Age does not influence levels of HbA1c in normal subject.

To resolve whether haemoglobin A1c(HbA1c) levels in normal subjects increase with age, we measured HbA1c in 399 patients undergoing routine oral glucose tolerance test (OGTT). The OGTT results categorized the patients into 127 normal, 94 impaired glucose tolerance (IGT) and 178 diabetic. None of these groups showed a significant correlation between HbA1c and age and we cannot, therefore, see a need for age-specific reference ranges for HbA1c. Some of the confusion in the literature may have arisen from less rigorous categorization of subjects than we used, resulting in the inclusion of some individuals with IGT or diabetes in the 'normal' groups of other studies. The prevalence of such abnormality would be expected to be greater amongst older subjects, falsely suggesting a correlation between HbA1c and age, and we were able to demonstrate this with our own data when insufficiently rigorous criteria were applied for the selection of normal subjects.     

空腹血糖及糖化血红蛋白用于筛查糖耐量减退的比较性研究

目的比较空腹血糖（FPG）和糖化血红蛋白（HbAlc）在筛查糖耐量减退（IGT）中的应用价值。方法到我院门诊为明确有无血糖异常而就诊者336人，测定空腹血糖、糖化血红蛋白，并行口服葡萄糖耐量试验（OGTT）。结果按照1999年WHO的DM诊断标准，本研究人群空腹血糖〈6．1者124例，≥6．1-〈7．0者56例，≥7．0者156例；糖化血红蛋白〈6．1者84例，≥6．1者252例；OGTT2 hPG〈7．8者92例，≥7．8-〈11．1者99例，≥11．1者145例。结论糖化血红蛋白和空腹血糖均不适用于筛查IGT人群，但糖化血红蛋白比空腹血糖提示病人是否存在血糖异常更敏感。     

Point‐of‐care Glucose and Hemoglobin A1c in Emergency Department Patients without Known Diabetes: Implications for Opportunistic Screening

Objectives: The objectives were to evaluate the correlation between random glucose and hemoglobin A1c (HbA1c) in emergency department (ED) patients without known diabetes and to determine the ability of diabetes screening in the ED to predict outpatient diabetes. Methods: This was a cross‐sectional study at an urban academic ED. The authors enrolled consecutive adult patients without known diabetes during eight 24‐hour periods. Point‐of‐care (POC) random capillary glucose and HbA1c levels were tested, as well as laboratory HbA1c in a subset of patients. Participants with HbA1c ≥ 6.1% were scheduled for oral glucose tolerance test (OGTT). Results: The 265 enrolled patients were 47% female and 80% white, with a median age of 42 years. Median glucose and HbA1c levels were 93 mg/dL (interquartile range [IQR] = 82–108) and 5.8% (IQR = 5.5–6.2), respectively. The correlation between POC and laboratory HbA1c was r = 0.96, with mean difference 0.33% (95% confidence interval [CI] = 0.27% to 0.39%). Glucose threshold ≥ 120 mg/dL had 89% specificity and 26% sensitivity for predicting the 76 (29%) patients with abnormal HbA1c; ≥ 140 mg/dL had 98% specificity and 14% sensitivity. The correlation between random glucose and HbA1c was moderate (r = 0.60) and was affected by age, gender, prandial status, corticosteroid use, and current injury. Only 38% of participants with abnormal HbA1c returned for OGTTs; 38% had diabetes, 34% had impaired fasting glucose/impaired glucose tolerance, and 28% had normal glucose tolerance. Conclusions: ED patients have a high prevalence of undiagnosed diabetes. Although screening with POC random glucose and HbA1c is promising, improvement in follow‐up with confirmatory testing and initiation of treatment is needed before opportunistic ED screening can be recommended.     

