free at the end of follow up,those who developed T2DM had higher MetS Z-score at baseline(P<0.001).In multivariable logistic regression analyses for every unit elevation in MetS Z-score at the baseline,the RR for developing future T2DM and prediabetes was(RR=1.94,RR=3.84),(RR=1.5,RR=2.17)in total population and female group,respectively(P<0.05).The associations remained significant after adjusting the potential confounding variables.A cut off value of 0.97 and 0.94 was defined in the receiver-operator characteristic curve based on the MetS Z-score for differentiating female patients with diabetes and prediabetes from the normal population,respectively.CONCLUSION The MetS Z-score was associated with an increased risk of future T2DM.Appropriate interventions at earlier stages for preventing and attenuating MetS effects may be considered as an effective strategy for FDR as at-risk population.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;">Visceral adiposity mediates insulin resistance, but their association among adults with prediabetes is scarce in the...<div style="text-align:justify;"> <span style="font-family:Verdana;">Visceral adiposity mediates insulin resistance, but their association among adults with prediabetes is scarce in the literature. This study is aimed to determine the association of visceral adiposity index (VAI) with insulin resistance in adults with prediabetes. This cross-sectional study was done among 117 adults with newly detected prediabetes [m/f;23/94;mean ± SD: Age 36.30 ± 9.99 years, BMI 28.89 ± 4.35 kg/m<sup>2</sup>] based on American Diabetes Association 2018 criteria and 141 matched healthy controls [m/f: 28/113;mean ± SD: 35.30 ± 6.88 years, BMI 25.03 ± 4.58]. Waist circumference, body mass index, fasting triglyceride, HDL cholesterol, fasting blood glucose and insulin were measured in each group to calculate VAI and homeostatic model assessment of insulin resistance (HOMA-IR). People with prediabetes had significantly higher median value of VAI {3.08 (2.26) vs. 1.86 (2.31);p < 0.001} with higher frequency of high VAI (>1) (98.3% vs. 85.8%;p < 0.001) than the control population. HOMA-IR level was significantly higher in prediabetes with high VAI (cut-off of 2.64) than control with normal VAI [2.78 (2.22, 4.15) vs. 2.20 (1.53, 3.36);p = 0.002]. VAI was positively correlated with HOMA-IR in females with prediabetes (r = 0.299, p = 0.003). VAI had predictive association with prediabetes [OR (95% CI: 9.504 (2.173, 41.576);p = 0.03] and high insulin resistance (HOMA-IR ≥ 2.6) in females with prediabetes [OR (95% CI) = 3.50 (1.476, 8.297);p = 0.004] only. It could satisfactorily discriminate prediabetes in both sexes (male: AUC = 0.767, p = 0.001;female: AUC = 0.641, p < 0.001) and high insulin resistance in females with prediabetes (AUC = 0.641;p = 0.019) only. So, VAI was associated with prediabetes and insulin resistance only in females with prediabetes.</span> </div>展开更多
Background and Objective Prediabetes(Pre-DM)is a serious condition that is associated with an increase in cardiovascular morbidity and mortality.We sought to explore the prevalence of prediabetes in patients admitted ...Background and Objective Prediabetes(Pre-DM)is a serious condition that is associated with an increase in cardiovascular morbidity and mortality.We sought to explore the prevalence of prediabetes in patients admitted with coronary artery disease who were not known to have diabetes and to determine the impact of prediabetes on 2-year clinical outcomes versus non-diabetic patients.展开更多
BACKGROUND Prediabetes risk assessment models derived from large sample sizes are scarce.AIM To establish a robust assessment model for prediabetes and to validate the model in different populations.METHODS The China ...BACKGROUND Prediabetes risk assessment models derived from large sample sizes are scarce.AIM To establish a robust assessment model for prediabetes and to validate the model in different populations.METHODS The China National Diabetes and Metabolic Disorders Study(CNDMDS)collected information from 47325 participants aged at least 20 years across China from 2007 to 2008.The Thyroid Disorders,Iodine Status and Diabetes Epidemiological Survey(TIDE)study collected data from 66108 participants aged at least 18 years across China from 2015 to 2017.A logistic model with stepwise selection was performed to identify significant risk factors for prediabetes and was internally validated by bootstrapping in the CNDMDS.External validations were performed in diverse populations,including populations of Hispanic(Mexican American,other Hispanic)and non-Hispanic(White,Black and Asian)participants in the National Health and Nutrition Examination Survey(NHANES)in the United States and 66108 participants in the TIDE study in China.C statistics and calibration plots were adopted to evaluate the model’s discrimination and calibration performance.RESULTS A set of easily measured indicators(age,education,family history of diabetes,waist circumference,body mass index,and systolic blood pressure)were selected as significant risk factors.A risk assessment model was established for prediabetes with a C statistic of 0.6998(95%CI:0.6933 to 0.7063)and a calibration slope of 1.0002.When externally validated in the NHANES and TIDE studies,the model showed increased C statistics in Mexican American,other Hispanic,Non-Hispanic Black,Asian and Chinese populations but a slightly decreased C statistic in non-Hispanic White individuals.Applying the risk assessment model to the TIDE population,we obtained a C statistic of 0.7308(95%CI:0.7260 to 0.7357)and a calibration slope of 1.1137.A risk score was derived to assess prediabetes.Individuals with scores≥7 points were at high risk of prediabetes,with a sensitivity of 60.19%and specificity of 67.59%.CONCLUSION An easy-to-use assessment model for prediabetes was established and was internally and externally validated in different populations.The model had a satisfactory performance and could screen individuals with a high risk of prediabetes.展开更多
