Family history of diabetes is associated with higher risk for prediabetes: a multicentre analysis from the German Center for Diabetes Research

Aims/hypothesis

Prediabetes is a collective term for different subphenotypes (impaired glucose tolerance [IGT] and/or impaired fasting glucose [IFG]) with different pathophysiologies. A positive family history for type 2 diabetes (FHD) is associated with increased risk for type 2 diabetes. We assumed that it would also associate with prediabetes, but wondered whether all subphenotypes are related to a positive family history.

Methods

In a study population of 8,106 non-diabetic individuals of European origin collected from four study centres (normal glucose tolerance, NGT n?=?5,482, IFG and/or IGT n?=?2,624), we analysed whether having at least one first degree relative with diabetes is associated with prediabetes. The analyses were performed using the same models in each population separately. Afterwards, a meta-analysis was performed.

Results

FHD was significantly associated with the risk for prediabetes (IFG and/or IGT, OR 1.40; 95% CI 1.27, 1.54). This association remained significant in multivariable logistic regression models including sex, age and BMI (OR 1.26; 95% CI 1.14, 1.40). When different prediabetic outcomes were considered separately, the association was found for isolated IFG (OR 1.37; 95% CI 1.20, 1.57), isolated IGT (OR 1.25; 95% CI 1.07, 1.46) as well as for the combination IFG+IGT (OR 1.64; 95% CI 1.40, 1.93). After stratification on BMI, association between FHD and prediabetes was seen only in non-obese individuals (BMI?<?30 kg/m²).

Conclusions/interpretation

We found that FHD is an important risk factor for prediabetes, especially for combined IGT and IFG. Its relevance seems to be more evident in the non-obese.     

Five-year predictive factors of type 2 diabetes in men with impaired fasting glucose

AIM: The outcome of 743 French men (age 20-60) with impaired fasting glucose (IFG) [blood glucose 6.1-6.9 mmol/l] at T1 was evaluated 5 years later, at T2. METHODS: Personal and family medical history, smoking, nutritional habits, physical activity, blood pressure, body mass index (BMI) and waist girth, fasting biological data were collected at T1 and T2. Predictive factors for developing diabetes were compared between those who returned to normal fasting glucose and those who had diabetes, before and after adjustment for age, BMI, glucose and triglyceride (TG) levels. RESULTS: At T2, 44%, 39%, 17% were classified as normal fasting plasma glucose (FPG), IFG or diabetic, respectively. Odd ratios for diabetes were 4.2 for men with a family history of diabetes (FHD), 3.4 if BMI > or = 25 kg/m(2), 2.9 if waist girth > or = 90 cm, 2.8 if TG > or = 2 mmol/l and 1.9 if no daily dairy products were eaten. Still significant after adjustment for age, BMI, glucose and TG levels were: FHD (P=0.001), no daily dairy products (P=0.001), high alcohol intake (P=0.02) and low physical activity (P = 0.02). CONCLUSION: No daily dairy products, high alcohol intake and low physical activity were independent predictive factors of a 5-year onset of diabetes after adjusting for BMI, FHD, triglyceride and glucose levels at baseline. For a better prevention of diabetes, these findings give clues for behaviour modifications as soon as IFG is detected.     

Prevalence of impaired fasting glucose and analysis of risk factors in Han adolescents