Performance characteristics and clinical utility of an enzymatic method for the measurement of glycated albumin in plasma

OBJECTIVE: The measurement of plasma glycated albumin is particularly useful in the short-middle term monitoring of glycometabolic control in diabetics. The aim of this work is to evaluate a new enzymatic method for the measurement of glycated albumin in plasma, with particular attention to some selected cases and comparison with other relevant tests (fasting plasma glucose, after glucose load, fructosamine, glycated hemoglobin). DESIGN AND METHODS: We have performed a multicenter study by which sample collection was performed in three different centers (Milano, Padova and Cagliari) and serum samples, frozen at -80 degrees C, were then delivered under dry ice to the centralized laboratory in Milano. Glycated plasma albumin was measured with reagents from Asahi Kasei Pharma (Lucica GA-L enzymatic assay; AKP, Tokyo, Japan) on a Modular P Roche system. Fructosamine was assessed by a Roche method and HbA(1c) (measured separately in the three centers on fresh EDTA blood) by DCCT-aligned HPLC systems. We have investigated 50 type 2 diabetics, 26 subjects with gestational diabetes, 35 subjects with thalassemia major, 10 subjects with cirrhosis, 23 patients with end-stage renal disease subjected to dialysis treatment and 32 healthy adult control subjects. RESULTS: The main analytical performance characteristics of the new GA test were the following: (a) the within-assay reproducibility was between 3.0 and 3.9% (in terms of GA% CV, measured on 2 serum pools and 2 control materials at normal and pathological glycated albumin levels); (b) the between-assays reproducibility was from 2.8 to 4.1%; (c) the linearity was tested in the interval between 13 and 36% and found acceptable (r(2)=0.9932). Concerning the clinical utility of the new test, we have evaluated the relationships between GA, HbA(1c), fructosamine and fasting and post-prandial glucose in several patients, as well as the changes in the above mentioned parameters in a sub-group of type 2 diabetic patients for 18 weeks as they progressed from severe hyperglycemia (HbA(1c) >or=10.0%) toward a better glycemic control. The correlations between glycated albumin and HbA(1c) were as follows: (a) type 2 diabetics: r(2)=0.483 (good glycemic control), r(2)=0.577 (poor control); (b) diabetic patients under dialysis: r(2)=0.480; (c) liver disease: r(2)=0.186; (d) transfused non-diabetics with thalassemia: r(2)=0.004. Glycated albumin, as well as HbA(1c) and fructosamine, was of little value in the study of women with gestational diabetes, mainly because of the very limited glucose fluctuations in this particular category of subjects. In 11 type 2 diabetic patients under poor metabolic control, GA was better correlated with fasting plasma glucose then HbA(1c) (r(2)=0.555 vs. 0.291, respectively), and decreased more rapidly than HbA(1c) during intensive insulin therapy. CONCLUSIONS: The experience we have acquired with the new enzymatic test demonstrates its reproducibility and robustness. We confirm that plasma glycated albumin is better related to fasting plasma glucose with respect to HbA(1c). Moreover, glycated albumin is more sensitive than HbA(1c) with regard to short-term variations of glycemic control during treatment of diabetic patients. This test is also very appropriate when the interpretation of HbA(1c) is critical.     

Relationship between osteocalcin and glucose metabolism in postmenopausal women

BACKGROUND: Recently, osteocalcin was found to regulate blood glucose, insulin secretion, and fat deposition in mice. However, the relationship between osteocalcin levels and factors related to glucose metabolism in humans has not yet been investigated. We investigated the relationship between osteocalcin and glucose metabolism in postmenopausal women. METHODS: Three hundred thirty-nine postmenopausal women were recruited for this study. Glucose metabolism related substance and serum osteocalcin were assayed. RESULTS: There was a significant reduction in osteocalcin levels among type 2 diabetes mellitus patients compared with the normal glucose and impaired fasting glucose groups. Next, the subjects in the highest quartile for osteocalcin were observed to have significantly decreased fasting glucose and HbA1c levels compared with subjects in the lowest quartile. In addition, osteocalcin levels were inversely correlated with glucose, insulin, HbA1c, and insulin resistance. Moreover, multivariate analysis showed that serum osteocalcin was found to be an independent factor associated with glucose and HbA1c. CONCLUSIONS: There is a potential role of osteocalcin in regulating blood glucose levels in postmenopausal women. This finding indicates that in humans the skeleton may be involved in energy metabolism by functioning as part of the endocrine system.     