Background:Measuring glycosylated hemoglobin(HbA1c)is a simple way to assess patients with prediabetes or diabetes mellitus.It has been shown that HbA1c level predicts prognosis in patients with coronary artery diseas...Background:Measuring glycosylated hemoglobin(HbA1c)is a simple way to assess patients with prediabetes or diabetes mellitus.It has been shown that HbA1c level predicts prognosis in patients with coronary artery disease(CAD)and the incidence of diabetes mellitus.However,the prognostic significance of HbA1c level in Asian patients with prediabetes and CAD is not yet clear.Our study aimed to determine the relationship between HbA1c level and major adverse cardiovascular events(MACE)in patients with prediabetes and CAD.Methods:We enrolled 1367 patients with prediabetes and CAD in the final analysis,and grouped them according to the HbA1c level.Primary end points included nonfatal myocardial infarction,hospitalization for unstable angina,and ischemia-driven revascularization.Cox proportional-hazards regression analysis was used to determine the relation-ship between HbA1c level and MACE after our accounting for confounding factors.Results:A total of 1367 patients(age 58.8±10.3 years;71.6%men)were included.During 43 months of follow-up,197 patients experienced at least one primary end point event.Multivariate Cox proportional-hazards regression analy-sis showed in comparison of HbA1c levels that the hazard ratio for primary end points was 4.110,with a 95%confidence interval of 2.097-6.011(P<0.001).Conclusions:HbA1c level positively correlated with MACE,demonstrating it is a valuable indicator for indepen-dently predicting MACE in Asian patients with prediabetes and CAD.展开更多
Objective: The article will review the associations between Prediabetes (PD) and Polycystic Ovarian Syndrome (PCOS) and present factors that decrease the progression of PD into type 2 diabetes mellitus (T2DM).Metformi...Objective: The article will review the associations between Prediabetes (PD) and Polycystic Ovarian Syndrome (PCOS) and present factors that decrease the progression of PD into type 2 diabetes mellitus (T2DM).Metformin will also be examined for its role in ovulation induction, pregnancy and ameliorating the metabolic syndrome. Study Design: Medline search. Methods of study: Keyword search: Prediabetes (PD), Polycystic Ovarian Syndrome (PCOS), Metformin, Glucose Tolerance Test (GTT), Type 2 Diabetes Mellitus. Results: As the most common endocrinopathy during the reproductive years, PCOS has a genetic multifactorial inheritance and is associated with a high risk of insulin resistance. The use of metformin has shown mixed results in this patient population as a therapy to improve ovulation function and the metabolic syndrome and showed no definitive reduction in the rate of miscarriage. PCOS patients are significantly predisposed to PD and T2DM. Conclusion: Lifestyle changes such as weight loss and physical activity reduce the progression of PD into T2DM in PCOS patients. The new AACE and ADA guidelines establish simplified methods of screening and treating PD. The role of metformin remains undefined in the infertile PCOS patient.展开更多
文摘BACKGROUND Cardiovascular disease(CVD)is a leading cause of morbidity and mortality worldwide,the global burden of which is rising.It is still unclear the extent to which prediabetes contributes to the risk of CVD in various age brackets among adults.To develop a focused screening plan and treatment for Chinese adults with prediabetes,it is crucial to identify variations in the connection between prediabetes and the risk of CVD based on age.AIM To examine the clinical features of prediabetes and identify risk factors for CVD in different age groups in China.METHODS The cross-sectional study involved a total of 46239 participants from June 2007 through May 2008.A thorough evaluation was conducted.Individuals with prediabetes were categorized into two groups based on age.Chinese atherosclerotic CVD risk prediction model was employed to evaluate the risk of developing CVD over 10 years.Random forest was established in both age groups.SHapley Additive exPlanation method prioritized the importance of features from the perspective of assessment contribution.RESULTS In total,6948 people were diagnosed with prediabetes in this study.In prediabetes,prevalences of CVD were 5(0.29%)in the younger group and 148(2.85%)in the older group.Overall,11.11%of the younger group and 29.59% of the older group were intermediate/high-risk of CVD for prediabetes without CVD based on the Prediction for ASCVD Risk in China equation in ten years.In the younger age group,the 10-year risk of CVD was found to be more closely linked to family history of CVD rather than lifestyle,whereas in the older age group,resident status was more closely linked.CONCLUSION The susceptibility to CVD is age-specific in newly diagnosed prediabetes.It is necessary to develop targeted approaches for the prevention and management of CVD in adults across various age brackets.
