Association of 1,5-anhydroglucitol and 2-h postprandial blood glucose in type 2 diabetic patients

OBJECTIVE—To assess the association of 1,5-anhydroglucitol (1,5-AG) with 2-h postprandial glucose values in type 2 diabetic patients followed over 12 months in an outpatient setting.RESEARCH DESIGN AND METHODS—In 55 patients, we examined self-measured postprandial blood glucose values for correlations with 1,5-AG values over prespecified preceding time periods (3 days, 1 week, and weekly up to 12 weeks).RESULTS—The correlation coefficients for postprandial glucose values were −0.34 (P < 0.05) for 3 days, −0.38 (P < 0.001) for 1 week, and −0.40 (P < 0.001) for 2 weeks preceding the measurement of 1,5-AG. Correlations declined for time periods >2 weeks before measurement of 1,5-AG. The correlation was lower with fasting/preprandial plasma glucose levels. There was no time dependency for the correlation between A1C and fasting or postprandial glucose.CONCLUSIONS—1,5-AG best reflected the 2-h postprandial glucose values of the 2 previous weeks.Recent studies found 1,5-anhydroglucitol (1,5-AG) to generally reflect postprandial hyperglycemia (1–4). However, these studies were cross-sectional, had a comparably short follow-up (1–4), or included patients in the pre-diabetic state (3). The present study assessed the correlation of 2-h postprandial glucose measurements, frequently recommended in clinical practice, with 1,5-AG and aimed at defining the time interval of glucose values yielding the closest correlation with 1,5-AG in diabetic patients.     

Trunk fat and leg fat have independent and opposite associations with fasting and postload glucose levels: the Hoorn study

OBJECTIVE: Waist and hip circumferences have been shown to have independent and opposite associations with glucose levels. Waist circumference is positively associated with glucose levels, whereas hip circumference is negatively associated. It is unclear which tissues are involved in the pathophysiological mechanism causing these associations. The main goal was to determine which tissue in the trunk and legs, fat or lean tissue, is associated with measures of glucose metabolism. RESEARCH DESIGN AND METHODS: In 623 participants of the third examination of the Hoorn Study, whole-body dual-energy X-ray absorptiometry was performed to determine fat and lean soft-tissue mass in the trunk and legs. Fasting and 2-h postload glucose levels after 75-g oral glucose tolerance test (OGTT) were determined. After exclusion of known diabetic patients, cross-sectional analyses were performed in 275 men aged 60-87 years (140 with normal glucose metabolism, 92 with impaired glucose metabolism; and 43 with diabetes) and in 281 women (148 with normal glucose metabolism, 90 with impaired glucose metabolism, and 43 with diabetes). RESULTS: Greater trunk fat mass was associated with higher glucose levels after adjustment for age, trunk lean mass, leg lean mass, and leg fat mass. Standardized beta (95% CI) in men were 0.44 (0.25-0.64) for fasting and 0.41 (0.22-0.60) for postload glucose. For women, these values were 0.49 (0.35-0.63) and 0.47 (0.33-0.61), respectively. In contrast, in the same regression models, a larger leg fat mass was associated with lower glucose levels. Standardized beta in men were -0.24 (-0.43 to -0.05) and -0.12 (-0.31 to 0.07) and in women -0.24 (-0.37 to -0.10) and -0.27 (-0.40 to -0.13) for fasting and postload glucose, respectively. In these models, larger leg lean mass was also associated with lower glucose levels but was only statistically significant in men. CONCLUSIONS: If trunk fat is taken into account, accumulation of fat in the legs seems to be protective against a disturbed glucose metabolism, particularly in women. Further research is needed to unravel underlying pathophysiological mechanisms.     

