Physical activity, physical fitness, and risk of type 2 diabetes mellitus

Type 2 diabetes mellitus (DM) is a common chronic disease. Cardiovascular disease is the most prevalent complication of DM. In the past decade, the associations of physical activity, physical fitness, and changes in lifestyle with the risk of type 2 DM have been assessed by a number of prospective epidemiologic studies and clinical trials. Several studies also evaluate the joint associations of physical activity, body mass index, and glucose levels with the risk of type 2 DM. The results of 21 prospective studies and four clinical trials demonstrated that moderate or high levels of physical activity or physical fitness, as well as changes in lifestyle (dietary modification and enhanced physical activity) could prevent type 2 DM.     

Haptoglobin polymorphism in relation to antioxidative enzymes activity in type 2 diabetes mellitus

BackgroundIncreased oxidative stress and impaired antioxidative capacity are common findings in diabetics. This study reports on the status of antioxidative enzymes in relation to haptoglobin (Hp) polymorphism in type 2 diabetes.MethodsThe study comprised 165 type 2 diabetic patients and 94 controls. Erythrocytic superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT), and plasmatic ceruloplasmin ferroxidase (Cp) were measured by spectrophotometry and Hp phenotypes were determined by gel electrophoresis.ResultsIrrespective of Hp phenotype, while the activities of Cp ferroxidase and GPx were significantly higher in patients than in controls, those of SOD were significantly lower. No significant differences observed for CAT. However, significant Hp-phenotype dependent differences were observed between patients and controls regarding the activity of these enzymes. While ferroxidase activity in Hp2-2 patients was significantly higher than that in Hp1-1 or Hp2-1 patients, that of SOD and GPx were significantly lower. When patients were analyzed as a single group, Spearman's univariate analysis has demonstrated that HbA1c positively correlates with ferroxidase activity and negatively correlates with levels of GPx and SOD. However, when patients were treated as separate Hp-dependent groups, similar but stronger correlations between these variable were noted only in the case of Hp2-2 patients.ConclusionsThese findings suggest that Hp polymorphism has some bearing on the activity of antioxidative enzymes in type 2 diabetes and that Hp2-2 diabetics are under increased oxidative stress as compared with those expressing Hp1-1 or Hp2-1.     

Dietary glycemic index and risk of type 2 diabetes mellitus in middle-aged Japanese men

This cohort study investigated the association between dietary glycemic index (GI), glycemic load (GL), and the incidence of type 2 diabetes mellitus in middle-aged Japanese men, and the effect of insulin resistance and pancreatic B-cell function on the association. Participants were 1995 male employees of a metal products factory in Japan. Dietary GI and GL were assessed using a self-administered diet history questionnaire. The incidence of diabetes was detected in annual medical examinations over a 6-year period. The association between GI, GL, and the incidence of diabetes was evaluated using Cox proportional hazards models. During the study, 133 participants developed diabetes. Age- and body mass index-adjusted hazard ratios across the GI quintiles were 1.00 (reference), 1.62, 1.50, 1.68, and 1.80; and those of GL were 1.00 (reference), 1.07, 1.48, 0.95, and 0.98. The hazard ratio for the highest GI quintile was significantly greater than that for the lowest quintile. The influence of GI was more pronounced in the lowest insulin resistance subgroups. GI and pancreatic B-cell function were independently associated with the incidence of type 2 diabetes mellitus; participants with low B-cell function and the highest tertile of GI had the highest risk of diabetes. Dietary GI is associated with the incidence of diabetes in middle-aged Japanese men. GI and B-cell function were independently associated with incidence of diabetes.     