文摘BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.
基金Supported by National Natural Science Foundation of China,No.31770948,No.31570875,and No.81803547Natural Science Foundation of Fujian Province,No.2021J01204and Fujian Provincial Regional Development Project,No.2021N3005.
文摘Diabetes,one of the world's top ten diseases,is known for its high mortality and complication rates and low cure rate.Prediabetes precedes the onset of diabetes,during which effective treatment can reduce diabetes risk.Prediabetes risk factors include high-calorie and high-fat diets,sedentary lifestyles,and stress.Consequences may include considerable damage to vital organs,including the retina,liver,and kidneys.Interventions for treating prediabetes include a healthy lifestyle diet and pharmacological treatments.However,while these options are effective in the short term,they may fail due to the difficulty of long-term implementation.Medications may also be used to treat prediabetes.This review examines prediabetic treatments,particularly metformin,glucagon-like peptide-1 receptor agonists,sodium glucose cotransporter 2 inhibitors,vitamin D,and herbal medicines.Given the remarkable impact of prediabetes on the progression of diabetes mellitus,it is crucial to intervene promptly and effectively to regulate prediabetes.However,the current body of research on prediabetes is limited,and there is considerable confusion surrounding clinically relevant medications.This paper aims to provide a comprehensive summary of the pathogenesis of prediabetes mellitus and its associated therapeutic drugs.The ultimate goal is to facilitate the clinical utilization of medications and achieve efficient and timely control of diabetes mellitus.
基金The study was reviewed and approved by The First People’s Hospital of Wenling City(Approval No.KY-2019-1024-01).
文摘BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention.The weight change in patients with prediabetes has not attracted much attention.AIM To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.METHODS We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance(NGT),and collected clinical data and follow-up results of all patients.Based on natural blood glucose outcomes,we classified 66 patients with progression to T2DM into the disease progression(DP)group,and 170 patients without progression to T2DM into the disease outcome(DO)group.We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression.A general linear model(univariate)was used to analyze the interaction between body weight and independent influencing factors.RESULTS There were 98 cases of impaired fasting glucose(IFG),90 cases of impaired glucose tolerance(IGT),and 48 cases of coexistent IFG and IGT.The body weight,waist circumference,body mass index,fasting blood glucose,and 2 h plasma glucose of patients with IFG,IGT,and coexistent IFG and IGT were higher than those in patients with NGT(P<0.05).Logistic regression analysis showed that body weight,glycosylated hemoglobin,uric acid,fasting insulin,and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905[95%confidence interval(CI):0.863-0.948],which was greater than that predicted by each indicator alone.Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1,the odds ratio(95%CI)of body weight 3 was 1.399(1.142-2.126)(P=0.033).There was a multiplicative interaction between body weight and uric acid(β=1.953,P=0.005).CONCLUSION High body weight in patients with prediabetes is an independent risk factor for progression to T2DM,and the risk of progression is increased when coexisting with high uric acid level.
文摘Prediabetes,the precursor of type 2 diabetes mellitus,is an intermediate stage between normal glucose homeostasis and overt diabetes.This asymptomatic metabolic state is increasingly prevalent in pediatric population and is very difficult to detect without appropriate screening.Studies have shown that a certain proportion of children with prediabetes will develop diabetes in a few years.Even more alarming is the evidence that youth-onset diabetes has a more aggressive clinical course with progressive beta-cell decline and accelerated endorgan damage.Despite its importance,several aspects involving prediabetes in childhood are disputed or unknown.This review presents the latest insights into this challenging entity and outlines a simplified screening approach to aid clinical practice.In summary,childhood prediabetes is an important clinical condition indicating the need for proper screening and timely intervention.