空腹血糖受损患者血脂改变情况分析

目的探讨空腹血糖受损(impaired fasting glucose,IFG)患者血脂成分的改变情况。方法收集23例正常糖耐量(NGT)者和新诊断的44例IFG患者的临床资料,分别测定血脂谱。结果IFG患者血清甘油三酯(TG)水平显著高于NGT组(P<0.05),高密度脂蛋白—胆固醇(HDL-C)值明显低于NGT组(P<0.01)。结论新诊断的IFG患者已经存在血脂代谢异常。     

Insulin resistance and dyslipidaemia in obese premenopausal and postmenopausal women matched for leg/trunk fat mass ratio

Objectives To investigate the influence of age, menopausal stage and selected hormonal factors on insulin resistance and dyslipidaemia in obese (BMI>30 kg/m²) pre‐ and postmenopausal women. Material and methods: Thirty‐ eight pre‐ and postmenopausal women were matched one by one for leg/trunk fat mass (FM) ratio. Body composition and regional FM by dual X‐ ray absorptiometry (DXA), fasting glucose, insulin and C‐ peptide, insulin resistance by homeostasis model assessment (HOMA‐ IR), insulin sensitivity by quantitative insulin sensitivity check index (QUICKI) and metabolic clearance rate (MCRestOGTT), insulin secretion (HOMAsecr), serum lipids, oestradiol, SHBG, testosterone and testosterone index (total testosterone/SHBG), free thyroxine, free triiodothyronine, cortisol and IGF‐ 1 were assessed. Results: HDL‐ cholesterol was higher (p=0.025) and total cholesterol/HDL‐ cholesterol ratio lower (p=0.026) in post‐ than in premenopausal women. No differences in parameters of insulin resistance or hormonal factors except oestradiol were found. In forward stepwise multiple regression analysis, cholesterol/HDL‐ cholesterol ratio was negatively predicted by age (R²=0.25, p=0.02) and HDL‐ cholesterol negatively (R²=0.16, p=0.013) predicted by belonging to the premenopausal group. MCRestOGTT was unfavourably predicted by IGF‐ 1 (R²=0.28, p=0.005) and testosterone (R²=0.36, p=0.048). Because of the relatively small number of subjects studied, interpretation of the results may to some extent have limited general validity. Conclusion: FM distribution is the major determinant of insulin resistance and dyslipidaemia, with only minor roles for menopausal status, age as such and age‐ related changes in hormonal factors in the regulation of glucose and lipid metabolism.     

非受累侧上肢运动训练对脑卒中患者躯干控制与平衡功能的影响

目的：探讨非受累侧上肢运动训练对脑卒中患者躯干控制能力及平衡功能的影响。方法：选取我科收治的脑卒中患者36例,随机分配至试验组与对照组各18例,两组患者均接收常规康复治疗,试验组在此基础上增加非受累侧上肢运动训练,训练4周后评估两组患者的TIS、BBS、TUG以及ABC评分。结果：治疗后两组TIS、BBS、TUG和ABC均显著改善（P<0.001）,试验组TIS(t=2.94,P=0.006)、BBS(t=2.82,P=0.006)、TUG(t=3.70,P=0.001)和ABC(t=﹣2.17,P=0.037)均显著优于对照组,差异有显著性意义。结论：非受累侧上肢运动训练可以提高脑卒中患者躯干控制能力和平衡功能。     

Influence of local β-adrenoceptor blockade on exchange of fat and glucose in the human leg after surgery

Summary. The metabolic effects of the local administration of propranolol were determined in seven patients undergoing cholecystectomy. Measurements were carried out in the early postoperative period before and after infusion of 2 mg of intraarterial propranolol into the femoral artery of one leg using the other leg as control. Blood flow and arterio-venous concentration differences for oxygen, glucose, lactate, alanine, glycerol and total FFAs were determined. Uptake and release of FFAs were determined by using a tracer technique. The statistical analyses were based on differences between the test and the control leg in changes following the blockade. Glycerol release was significantly more suppressed in the test leg than in the control leg. No difference between the legs was seen in the uptake of oxygen, FFA and glucose or the release of lactate and alanine. The arterial concentration of propranolol was 6·07 ± 0·72 ng ml^-1 (mean ± SEM). This study indicates that a local β-blockade by intra-arterial propranolol infusion after surgery slightly reduces the postoperative lipolysis in leg tissues but does not influence or only marginally influences leg blood flow and oxygen uptake or the exchange of glucose, lactate and alanine after moderate surgical trauma.     