糖化血红蛋白在早孕期糖尿病筛查中的意义

目的：探讨糖化血红蛋白（HbA1c）在早孕期糖尿病（GDM）筛查中的意义。方法正常组120例、糖耐量异常组59例及糖尿病组78例,在妊娠20周时分别进行空腹血糖（FPG）、75g葡萄糖耐量实验（OGTT）和HbA1c测定。结果糖尿病组FPG,OGTT,HbA1c水平均高于正常组（P〈0.01）,HbA1c在糖耐量异常组及糖尿病组中的阳性率分别为96.7%、98.7%。结论 HbA1c在GDM筛查中的诊断效率明显高于FPG和OGTT,可作为临床GDM早孕期筛查诊断的指标。     

Analysis of urinary albumin,transferrin, N-acetylβ-D-glucosaminidase and β2-microglobulin in patients with impaired glucose tolerance

We investigated the changes in urinary albumin and urinary transferrin as glomerular proteins, and in urinary N-acetyl-β-D -glucosaminidase and urinary β₂-microglobulin as tubular proteins, in patients with impaired glucose tolerance. We attempted to compare the proteins of normal subjects to those of diabetics with pre-nephropathy. Transferrin and N-acetyl-β-D -glucosaminidase levels were significantly increased in patients with impaired glucose tolerance, while albumin and β₂-microglobulin levels were only slightly increased. In addition, there was no significant difference in transferrin levels between patients with impaired glucose tolerance and type 2 diabetics with pre-nephropathy. In our observation, although albumin levels were only slightly increased in patients with impaired glucose tolerance, a sharp increase in transferrin levels was reflected in patients with glomerular disorders. In addition, since N-acetyl-β-D -glucosaminidase levels varied markedly, tubular disorders were suspected. It should be stressed that increased parameters for both glomerular and tubular disorders in group C—patients who showed abnormal levels in three proteins—had already been observed in some patients with impaired glucose tolerance. Therefore, the evaluation of the mutual relationships between various urinary protein components in patients with impaired glucose tolerance will become a more important assessment tool than that of single urinary protein components. J. Clin. Lab. Anal. 12:351–355, 1998. © 1998 Wiley-Liss, Inc.     

食药材降糖方治疗糖耐量异常及2型糖尿病气阴两虚证的临床效果

目的探讨食药材降糖方治疗糖耐量异常及2型糖尿病气阴两虚证的临床效果。方法选取2019年1月至2019年6月在陕西省中医医院就诊的糖耐量异常(5例)及2型糖尿病气阴两虚证(55例)共计60例患者作为研究对象,给予食药材降糖方治疗。观察临床疗效,比较患者治疗前、后的中医证候积分、血糖指标、血脂指标及胰岛素功能指标,同时对药物安全性进行评价。结果患者临床治疗总有效率为91.67%。治疗后,患者的中医证候积分、HbA1c、HOMA-IR均较治疗前降低,HDL-C水平较治疗前升高,差异具有统计学意义(P<0.05)。患者治疗前、后的FBG、2 h PG、CHO、TG、LDL-C、FINS水平比较,差异无统计学意义(P>0.05)。治疗期间,患者均未发生严重不良反应。结论食药材降糖方对糖耐量异常及2型糖尿病患者可起到辅助降糖作用,能够改善患者的临床症状、HbA1c、HDL-C水平及HOMA-IR。     

Levels of serum sialic acid and thiobarbituric acid reactive substances in subjects with impaired glucose tolerance and type 2 diabetes mellitus

