Association of aortic pressures with fasting plasma glucose in patients with and without impaired fasting glucose

BACKGROUND: Diabetes mellitus and impaired fasting glucose (IFG) are associated with future cardiovascular disorders. Aortic pulse pressure (PP) and fractional pulse pressures (FPPs) are strong and independent indicators of the risk of coronary heart disease. These conditions have been reported to be associated with endothelial dysfunction. In the present study, aortic PP and FPPs of patients with and without impaired fasting glucose were evaluated. METHODS: Fifty patients with IFG with a mean age of 56.8+/-12.2 years and 47 patients with normal fasting glucose (NFG) with a mean age of 53.1+/-11.2 years were included in the study. All subjects had angiographically proven normal coronary arteries without coronary slow flow. Aortic systolic and diastolic blood pressures were measured invasively. Mean pressure, PP and FPPs (aortic PP/mean pressure) were calculated. RESULTS: All parameters measured were significantly higher in the IFG group than in the control (NFG) group (133+/-21 mmHg and 117+/-12 mmHg, p<0.001 for aortic systolic pressure; 79+/-12 mmHg and 74+/-8 mmHg, p = 0.035 for aortic diastolic pressure; 97+/-14 mmHg and 88+/-9 mmHg, p = 0.001 for aortic mean pressure; 54+/-13 mmHg and 43+/-8 mmHg, p<0.001 for aortic PP; 0.56+/-0.10 and 0.48+/-0.08, p<0.001 for aortic FPP). In addition, in linear regression analysis, a positive correlation was found between fasting plasma glucose and the aortic FPP (p = 0.001, R2 = 0.12). CONCLUSION: Ascending aorta PP and FPPs are significantly associated with the presence of IFG. These findings suggest that IFG is associated with endothelial dysfunction and so aortic stiffness.     

从血糖稳态看空腹血糖受损下限切点下调

目的寻找预测2型糖尿病（T2DM）和糖耐量受损（IGT）发生的最佳空腹血糖受损（IFG）下限切点及下调的合理性。方法根据OGTT结果对北京城区2589例年龄≥20岁、既往无糖尿病史的自然人群的FPG进行ROC分析,绘制ROC曲线,并进行糖脂代谢分析。结果预测T2DM和IGT发生的最佳IFG下限切点ROC曲线下面积分别为0．949、0．692。用FPG来预测T2DM和IGT,其灵敏度及特异度均较好的点分别为5．6mmol／L和5．2mmol／L。与FPG〈5．6mmol／L组比较,FPG5．6～6．1mmol／L组胰岛素抵抗更加明显,胰岛素分泌下降,TG升高和HDL—C降低。结论将5．6mmol／L作为IFG的下限值适用于北京城区中国人群。     

空腹血糖异常、糖耐量减低患者血清胰岛素水平的变化及其意义

目的 观察空腹血糖异常(IFG)、糖耐量减低(IGT)患者血清胰岛素水平的变化。方法 对50例空腹血糖和糖耐量正常者(NGT)、40例IFC和80例IGT患者行口服葡萄糖耐量试验(0GTT)，用氧化酶法检测血糖，用放免法测定血清空腹及餐后2小时胰岛素。结果 IFG、IGT组空腹血糖、空腹胰岛素水平及胰岛素敏感指数较NGT组明显升高(P＜0.05或P＜0．01)，IFG组胰岛素敏感指数与IGT组比较无显著性差异(P＞0．05)。结论 在IFG、IGT状态下已经存在胰岛素抵抗，而且在程度上两者间并没有显著性差异，应早期干预治疗。     

The development and validation of the Portuguese risk score for detecting type 2 diabetes and impaired fasting glucose