文摘Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. While, the diagnostic criteria of prediabetes are not uniform across various international professional organizations, it remains a state of high risk for developing diabetes with yearly conversion rate of 5%-10%. Observational evidence suggests as association between prediabetes and complications of diabetes such early nephropathy, small fiber neuropathy, early retinopathy and risk of macrovascular disease. Several studies have shown efficacy of lifestyle interventions with regards to diabetes prevention with a relative risk reduction of 40%-70% in adults with prediabetes. While there is increasing evidence to prove the efficacy of pharmacotherapy in prevention of diabetes in adults with prediabetes, pharmaceutical treatment options other than metformin are associated with adverse effects that limit their use for prediabetes. There are no reports of systematic evaluation of health outcomes related to prediabetes in children. The effects of pharmacotherapy of prediabetes on growth and pubertal development in children remains unknown. Secondary intervention with pharmacotherapy with metformin is advocated for high-risk individuals but criteria for such consideration benefit of early intervention, long term cost effectiveness of such interventions and the end point of therapy remain unclear. Pharmacotherapy must be used with caution in children with prediabetes. Prediabetes is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It is considered to be an at risk state, with high chances of developing diabetes. While, prediabetes is commonly an asymptomatic condition, there is always presence of prediabetes before the onset of diabetes. The elevation of blood sugar is a continuum and hence prediabetes can not be considered an entirely benign condition. This aim of this review is to describe the challenges associated with diagnosis of prediabetes, the possible adverse medical outcomes associated with prediabetes and the treatment options and rationale for their use in context of prediabetes.
文摘Progression of normal glucose tolerance(NGT) to overt diabetes is mediated by a transition state called impaired glucose tolerance(IGT). Beta cell dysfunction and insulin resistance are the main defects in type 2 diabetes mellitus(type 2 DM) and even normoglycemic IGT patients manifest these defects. Beta cell dysfunction and insulin resistance also contribute to the progression of IGT to type 2 DM. Improving insulin sensitivity and/or preserving functions of beta-cells can be a rational way to normalize the GT and to control transition of IGT to type 2 DM. Loosing weight, for example, improves whole body insulin sensitivity and preserves beta-cell function and its inhibitory effect on progression of IGT to type 2 DM had been proven. But interventions aiming weight loss usually not applicable in real life. Pharmacotherapy is another option to gain better insulin sensitivity and to maintain beta-cell function. In this review, two potential treatment options(lifestyle modification and pharmacologic agents) that limits the IGT-type 2 DM conversion in prediabetic subjects are discussed.
文摘AIM To determine the predictive role of body mass index(BMI) and waist circumference(WC) for diabetes and prediabetes risk in future in total sample as well as in men and women separately. METHODS In a population based cohort study, 1765 with mean ± SD age: 42.32 ± 6.18 healthy participants were followed up from 2003 till 2013(n = 960). Anthropometric and biochemical measures of participants were evaluated regularly during the follow up period. BMI and WC measures at baseline and diabetes and prediabetes status of participants at 2013 were determined. Multivariable logistic regression analysis was used for determining the risk of diabetes and prediabetes considering important potential confounding variables. Receiver operatingcharacteristic curve analysis was conducted to determine the best cut of values of BMI and WC for diabetes and prediabetes. RESULTS At 2013, among participants who had complete data, 45 and 307 people were diabetic and prediabetic, respectively. In final fully adjusted model, BMI value was a significant predictor of diabetes(RR = 1.39, 95%CI: 1.06-1.82 and AUC = 0.68, 95%CI: 0.59-0.75; P < 0.001) however not a significant risk factor for prediabetes. Also, WC was a significant predictor for diabetes(RR = 1.2, 95%CI: 1.05-1.38 and AUC = 0.67, 95%CI: 0.6-0.75) but not significant risk factor for prediabetes. Similar results were observed in both genders.CONCLUSION General and abdominal obesity are significant risk factors for diabetes in future.
基金supported by the Project of Employees Health Status and Disease Burden Trend Study in Jinchuan Nonferrous Metals Corporation,Grant JKB20120013Fogarty training grants D43TW 008323 and D43TW 007864-01 from the US National Institutes of Health
文摘Objective To study the association between metal exposure and risk of diabetes and prediabetes among Chinese workers exposed to metals.Methods We used data obtained from the baseline survey of the Jinchang Cohort Study of workers in Jinchang Industry,the largest nickel production company in China.A total of 42,122 workers ≥20 years of age were included in the study.A standardized,structured questionnaire was used to collect epidemiological information.Physical examinations and laboratory tests were conducted to evaluate the health status of the participants and to measure various biomarkers including blood sugar,lipids,and urinary metal concentrations.Logistic regression was used to study the association between occupational groups categorized according to the measured metal levels(office workers,low-level;mining/production workers,mid-level;and smelting/refining workers,high-level)and risk of diabetes and prediabetes.Results The overall prevalence of diabetes and prediabetes was 7.5% and 16.8%,respectively.The adjusted odds ratios for diabetes among mining/production workers and smelting/refining workers compared to office workers were 1.5(95% CI:1.3,1.7)and 3.8(95% CI:3.4,4.3),respectively.No association was observed between these occupational groups and prediabetes in this study.Conclusion Occupations associated with higher levels of metal exposure were associated with an increased risk of diabetes in this cohort.More studies are needed to confirm this observed association.