Cardiovascular disease is a common cause of death for diabetic patients. High sialic acid levels (SA) and increased oxidative stress are important factors for cardiovascular diseases. We aimed to research whether SA and thiobarbituric acid reactive substances (TBARS) levels are associated with the degree of the diabetic regulation and investigate if SA and TBARS levels can be controlled with the regulation of the blood glucose levels. A total of 179 subjects were included in the study. Three groups, which were comprised of subjects with type 2 diabetes mellitus (DM) (DM group [DMG], n=149), impaired glucose tolerance (IGT) (IGT group [IGTG], n=15), and normal oral glucose tolerance (NGT) (NGTgroup [NGTG], n=15) were constituted. Glucose, cholesterol, high-density lipoprotein (HDL) and glycated hemoglobin (HbA1C), SA, and TBARS were measured in the sera of the patients. SA and TBARS levels were significantly increased in subjects with type 2 DM (P<0.001 for both). SA concentrations showed significant correlation with triglycerides (r=0.229; P<0.05), fasting glucose (r=0.508; P<0.01), 2-hr postprandial glucose (r=0.455; P<0.01), and HbA1C (r=0.467; P<0.01), and there was a positive correlation between TBARS and HbA1C (r=0.251; P<0.01). Diabetic patients were found to have higher risk for inflammation and oxidative stress. The regulation of blood glucose levels may contribute to the decline of both SA and TBARS levels.     

糖耐量低减患者颈动脉内膜中层厚度与胰岛素敏感性的关系研究

目的:探讨糖耐量低减(IGT)患者颈动脉内膜中层厚度(IMT)值与机体胰岛素敏感性和胰岛素分泌功能的关系。方法:对47例按世界卫生组织1999年标准确诊的IGT患者和20名健康对照者进行研究。运用高分辨率B型超声仪检测受试者的颈动脉IMT,同时检测血糖、血清胰岛素、糖基化血红蛋白(HbA1c)、尿微量白蛋白排泌率(UAER)和血脂,并计算HOMA胰岛素抵抗指数(HOMAIR)和胰岛B细胞分泌指数(HOMAIS)以分别反映机体的胰岛素敏感性和胰岛素分泌功能。结果:IGT患者的颈动脉IMT值显著高于正常对照(P<0.01),HOMAIR指数和HOMAIS指数均低于正常对照(P<0.01)。进一步将患者分为合并空腹血糖异常(IFG)组(IGT1组)和单纯IGT组(IGT2组)后发现,IGT1组的颈动脉IMT值显著高于血糖相对较低的IGT2组(P<0.05)。线性相关分析显示,IGT患者的颈动脉IMT值均与HbA1c、空腹血糖、BMI、舒张压和HOMAIR指数呈显著正相关(P<0.5)。结论:IGT患者颈动脉IMT值高于正常人,而且与糖尿病患者胰岛素抵抗发生、发展有密切的关系。     

Evaluation of the comparative relationship between HbA1 and HbA1c in subjects with OGTT type diabetes and in normal subjects

The authors investigated if significantly high glycosylated hemoglobin and glycosylated hemoglobin c levels are present in patients with impaired glucose tolerance tested with oral glucose tolerance test. The patients with impaired glucose tolerance presented higher, but non significantly, glycosylated hemoglobin levels then normal subjects.     

Postprandial peaks as a risk factor for cardiovascular disease: epidemiological perspectives