AimsTo develop and validate a non-invasive score for detecting undiagnosed impaired fasting glucose (IFG) and type 2 diabetes (T2DM) in a Portuguese population.MethodsWe used data from 3,374 individuals aged 18–94 years from a Portuguese cross-sectional study. We developed a logistic regression model for predicting IFG/T2DM (diagnosed using fasting glucose). We externally validated the score using data from two cohorts of the EPI-Porto study, cross-sectional (n = 2,131) and data from the 5 year follow-up (n = 1,304).ResultsThe final model included age, sex, BMI and hypertension with an area under the ROC curve of 70.1 (95%CI 68.4, 71.7). Using a cut-point which classifies 50% of the EPI-Porto cross-sectional data as high-risk gave sensitivity 73.2% (95%CI 68.5%, 77.6%), specificity 55.5% (53.1%, 57.8%), positive predictive value (PPV) 27.0% (24.3%, 29.8%) and negative predictive value (NPV) 90.2% (88.3%, 92.0%) for IFG/T2DM. Using the same cut-point on the prospective data classified 45% as high-risk; sensitivity 69.1% (63.4%, 74.4%), specificity 63.3% (60.0%, 66.5%), PPV 38.0% (33.9%, 42.4%), and NPV 86.2% (83.3%, 88.8%).ConclusionThe Portuguese risk score can be used to identify those at high risk of both prevalent undiagnosed and incident IFG/T2DM.     

Daily life activity and risk of developing impaired fasting glucose or Type 2 diabetes in middle-aged Japanese men

Aims/hypothesis The aim of this study was to investigate the association between daily life activity and risk of developing diabetes.Methods The study population included 2924 Japanese male office workers aged 35 to 59 years who did not have IFG (fasting plasma glucose level 6.1–6.9 mmol/l), Type 2 diabetes (fasting plasma glucose level 7.0 mmol/l and/or medication for diabetes) or a history of cardiovascular disease, and were not receiving medication for hypertension. A 1-day activity record during an ordinary weekday was used to estimate daily energy expenditure. Fasting glucose levels were measured at annual health examinations performed in May from 1994 to 2001.Results Over a 7-year follow-up period the relative risk of IFG and Type 2 diabetes decreased with increasing daily energy expenditure after controlling for potential predictors of diabetes (p<0.001 and p=0.001 for trend respectively). The age-adjusted relative risk of IFG or Type 2 diabetes decreased with increasing energy expenditure on occupational physical activity, brisk walking, riding on vehicles (standing position) to and from work and other physical activities (all p<0.001 for trend). The association with riding on vehicles (standing position) and other physical activities remained after controlling for other potential confounders of diabetes (p=0.026 and p=0.003 for trend respectively). Results of stratified analyses by the presence or absence of different risk factors for diabetes revealed that the risk of IFG or Type 2 diabetes was inversely related to daily energy expenditure both in men at low risk of diabetes and those at high risk.Conclusions/interpretation Physical activity in daily life is inversely associated with the risk of developing IFG or Type 2 diabetes.     

Psychosocial factors are independent risk factors for the development of Type 2 diabetes in Japanese workers with impaired fasting glucose and/or impaired glucose tolerance1

Aims We prospectively studied Japanese workers with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and analysed possible risk factors for diabetes, including psychosocial factors such as stress. Methods The participants were 128 male Japanese company employees (mean age, 49.3 ± 5.9 years) with IFG and/or IGT diagnosed by oral glucose tolerance test (OGTT). Participants were prospectively studied for 5 years with annual OGTTs. The Kaplan–Meier method and Cox's proportional hazard model were used to analyse the incidence of diabetes and the factors affecting glucose tolerance, including anthropometric, biochemical and social–psychological factors. Results Of 128 participants, 36 (28.1%) developed diabetes and 39 (30.5%) returned to normal glucose tolerance (NGT) during a mean follow‐up of 3.2 years. Independent risk factors for diabetes were night duty [hazard ratio (HR) = 5.48, P = 0.002], higher fasting plasma glucose (FPG) levels within 6.1–6.9 mmol/l (HR = 1.05, P = 0.031), stress (HR = 3.81, P = 0.037) and administrative position (HR = 12.70, P = 0.045), while independent factors associated with recovery were lower FPG levels (HR = 0.94, P = 0.017), being a white‐collar worker (HR = 0.34, P = 0.033), non‐smoking (HR = 0.31, P = 0.040) and lower serum alanine aminotransferase (ALT) levels (HR = 0.97, P = 0.042). Conclusions In addition to FPG levels at baseline, psychosocial factors (night duty, stress and administrative position) are risk factors for Type 2 diabetes, while being a white‐collar worker, a non‐smoker and lower serum ALT levels are factors associated with return to NGT in Japanese workers with IFG and/or IGT.     