ObjectiveTo evaluate the prevalence of impaired fasting glucose (IFG) and its relationship with cardiovascular risk factors in Han adolescents aged 13 to 18 years.MethodsStep 1: A cross-sectional study was conducted on 3937 Han adolescents. IFG was defined as a fasting glucose of 5.6 to 7.0 mmol/l. Measurements included anthropometric measurements, fasting plasma glucose (FPG), and serum lipids. Step 2: We identified 60 adolescents with IFG from the IFG group using a random number table, and 60 adolescents with normal fasting glucose (NFG) were matched for age and gender with the random IFG sample. Serum true insulin (TI) was further measured.Results(1) The prevalence of IFG was 3.5% and was similar in boys and girls (3.9% vs. 3.1%, P=.177). The prevalence of IFG in adolescents with a family history of type 2 diabetes (FHD) was higher than in adolescents without FHD (6.3% vs. 2.5%, P=.000). (2) In logistic regression, the clustering of cardiovascular risk factors among adolescents with IFG was 1.889 (95% CI: 1.125–3.171, P=.016) times compared with adolescents with NFG adjusted by age and gender. (3) Multiple linear regression analysis using FPG as the dependent variable showed that waist circumference (β=0.003, P=.000) was a significant independent predictor. (4) In Step 2, the IFG group showed significantly higher levels of lnTI and lnHOMA-IR than the NFG group (P<.01). FPG was a significant independent predictor for lnTI (β=0.478, P=.000) and lnHOMA-IR (β=0.671, P=.000).ConclusionWe found a high prevalence of IFG in Han adolescents. Genetic susceptibility and abdominal obesity were the main factors causing adolescent IFG. Adolescents with IFG increased the clustering of cardiovascular risk factors.     

Associations between body mass index, cardiorespiratory fitness, metabolic syndrome, and impaired fasting glucose in young, urban native american women

Background: To investigate the baseline associations between body composition, cardiorespiratory fitness, physical activity, family history of type 2 diabetes, metabolic syndrome and impaired fasting glucose (IFG) among 200 asymptomatic urban Native American women aged 18-40 years participating in a diabetes prevention intervention. Methods: Participants without diabetes who self-identified as Native American were recruited from the general urban community into a randomized controlled trial. Inclusion criteria included not being pregnant and willingness to stay in the urban area for 2 years. From June 2002 to June 2004, baseline measures were taken and included fasting serum glucose, insulin, and lipids, body mass index (BMI), waist circumference, percent body fat, submaximal predicted cardiorespiratory fitness, and self-reported leisure physical activity and family history of type 2 diabetes. Results: Most participants were overweight or obese (mean BMI = 29.4 +/- 6.3 kg/m(2); mean percent body fat = 41.2% +/- 6.2%). Fifty-five (27.5%) had metabolic syndrome and 42 (21%) had IFG. Stepwise logistic regression indicated that BMI (odd ratio [OR] = 1.24; p < 0.001) and a family history of type 2 diabetes (OR = 4.96; p = 0.008) were significantly associated with metabolic syndrome. BMI (OR = 1.13; p = 0.003) was strongly positively associated with IFG. After adjusting for BMI, age (OR = 1.08; p = 0.021) was positively, and high-density lipoprotein cholesterol (HDL-C; OR = 0.93; p = 0.008) and cardiorespiratory fitness (OR = 0.36; p = 0.046) were inversely significantly associated with IFG. Conclusions: BMI, cardiorespiratory fitness, and physical activity levels are important variables to modify when attempting to reduce the prevalence of metabolic syndrome and IFG among young, asymptomatic Native American women. This information can be used to design effective diabetes prevention interventions.     

Relationship between diabetes risk factors and fasting blood glucose among civil servants in Ibadan,Nigeria

The study was carried out to determine the relationship between diabetes risk factors and fasting blood glucose among civil servants in Nigeria. Three hundred and one civil servants aged ≥35 years from randomly selected ministries and agencies of the Oyo State Secretariat took part in the study. Measurements of blood pressure, anthropometrics, and fasting blood glucose were made and information on demographic variables was documented.Of the 301 participants, 62.8 % were women. The mean age of men was 49.1?Â?±?6.9 while that of women was 49.4?Â?±?6.2. There was a significant relationship between the income and fasting blood glucose, but gender, age, positive family history of diabetes mellitus, blood pressure, history of having given birth to a baby weighing ≥4 kg, and obesity were not statistically associated with the fasting blood glucose.Apart from participants’ income, other factors were not significantly related to IFG and DM     

Diabetes and impaired glucose regulation in first-degree relatives of patients with type 2 diabetes in isfahan, iran: prevalence and risk factors