Higher prevalence of risk factors for type 2 diabetes mellitus and subsequent higher incidence in men

BACKGROUND: This study investigates risk factors and the incidence of type 2 diabetes mellitus (type 2 DM) in both sexes of a northern European population. METHODS: A total of 14,223 randomly selected men and women were studied from 1976 to 1978. Patients with diabetes (self-reported type 2 DM or non-fasting plasma glucose >11.1 mmol/l) were excluded. Some 6154 women and 4733 men were studied and followed up in 1981-1983 or in 1991-1994. The significance of risk factors was examined by multiple logistic regression analysis. RESULTS: Initially, a higher proportion of men than women had high, non-fasting blood glucose and triglycerides. Significantly more men (242, 5.4%) than women (152, 2.5%) developed type 2 DM. The odds ratio (OR) for developing diabetes with a BMI above 30 kg/m(2) compared to a BMI of 20-25 kg/m(2) was 8.1 in women and 6.3 in men; for a non-fasting plasma glucose of 8.4-11.0 mmol/l compared to a plasma glucose of 5.5-6.4, the ORs were 7.8 in women and 4.7 in men. The OR for developing diabetes in persons with a non-fasting triglyceride level above 2.0 mmol/l compared to 1.0-2.0 mmol/l was 1.8 in both sexes; women with non -fasting triglycerides below 1.0 mmol/l had an OR of 0.4. CONCLUSION: In a randomly selected northern European population, significantly more men than women develop type 2 DM.     

Physical activity reduces the risk for hospitalizations in patients with type 2 diabetes

The purpose of this study is to examine factors and variables associated with hospitalizations in type 2 diabetes mellitus (T2DM). This is a 2-year follow-up study of 145 patients (87 women/58 men), mean age 55.0 ± 3.3 (40 to 60). At baseline, comorbidity severity was evaluated by the Charlson Comorbidity Index (CCI), depressive symptoms by the Beck Depression Inventory (BDI II), sleep quality by the Pittsburgh Sleep Quality Index, daytime sleepiness by the Epworth Sleepiness Scale, and levels of physical activity by the International Physical Activity Questionnaire (IPAQ). Arterial hypertension (74 %), cardiovascular pathology (30 %), and stroke (10 %) were found at baseline. After 2 years, eight cases (6 %) developed a new stroke. At baseline, 70 % (N = 102) of patients had a sedentary life, and 30 % (N = 43) were irregularly active. Two years later, the number of patients with a sedentary life decreased to 52 % (N = 76), and an increase of irregularly active (35 %, N = 51) and active patients (13 %, N = 18; p < 0.005) was observed. Twenty-four individuals (16 %) reported at least one hospitalization. Logistic regression analysis showed that the presence of hypertension and lower physical activity status (IPAQ levels) were predictors of hospitalizations (OR = 0.34, CI 0.14–0.85, p = 0.02); lower physical activity status remained significant in the presence of hypertension (OR = 0.33, CI 0.13–0.84, p = 0.02). In conclusion, higher physical activity status is an independent predictor of lower hospitalizations in T2DM proving that exercising is an important strategy not only to reduce health care costs but also to improve the human burden of hospitalizations for the patients.

     

Hypogonadism in Nigerian men with type 2 diabetes mellitus

Hypogonadism in patients with diabetes mellitus (DM) has been associated with insulin resistance and poor glycaemic control. This study was conducted to determine the prevalence, types, and associations of hypogonadism in Nigerian men with established type 2 diabetes mellitus. The study was a cross-sectional observational work, which was conducted at the Lagos University Teaching Hospital (LUTH). The participants consisted of 108 men with type 2 DM and 56 non-diabetic controls. A questionnaire was used to obtain demographic data while the Androgen Deficiency in Aging Male (ADAM) questionnaire was administered to elicit symptoms of hypogonadism. The enzyme-linked immunosorbent assay (ELISA) method was used to test for serum-free testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and estradiol. Other investigations done included fasting lipid profile, fasting plasma glucose, and glycated haemoglobin (HbA1c). Statistical analysis was done with SPSS v20. Tests of normality were carried out on the data to determine appropriate statistical analytic methods. The mean (±SD) ages of the DM patients and controls were 51.7 ± 5.9 and 50.9 ± 4.6 years, respectively (p = 0.349), with a mean duration of diabetes 93.6 ± 6.29 months. Among the DM patients, 17 (15.7 %) were obese, while 6 (10.7 %) controls had obesity. Hypogonadism (predominantly secondary in (78.5 %)) was present in 42 (38.9 %) of the DM patients. In the controls, only 2 (3.6 %) had hypogonadism. Predictors of hypogonadism were a high HbA1c. Hypogonadism, which was predominantly secondary hypogonadism, was prevalent in the patients and was associated with HbA1c levels.     