Lipid risk factors among elderly with normal fasting glucose,impaired fasting glucose and type 2 diabetes mellitus. The Italian longitudinal study on aging

Background and aimsThree groups of subjects were identified within a representative sample of older Italians: subjects with normal fasting glucose (NFG), with impaired fasting glucose (IFG) or with type 2 diabetes mellitus (T2D). The aim of the present study was to evaluate the relationship among plasma lipids, lipoproteins, other metabolic factors in the three groups, and their role in predicting total fatal events.Methods and results2422 subjects, aged 65–84 years, taking part into the Italian Longitudinal Study on Aging were included in the analyses. Factor analysis was conducted separately for men and women. Factor scores were used as independent variables in Cox Proportional Hazard models, to determine factors predicting death at the follow-up in NFG, IFG and T2D subjects.Four major factors were found for men (“insulin resistance”, “body size”, “total cholesterol”, “HDL cholesterol”) and four also for women (“insulin resistance”, “total cholesterol”, “body size”, “HDL cholesterol”). For NFG and IFG men, and for both T2D men and women, the “HDL cholesterol” was a significant protective factor for total deaths (NFG men: HR = 0.79, 95% CI 0.67–0.93; IFG men: HR = 0.59, 95% CI 0.45–0.79; T2D men: HR = 0.55, 95% CI 0.34–0.89; T2D women: HR = 0.61, 95% CI 0.44–0.86). Among NFG women, the “body size” factor was also a protective factor with respect to total deaths (HR = 0.74, 95% CI 0.57–0.95).ConclusionA factor including HDL Cholesterol and Apo A-I showed protection against all-cause mortality in older men, independently from the glycemia level, and in women only in those diagnosed with T2D.     

Levels of plasma fibrinogen and d-dimer in patients with impaired fasting glucose.

BACKGROUND: Cardiovascular risk associated with impaired fasting glucose has been examined in various studies with conflicting results. During the last 10 years, several risk markers for atherosclerosis such as fibrinogen and D-dimer have been identified. The present study was designed to evaluate plasma fibrinogen and D-dimer levels in patients with impaired fasting glucose compared with normal subjects and those with type 2 diabetes mellitus. METHODS: Age-, sex-, and body mass index-matched 30 normal subjects, 30 patients with impaired fasting glucose (fasting glucose 110 to 125 mg/dl), and 30 patients with type 2 diabetes mellitus (fasting glucose >/= 126 mg/dl) were included in the study. RESULTS: The levels of plasma fibrinogen in patients with type 2 diabetes mellitus, impaired fasting glucose, and normal subjects were 449 (306 - 605) mg/dl, 348 (264 - 468) mg/dl, and 216 (179 - 260) mg/dl, respectively. Patients with impaired fasting glucose had significantly lower plasma fibrinogen levels than patients with type 2 diabetes mellitus (p < 0.05). There were significantly higher plasma fibrinogen levels in patients with impaired fasting glucose than in normal subjects (p < 0.05). The levels of plasma D-dimer in patients with type 2 diabetes mellitus, impaired fasting glucose, and normal subjects were 615 (505 - 768) mg/l, 518 (412 - 664) mg/l, and 424 (356 - 557) mg/l, respectively. Patients with impaired fasting glucose had significantly lower plasma D-dimer levels than patients with type 2 diabetes mellitus (p < 0.05). There were significantly higher plasma D-dimer levels in patients with impaired fasting glucose than in normal subjects (p < 0.05). The levels of plasma fibrinogen and D-dimer were related to fasting glucose in type 2 diabetes mellitus and impaired fasting glucose groups (p < 0.05). We also detected positive correlation between plasma fibrinogen levels and age in study groups (p < 0.05). CONCLUSION: Our data suggest that patients with impaired fasting glucose pose a hypofibrinolytic status and cardiovascular risk, although this was lower than in patients with type 2 diabetes mellitus.     