A key issue in diabetes care is selecting glucose parameters to monitor and control. The recommendations of the American Diabetes Association for glycaemic control do not address postprandial glucose (PPG), but patients with type 2 diabetes experience wide variations in glucose levels after meals. We have observed a remarkable increase in plasma glucose two hours after breakfast and/or lunch in most non-insulin-treated patients; for up to 40% of them the increase is >40 mg/dl (2.2 mmol/l). As many as 70% of patients with an HbA1c <7% have PPG values >160 mg/dl (8.9 mmol/l) after meals. Fasting plasma glucose (FPG) is a poor indicator of plasma glucose at other times. The coefficient of correlation of FPG with plasma glucose at other times ranges from 0.50-0.70. Nor is the correlation of FPG with HbA1c very strong: in hundreds of determinations of HbA1c and FPG in our patients, the coefficient of correlation was not greater than 0.73. For the same FPG value, HbA1c varied markedly, and vice versa; further, the correlation between PPG and HbA1c was no higher than that between FPG and HbA1c (r = 0.65). Thus, monitoring in type 2 diabetes should include PPG along with FPG and HbA1c. Recent data provide direct and indirect evidence suggesting that PPG is independently related to cardiovascular disease (CVD), and supporting the idea that PPG should be assessed and glucose excursions with meals should be controlled: 1. Studies conducted by other investigators and ourselves in patients with type 2 diabetes have shown that the incidence of CVD is independently related to postprandial or post-OGTT (oral glucose tolerance test) blood glucose at baseline. In addition, data collected in the general population show an association between 2-hour OGTT plasma glucose (a surrogate of PPG) and cardiovascular morbidity and mortality that is independent of FPG. Also, subjects with impaired glucose tolerance (IGT) and isolated post-challenge hyperglycaemia have an increased cardiovascular risk over subjects with normal glucose tolerance (NGT). We found that IGT subjects had a risk of carotid stenosis 3-fold higher than subjects with NGT, even after adjustment for several confounders. Thus, a modest increase in post-OGTT plasma glucose and, by extrapolation, PPG seems to have a major detrimental effect on the arteries. 2. When FPG and/or HbA1c were the targets of glucose control in studies of patients with type 2 diabetes (the UGDP, VACSDM, and UKPDS) the effects on CVD were minimal. However, when the targets of glucose control included PPG (the Kumamoto Study and DIGAMI Study) favorable effects on CVD were observed. 3. There is experimental data suggesting that acute hyperglycaemia can exert deleterious effects on the arterial wall through mechanisms including oxidative stress, endothelial dysfunction, and activation of the coagulation cascade. This evidence prompted the European Diabetes Policy Group to set postprandial targets for blood glucose control: postprandial peaks should not exceed 135 mg/dl (7.5 mmol/ml) to reduce arterial risk and should not exceed 160 mg/dl (8.9 mmol/l) to reduce microvascular risk. Thus, glucose care in diabetes is not only "fasting glucose care" or "HbA1c care" but is also "postprandial glucose care."     

稳定型冠心病合并不同糖代谢状态患者中甲状腺激素测定的意义

目的：探讨甲状腺激素水平在稳定型冠心病合并不同糖代谢状态的患者中的意义。方法采用电化学发光法检测173例稳定型冠心病合并不同糖代谢状态的患者和58例健康对照者血中甲状腺激素水平,所有研究者均行75 g 葡萄糖粉口服试验评价糖代谢情况和胰岛素抵抗指数。结果甲状腺激素、收缩压、舒张压和胰岛素抵抗指数在稳定型冠心病合并不同糖代谢状态患者中的差异均无统计学意义（P ＞0．05）。稳定型冠心病合并2型糖尿病组患者的空腹血糖、餐后2 h 血糖和糖化血红蛋白高于稳定型冠心病合并糖耐量减退和正常糖耐量组,差异均有统计学意义（P ＜0．05）。稳定型冠心病合并糖耐量减退组患者的餐后2 h 血糖高于稳定型冠心病合并正常糖耐量组和健康对照组,差异均有统计学意义（P ＜0．05）。结论血清甲状腺激素水平可能不是参与冠心病合并糖尿病发病机制的影响因素。     