文摘BACKGROUND The risk of developing prediabetes based on the metabolic/obesity phenotypes has been poorly investigated. AIM To examine the association of baseline metabolic/obesity phenotypes and their changes over time with the risk of prediabetes development. METHODS In a population-based cohort study, 1741 adults (aged > 19 years) with normal blood glucose were followed for 14 years. Anthropometric and biochemical measures were evaluated regularly during the follow-up period. According to body mass index and metabolic health status, participants were categorized into four groups: Metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Multivariable Cox regression analysis was used to measure the risk of prediabetes according to the baseline metabolic/obesity phenotype and their changes during the follow-up. RESULTS In the whole population with a mean (95CCI for mean) follow up duration of 12.7 years (12.6-12.9), all three MUNW, MHO, MUO groups were at higher risk for developing prediabetes compared to the MHNW group (P = 0.022). The MUNW group had the highest risk for developing prediabetes (hazard ratio (HR): 3.84, 95%CI: 1.20, 12.27). In stratified analysis by sex, no significant association was found in men, while women in the MUNW group were at the greatest risk for prediabetes (HR: 6.74, 95%CI: 1.53, 29.66). Transforming from each phenotype to MHNW or MHO was not related to the risk of prediabetes development, whereas transforming from each phenotype to MUO was associated with an increased risk of prediabetes (HR > 1;P < 0.05). CONCLUSION Our findings indicate that MHO is not a high risk, unless it transforms into MUO over time. However, people in the MUNW group have the greatest risk for developing prediabetes, and therefore, they should be screened and treated.
文摘Bone fragility has been recognized as a complication of diabetes,both type 1 diabetes (T1D) and type 2 diabetes (T2D),whereas the relationship between prediabetes and fracture risk is less clear.Fractures can deeply impact a diabetic patient’s quality of life.However,the mechanisms underlying bone fragility in diabetes are complex and have not been fully elucidated.Patients with T1D generally exhibit low bone mineral density (BMD),although the relatively small reduction in BMD does not entirely explain the increase in fracture risk.On the contrary,patients with T2D or prediabetes have normal or even higher BMD as compared with healthy subjects.These observations suggest that factors other than bone mass may influence fracture risk.Some of these factors have been identified,including disease duration,poor glycemic control,presence of diabetes complications,and certain antidiabetic drugs.Nevertheless,currently available tools for the prediction of risk inadequately capture diabetic patients at increased risk of fracture.Aim of this review is to provide a comprehensive overview of bone health and the mechanisms responsible for increased susceptibility to fracture across the spectrum of glycemic status,spanning from insulin resistance to overt forms of diabetes.The management of bone fragility in diabetic patient is also discussed.
文摘Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is more common in diabetic patients. There are limited studies on clinical, biochemical and histological features of NAFLD patients who are diabetic. The aim of the study was to determine the prevalence of diabetes and prediabetes in a cohort of NAFLD patients and to compare anthropometry, biochemical and metabolic parameters and hepatic histology of diabetic NAFLD patients with non-diabetic NAFLD patients. Methods: 515 consecutive NAFLD patients diagnosed by abdominal ultrasound and 100 healthy controls were subjected to detailed anthropometric measurements and biochemical assays including blood sugars, LFT, lipid profile and HOMA. Diabetes and prediabetes were defined according to WHO criteria. Patients were categorized and compared according to the presence or absence of diabetes. Liver biopsy was performed in 240 NAFLD patients and the liver histology was also compared between the two groups. Statistical analysis was performed on SPSS 16. Results: 124 out of the 515 (24.08%) NAFLD patients were diabetics, 118 out of 515 (22.9%) were pre-diabetics, while only 3 out of 100 controls had impaired glucose tolerance. Diabetic patients were older. NAFLD patients with diabetes had significantly higher waist circumference [98.02 ± 12.01 vs 93.89 ± 8.8, p = 0.000] as compared to the NAFLD patients without diabetes. Fasting blood sugar [124 ± 46.3 vs 90.8 ± 10.2, p = 0.000], triglyceride level [218.4 ± 17.6 vs 192 ± 9, p = 0.03] and HOMA-IR [2.6 ± 0.36 vs 1.84 ± 0.2, p < 0.001] were significantly higher in NAFLD-diabetes group. Hypertension [35% vs 11.7%, p = 0.000] was commoner in diabetic NAFLD patients. Histopathology in the diabetic patients revealed steatosis alone in 34.2% cases, borderline NASH in 31.4% and definite NASH in 34.2%. Fatty change alone was noted in 16.5% cases, borderline NASH in 34.1%, while 49% had definite NASH on liver biopsy of NAFLD patients without diabetes. Fibrosis was noted in 31.4% in diabetic and 27% in non-diabetic patients. IR alone had a linear correlation with necroinflammatory activity. Conclusion: The prevalence of diabetes and prediabetes is six times more in NAFLD patients than in healthy controls. NAFLD patients with diabetes have higher metabolic risk factors such as large waistline, hypertension, high triglyceride levels and increased insulin resistance. Diabetes or pre diabetes patients per se do not have histologically severe disease, rather insulin resistance play an important role in increasing the severity of the disease.