Differences in the risk of fatty liver for onset of impaired fasting glucose according to baseline plasma glucose levels

Journal of Gastroenterology - It remains unclear whether fatty liver is a risk factor for the onset of abnormal glucose tolerance in any patient. The objective of this study was to clarify the...     

Genetic risk scores in the prediction of plasma glucose,impaired insulin secretion,insulin resistance and incident type 2 diabetes in the METSIM study

Aims/hypothesis

Many SNPs have been associated with glycaemic traits and type 2 diabetes, but their joint effects on glycaemic traits and the underlying mechanisms leading to hyperglycaemia over time are largely unknown. We aimed to investigate the association of six genetic risk scores (GRSs) with changes in plasma glucose, insulin sensitivity, insulin secretion and incident type 2 diabetes in the prospective METabolic Syndrome In Men (METSIM) study.

Methods

We generated weighted GRSs for fasting plasma glucose ([FPG] GRS_FPG, 35 SNPs), 2 h plasma glucose ([2hPG] GRS_2hPG, 9 SNPs), insulin secretion (GRS_IS, 17 SNPs), insulin resistance (GRS_IR, 9 SNPs) and BMI (GRS_BMI, 95 SNPs) and a non-weighted GRS for type 2 diabetes (GRS_T2D, 76 SNPs) in up to 8749 non-diabetic Finnish men. Linear regression was used to test associations of the GRSs with changes in glycaemic traits over time.

Results

GRS_T2D, GRS_FPG and GRS_IS were associated with an increase in FPG, GRS_T2D with an increase in glucose AUC and a decrease in insulin secretion, and GRS_2hPG with an increase in 2hPG during the follow-up (p < 0.0017 for all models). GRS_T2D, GRS_FPG and GRS_IS were associated with incident type 2 diabetes (p < 0.008 for all models). GRS_BMI and GRS_IR were not significantly associated with any changes in glycaemic traits.

Conclusions/interpretation

In the METSIM follow-up study, GRS_T2D, GRS_FPG and GRS_IS were associated with the worsening of FPG and an increase in incident type 2 diabetes. GRS_T2D was additionally associated with a decrease in insulin secretion, and GRS_2hPG with an increase in 2hPG.

     

Diabetes and impaired glucose tolerance prevalences in Turkish patients with impaired fasting glucose

Impaired fasting glucose (IFG) like impaired glucose tolerance (IGT) has increased risk of progressing to diabetes mellitus (DM). The aim of the study was to evaluate prevalance of IGT and type 2 DM with oral glucose tolerance test (OGTT) in Turkish patients who had fasting glucose of 110 and 125 mg/dl. Hundred and forty-eight (67.3%) women and 72 (32.7%) men (30-65 years old with mean age of 51.3 +/- 8.7 year) who had fasting glucose range 110-125 mg/dl were evaluated with OGTT. Seventy-two patients had IGT (32.8%), 74 (33.6%) patients had type 2 diabetes and 74 (33.6%) patients had normal glucose tolerance (NGT). Mean fasting glucose and insulin levels were higher in the IGT group than in the NGT group. Mean level of total cholesterol was higher in DM than that in NGT and IGT groups. Mean triglyceride (TG) (P = 0.476), high-density lipoprotein (HDL) (P = 0.594), low-density lipoprotein (LDL) (P = 0.612), Apoproteine A (P = 0.876), Apoproteine B (P = 0.518), uric acid (P = 0.948) and ferritin (P = 0.314) were found higher in diabetic patients. Lipoproteine a (P = 0.083), fibrinogen (P = 0.175) and hsCRP (P = 0.621) levels were higher in IGT. Mean HOMA S% levels of NGT, IGT and DM were found to be 65.0 +/- 13.0%, 60.9 +/- 16.0% and 50.1 +/- 11.1%, respectively. HOMA B% levels were measured to be 80.4 +/- 29.1% in NGT, 85.3 +/- 14.59% in IGT and 60.1 +/- 10.1% in DM. Significant difference was found between IFG and DM (P = 0.043) groups. The prevalences of diabetes and IGT were found to be 33.63 and 32.7% in IFG, respectively.     