Low-density lipoprotein subclass and its correlating factors in diabetics

OBJECTIVES: Small dense LDL, low density lipoprotein (LDL) particles with small size and high density, is regarded as a significant risk factor for cardiovascular diseases. Diabetes mellitus is one of the conditions accompanied by increased small dense LDL. We analyzed LDL subclass in type 2 diabetics and normal controls with LipoPrint LDL System to investigate the LDL heterogeneity in diabetics and factors affecting it. DESIGN AND METHODS: We selected 40 normal controls and 40 type 2 diabetics with fasting blood glucose level over 7.0 mmol/L and HbA1c level over 7%. LDL subclass was determined with LipoPrint LDL System. LipoPrint LDL System fractionates LDL into seven parts (LDL1-7) by size and LDL3 to LDL7 are defined as small-sized LDL. In addition we estimated 'the percent of small-sized LDL over whole LDL' and defined it as 'small-sized LDL proportion'. RESULTS: Mean small-sized LDL proportion was significantly higher in diabetics (23.4%) than in controls (11.8%) (p<0.001) and small-sized LDL proportion showed positive correlation with blood levels of glucose, HbA1c, total cholesterol, triglyceride, and oxidized LDL and negative correlation with HDL cholesterol level in univariate analysis (p<0.001). Of these parameters, triglyceride, HbA1c, oxidized LDL were statistically significant variables contributing to the small-sized LDL proportion in stepwise multiple regression analysis. CONCLUSIONS: We analyzed small-sized LDL proportion in type 2 diabetics and found that it was significantly increased in diabetics than control subjects and it was independently correlated with triglyceride, HbA1c, oxidized LDL in descending order, which are reflecting lipid metabolism, glycation, and oxidative stress, respectively.     

HbA_(1c)诊断2型糖尿病特性观察及在空腹血糖正常人群中的分布特征研究

目的观察糖化血红蛋白(HbA1c)诊断2型糖尿病(T2DM)的特点及其在空腹血糖(FPG)正常者中的分布情况。方法同时测定729例FPG正常者尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C);用免疫抑制比浊法测定247例接受口服葡萄糖耐量试验(OGTT)者(包括T2DM 164例、糖耐量受损41例、空腹血糖受损18例、糖耐量正常者24例)的HbA1c,以OGTT和临床诊断结果作为标准,绘制HbA1c和FPG的受试者工作特征(ROC)曲线,确定HbA1c诊断T2DM的切点,通过对比分析观察不同性别及同性别不同年龄组中HbA1c的分布情况。结果免疫抑制比浊法测定HbA1c诊断T2DM的切点为6.36%,诊断灵敏度为86.50%、特异性为90.60%、阳性预测值为94.63%、阴性预测值为76.50%、曲线下面积为0.944[95%可信区间(CI):0.917~0.971],FPG7.0 mmol/L时诊断糖尿病的灵敏度为85.90%、特异性为93.80%、曲线下的面积为0.957[95%CI:0.932~0.981]。FPG正常者中女性HbA1c、HDL-C水平明显高于男性(P=0.000),男性血红蛋白(Hb)、FPG、UA、TG水平高于女性(P值分别为0.000、0.020、0.000、0.000)。随着年龄的增加,男、女性HbA1c、FPG、TC和LDL-C均有增高的趋势;特别是在60岁以后,女性HbA1c升高更高明显;但HDL-C在男性中有上升的趋势,在女性中有下降的趋势。结论免疫抑制比浊法测定HbA1c诊断T2DM的切点为6.36%,随着年龄的增加要定期测定HbA1c,以达到预防糖尿病的目的。     

Receptor and postreceptor defects contribute to the insulin resistance in noninsulin-dependent diabetes mellitus.