文摘Background: Several recent studies have shown that treatment with therapeutic lifestyle changes, and/or several drugs retard progression of prediabetes to type 2 diabetes. However, none of these studies used a Sulfonylurea (SU), although in UKPDS, SUs delayed the progression of hyperglycemia and several subjects would have been categorized as having prediabetes by present diagnostic criteria. Thus, SUs may have delayed the progression in this group as well. Objective: Therefore, we examined comparative efficacy of glimepiride and metformin in progression to diabetes in subjects with prediabetes. Methods: Twenty men and 18 women ages 28 - 81 years with prediabetes were followed for 5 - 9 years. Prediabetes was diagnosed by impaired fasting glucose and HbA1Cbetween 5.7% - 6.4% with two consecutive determinations as recommended by American Diabetes Association. Twenty obese subjects were administered metformin 500 mg/day and 18 non obese subjects received glimepiride 0.5 mg/day, in addition to dietary and exercise counseling. Results: Mean duration of follow up was 5.8 ± 0.2 years. Fasting Plasma Glucose (FPG) and HbA1Cdeclined to <100 mg/dl and <5.7% in all subjects by 6 months. During the follow up period, 9 of 20 (45%) subjects receiving metformin and 5 of 18 (27%) in glimepiride group progressed to diabetes (p < 0.01) as determined by FPG ≥ 126 mg/dl and HbA1C≥ 6.5% (RR, 1.61 with Confidence Interval, 1.43 - 1.74 for metformin vs glimepiride;p < 0.01). The mean duration to progression was 32 ± 4 months in metformin group and 47 ± 5 months in subjects receiving glimepiride. FPG and HbA1clevels promptly returned to <100 mg/dl and <5.7% on increasing daily dose of both metformin (1000 - 1500 mg) and glimepiride (2 - 4 mg). The glycemic control was maintained till the end of observation period. None of the subjects in either group manifested a cardiovascular event nor any of the subjects died during the period of observation. Conclusion: Glimepiride may be more effective in delaying the progression of prediabetes to diabetes in non-obese subjects in comparison to metformin in obese subjects with no significant difference in cardiovascular morbidity or overall mortality.
基金Supported by Jiangsu Provincial Health Commission of China(M2021094)Youth Medical Talents Project of Jiangsu Province(QNRC2016252)Suzhou Science and Technology Development Plan:Key Technology Project of Medical and Health Technology Innovation(SKY2021058).
文摘[Objectives]To study the clinical effect of Zishenwan on elderly patients with prediabetes based on the method of Sweet-Bitter Therapeutic.[Methods]Total 64 elderly patients with prediabetes in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine from April,2020 to July,2021 were randomly divided into control group(32 cases)and Zishenwan group(32 cases).The control group received basic treatment(diet control and regular luck exercise),while the Zishenwan group was treated with Zishenwan on the basic treatment.[Results]The results of intragroup comparisons after treatment show that both of the groups improved plasma glucose,insulin,plasma lipid metabolism and other related indexes.The results of inter-group comparisons were as follows.(i)The FPG and 2hPG of the Zishenwan group were significantly lower than the control group(P<0.05).(ii)The FINS and HOMA-IR of the Zishenwan group were significantly lower than the control group(P<0.05).(iii)The LDL-C of the Zishenwan group were significantly lower than the control group(P<0.05).(iv)The ADP,hs-CRP,and GLP-1 of the Zishenwan group were significantly improved compared to those of the control group(P<0.05).Although there was no significant difference in other indicators,the improvement trend is better than that of the control group.[Conclusions]Zishenwan can further improve plasma glucose level of the elderly patients with prediabetes on the basis of basic treatment,and to a certain extent,reduce the plasma glucose to normal,which is beneficial to the benign outcome of the elderly patients with prediabetes.In addition,it can improve insulin secretion and reduce insulin resistance,which provides a basis for the disease control of elderly patients with prediabetes.It can also improve the lipid metabolism of elderly patients with prediabetes,and the effect on LDL-C is significant.It is speculated that its mechanism may be closely related to the changes of ADP,hs-CRP and GLP-1 in the body of elderly patients with prediabetes.
