Prediabetes diagnosis criteria,type 2 diabetes risk and dietary modulation: The CORDIOPREV study

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不同自我管理水平糖尿病前期患者的糖尿病知识现状和需求

目的：了解不同自我管理水平糖尿病前期患者知识与需求现状,为提高糖尿病前期患者知识水平的靶向 性干预提供参考。方法：选取长沙市3所三级甲等医院体检筛查出的312名糖尿病前期患者,采用糖尿病自我管理行 为量表及自行编制糖尿病前期患者知识现状与需求问卷进行调查,对不同自我管理水平患者的糖尿病知识获得和需 求状况进行分析。结果：糖尿病前期患者自我管理行为得分39.1±13.9。糖尿病前期患者知识获得率低而需求率高; 自我管理水平高的个体,知识获得率较高,知识需求率较低,其中饮食搭配和血糖检测方法是各个自我管理水平等 级患者需求率高的知识条目。结论：糖尿病前期患者自我管理水平低,对糖尿病知识掌握现状不容乐观,医务人员 应关注患者的个体化需求,以需求为导向,准确、有针对性地开展健康教育。     

Differences in metabolic parameters and cardiovascular risk between American Diabetes Association and World Health Organization definition of impaired fasting glucose in European Caucasian subjects: a cross-sectional study

Introduction

The American Diabetes Association (ADA) defines impaired fasting glucose (IFG) as fasting plasma glucose concentration of 100–125 mg/dl, whereas the World Health Organization (WHO) and the International Diabetes Federation (IDF) define IFG as fasting plasma glucose levels of 110–125 mg/dl. We identified differences in metabolic parameters and cardiovascular disease (CVD) risk according to the ADA or WHO/IDF definition of IFG.

Material and methods

Healthy drug-naive Caucasian (Greek) subjects (n = 396; age 55 ±12 years) participated in this cross-sectional study.

Results

Diastolic blood pressure (DBP) and uric acid levels were higher in the subjects with glucose 100–109 mg/dl compared with those with glucose < 100 mg/dl (87 ±9 mm Hg vs. 84 ±11 mm Hg, p = 0.004 for DBP, 5.6 ±1.5 mg/dl vs. 5.0 ±1.0 mg/dl, p = 0.002 for uric acid), whereas triglyceride levels were lower in subjects with glucose 100–109 mg/dl compared with those with glucose ≥ 110 mg/dl (169 mg/dl (interquartile range (IQR) = 102–186) vs. 186 mg/dl (IQR = 115–242), p = 0.002). Only the ADA definition recognized subjects with significantly increased 10-year CVD risk estimation (SCORE risk calculation) compared with their respective controls (5.4% (IQR = 0.9–7.3) vs. 4.1% (IQR = 0.7–5.8), p = 0.002).

Conclusions

The ADA IFG definition recognized more subjects with significantly increased CVD risk (SCORE model) compared with the WHO/IDF definition.     

糖尿病前期干预现状分析

从降糖药物干预、中医干预、健康宣教及饮食、运动干预、综合疗法干预、传统功法干预等方面,对近10年有关糖尿病前期的干预现状进行综述。     

Adiposity by Differing Measures and the Risk of Cataract in the UK Biobank: The Importance of Diabetes

PurposeTo examine the association between adiposity by differing measures and incident cataract and identify important factors contributing to the association.MethodsOur analysis included 153,139 adults from the UK Biobank, aged 40 to 70 years at baseline (2006–2010). Cataract was ascertained using hospital inpatient, and self-reported data until the early of 2021. Anthropometric measures, body fat percentage, and glycosylated hemoglobin (HbA1c) were measured at baseline.ResultsDuring a median follow-up of 10.9 years, 15,255 cases of incident cataract were documented. HbA1c was an important contributor to the association between obesity and incident cataract. Obesity; defined by body mass index was associated with an increased risk of cataract (hazard ratio [HR], 1.21 95% confidence interval [CI], 1.16–1.26), and this association was attenuated but remained significant after additional adjustment for HbA1c (HR, 1.05; 95% CI, 1.00–1.10). Similar results were observed for obesity defined by waist circumference or waist-to-hip ratio. Obesity defined by fat percentage was associated with an increased risk of cataract before but not after adjustment for covariates. The association between obesity defined by body mass index and incident cataract was positively significant in individuals with normal HbA1c (HR, 1.07; 95% CI, 1.02–1.13), but inversely significant in those with prediabetes (HR, 0.80; 95% CI, 0.67–0.96) or diabetes (HR, 0.74; 95% CI, 0.61–0.89).ConclusionsAnthropometric measurements are more predictive of cataract than bioelectrical impedance measures. Diabetes plays an important role in the association between obesity and incident cataract.     