We have assessed the mechanisms involved in the pathogenesis of the insulin resistance associated with impaired glucose tolerance and Type II diabetes mellitus by exploring, by means of the euglycemic glucose-clamp technique, the in vivo dose-response relationship between serum insulin and the overall rate of glucose disposal in 14 control subjects; 8 subjects with impaired glucose tolerance, and 23 subjects with Type II diabetes. Each subject had at least three studies performed on separate days at insulin infusion rates of 40, 120, 240, 1,200, or 1,800 mU/M2 per min. In the subjects with impaired glucose tolerance, the dose-response curve was shifted to the right (half-maximally effective insulin level 240 vs. 135 microunits/ml for controls), but the maximal rate of glucose disposal remained normal. In patients with Type II diabetes mellitus, the dose-response curve was also shifted to the right, but in addition, there was a posal. This pattern was seen both in the 13 nonobese and the 10 obese diabetic subjects. Among these patients, an inverse linear relationship exists (r = -0.72) so that the higher the fasting glucose level, the lower the maximal glucose disposal rate. Basal rates of hepatic glucose output were 74 +/- 4, 82 +/- 7, 139 +/- 24, and 125 +/- 16 mg/M2 per min for the control subjects, subjects with impaired glucose tolerance, nonobese Type II diabetic subjects, and obese Type II diabetic subjects, respectively. Higher serum insulin levels were required to suppress hepatic glucose output in the subjects with impaired glucose tolerance and Type II diabetics, compared with controls, but hepatic glucose output could be totally suppressed in each study group. We conclude that the mechanisms of insulin resistance in patients with impaired glucose tolerance and in patients with Type II noninsulin-dependent diabetes are complex, and result from heterogeneous causes. (a) In the patients with the mildest disorders of carbohydrate homeostasis (patients with impaired glucose tolerance) the insulin resistance can be accounted for solely on the basis of decreased insulin receptors. (b) In patients with fasting hyperglycemia, insulin resistance is due to both decreased insulin receptors and postreceptor defect in the glucose mechanisms. (c) As the hyperglycemia worsens, the postreceptor defect in peripheral glucose disposal emerges and progressively increases. And (d) no postreceptor defect was detected in any of the patient groups when insulin's ability to suppress hepatic glucose output was measured.     

Post-load glucose measurements in oral glucose tolerance tests correlate well with 1,5-anhydroglucitol, an indicator of overall glycaemic state, in subjects with impaired glucose tolerance

Using both cross-sectional and longitudinal methods, we investigated the relationship between post-load serum glucose concentration in a 75 g oral glucose tolerance test (OGTT) and overall glycaemic state in subjects with impaired glucose tolerance (IGT). Glycaemic state was assessed by measuring glycated haemoglobin (HbA1c) and the serum concentration of 1,5-anhydroglucitol (1,5-AG). In the cross-sectional study, the concentration of 1,5-AG, while remaining within a normal range, was reduced to a degree proportional to the post-load glycaemic level. Although the correlation between HbA1c and post-load plasma glucose was relatively weak (r=0.281, P<0.001), a significant inverse correlation (r=-0.824, P<0.0001) was found between 1,5-AG and mean post-load plasma glucose concentration in 211 subjects with IGT. Fasting plasma glucose (r=-0.539, P<0.0001) and 2 h plasma glucose (r=-0.621, P<0.0001) were correlated with 1,5-AG less strongly than was post-load glycaemia. Both 1,5-AG and HbA1c were correlated weakly but significantly with the fasting insulin concentration. In the longitudinal study we measured 1,5-AG and mean post-load plasma glucose with an OGTT once yearly for 10 years in 15 subjects with IGT. Strong inverse correlations were seen between 1,5-AG and mean post-load plasma glucose in each subject (range of r values among subjects of -0.584 to -0.978). These findings suggest a close relationship between post-load plasma glucose concentration measured by OGTT and overall glycaemic state in subjects with IGT.     

Randomized controlled trial of two forms of self-management group education in Japanese people with impaired glucose tolerance

The aim of this study was to determine the effectiveness of education on diabetes prevention in subjects with impaired glucose tolerance. A total of 100 subjects of impaired glucose tolerance with hemoglobin A1c (HbA1c) levels >/=5.5 to <6.1% were assigned randomly to either support or control groups. All subjects received education in 8 sessions over a 6-month period. The support group consisted of 10 members collaborating with a dietitian or a nurse who learned coping skills by employing a participant-centered approach. Participants in the support group were required to keep a diary that monitored weight, food intake and blood glucose levels, while the control group attended several lectures. Subjects assigned to the support group had a reduction in mean HbA1c levels from 5.77 +/- 0.36% at baseline to 5.39 +/- 0.24% at the endpoint (p<0.01). Weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels also decreased (p<0.01) in the support group, whereas subjects in the control group had no observable reduction in these indices. After intervention, participants of the support group had improvements in their 2-h post-meal blood glucose levels. Support group education can be effective for improving glycemic control in participants when carried out in collaboration with educators and other team members.     