OBJECTIVES: The aim of this study was to estimate the prevalence of diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in first-degree relatives (FDR) of people with type 2 diabetes mellitus. METHODS: A cross-sectional study of FDR of type 2 diabetes patients was conducted between 2003 and 2005. A total of 2,368 FDR of type 2 diabetes outpatients aged 30-60 years (614 men and 1754 women) from Isfahan Endocrine and Metabolism Research Center (Iran) were examined. All subjects underwent a standard 75 g 2-h oral glucose tolerance test (OGTT). IGT, IFG and type 2 diabetes were diagnosed according to the criteria of the American Diabetes Association (ADA). The mean (SD) age of participants was 43.1 (6.9) years. RESULTS: The prevalence of type 2 diabetes, IGT and IFG were 10.3% (95% CI: 9.1-11.5), 19.5% (17.9-21.1) and 17.3% (15.8-18.8) respectively. The prevalence rates were significantly higher than those reported for a control population of the same age (type 2 diabetes, 6.0% (95% CI: 5.7-6.2) and IGT 9.6 (95% CI: 9.3-9.9)). IGT was more frequent among women (OR: 0.66; 95% CI: 0.51-0.87), whereas diabetes (OR: 1.31; 95% CI: 0.96-1.78) and IFG (OR: 1.41; 95% CI: 1.10-1.80) were higher in men. Multivariate analysis revealed that age and obesity or abdominal obesity were significantly associated with diabetes, IGT and IFG. CONCLUSIONS: FDR of people with type 2 diabetes in Iran are at higher risk of IGT and type 2 diabetes than the population at large. Risk increases with age and obesity. These findings may be useful for the identification of persons at risk of developing type 2 diabetes and strongly support the regular screening of FDR of type 2 diabetes patients.     

Association and interaction between triglyceride–glucose index and obesity on risk of hypertension in middle-aged and elderly adults

Aims: To investigate the association between triglyceride–glucose(TyG) index and the risk of hypertension. Method: A cross-sectional study was conducted in Bengbu, China. The participants received relevant questionnaire survey, anthropometric tests, and laboratory examination. Multivariate logistic regression analysis was performed to estimate the possible association between TyG index and hypertension risk. The additive interaction evaluated by the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index(SI) was calculated. Results: A total of 1777 participants (748 men and 1029 women) were investigated. There was a significant increase in the risk of hypertension and isolated systolic hypertension (ISH) when comparing the highest TyG index (the fourth quartile) to the lowest TyG index (the first quartile) and corresponding ORs were 2.446 (95% CI: 1.746–3.426) and 2.621(95%CI: 1.627–4.224), respectively. However, no significant relationship was observed between TyG index and isolated diastolic hypertension (IDH). In males, significant interactions between TyG index and WHtR (RERI:1.978, 95%CI: 0.162–3.792; AP: 0.359, 0.113–0.605; SI:1.782, 1.017–3.122), smoking (AP: 0.437, 95%CI: 0.048–0.825), family history of hypertension (AP:0.433, 95%CI: 0.203–0.662; SI:2.248, 95%CI: 1.333–3.791) were observed. As for females, there were also significant interactions between TyG index and WHtR (RERI:1.415, 95%CI: 0.693–2.136; AP: 0.198, 95%CI: 0.104–0.291; SI:1.298, 95%CI:1.101–1.530), family history of hypertension (RERI:1.744, 95%CI: 0.221–3.267; AP:0.405, 95%CI: 0.113–0.697) on risk of hypertension. Conclusions: Increased TyG index was significantly associated with higher risk of hypertension and ISH, but not for IDH in middle-aged and elderly adults. Our results also demonstrated interactions of TyG index and abdominal obesity and family history of hypertension on hypertension risk.     