Normal fasting plasma glucose and risk of type 2 diabetes diagnosis

Purpose

The study compares the risk of incident diabetes associated with fasting plasma glucose levels in the normal range, controlling for other risk factors.

Methods

We identified 46,578 members of Kaiser Permanente Northwest who had fasting plasma glucose levels less than 100 mg/dL between January 1, 1997, and December 31, 2000, and who did not previously have diabetes or impaired fasting glucose. After assigning subjects to 1 of 4 categories (<85, 85-89, 90-94, or 95-99 mg/dL), we followed them until they developed diabetes, died, or left the health plan, or until April 30, 2007. We used Cox regression analysis to estimate the risk of incident diabetes, adjusted for age, sex, body mass index, blood pressure, lipids, smoking, cardiovascular disease, and hypertension.

Results

Subjects developed diabetes at a rate of less than 1% per year during a mean follow-up of 81.0 months. Each milligram per deciliter of fasting plasma glucose increased diabetes risk by 6% (hazard ratio [HR] 1.06, 95% confidence interval [CI], 1.05-1.07, P < .0001) after controlling for other risk factors. Compared with those with fasting plasma glucose levels less than 85 mg/dL, subjects with glucose levels of 95 to 99 mg/dL were 2.33 times more likely to develop diabetes (HR 2.33; 95% CI, 1.95-2.79; P < .0001). Subjects in the 90 to 94 mg/dL group were 49% more likely to progress to diabetes (HR 1.49; 95% CI, 1.23-1.79; P <.0001). All other risk factors except sex were significantly associated with a diabetes diagnosis.

Conclusions

The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors suggests that diabetes risk increases as fasting plasma glucose levels increase, even within the currently accepted normal range.     

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。     

Nontraditional atherosclerotic risk factors and extent of coronary atherosclerosis in patients with combined impaired fasting glucose and impaired glucose tolerance

Partially inconsistent data exist on mutual relations between nontraditional atherosclerotic risk factors, including the magnitude of insulin resistance (IR), as well as on their relevance for atherogenesis in the metabolic syndrome. Subjects exhibiting combined impaired fasting glucose and impaired glucose tolerance (IFG/IGT) are exposed to an exceptionally high risk for atherogenesis and development of type 2 diabetes mellitus. Because of islet Beta-cell dysfunction, the usefulness of commonly used indices of IR is limited in IFG/IGT. Our aim was to assess the relationship between extent of angiographic coronary artery disease (CAD) and nontraditional atherosclerotic risk factors (including IR by a clamp-based golden standard method) in IFG/IGT. Fifty-three subjects (32 men, 21 women; mean age, 55 +/- 11 years) with stable angina, preserved left ventricular systolic function, and IFG/IGT were divided into 3 groups: group A (no coronary stenoses >50%, n = 22), group B (1-vessel CAD, n = 15), and group C (2/3-vessel CAD, n = 16). Insulin sensitivity was quantified by a hyperinsulinemic euglycemic clamp technique and expressed as M. M value, plasma homocysteine (Hcy) level, and asymmetric dimethyl-L-arginine (ADMA)/L-arginine ratio were independent determinants of CAD extent as shown by forward stepwise discriminant function analysis. Compared with group A (M = 32.7 +/- 9.3 micromol/kg fat-free mass [FFM] per minute; Hcy, 8.1 +/- 1.4 micromol/L), lower M and higher Hcy levels were found in group B (M = 16.9 +/- 8.2 micromol/kg FFM per minute, P < .001; Hcy, 11.2 +/- 2.9 micromol/L, P = .003) and C (M = 16.4 +/- 7.8 micromol/kg FFM per minute, P < .001; Hcy, 12.8 +/- 3.9 micromol/L, P < .001). The ADMA/L-arginine ratio was increased in group C (0.0078 +/- 0.0011) compared with group A (0.0063 +/- 0.0013, P = .03) and B (0.0058 +/- 0.0012, P = .01). Multivariate correlates (P < .05) of plasma Hcy concentrations were M (beta = -.34 +/- .12, P = .008), creatinine clearance (beta = -.23 +/- .10, P = .03) and fasting insulin (beta = .25 +/- .12, P = .04). This indicates an additive contribution of IR, plasma Hcy, and elevated ADMA/L-arginine ratio to the extent of angiographic CAD in combined IFG/IGT.     