基金Supported by Isfahan Endocrine and Metabolism Research Center,No. 95017.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)has high morbidity and mortality worldwide,therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness.A strong correlation between severity of metabolic syndrome(MetS)and HbA1c,fasting insulin and insulin resistance has been reported.Accordingly,the MetS severity score(or MestS Zscore)can potentially be used to predict the risk of T2DM progression over time.AIM To evaluate the association the of MestS Z-score in first degree relatives(FDRs)of T2DM with the risk of prediabetes and type 2 diabetes in future.METHODS A prospective open cohort study was conducted between 2003-2018.At baseline,the sample comprised of 1766 FDRs of patients with T2DM who had a normal glucose tolerance test.Relative risk(RR)and 95%confidence interval were calculated based on logistic regression.The receiver-operator characteristic analysis and area under the curve based on MetS Z-score were used to evaluate the risk of prediabetes and diabetes among the FDR population.RESULTS Baseline MetS Z-scores were associated with the its latest values(P<0.0001).Compared with individuals who were T2DM free at the end of follow up,those who developed T2DM had higher MetS Z-score at baseline(P<0.001).In multivariable logistic regression analyses for every unit elevation in MetS Z-score at the baseline,the RR for developing future T2DM and prediabetes was(RR=1.94,RR=3.84),(RR=1.5,RR=2.17)in total population and female group,respectively(P<0.05).The associations remained significant after adjusting the potential confounding variables.A cut off value of 0.97 and 0.94 was defined in the receiver-operator characteristic curve based on the MetS Z-score for differentiating female patients with diabetes and prediabetes from the normal population,respectively.CONCLUSION The MetS Z-score was associated with an increased risk of future T2DM.Appropriate interventions at earlier stages for preventing and attenuating MetS effects may be considered as an effective strategy for FDR as at-risk population.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;">Visceral adiposity mediates insulin resistance, but their association among adults with prediabetes is scarce in the literature. This study is aimed to determine the association of visceral adiposity index (VAI) with insulin resistance in adults with prediabetes. This cross-sectional study was done among 117 adults with newly detected prediabetes [m/f;23/94;mean ± SD: Age 36.30 ± 9.99 years, BMI 28.89 ± 4.35 kg/m<sup>2</sup>] based on American Diabetes Association 2018 criteria and 141 matched healthy controls [m/f: 28/113;mean ± SD: 35.30 ± 6.88 years, BMI 25.03 ± 4.58]. Waist circumference, body mass index, fasting triglyceride, HDL cholesterol, fasting blood glucose and insulin were measured in each group to calculate VAI and homeostatic model assessment of insulin resistance (HOMA-IR). People with prediabetes had significantly higher median value of VAI {3.08 (2.26) vs. 1.86 (2.31);p < 0.001} with higher frequency of high VAI (>1) (98.3% vs. 85.8%;p < 0.001) than the control population. HOMA-IR level was significantly higher in prediabetes with high VAI (cut-off of 2.64) than control with normal VAI [2.78 (2.22, 4.15) vs. 2.20 (1.53, 3.36);p = 0.002]. VAI was positively correlated with HOMA-IR in females with prediabetes (r = 0.299, p = 0.003). VAI had predictive association with prediabetes [OR (95% CI: 9.504 (2.173, 41.576);p = 0.03] and high insulin resistance (HOMA-IR ≥ 2.6) in females with prediabetes [OR (95% CI) = 3.50 (1.476, 8.297);p = 0.004] only. It could satisfactorily discriminate prediabetes in both sexes (male: AUC = 0.767, p = 0.001;female: AUC = 0.641, p < 0.001) and high insulin resistance in females with prediabetes (AUC = 0.641;p = 0.019) only. So, VAI was associated with prediabetes and insulin resistance only in females with prediabetes.</span> </div>
文摘Background and Objective Prediabetes(Pre-DM)is a serious condition that is associated with an increase in cardiovascular morbidity and mortality.We sought to explore the prevalence of prediabetes in patients admitted with coronary artery disease who were not known to have diabetes and to determine the impact of prediabetes on 2-year clinical outcomes versus non-diabetic patients.