Fasting, non-fasting glucose and HDL dysfunction in risk of pre-diabetes, diabetes, and coronary disease in non-diabetic adults

We determined in non-diabetic persons the risk of fasting and non-fasting glucose levels for pre-diabetes, diabetes, and coronary heart disease (CHD), including the roles of serum C-reactive protein (CRP) and HDL cholesterol, and delineated risk profiles of the pre-diabetic states. Over 7¼ years, 2,619 middle-aged Turkish adults free of diabetes and CHD were studied prospectively. Using different serum glucose categories including impaired fasting glucose (IFG, 6.1–6.97 mmol/L) and impaired glucose tolerance (IGT), outcomes were analyzed by Cox regression. IFG was identified at baseline in 112 and IGT in 33 participants. Metabolic syndrome components distinguished individuals with IFG from those with normoglycemia. Participants with IGT tended to differ from adults in normal postprandial glucose categories in regard to high levels of triglycerides, apoA-I, and CRP. Diabetes risk, adjusted for sex, age, waist circumference, CRP, and HDL cholesterol, commenced at a fasting 5.6–6.1 mmol/L threshold, was fourfold at levels 6.1–6.97 mmol/L. Optimal glucose values regarding CHD risk were 5.0–6.1 mmol/L. Fasting and postprandial glucose values were not related to CHD risk in men; IGT alone predicted risk in women (HR 3.74 [1.16;12.0]), independent of age, systolic blood pressure, non-HDL cholesterol, waist circumference, smoking status, and CRP. HDL cholesterol was unrelated to the development of IFG, IGT, and diabetes, while CRP elevation independently predicted the development of diabetes. IGT independently predicts CHD risk, especially in women. HDL dysfunction associated with low-grade inflammation is a co-determinant of pre-diabetic states and their progression to diabetes.     

Insulin action and secretion in healthy Hispanic-Mexican first-degree relatives of subjects with type 2 diabetes.

The aim of this study was to assess the early insulin secretion and insulin action of healthy non-diabetic Hispanic-Mexican subjects with and without family history of Type 2 diabetes (FHD). One hundred and twenty non-relative subjects were compared against 115 first-degree relatives of individuals with Type 2 diabetes. To assign the subjects to the correspondent group, the FHD was carefully ascertained by clinical examination of the participants' parents. Age and gender were matched criteria. Incomplete or unclear data about FHD, previous diagnosis of diabetes or chronic diseases were exclusion criteria. Subjects in both groups were required to have fasting glucose <6.1 mmol/l, and 2-h PG<7.7 mmol/l. Insulin action and secretion were estimated by HOMA (homeostasis model insulin analysis resistance index) and insulinogenic index, respectively. Logistic regression analysis showed an independent relationship between BMI and insulin resistance (HOMA score >5.0) (odds ratio, OR, 1.42, p=0.03), and between FHD and insulin resistance (OR 1.27, p=0.04). On the other hand, there was a strong and independent relationship between FHD and high early insulin secretion (insulinogenic index >0.72) (OR 1.64, p=0.01) but not between BMI and high early insulin secretion (OR 0.93, p=0.3). Healthy Mexican first-degree relatives of subjects with Type 2 diabetes show an independent relationship between FHD and both high early insulin response and decreased insulin action, whereas BMI was only related to insulin resistance.     

Characterisation of subjects with early abnormalities of glucose tolerance in the Stockholm Diabetes Prevention Programme: the impact of sex and type 2 diabetes heredity

AIMS/HYPOTHESIS: We evaluated the impact of sex and type 2 diabetes heredity on the prevalence and pathogenesis of early abnormalities of glucose homeostasis in subjects participating in the Stockholm Diabetes Prevention Programme. METHODS: A sample of 3,128 men and 4,821 women, of whom approximately half had a family history of type 2 diabetes (FHD) was categorised according to an OGTT: NGT, IFG, IGT, combined glucose intolerance and type 2 diabetes. The homeostasis model assessment was used to determine insulin sensitivity and beta cell function. RESULTS: Prevalence of early abnormalities of glucose metabolism was two to three times higher in subjects with FHD and two to three times higher in men compared to women. Both maternal and paternal heredity of type 2 diabetes were associated with an increased risk of having early abnormalities of glucose metabolism. However, in women with type 2 diabetes heredity on the father's side seems to have less impact on an increased risk of having type 2 diabetes. Both waist circumference and systolic blood pressure were increased in subjects with abnormalities of glucose homeostasis, whereas insulin sensitivity and beta cell function were decreased. Subjects with IFG had more pronounced impairment of beta cell function and insulin sensitivity than subjects with IGT. CONCLUSION/INTERPRETATION: An FHD and male sex increased the prevalence of abnormalities of glucose homeostasis. Subjects with IFG had more pronounced defects of insulin secretion and action than subjects with IGT.     