Fibroblast Growth Factor 21 as a Marker of Prediabetes in Patients with Non-alcoholic Fatty Liver Disease

BackgroundFibroblast growth factor 21 is a peptide primarily secreted by the liver in response to peroxisome proliferator-activated receptor-α activation which plays an important role in regulating carbohydrate and lipid metabolism. This study investigated the association between fibroblast growth factor 21 and prediabetes in obese patients with non-alcoholic fatty liver disease in adult population.MethodsA total of 85 obese non-alcoholic fatty liver disease patients without (n = 49) and with prediabetes (n = 36) were included. Serum fibroblast growth factor 21 levels were determined by enzyme-linked immunosorbent assay.ResultsHigher fibroblast growth factor 21 serum levels were observed in patients with prediabetes, metabolic syndrome, dyslipidemia, and insulin resistance. There were significant correlations between fibroblast growth factor 21 and waist-to-stature ratio, visceral adiposity index, triglycerides, very low-density lipoproteins, alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), Quantitative Insulin Sensitivity Check Index, and Stumvoll index of insulin sensitivity. Fibroblast growth factor 21 level ≥320 pg/mL was associated with a 4.2-fold higher risk of prediabetes and ≥270 pg/mL for metabolic syndrome approximately 4 times.ConclusionFibroblast growth factor 21 is associated with increased risk for prediabetes, metabolic syndrome, and insulin resistance in obese patients with non-alcoholic fatty liver disease.     

Weak Association between Skin Autofluorescence Levels and Prediabetes with an ILERVAS Cross-Sectional Study

A large body of evidence demonstrates a relationship between hyperglycemia and increased concentrations of advanced glycation end-products (AGEs). However, there is little information about subcutaneous AGE accumulation in subjects with prediabetes, and whether or not this measurement could assist in the diagnosis of prediabetes is unclear. A cross-sectional study was conducted in 4181 middle-aged subjects without diabetes. Prediabetes (n = 1444) was defined as a glycosylated hemoglobin (HbA1c) level between 39 and 47 mmol/mol (5.7 to 6.4%), and skin autofluorescence (SAF) measurement was performed to assess AGEs. A multivariable logistic regression model and receiver operating characteristic curve were used. The cohort consisted of 50.1% women with an age of 57 [52;62] years, a BMI of 28.3 [25.4;31.6] kg/m², and a prevalence of prediabetes of 34.5%. Participants with prediabetes showed higher SAF than control participants (2.0 [1.7;2.2] vs. 1.9 [1.7;2.2], p < 0.001). However, HbA1c was not significantly correlated with SAF levels (r = 0.026, p = 0.090). In addition, the SAF level was not independently associated with prediabetes (OR = 1.12 (0.96 to 1.30)). Finally, there was no good cutoff point for SAF to identify patients with prediabetes (AUC = 0.52 (0.50 to 0.54), sensitivity = 0.61, and 1-specificity = 0.56). Given all of this evidence, we can conclude that although there is an increase in SAF levels in participants with prediabetes, the applicability and clinical relevance of the results is low in this population.     

Real World Practice Study of the Effect of a Specific Oral Nutritional Supplement for Diabetes Mellitus on the Morphofunctional Assessment and Protein Energy Requirements

Introduction: The prevalence of malnutrition in patients with diabetes mellitus is high. In these patients, monitoring nutritional intervention is complex. Aims: To evaluate the evolution in the nutritional status in patients with diabetes/prediabetes and malnutrition with a diabetes-specific enteral formula. Methods: Real-life study of one arm in 60 patients with diabetes and prediabetes, performing a dietary adaptation with diabetes-specific oral nutritional supplementation. A morphofunctional assessment was performed, consisting of intake assessment, anthropometry, body composition (bioimpedance and muscle ultrasound), handgrip strength and biochemical markers. The diagnosis of malnutrition was made using the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The variables were measured at baseline and 3 months after starting the intervention. Results: The mean age was 67.13 (14.9) years. In total, 30 (50%) of the patients were women. Of the total, 60% of the patients had diabetes mellitus and 40% of the patients had prediabetes. The initial body mass index was 24.65 (5.35) kg/m². It was observed that 80% of the patients had malnutrition, whereas after the intervention, the prevalence was 51.7% (p < 0.01). At the beginning of the study, 20% of the patients suffered from sarcopenia and after the intervention it was 16.7% (p = 0.19). Conclusions: Medical Nutrition Therapy with an adapted oral diet associated with diabetes-specific oral nutritional supplementation reduces malnutrition in patients at nutritional risk and disturbances of carbohydrate metabolism.