Plasma apolipoprotein CI and CIII levels are associated with increased plasma triglyceride levels and decreased fat mass in men with the metabolic syndrome

OBJECTIVE—To determine whether, in accordance with observations in mouse models, high concentrations of the lipoprotein lipase inhibitors apolipoprotein (Apo) CI and ApoCIII are associated with increased triglyceride concentrations and decreased fat mass in men with the metabolic syndrome.RESEARCH DESIGN AND METHODS—Plasma ApoCI, ApoCIII, and triglyceride concentrations were measured in the postabsorptive state in 98 men with the metabolic syndrome. Subcutaneous and visceral fat areas were measured by 3T-magnetic resonance imaging.RESULTS—Triglyceride concentrations were 49% higher, and the average visceral fat area was 26% lower (both P < 0.001), in subjects with high ApoCI and ApoCIII compared with low ApoCI and ApoCIII. Subjects with either high ApoCI or ApoCIII had 16% (P < 0.05) and 18% (P < 0.01) decreased visceral fat area, respectively.CONCLUSIONS—High concentrations of ApoCI and ApoCIII are associated with increased triglycerides and decreased visceral fat mass in men with the metabolic syndrome. These findings translate mouse studies into human pathophysiology.Apolipoprotein (Apo) CI and ApoCIII are present on HDL and triglyceride (TG)-rich lipoproteins (1) and mainly affect plasma lipid metabolism by inhibition of lipoprotein lipase (LPL) (2). This enzyme hydrolyzes TG in VLDL and chylomicrons, releasing fatty acids for storage by adipocytes or for energy metabolism in muscles (2,3). Overexpression of human ApoCI in mice increases VLDL-associated TG plasma levels in combination with decreased body fat (4). The effect of ApoCIII overexpression is unknown, but ApoCIII deficiency in mice led to lower VLDL-associated TG levels and increased diet-induced obesity (5). Because it has recently been shown that LPL activity is higher in visceral adipose tissue (VAT) compared with subcutaneous adipose tissue (SAT) (6), LPL inhibitors such as ApoCI and ApoCIII may differentially affect VAT compared with SAT. The objective of this study was to determine whether, like in mouse models, high ApoCI and ApoCIII concentrations are associated with increased TG concentrations and decreased fat mass (VAT vs. SAT) in men with the metabolic syndrome.     

健康查体者体脂分布与糖脂代谢指标及血压的相关性分析

目的探讨健康查体者体质量指数(BMI)、腰臀比(WHR)、腰围身高比(WHtR)、臀围身高比与糖脂代谢指标及血压的相关性。 方法选取微山县人民医院体检中心2014年1—5月107例健康查体者为研究对象。测量其身高、体质量、空腹血糖(GLU)、血脂及血压(BP),计算不同性别查体者BMI、WHR、WHtR、臀围身高比并与糖脂代谢指标、血压的相关性并进行比较。 结果①男性：BMI与收缩压(SBP)、舒张压(DBP)、平均动脉血压(MAP)、甘油三酯(TG)、胆固醇(CHOL)、低密度脂蛋白(LDL-C)、极低密度脂蛋白(VLDL-C)、高密度脂蛋白(HDL-C)、谷氨酰转肽酶(GGT)、空腹葡萄糖(GLU)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI)、胰岛β细胞功能(HOMA-β)的相关系数分别为0.26,0.33,0.32,0.24,0.25,0.36,0.18,－0.15,0.38,0.54,0.61,0.59,－0.59,0.59; WHR与上述指标的相关系数分别为0.12,0.25,0.20,0.43,0.43,0.48,0.34,－0.15,0.36,0.43,0.49,0.55,－0.55,0.40;WHtR与上述指标的相关系数分别为0.32,0.27,0.24,0.25,0.34,0.44,0.22,－0.10,0.30,0.26,0.59,0.57,－0.57,0.54;臀围身高比与上述指标相关系数分别为0.17,0.20,0.20,0.03,0.16,0.26,0.05,－0.03,0.15,0.04,0.46,0.41,－0.41,0.46;②女性：BMI与SBP、DBP、MAP、TG、CHOL、LDL-C、VLDL-C、HDL-C、GGT、GLU、FINS、HOMA-IR、ISI、HOMA-β的相关系数分别为0.21,0.21,0.30,0.38,0.13,0.26,0.27,－0.37,0.49,0.46,0.55,0.55,－0.55,0.47;WHR与上述指标的相关系数分别为0.32,0.17,0.25,0.38,0.16,0.04,0.31,－0.02,0.34,0.15,0.18,0.15,－0.15,0.2;WHtR与上述指标的相关系数分别为0.27,0.16,0.23,0.39,0.16,0.15,0.30,－0.12,0.46,0.33,0.39,0.37,－0.37,0.36;臀围身高比与上述指标相关系数分别为0.12,0.10,0.11,0.30,0.11,0.23,0.20,－0.31,0.47,0.45,0.54,0.55,－0.55,0.47;③男性BMI与血压、糖代谢指标、GGT的相关性和WHR与TG、CHOL、LDL-C、VLDL-C的相关性均有统计学意义(P<0.05)。女性BMI与糖代谢指标、GGT的相关系数大于其他指标(P<0.01)。 结论与其他三种测量指标比较,BMI与糖代谢紊乱及GGT的升高的相关性较显著;WHR与男性TG、CHOL、LDL-C、VLDL-C的相关性较显著。     