青少年空腹血糖受损相关危险因素分析

目的探讨青少年空腹血糖受损（IFG）的相关危险因素。方法秦皇岛地区一项3937名13-18岁青少年的横断面调查。根据空腹血糖分为空腹血糖正常组和空腹血糖受损组（IFG组）。测量身高、体重、腰围、血压、TG、TC、HDL-C、LDL-C水平。结果共检出IFG136例（3.5%）,男女IFG检出率分别为3.9%和3.1%,两性间比较无统计学差异（P=0.177）。IFG组具有2项以上心血管危险因素的危险性是空腹血糖正常组青少年的1.889倍（95%CI1.125-3.171）。IFG组45.6%存在糖尿病家族史。多元逐步回归显示年龄、腰围、胆固醇均为独立影响因素。结论青少年群体中IFG相当多见,并已开始导致心血管危险因素聚集。遗传因素、腹型肥胖及脂代谢异常是IFG的危险因素。     

Hypertriglyceridemia is an independent risk factor for development of impaired fasting glucose and diabetes mellitus: a 9-year longitudinal study in Japanese

OBJECTIVE: Hypertriglyceridemia is often associated with impaired fasting glucose (IFG) and diabetes mellitus. But the contribution of hypertriglyceridemia to the development of IFG and diabetes mellitus remains unclear. We evaluated whether or not hypertriglyceridemia is a risk factor for the development of IFG and diabetes mellitus. METHODS: From 1990 through 1999, 7, 222 Japanese with normoglycemia at baseline were followed. Fasting plasma glucose levels were measured. IFG and diabetes mellitus were defined by ADA criteria. RESULT: The multivariate-adjusted relative risks for the development of IFG were 1.38 for hypertriglyceridemia (p=0.001), 1.30 for obesity (p=0.003), 1.29 for hypertension (p=0.007), 1.26 for family history of diabetes (p=0.027), and 1.02 for age (p=0.035). The multivariate-adjusted relative risks for the development of diabetes mellitus were 1.003 for triglyceride level (p=0.013), 1.30 for level of body mass index (p=0.003), and 2.38 for family history of diabetes (p=0.001). CONCLUSION: Hypertriglyceridemia is an independent risk factor for the development of IFG and diabetes mellitus in Japanese patients.     

Duration of obesity is not a risk factor for type 2 diabetes mellitus, arterial hypertension and hyperlipidemia

Background:  Obesity is known to be a risk factor for type 2 diabetes mellitus (DM), arterial hypertension (HT) and hyperlipidaemia (HL), but the relationship between the duration of obesity and these outcomes is variable in the literature.
Aims:  The aims of this study were 1) to evaluate whether the duration of obesity is a risk factor for type 2 DM, HT and HL, 2) to determine the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), type 2 DM, HT and HL in the patients attending our clinic because of obesity and 3) to determine the correlation between DM, HT and HL and age, body mass index (BMI), duration of obesity and waist-hip ratio (WHR).
Methods:  Informed consent was obtained from 200 consecutive women presenting to our Endocrinology and Metabolism Unit for the first time because of obesity. The patient's history of the age at onset of obesity, HT and family history of DM were obtained. Anthropometric measurements and a 75-g oral glucose tolerance test (OGTT) were performed.
Results:  On OGTT, 15 (7.5%) had IFG, 36 (18%) had IGT and 18 (9%) had type 2 DM; in addition, 96 (48%) had HT and 76 (38%) had HL. Upon multivariate logistic regression analysis, age was a common risk factor for IGT, type 2 DM, HT and HL, and a family history of diabetes was an additional risk factor for type 2 DM.
Conclusion:  The duration of obesity, as reported by women presenting for treatment of obesity, is not a risk factor for type 2 DM, HT and HL.     