空腹血糖受损、糖耐量受损人群3年自然转归及其影响因素的研究

目的 探讨空腹血糖受损(IFG)、糖耐量受损(IGT)人群发生糖尿病的危险性及其影响因素. 方法对2003年4～6月朝阳市市区居民1 062人糖尿病普查中IFG、IGT患者79人于2006年4～6月进行随访调查.测量身高、体重、腰围、血压,做过夜空腹75g葡萄糖耐量试验,同时测定血总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C).结果 随访的65人中22人发生糖尿病.其中孤立性IFG(I-IFG)糖尿病转变率为10.8%,孤立性IGT(I-IGT)为9.2%, IFG/IGT为10.4%.在不同的年龄组,随着年龄增长糖代谢异常、高血压、肥胖、脂代谢异常有增加趋势,在40岁以上人群糖代谢异常的患病率有明显增加趋势.进行单因素相关分析结果发现血糖升高可能与增龄、糖尿病(DM)家族史、劳动强度、腰围指数(WC)增加、收缩压(SBP)增加、血脂异常等相关.进行Logistic回归分析,高龄、血压升高、中心性肥胖、体力活动强度减弱均为糖尿病危险因素.结论 I-IGT、IGT/IFG人群糖尿病累计发病率明显高于I-IFG人群.增龄、向心性肥胖、高血压、体力活动减少是糖代谢异常的重要危险因素,因此控制血压、体重,增加体力活动,对糖尿病预防具有重要意义.     

Effects of supervised exercise on gamma-glutamyl transferase levels in patients with isolated impaired fasting glucose and those with impaired fasting glucose plus impaired glucose tolerance

To study the effects of a supervised exercise program on serum gamma-glutamyl transferase (GGT), glycemic control and cardiovascular risk factors in pre-diabetic patients with isolated impaired fasting glucose (IFG) and those with IFG plus impaired glucose tolerance (IGT).Out of 60 pre-diabetic patients (30 with isolated IFG and 30 with IFG?+?IGT) 24 were randomly assigned to the supervised exercise program (1?h twice a week) and 36 only obtained counselling on the risk of diabetes and its prevention. Patients have been followed over a 12-month period.The main findings were that patients with IFG?+?IGT had increased GGT levels at baseline (49.2±27.4?U/L) compared to subjects with isolated IFG (28.1±21.9?U/L) (p<0.01), and that GGT levels improved only after the supervised exercise intervention within the IFG?+?IGT subjects (?-?17.7±19.6?U/L). Similarly, baseline triglyceride levels were also higher in IFG?+?IGT patients (p<0.001) and there was a decrease through exercise intervention in these patients only (p<0.05).GGT is an unspecific marker of oxidative stress and both high plasma glucose and triglycerides levels may produce oxidative stress. Thus, patients with IFG?+?IGT seem to have higher levels of oxidative stress than those with isolated IFG. Based on the known association between GGT levels and cardiovascular risk factors, IFG?+?IGT patients may be at higher risk for the development of cardiovascular diseases. The specific effect of regular exercise on GGT in pre-diabetic patients may contribute to the understanding of the preventive effects related to exercise.     

