Re: short de-lurk to say hi

x-no-archive: yes

Susan wrote:

Folks develop DM complications before they're diagnosed with DM, very commonly, due to insulin resistance and IGT. Those are DM related, even if not now considered above the DM dx threshhold.



These demonstrate that DM related CVD begins even during the normal, non-diabetic glucose ranges, in all likelihood due to insulin resistance, which is, of course, DM related.

Type 2 diabetes isn't typically a sudden onset condition.


Ann Intern Med 1998 Apr 1;128(7):524-33



Metabolic risk factors worsen continuously across the spectrum of nondiabetic glucose tolerance. The Framingham Offspring Study.

Meigs JB, Nathan DM, Wilson PW, Cupples LA, Singer DE
Massachusetts General Hospital, Harvard Medical School, Boston University School of Public Health, 02114, USA. jmeigs@xxxxxxxxxxxxxxxxxxx

BACKGROUND: Categorical definitions for glucose intolerance imply that risk thresholds exist, but metabolic risk for type 2 diabetes mellitus or cardiovascular disease may increase continuously as glucose intolerance increases. OBJECTIVE: To examine the distributions of the following metabolic risk factors across the spectrum of glucose tolerance: overall and central obesity, hypertension, low levels of high-density lipoprotein cholesterol, and increased triglyceride and insulin levels. DESIGN: Cross-sectional analysis. SETTING: The community-based Framingham Offspring Study. PARTICIPANTS: 2583 adults without previously diagnosed diabetes. MEASUREMENTS: Clinical data; fasting glucose, insulin, and lipid levels; and glucose and insulin levels taken 2 hours after oral challenge were collected from 1991 to 1993. Glucose tolerance was determined by 1980 World Health Organization criteria. Patients with normal glucose tolerance were categorized into quintiles of fasting glucose. The distributions of each metabolic risk factor and the metabolic sum of the six risk factors were assessed across seven categories from the lowest quintile of normal fasting glucose level through impaired glucose tolerance and previously undiagnosed diabetes. RESULTS: The mean age of patients was 54 years (range, 26 to 82 years); 52.7% of patients were women. Glucose tolerance testing found that 12.7% of patients had impaired glucose tolerance and 4.8% had previously undiagnosed diabetes. Multivariable-adjusted mean measures of risk factors and odds ratios for obesity, elevated waist-to-hip ratio, hypertension, low levels of high-density lipoprotein cholesterol, elevated triglyceride levels, and hyperinsulinemia showed continuous increases across the spectrum of nondiabetic glucose tolerance. Although a threshold effect near the upper range of nondiabetic glucose tolerance could not be ruled out for triglyceride levels in men and for insulin levels 2 hours after oral challenge in men and women, no other metabolic risk factors showed clear evidence of thresholds for increased risk. CONCLUSIONS: Metabolic risk factors for type 2 diabetes mellitus and for cardiovascular disease worsen continuously across the spectrum of glucose tolerance categories, beginning in the lowest quintiles of normal fasting glucose level.

PMID: 9518396, UI: 98175274


Susan



: Endocr Pract. 2006 Jan-Feb;12 Suppl 1:16-9. Related Articles, Links
Click here to read
Impaired glucose tolerance, diabetes, and cardiovascular disease.

Schnell O, Standl E.

University of Munich and Diabetes Research Institute, Germany.

OBJECTIVE: To analyze the association among impaired glucose tolerance (IGT), diabetes, and cardiovascular disease (CVD). METHODS: We review current studies that have addressed the foregoing relationship and summarize the results of diagnostic and therapeutic interventions. RESULTS: A major cause of the reduction in life expectancy in patients with diabetes is CVD and cardiovascular complications. Both prediabetes and diabetes predispose to cardiovascular alterations. IGT and even the upper normal values of nondiabetic glucose levels are associated with an increased cardiovascular risk. The risk of heart disease can be increased as early as 15 years before the diagnosis of diabetes. Patients with chronic or acute CVD and no previous diagnosis of diabetes frequently present with either IGT or diabetes. Thus, such patients should undergo screening for diabetes with an oral glucose tolerance test. In acute coronary syndromes, lowering of glucose levels to the near-normal range by administration of insulin is highly beneficial. Early, rigorous interventions to improve metabolic control will yield better cardiovascular outcomes in patients with dysglycemia. CONCLUSION: Aggressive preventive and treatment strategies, which can include multiple interventions, are needed to minimize the potential effects of CVD in patients with diabetes or IGT.

PMID: 16627374 [PubMed - in process]


1: Diabetes Care. 2005 Oct;28(10):2388-93. Related Articles, Links
Click here to read
Differences in cardiovascular risk factors, insulin resistance, and insulin secretion in individuals with normal glucose tolerance and in subjects with impaired glucose regulation: the Telde Study.

Novoa FJ, Boronat M, Saavedra P, Diaz-Cremades JM, Varillas VF, La Roche F, Alberiche MP, Carrillo A.

Endocrinology and Nutrition Section, Hospital Universitario Insular, Las Palmas de Gran Canaria 35016, Spain. fnovoa@xxxxxxxxxxxxx

OBJECTIVE: To assess the cardiovascular risk profile, the degree of insulin resistance, and beta-cell secretion in a cohort of subjects with different categories of impaired glucose regulation (IGR): impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT. RESEARCH DESIGN AND METHODS: We studied 902 nondiabetic subjects between 30 and 80 years of age, recruited from a cross-sectional population-based study in Telde, Gran Canaria Island, Spain. Categories of glucose tolerance were defined according to 2003 modified American Diabetes Association criteria. Risk factors for cardiovascular disease, the presence of the metabolic syndrome, and indirect measures of both insulin resistance and beta-cell function were analyzed. RESULTS: A total of 132 (14.6%) participants had isolated IFG, 59 (6.5%) isolated IGT, and 48 (5.3%) combined IFG/IGT. Groups with normal glucose tolerance (NGT) and combined IFG/IGT had, respectively, the most favorable and unfavorable levels of cardiovascular risk factors, metabolic syndrome rates, and measures of insulin resistance. Subjects with IFG and IGT showed an intermediate profile between NGT and IFG/IGT categories. We found no significant differences between IFG and IGT in cardiovascular risk factors, metabolic syndrome prevalence, or insulin resistance. The IFG group exhibited a more impaired insulin secretion than those with IGT or IFG/IGT. CONCLUSIONS: Individuals with IGR, especially those with IFG/IGT, have increased values of cardiovascular risk factors and higher indexes of insulin resistance. Groups with isolated IFG and isolated IGT present similar cardiovascular risk profiles. Subjects with IFG are characterized by more defective beta-cell function than other forms of IGR.

PMID: 16186268 [PubMed - indexed for MEDLINE]
.

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