Identification of risk factors affecting impaired glucose metabolism among the adult population of district Srinagar

BackgroundThe World has seen an emerging trend of diabetes among adolescents and moderately aged people over the last decade. The aim of the study was to identify the risk factors associated with impaired glucose metabolism and the prevalence of impaired glucose metabolism among the adult population of district Srinagar.MethodsMulti-stage cluster random sampling design was used and from each household, participants were selected using a Kish grid method. Socio-demographic and clinical data were collected. The participants were then subjected to fasting venous blood glucose estimation.ResultsAge, waist circumference, hip circumference, weight, and body mass index were all statistically significant between normoglycemic participants and those with impaired glucose metabolism (p < 0.018). On logistic regression, subjects who had a higher BMI were more likely to develop Impaired glucose metabolism (OR = 3.52, OR 95% CI = 1.25–9.87); Moreover, consumption of carbonated drinks, (3–6 times/week OR = 4.40, OR 95% CI = 2.06–9.40; >6 times/week OR = 11.04, OR 95% CI = 0.86–140.66) was found to be a potential risk factor. Participants with a family history of diabetes were more susceptible to develop impaired glucose metabolism (OR = 6.41, OR 95% CI = 3.22–12.78). The risk effect of these factors was even stronger before adjusting for age, sex, family history of diabetes, and BMI in participants.ConclusionRisk factors for impaired glucose metabolism include increasing age, obesity, and higher consumption of carbonated drinks, hypertension, smoking behavior, high-calorie diet intake and positive family history of diabetes.     

Prevalence of prediabetes and associated risk factors in a rural Nigerian community

There is very scanty population-based data on the prevalence of prediabetes, a forerunner to type 2 diabetes, in both rural and urban Nigeria. The purpose of the study was to determine the prevalence and risk factors for prediabetes in a rural Nigerian population. A cross-sectional, village by village, clan-based stratified convenient sampling was done in Ihuokpara, a rural community in Nkanu East Local Government Area of Enugu State, Nigeria. A total of 824 adult men and women participated. Questionnaires were used to obtain sociodemographic data, awareness of diabetes, and common symptoms including family history of diabetes. Fasting plasma glucose and 2-hour post 75g-glucose-load plasma glucose levels were measured after the subjects’ blood pressure and anthropometric indices were obtained. Fasting lipid profile was also assessed in a subset of the study population. Males constituted 34.7 % of the 824 participants. The mean age of the subjects was 51.1?±?16.2 years. Prevalence of impaired fasting glucose (IFG) was 9.2 %, while that of impaired glucose tolerance (IGT) was 15.8 %. The overall prevalence of prediabetes (both IGT and IFG) was 21.5 %. Hypertension was prevalent at 45.3 % and was the strongest predictor of prediabetes. Obesity was prevalent at 5.8 % and overweight at 16.7 %, while 15.7 % had central obesity. Prevalence of prediabetes was high in the community with hypertension emerging as the possible driving force.     

Prevalence and determinants of diabetes and impaired fasting glucose among urban community-dwelling adults in Guangzhou,China

AimThis study aimed to estimate the prevalence of diabetes and impaired fasting glucose (IFG) in the adult population aged ≥ 20 years in Guangzhou and to evaluate the associated risk factors.MethodA total of 6197 randomly selected adults, aged ≥ 20 years and living for at least 5 years in Guangzhou, participated in questionnaire-based interviews between 2006 and 2007, and had their clinical characteristics and standard blood chemistries measured. A 75 g OGTT was conducted for those subjects with fasting glucose levels ≥ 5.6 mmol/L. Diabetes and IFG were defined according to WHO 1999 criteria.ResultsBased on Chinese census data, the age- and gender-standardized prevalences of diabetes and IFG were 5.5% and 3.3%, respectively. Among the identified diabetic individuals in the present investigation, 42.3% were newly diagnosed. The prevalence of diabetes and IFG increased with age. The results of multivariate logistic-regression analyses showed that diabetes and IFG were significantly associated with age, a family history of diabetes, obesity, hypertension and hyperlipidaemia.ConclusionThe prevalences of diabetes and IFG have increased dramatically over the past decade. Yet, a large proportion of cases go undiagnosed. These results suggest an urgent need to establish regular population-based diabetes screening in Guangzhou.     