Hemoglobin concentration in men with type 2 diabetes mellitus

Anemia is a common but often overlooked complication of diabetes. We investigated the relationship between hemoglobin concentration and various factors as well as markers of subclinical atherosclerosis in men with type 2 diabetes mellitus. Hemoglobin concentration was measured in 319 men with type 2 diabetes mellitus. We evaluated the relationship between hemoglobin concentration and various factors including age, body mass index, and glycemic control, as well as between hemoglobin concentration and pulse wave velocity or ankle-brachial index (n = 209) and between hemoglobin concentration and carotid intima-media thickness or plaque score (n = 125). Mean hemoglobin concentration was 14.2 ± 0.80 g/dL. Body mass index (r = 0.340, P < .0001) and estimated glomerular filtration rate (r = 0.219, P = .0011) were positively associated with hemoglobin concentration, whereas age (r = −0.388, P < .0001), glycated albumin (r = −0.148, P = .0121), serum creatinine concentration (r = −0.206, P = .0019), and log (urinary albumin excretion) (r = −0.188, P = .0010) were negatively associated with hemoglobin concentration. Multiple regression analysis identified age (β = −0.222, P = .0019), body mass index (β = 0.145, P = .0432), systolic blood pressure (β = 0.214, P = .0015), total cholesterol concentration (β = 0.170, P = .0077), and serum creatinine concentration (β = −0.181, P = .0045) as independent determinants of hemoglobin concentration. No significant association was observed between hemoglobin concentration and serum erythropoietin concentration (r = −0.079, P = .2980). Negative correlations were found between hemoglobin concentration and pulse wave velocity (r = −0.289, P < .0001) and between hemoglobin concentration and plaque score (r = −0.275, P = .0024). In conclusion, hemoglobin concentration was associated with various factors; and decreased hemoglobin concentration was associated with subclinical markers of atherosclerosis in men with type 2 diabetes mellitus.     

Bone stiffness in men with type 2 diabetes mellitus

Osteoporosis in elderly men as well as women is increasingly recognized, and patients with type 2 diabetes mellitus have higher risk of fracture than nondiabetic subjects. The aim of the present study was to investigate the relationship between bone stiffness and serum testosterone concentration as well as other variables in men with type 2 diabetes mellitus. The relationships between bone stiffness and serum bioavailable testosterone concentrations as well as other variables including age, duration of diabetes, glycemic control (hemoglobin A_1c), or body mass index were evaluated in 294 men with type 2 diabetes mellitus. An inverse correlation was found between stiffness index and age. A positive correlation was found between stiffness index and serum bioavailable testosterone concentration (r = 0.231, P = .0005). Stiffness index was significantly less in current smokers (81.6 ± 17.7) than in past smokers (86.6 ± 17.8, P = .0396) or nonsmokers (87.7 ± 15.2, P = .0426). Multiple regression analysis demonstrated that serum bioavailable testosterone concentration (β = .271, P = .0006) and smoking status (β = −0.147, P = .0408) were independent determinants of stiffness index. In conclusion, bone stiffness was associated with serum bioavailable testosterone concentration but not associated with hemoglobin A_1c or duration of diabetes in men with type 2 diabetes mellitus.     