基金Supported by the National Key Research and Development Program of China,No.2018YFC1313902。
文摘BACKGROUND Prediabetes risk assessment models derived from large sample sizes are scarce.AIM To establish a robust assessment model for prediabetes and to validate the model in different populations.METHODS The China National Diabetes and Metabolic Disorders Study(CNDMDS)collected information from 47325 participants aged at least 20 years across China from 2007 to 2008.The Thyroid Disorders,Iodine Status and Diabetes Epidemiological Survey(TIDE)study collected data from 66108 participants aged at least 18 years across China from 2015 to 2017.A logistic model with stepwise selection was performed to identify significant risk factors for prediabetes and was internally validated by bootstrapping in the CNDMDS.External validations were performed in diverse populations,including populations of Hispanic(Mexican American,other Hispanic)and non-Hispanic(White,Black and Asian)participants in the National Health and Nutrition Examination Survey(NHANES)in the United States and 66108 participants in the TIDE study in China.C statistics and calibration plots were adopted to evaluate the model’s discrimination and calibration performance.RESULTS A set of easily measured indicators(age,education,family history of diabetes,waist circumference,body mass index,and systolic blood pressure)were selected as significant risk factors.A risk assessment model was established for prediabetes with a C statistic of 0.6998(95%CI:0.6933 to 0.7063)and a calibration slope of 1.0002.When externally validated in the NHANES and TIDE studies,the model showed increased C statistics in Mexican American,other Hispanic,Non-Hispanic Black,Asian and Chinese populations but a slightly decreased C statistic in non-Hispanic White individuals.Applying the risk assessment model to the TIDE population,we obtained a C statistic of 0.7308(95%CI:0.7260 to 0.7357)and a calibration slope of 1.1137.A risk score was derived to assess prediabetes.Individuals with scores≥7 points were at high risk of prediabetes,with a sensitivity of 60.19%and specificity of 67.59%.CONCLUSION An easy-to-use assessment model for prediabetes was established and was internally and externally validated in different populations.The model had a satisfactory performance and could screen individuals with a high risk of prediabetes.
基金supported by grants from the Natural Science Foundation of Beijing,China(grant no.7214223)to Qianyun Guo.Yujie Zhou was supported by the National Key Research and Development Program of China(grant no.2017YFC0908800)+1 种基金Beijing Municipal Health Commission(grant nos.PXM2020_026272_000002,PXM2020_026272_000005,and PXM 2020_026272_000014)the Natural Science Foundation of Beijing,China(grant no.7212027).
文摘Background:Measuring glycosylated hemoglobin(HbA1c)is a simple way to assess patients with prediabetes or diabetes mellitus.It has been shown that HbA1c level predicts prognosis in patients with coronary artery disease(CAD)and the incidence of diabetes mellitus.However,the prognostic significance of HbA1c level in Asian patients with prediabetes and CAD is not yet clear.Our study aimed to determine the relationship between HbA1c level and major adverse cardiovascular events(MACE)in patients with prediabetes and CAD.Methods:We enrolled 1367 patients with prediabetes and CAD in the final analysis,and grouped them according to the HbA1c level.Primary end points included nonfatal myocardial infarction,hospitalization for unstable angina,and ischemia-driven revascularization.Cox proportional-hazards regression analysis was used to determine the relation-ship between HbA1c level and MACE after our accounting for confounding factors.Results:A total of 1367 patients(age 58.8±10.3 years;71.6%men)were included.During 43 months of follow-up,197 patients experienced at least one primary end point event.Multivariate Cox proportional-hazards regression analy-sis showed in comparison of HbA1c levels that the hazard ratio for primary end points was 4.110,with a 95%confidence interval of 2.097-6.011(P<0.001).Conclusions:HbA1c level positively correlated with MACE,demonstrating it is a valuable indicator for indepen-dently predicting MACE in Asian patients with prediabetes and CAD.
文摘Objective: The article will review the associations between Prediabetes (PD) and Polycystic Ovarian Syndrome (PCOS) and present factors that decrease the progression of PD into type 2 diabetes mellitus (T2DM).Metformin will also be examined for its role in ovulation induction, pregnancy and ameliorating the metabolic syndrome. Study Design: Medline search. Methods of study: Keyword search: Prediabetes (PD), Polycystic Ovarian Syndrome (PCOS), Metformin, Glucose Tolerance Test (GTT), Type 2 Diabetes Mellitus. Results: As the most common endocrinopathy during the reproductive years, PCOS has a genetic multifactorial inheritance and is associated with a high risk of insulin resistance. The use of metformin has shown mixed results in this patient population as a therapy to improve ovulation function and the metabolic syndrome and showed no definitive reduction in the rate of miscarriage. PCOS patients are significantly predisposed to PD and T2DM. Conclusion: Lifestyle changes such as weight loss and physical activity reduce the progression of PD into T2DM in PCOS patients. The new AACE and ADA guidelines establish simplified methods of screening and treating PD. The role of metformin remains undefined in the infertile PCOS patient.