Depression in patients with diabetes mellitus and its impact on diabetes self-care, medication adherence and glycemic control

Depression is an independent risk factor for the onset of type 2 diabetes. It negatively affects the course of diabetes and is associated with increased risk of complications, hyperglycemia, and mortality. Diabetes may exert its negative effect through hormonal, neuronal, or immune system changes that directly affect the body’s ability to produce or use insulin or, the effect of depression may be indirect, by resulting in poor self-care behavior, such as overeating, not exercising, skipping medication, or failing to keep medical appointments. Thus, identifying and treating depression in diabetes is strongly recommended. Cross-sectional study done in ambulatory care. A total of 320 diabetic patients who have duration of diabetes more than 1 year with out-patient diagnosis of diabetes (including fasting blood glucose >126 mg% twice in 1 year, random blood glucose >200 mg% twice in 1 year, currently taking any anti-diabetic agent, hospital discharge diagnosis of diabetes) were identified during the study period. Multivariable logistic regression was used to estimate odds ratio (Odds Ratios) and 95% confidence intervals (CIs). Overall depression was 17.5% (95% CI: 0.13–0.22%).The mean age was 55?±?12 years, 138 (43%) were females. Hypertension 197(61.6%) and ischemic heart disease(IHD) (N?=?68; 21.3%) were the most common co-morbidities. Factors independently associated with depression were; hypertension (OR 2.75; 95% CI: 0.99–7.37), complication of neuropathy (OR 4.56; 95% CI: 1.71–12.15) and nephropathy (OR 4.10; 95% CI: 1.26–13.33), family history of depression (OR 4.46; 95%CI: 1.50–13.26) and inadequate intake of fruit and vegetable (OR 0.32; 95% CI: 0.13–0.82). Depressed diabetics had more complications and sub-optimal self care. Coexistence of depression produced poor glycemic control.     

The impact of family history of diabetes and lifestyle factors on abnormal glucose regulation in middle-aged Swedish men and women

Aims/hypothesis We investigated associations between abnormal glucose regulation and family history of diabetes, separately and in combination with lifestyle risk factors.Subjects and methods This cross-sectional study comprised 3,128 men and 4,821 women, aged 35–56 years, half with a family history of diabetes. Oral glucose tolerance testing identified subjects with previously undiagnosed prediabetes (IFG, IGT) and type 2 diabetes. Information on lifestyle factors was obtained by questionnaire. Biological interaction was measured with the synergy index.Results A family history of diabetes conferred a higher odds ratio (OR) for type 2 diabetes in men (OR=3.1, 95% CI 1.7–5.6) than in women (OR=1.7, 95% CI 1.0–3.0), and the synergy index was 2.8 (95% CI 0.9–9.0), suggesting interaction between a family history of diabetes and sex. For prediabetes and diabetes combined, the synergy index was 1.7 (1.0–2.8). Exposure to only one lifestyle risk factor (obesity, physical inactivity, smoking or low sense of coherence [a psychosocial index]) increased the risk to a similar extent in men and women. Combined exposure to a family history of diabetes and lifestyle-related risk factors had a greater effect on type 2 diabetes than any of these factors alone, especially in men. However, analysis of interaction between a family history of diabetes and the lifestyle factors did not indicate any interaction for diabetes, but did indicate interaction for a family history of diabetes and obesity in women with prediabetes.Conclusions/interpretation Our data suggest a more pronounced effect of a family history of diabetes on the risk of type 2 diabetes in men than in women. While both a family history of diabetes and lifestyle risk factors had effects on type 2 diabetes, irrespective of sex, these effects did not appear to interact.     