Bimodality of 2-h plasma glucose distributions in whites: the Rancho Bernardo study

OBJECTIVE: Several studies have shown a bimodal curve in the distribution of glucose in populations with a high prevalence of type 2 diabetes, but bimodality has not been reported among whites of Northern European ancestry. It is not clear whether this difference reflects the lower prevalence of diabetes, obscuring a second mode, or implies a more fundamental difference between whites and nonwhites. We investigate this issue by studying glucose distributions in older white patients. RESEARCH DESIGN AND METHODS: A study of diabetes was conducted among older community-dwelling white residents of a suburban Southern California community between 1984 and 1987. Two-hour plasma glucose data were collected from 2,326 older white men and women aged 23-92. To investigate bimodality of glucose distributions, we fit unimodal and bimodal normal models to 2-h plasma glucose concentrations transformed by the Box-Cox family of transformations. RESULTS: We found that the bimodal normal mixture model fit the data significantly better than the unimodal skewed distribution model for both sexes and all age-groups except those > or =80 years. The cut points separating the two modes were generally within the 11.1- to 13.6-mmol/l range. CONCLUSIONS: The bimodality of glucose distributions among whites, combined with previous findings, indicates that this phenomenon may be universal. A smaller second mode in our study compared with other studies suggests that whites have diabetes susceptibility but may require more obesity to demonstrate it. With increasing obesity in the U.S., the predicted epidemic of diabetes may affect all ethnic groups including whites.     

The relationship of fasting plasma glucose values and other variables to 2-h postload plasma glucose in Japanese subjects.

OBJECTIVE: To investigate the relationship between fasting plasma glucose (FPG) values and other variables (e.g., age, sex, and BMI) to 2-h post-75-g oral glucose load glycemia (PG) in Japanese subjects. RESEARCH DESIGN AND METHODS: Subjects included 13,694 Japanese subjects between 20 and 83 years of age (10,677 men and 3,017 women) who were undergoing a 75-g oral glucose tolerance test (OGTT) during a health screening performed at our hospital. The influences of age for 2-h PG at a fixed fasting plasma glucose (FPG) level of 126 mg/dl were analyzed. Multiple linear regression analysis was performed using a model in which the dependent variable was 2-h PG using the following explanatory variables: FPG, age, sex, BMI, blood pressure, plasma cholesterol, and triglyceride (TG) levels. RESULTS: The 2-h PG at a fixed FPG of 126 mg/dl increased by 0.94 mg/dl per year in patients aged between 30 and 78 years (r = 0.68, P < 0.0001). In multiple regression, five explanatory variables (FPG, age, BMI, plasma TG levels, and systolic blood pressure levels) were all positively associated with 2-h PG. The percentages of patients with 2-h diabetes (isolated postchallenge hyperglycemia [IPH]) versus fasting plus 2-h diabetes by the World Health Organization criteria significantly (P = 0.005) increased as the patients' decades increased, whereas the impact of BMI on the percentages was significant only in young patients (P = 0.001). CONCLUSIONS: Aging was found to be the second best predictor of 2-h PG on multiple regression. Therefore, OGTT should be performed especially in elderly patients because they show IPH more frequently.     