不同年龄段的正常糖耐量人群血糖值及其相关因素分析

目的 分析不同年龄段正常糖耐量(NGT)者血糖水平及相互关系.方法 选择上海市杨浦区部分街道流行病学调研2098例30岁以上居民,根据糖耐量(OGTT)检测中空腹血糖值(FPG)和2 h血糖值(2 hPG),诊断为NGT、糖耐量低减(IGT)、空腹血糖受损(IFG)、IGT合并IFG(IGT/IFG)、糖尿病(DM),将NGT者按年龄分成5组,观察各年龄组的血糖水平,用稳态模式分析胰岛β细胞功能指数(HBCI),并对其进行统计学分析.结果 在NGT中60～69年龄组FPG值(5.17±0.48)mmol/L、糖化血红蛋白(HbA1c)(6.01±0.62)%较50～59年龄组FPG值(5.09±0.44)mmol/L、HbA1c值(5.95±0.66)%高(t值分别为2.06、2.48,P均<0.05).60～69年龄组FIG值较40～49年龄组FPG值(5.01±0.47)mmol/L高(t=2.26,P<0.01),50～59年龄组FPG值较40～49年龄组高(t=2.48,P<0.01),5组按年龄从小至大比较,空腹胰岛素(FINS)值变化无明显规律;60岁以上HBCI较60岁以下的HBCI值下降,差异有统计学意义(F值为33.75,P<0.01).结论 NGT人群随着年龄的增长,FPG、HbAlc可能增高.

Abstract：

Objective To compare the glucose levels and associated factors among the normal glucose tolerance subjects with different age.Methods Totally a community-based population of 2098 residences aged above 30 years Were tested with OGTT,and classified into normal glucose tolerance group(NGT),impaired glucose tolerance group(IGT),impaired fasting glucose group(IFG),both IGT and IFG group(ICT/IFC),anddiabetes group(DM) according to fasting and 2 hours glucose level(2 hPG).The subjects in NGT group were further divided into 5 groups according to different ages.The levels of blood glucose and HBCI in different groups and subgroups were measured and analyzed statistically. Results For patients in NGT,the FPG([5.17.±0.48]mmol/L vs.[5.09±0.44]mmol/L,P<0.05)and HbA1c([6.01±0.62]%vs.[5.95±0.66]%.P<0.05)in group aged 60-69 Were higher than that in group aged 50-59.The FPG in group aged 60-69 was also higher than those in group aged 40-49([5.17±0.48]mmol/L vs.[5.00±0.47]mmol/L,P<0.01),and the FPG in group aged 50-59 Was also higher than those in group aged 40-49([5.09±0.44]mmol/L vs..[5.00±0.47]mmol/L,P<0.01).There was no correlation between age and FINS,while a tendency of decreasing HBCI could be observed along with increasing of age(F=33.75,P<0.05).Conclusion In NGT subjects,the FPG and HbA1 C inereased along with age.     

Postchallenge Hyperglycemia Is Positively Associated With Diabetic Polyneuropathy: The KORA F4 study

OBJECTIVE To assess the prevalence of distal sensorimotor polyneuropathy (DSPN) in an older population and to examine its relationship with prediabetes. RESEARCH DESIGN AND METHODS Glucose tolerance status was determined in 61- to 82-year-old participants (n = 1,100) of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 Survey (2006-2008). Clinical DSPN was defined as bilaterally impaired foot-vibration perception and/or foot-pressure sensation. RESULTS Prevalence of clinical DSPN was similar in subjects with known diabetes (22.0%) and subjects with combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (23.9%). Among prediabetic subgroups, IFG-IGT, but not isolated-IFG and -IGT, was associated with a higher risk of clinical DSPN, compared with normal glucose tolerance. A J-shaped association was observed between clinical DSPN and quartiles of 2-h postchallenge glucose, but not with fasting glucose and HbA(1c) levels. CONCLUSIONS Subjects with IFG-IGT and known diabetes had a similar prevalence of clinical DSPN. Elevated 2-h postload glucose levels appeared important for disease risk.