Prevalence of diabetes,impaired fasting glucose and insulin resistance syndrome in an urban Indian population

OBJECTIVE: Epidemiological study among urban subjects in western India to determine prevalence of diabetes, insulin resistance syndrome (IRS) and their risk factors. METHODS: Randomly selected adults > or =20 years were studied using stratified sampling. Target sample was 1,800 (men 960, women 840). 1123 subjects (response 62.4%) were evaluated and blood samples were available in 532 men and 559 women (n=1091, 60.6%). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Atherosclerosis risk factors were determined using current guidelines. Diabetes was diagnosed when the subject was a known diabetic or fasting blood glucose was > or =126 mg/dl, impaired fasting glucose (IFG) diagnosed when fasting glucose was 110-125 mg/dl. IRS was diagnosed when any three of-IFG, high triglycerides >150 mg/dl, low HDL cholesterol (men<40 mg/dl, women<50 mg/dl), central obesity (men>102 cm, women>88 cm), or high normal blood pressure (>130/>85 mmHg) or hypertension-were present. RESULTS: Diabetes was present in 70 men (13.2%) and 64 women (11.5%). Age-adjusted prevalence of diabetes was 9.3% in men (95% confidence intervals (CI) 6.7-11.8), 8.1% in women (CI 5.8-10.4) and 8.6% overall (CI 6.9-10.3). IFG was in 28 men (5.3%) and 29 women (5.2%). IRS was present in 52 men (9.8%) and 114 women (20.4%) with age-adjusted prevalence of 7.9% in men (CI 6.7-9.1) and 17.5% in women (CI 14.4-20.6) with an overall prevalence of 12.8% (CI 10.8-14.8). Other metabolic abnormalities of IRS in men and women were high triglycerides in 32.1 and 28.6%, low HDL cholesterol in 54.9 and 90.2%; central obesity in 21.8 and 44.0%, and high normal blood pressure or hypertension in 35.5 and 32.4%. IFG subjects had similar atherosclerosis risk factor profile as normal subjects while those with IRS and diabetes had significantly greater prevalence of obesity, central obesity, hypertension, high triglycerides and low HDL (P<0.01). CONCLUSIONS: There is s significant prevalence of diabetes and IRS in this urban Indian population. Subjects with diabetes as well as IRS have greater prevalence of obesity, central obesity, hypertension, hypertriglyceridemia and low HDL as compared with normal subjects.     

Change of glycaemic status in Chinese subjects with impaired fasting glycaemia.

AIMS: To examine the risk of progression to diabetes in Chinese subjects with impaired fasting glycaemia (IFG) or normal fasting glucose (NFG). METHODS: Between 1988 and 1996, 657 Hong Kong Chinese subjects underwent annual screening, using an oral glucose tolerance test, until they had developed diabetes, or until June 1997, when the data were analysed. All subjects had a risk factor associated with the development of diabetes such as a history of gestational diabetes or a family history of diabetes. The follow-up interval for the subjects ranged from 0.87 to 8.54 years and of the 657, 319 had fasting plasma glucose levels of < 7.0 mmol/L where a fasting glucose level of > or = 7.0 mmol/L was used to diagnose diabetes RESULTS: Of the 319 nondiabetic subjects, 55 had IFG and 264 had NFG. After a median follow-up of 1.12 years (range: 0.87-8.54 years), 27 progressed to diabetes. The Kaplan-Meier analysis of progression to diabetes showed significant differences between subjects with IFG and subjects with NFG. Using Cox regression analysis, IFG (beta = 3.51, SE = 1.63, P = 0.032) and smoking (beta = 3.60, SE = 1.50, P = 0.017) were found to be independently associated with progression to diabetes. CONCLUSIONS: In Hong Kong Chinese with risk factors for glucose intolerance, IFG status is an independent risk factor for progression to diabetes.