Comparison of hemoglobin A1c with fasting plasma glucose and 2-h postchallenge glucose for risk stratification among women with recent gestational diabetes mellitus

OBJECTIVE

Postpartum testing with a 75-g 2-h oral glucose tolerance test or fasting plasma glucose (FPG) alone is often not performed among women with histories of gestational diabetes mellitus (GDM). Use of hemoglobin A_1c (A1C) might increase testing. The association between A1C and glucose has not been examined in women with histories of GDM.

RESEARCH DESIGN AND METHODS

We assessed the association of A1C ≥5.7% with FPG ≥100 mg/dL and 2-h glucose ≥140 mg/dL among 54 women with histories of GDM between 6 weeks and 36 months postpartum.

RESULTS

A1C ≥5.7% had 65% sensitivity and 68% specificity for identifying elevated FPG or 2-h glucose and 75% sensitivity and 62% specificity for elevated FPG alone. The area under the receiver operating characteristic curve for A1C was 0.76 for elevated FPG or 2-h glucose and 0.77 for elevated FPG alone.

CONCLUSIONS

The agreement between A1C and glucose levels is fair for detection of abnormal glucose tolerance among women with histories of GDM.Postpartum testing is recommended for women with histories of gestational diabetes mellitus (GDM) to diagnose diabetes and to stratify women for risk of future diabetes (1–3). Several groups have recommended postpartum testing with fasting plasma glucose (FPG) alone (1), others have recommended 2-h 75-g oral glucose tolerance tests (OGTTs) (2), and others have recommended hemoglobin A_1c (A1C) (4). Agreement between A1C and glucose has not yet been reported in this population. Our objective was to examine the agreement between A1C, FPG, and 2-h glucose among women with recent GDM.     

580例正常糖耐量人群糖化血红蛋白的检测与分析

目的 确定我院生物化学实验室糖化血红蛋白（glycatedhemoglobin,GHb）的参考范围,研究正常糖耐量人群糖化血红蛋白水平与年龄和性别的关系。方法根据要求从2012年1月3日-2012年月9月30日,前来我院就诊或体检者中筛选出符合条件的正常糖耐量人群580人的HbAlc检测值,并记录受捡者的年龄,性别等基本信息。采用正态分布法双侧95％可信区间确定参考范围,并分析糖化血红蛋白与性别、年龄的关系。结果580例正常糖耐量者测得HbAlc参考范围3．93％～5。97％。其中男性糖化血红蛋白平均值为4．92％,女性为4,98％,两者差异没有统计学意义（t=-1．49,P〉0．05）。不同年龄组糖化血红蛋白平均值分别为：儿童组4．42％,少年组4．65％,青年组5．11％,中年组5．07％,老年组5．12％。老年组与中年组、青年组,中年组和青年组的差异没有统计学意义,其他各组之间的差异均有显著统计学意义（P〈0．01）。结论我院生物化学实验室糖化血红蛋白参考范围3．93％～5．97％。糖化血红蛋白水平与性别无关,但随年龄有一定增加,建议实验室设置不同年龄组的参考范围。     

Brown and beige fat in humans: thermogenic adipocytes that control energy and glucose homeostasis

Brown adipose tissue (BAT), a specialized fat that dissipates energy to produce heat, plays an important role in the regulation of energy balance. Two types of thermogenic adipocytes with distinct developmental and anatomical features exist in rodents and humans: classical brown adipocytes and beige (also referred to as brite) adipocytes. While classical brown adipocytes are located mainly in dedicated BAT depots of rodents and infants, beige adipocytes sporadically reside with white adipocytes and emerge in response to certain environmental cues, such as chronic cold exposure, a process often referred to as “browning” of white adipose tissue. Recent studies indicate the existence of beige adipocytes in adult humans, making this cell type an attractive therapeutic target for obesity and obesity-related diseases, including type 2 diabetes. This Review aims to cover recent progress in our understanding of the anatomical, developmental, and functional characteristics of brown and beige adipocytes and discuss emerging questions, with a special emphasis on adult human BAT.     

Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes.