Long-term changes and variability in diabetes risk factors prior to the development of impaired glucose homeostasis.

AIMS: To determine whether rate of change and variability in risk factors provides insight into the development of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or Type 2 diabetes (DM). METHODS: In a nested case-control study, repeated risk factor measurements (mean number 4.3, duration 11.4 years) culminated in 59 men developing IFG (n = 37), IGT (n = 14) and/or DM (n = 11). For each case, two control subjects were matched for age and equivalence of follow-up. Rates of change and variability in diabetes risk factors prior to diagnosis were quantified by regression analysis. Changes between penultimate and diagnostic visits were also analysed. RESULTS: The age-related rise in body mass index (BMI) was attenuated prior to IFG compared with control subjects (+0.102 vs. +0.772 kg/m2/decade, P = 0.02). There was also some evidence for this prior to IGT and DM (IGT: -1.530 vs. +0.158 kg/m2/decade, P = 0.09; DM: -1.146 vs. +0.332 kg/m2/decade, non-significant). Prior to onset, IGT cases were distinguished by higher inflammatory marker levels, a decline in insulinogenic index and greater variability in oral glucose tolerance test (OGTT) insulin, and DM cases by lower insulin sensitivity and higher liver enzyme activities. Fasting and OGTT glucose levels changed little during the mean 8.9 years prior to onset of IFG, IGT or DM. The transition to IGT or DM was accompanied by a fall in insulin sensitivity. CONCLUSIONS: Except for BMI, change or variability in risk factor levels appears relatively unimportant in the development of clinically elevated glucose levels. Deterioration in glucose levels to IGT or DM occurs as a rapid, incremental increase accompanied by a decline in insulin sensitivity.     

White blood-cell count and the risk of impaired fasting glucose or Type II diabetes in middle-aged Japanese men

Aims/hypothesis: To investigate the association between white blood-cell (WBC) count and the development of diabetes, independent of cigarette smoking. Methods: We examined 2953 Japanese men who were office workers and between 35 and 59 years of age and who did not have impaired fasting glucose (IFG) (a fasting glucose concentration of 6.1–6.9 mmol/l), Type II (non-insulin-dependent) diabetes mellitus (a fasting glucose concentration of ≥ 7.0 mmol/l or more or receipt of hypoglycaemic medication), medication for hypertension, and a history of cardiovascular disease. Fasting glucose concentrations were measured at annual health examinations from May 1994 through May 2000. Results: After controlling for potential predictors of diabetes, the relative risk for IFG or Type II diabetes mellitus compared with a WBC count of less than 5.3 · 10⁹ cells/l was 1.2 (95 %-CI, 0.6–2.3), 1.6 (CI, 0.8–3.1), and 2.5 (CI, 1.2–5.1) among non-smokers (p for trend = 0.009): and 1.0 (CI, 0.4–2.5), 2.3 (CI, 1.0–5.1), and 3.1 (CI, 1.4–7.1) among ex-smokers (p for trend = 0.001) with WBC counts of 5.3–6.1, 6.2–7.2, and 7.3 · 10⁹ cells/l or more, respectively. Among current smokers, the respective multivariate-adjusted relative risks for IFG or Type II diabetes mellitus were 1.1 (CI, 0.6–2.1), 1.4 (CI, 0.8–2.4), and 1.2 (CI, 0.7–2.1) (p for trend = 0.460). Conclusion/hypothesis: Although the selection of a rigorously normoglycaemic cohort might have had an influence on these observations, higher WBC counts seem to predict the development of IFG or Type II diabetes mellitus, primarily in non-smokers. [Diabetologia (2002) 45: 42–48] Received: 16 July 2001 and in revised form: 13 September 2001