2型糖尿病与恶性肿瘤

2型糖尿病不仅是一个严重的健康问题，还与恶性肿瘤有着密切的联系。近年来流行病学研究证实2型糖尿病与一些常见恶性肿瘤如结、直肠癌、肝癌、胰腺癌、乳腺癌以及子宫内膜癌的发病有关，但其关联的确切机理仍无定论，可能与高血糖、胰岛素及胰岛素样生长因子、内皮素、脂联素、微量元素、激素和药物等诸多因素有关。     

Alcohol consumption and risk of coronary heart disease among men with type 2 diabetes mellitus

OBJECTIVES

The goal of this study was to examine the relationship between alcohol intake and risk of coronary heart disease (CHD) among men with type 2 diabetes.

BACKGROUND

Type 2 diabetes is associated with an increased risk of CHD. Emerging evidence suggests that moderate alcohol intake is associated with an important reduction in risk of CHD in individuals with type 2 diabetes.

METHODS

We studied 2,419 men who reported a diagnosis of diabetes at age 30 or older in the Health Professionals’ Follow-up study (HPFS). During 11,411 person-years of follow-up after diagnosis, we documented 150 new cases of CHD (81 nonfatal myocardial infarction [MI] and 69 fatal CHD). Relative risks (RR) were estimated from pooled logistic regression adjusting for potential confounders.

RESULTS

Alcohol use was inversely associated with risk of CHD in men with type 2 diabetes. The age-adjusted RRs corresponding to intakes of ≤0.5 drinks/day, 0.5 to 2 drinks/day and >2 drinks/day were 0.76 (95% confidence interval: [CI]: 0.52 to 1.12), 0.64 (95% CI: 0.40 to 1.02) and 0.59 (95% CI: 0.32 to 1.09), respectively, as compared with nondrinkers (p for TREND = 0.06). When we controlled for body mass index, smoking, family history of MI, hypertension, hypercholesterolemia, duration of diabetes, physical activity level, vitamin E supplements and intake of trans fat, polyunsaturated fat, fiber and folate, RRs were 0.78 (95% CI: 0.52 to 1.15), 0.62 (95% CI: 0.40 to 1.00) and 0.48 (95% CI: 0.25 to 0.94) (p for TREND = 0.03). The benefits of moderate consumption did not statistically differ by beverage type.

CONCLUSIONS

Moderate alcohol consumption is associated with lower risk of CHD in men with type 2 diabetes.     

Serum gamma-glutamyltransferase and risk of type 2 diabetes mellitus in men and women from the general population

OBJECTIVES: To examine gender-specific associations between gamma-glutamyltransferase (GGT) and incident type 2 diabetes mellitus in a representative population-based sample in Germany. DESIGN: Prospective population-based study. METHODS: The study was based on 1851 men and 1836 women (aged 25-64 years) who participated in the first Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA) Augsburg Survey 1984/1985, and who were free of diabetes at baseline. Incident cases of type 2 diabetes were assessed using follow-up questionnaires in 1987/1988, 1997/1998 and 2002/2003 and were validated with medical records. Gender-specific hazard ratios (HRs) were estimated from Cox proportional hazard models. RESULTS: A total of 172 cases of incident type 2 diabetes amongst men and 109 amongst women were registered during a mean follow-up period of 14.7 years. In both sexes the risk of type 2 diabetes increased with increasing levels of serum GGT. After multivariable adjustment HRs for incident type 2 diabetes across GGT categories (<25th, <50th, <75th, <87.5th and > or =87.5th percentiles) were 1.0, 1.81, 2.37, 3.41 and 4.24 (P-value for trend <0.0001) in men and 1.0, 1.42, 1.48, 1.95 and 2.41 (P-value for trend 0.0179) in women. Obesity appeared to be more strongly associated with type 2 diabetes in women with GGT equal or greater than the median compared to women with GGT below the median. However, in men the association between obesity and type 2 diabetes was almost identical in the two groups. CONCLUSIONS: The GGT is an important predictor for incident type 2 diabetes in men and women from the general population.