OBJECTIVE: To evaluate American Diabetes Association (ADA) and World Health Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes. RESEARCH DESIGN AND METHODS: This cohort study consecutively enrolled Brazilian adult women attending general prenatal clinics. All women were requested to undertake a standardized 2-h 75-g oral glucose tolerance test (OGTT) between their estimated 24th and 28th gestational weeks and were then followed to delivery. New ADA criteria for GDM require two plasma glucose values > or = 5.3 mmol/l (fasting), > or = 10 mmol/l (1 h), and > or = 8.6 mmol/l (2 h). WHO criteria require a plasma glucose > or = 7.0 mmol/l (fasting) or > or = 7.8 mmol/l (2 h). Individuals with hyperglycemia indicative of diabetes outside of pregnancy were excluded. RESULTS: Among the 4,977 women studied, 2.4% (95% CI 2.0-2.9) presented with GDM by ADA criteria and 7.2% (6.5-7.9) by WHO criteria. After adjustment for the effects of age, obesity, and other risk factors, GDM by ADA criteria predicted an increased risk of macrosomia (RR 1.29, 95% CI 0.73-2.18), preeclampsia (2.28, 1.22-4.16), and perinatal death (3.10, 1.42-6.47). Similarly, GDM by WHO criteria predicted increased risk for macrosomia (1.45, 1.06-1.95), preeclampsia (1.94, 1.22-3.03), and perinatal death (1.59, 0.86-2.90). Of women positive by WHO criteria, 260 (73%) were negative by ADA criteria. Conversely, 22 (18%) women positive by ADA criteria were negative by WHO criteria. CONCLUSIONS: GDM based on a 2-h 75-g OGTT defined by either WHO or ADA criteria predicts adverse pregnancy outcomes.     

Beneficial associations of physical activity with 2-h but not fasting blood glucose in Australian adults: the AusDiab study

OBJECTIVE: We examined the associations of physical activity with fasting plasma glucose (FPG) and with 2-h postload plasma glucose (2-h PG) in men and women with low, moderate, and high waist circumference. RESEARCH DESIGN AND METHODS: The Australian Diabetes, Obesity and Lifestyle (AusDiab) study provided data on a population-based cross-sectional sample of 4,108 men and 5,106 women aged >or=25 years without known diabetes or health conditions that could affect physical activity. FPG and 2-h PG were obtained from an oral glucose tolerance test. Self-reported physical activity level was defined according to the current public health guidelines as active (>or=150 min/week across five or more sessions) or inactive (<150 min/week and/or less than five sessions). Sex-specific quintiles of physical activity time were used to ascertain dose response. RESULTS: Being physically active and total physical activity time were independently and negatively associated with 2-h PG. When physical activity level was considered within each waist circumference category, 2-h PG was significantly lower in active high-waist circumference women (beta -0.30 [95% CI -0.59 to -0.01], P = 0.044) and active low-waist circumference men (beta -0.25 [-0.49 to -0.02], P = 0.036) compared with their inactive counterparts. Considered across physical activity and waist circumference categories, 2-h PG levels were not significantly different between active moderate-waist circumference participants and active low-waist circumference participants. Associations between physical activity and FPG were nonsignificant. CONCLUSIONS: There are important differences between 2-h PG and FPG related to physical activity. It appears that 2-h PG is more sensitive to the beneficial effects of physical activity, and these benefits occur across the waist circumference spectrum.     

胰岛素治疗期间餐后2h血糖水平与低血糖发生的相关性研究

目的研究餐后2 h血糖(PBG2h)值与随后发生低血糖的相关性。方法对使用胰岛素治疗的糖尿病患者进行血糖监测,观察记录在PBG2h小于6 mmol/L的情况下,餐后2 h至下次进餐期间是否发生低血糖,了解低血糖的原因。结果共观察到160人231例次PBG2h小于6 mmol/L的情况,对106例次PBG2h在4.0~5.9 mmol/L进行观察,60例次出现低血糖症状或血糖≤3.9 mmol/L,46例次未出现低血糖,低血糖发生率56.6%(60/106)。PBG2h值4.0~4.4、4.5~4.9、5.0~5.4、5.5~5.9 mmol/L各段低血糖发生率分别为86.7%(13/15)、61.5%(24/39)、48.3%(14/29)、34.6%(9/26)。结论使用胰岛素的糖尿病患者当PBG2h低于6.0 mmol/L时,随后发生低血糖的风险较高。且PBG2h值越低,随后低血糖发生率越高。