Nondiabetic Subjects (nondiabetic + subject)

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Distribution within Medical Sciences

Selected Abstracts

Higher arterial stiffness, greater peripheral vascular resistance and lower blood flow in lower-leg arteries are associated with long-term hyperglycaemia in type 2 diabetic patients with normal ankle-brachial index

Eiji Suzuki
Abstract Background Higher arterial stiffness and greater peripheral vascular resistance reduce blood flow in lower-leg arteries and contribute to the development of ischaemic limb in diabetic patients even without peripheral artery occlusive disease. The aim of this study was to clarify whether these vascular parameters are associated with long-term hyperglycaemia in diabetic patients. Methods We examined 45 type 2 diabetic patients and 38 age-matched nondiabetic subjects without peripheral artery occlusive disease assessed by ankle-brachial index consecutively admitted to our hospital, and followed them over a 3-year period (3.7 0.7 years) with no vasodilative medication. Blood flow and resistive index, a measure of peripheral vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Brachial-ankle pulse wave velocity was measured to assess arterial stiffness. Results At baseline, consistent with our previous report, diabetic patients showed higher brachial-ankle pulse wave velocity (p < 0.0001) and resistive index (p < 0.0001) and lower flow volume (p = 0.0044) than those of nondiabetic subjects. Stepwise multiple regression analysis revealed that duration of diabetes, mean HbA1c during the study, use of renin-angiotensin system inhibitors and change per year in resistive index were identified as significant independent variables predicting change per year in blood flow (r2 = 0.733, p < 0.0001) in diabetic patients. Mean HbA1c during the study was positively correlated with changes per year in brachial-ankle pulse wave velocity (p = 0.00007) and resistive index (p = 0.0014) and was negatively correlated with that in blood flow (p < 0.0001) in diabetic patients. Conclusions Long-term hyperglycaemia is a major cause of impaired peripheral circulation in lower-leg arteries in diabetic patients without peripheral artery occlusive disease. Copyright 2009 John Wiley & Sons, Ltd. [source]

Diabetes in the elderly: problems of care and service provision

S. Croxson
Abstract Diabetes is common in the elderly and old UK citizens, affecting between 10% and 25%. There is considerable associated morbidity and mortality, with dementia being a common problem. The diabetic elder is also at risk of drug side-effects. Most of the evidence base for treatment is based on trials performed in younger diabetic subjects or older nondiabetic subjects; however, we can practice evidence-biased medicine whilst awaiting the results of ongoing trials. The older persons national service framework (NSF) may share some similarities with the diabetes NSF; it was 1 year late, and had no clear funding, amongst several other worries. Residential care, which is more likely to be required by diabetic elders, is also under-funded with major concerns about the quality of care for the diabetic resident. The little evidence that we have regarding care of the older diabetic person also suggests inadequacies. Given the likelihood that we will have to manage with present resources, managed clinical networks may be one way to cope. [source]

Comparison of in vivo effects of nitroglycerin and insulin on the aortic pressure waveform

J. Westerbacka
Abstract Background, Individuals whose platelets are resistant to the antiaggregatory effects of insulin in vitro are also resistant to the antiaggregatory effects of nitroglycerin (GTN). We have previously shown that insulin acutely diminishes central wave reflection in large arteries and that this action of insulin is blunted in insulin-resistant subjects. However, as yet, no studies have compared the haemodynamic effects of insulin and GTN on large arterial function in the same group of subjects. The aim of this study was to determine whether resistance to the haemodynamic effects of insulin is a defect specific to insulin or whether individuals resistant to the vascular actions of insulin are also resistant to GTN. Design and results, Dose,response characteristics of insulin and GTN on the aortic waveform were determined using applanation tonometry and pulse wave analysis (PWA) in seven healthy men (age 26 1 year, BMI 25 2 kg m,2). Three doses of sublingual GTN (500 g for 1, 3 or 5 min) and insulin (05, 1 or 2 mU kg,1 min,1 for 120 min) were administered on three separate occasions. Both agents dose-dependently decreased central pulse pressure and the augmentation index (AIx) without changing brachial artery blood pressure. We next compared responses to insulin (2 mU kg,1 min,1 for 120 min) and sublingual GTN (500 g for 5 min) in 20 nondiabetic subjects (age 50 2 year, BMI 210,363 kg m,2). Again, both agents significantly decreased AIx. Although the vascular effects of insulin and GTN vascular were positively correlated [Spearman's r = 092 (95% confidence interval 081,097), P < 00001], the time-course for the action GTN was faster than that of insulin. Brachial systolic blood pressure remained unchanged during the insulin infusion (122 3 vs. 121 3 mmHg, 0 vs. 120 min) but aortic systolic blood pressure decreased significantly by 30 min (111 3 vs. 107 3 mmHg, 0 vs. 30 min, P < 001). Similarly, GTN decreased aortic systolic blood pressure from 119 4 to maximally 112 3 mmHg (P < 0001) without significantly decreasing systolic blood pressure in the brachial artery. Conclusions, The effects of insulin and GTN on large arterial haemodynamics are dose-dependent and significantly correlated. The exact mechanisms and sites of action of insulin and GTN in subjects with insulin resistance remain to be established. [source]

Glycated Hemoglobin Levels and Intellectual Activity in an Aged Population

Hidenori Amano MHSc
Objectives: To examine the association between glycated hemoglobin (GHb) and aspects of daily activities in an elderly population. Design: Cross-sectional population-based survey. Setting: Nangai village, an agricultural community with a population of about 5,000 located in Akita prefecture in the north of Japan. Participants: Nine hundred thirty-five people aged 65 and older. Measurements: GHb percentages, self-reported measures of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), intellectual activity (IA), and social role (SR). Results: An exploratory analysis indicated that nondiabetic subjects in the lowest tertile of GHb tend to have lower IA than those in the middle tertile, if they were aged 70 and older. No consistent association appeared between GHb and ADLs, IADLs, or SR. Linear and logistic regression analyses, controlling for other risk factors, indicated significantly lower IA scores in the low and high GHb tertiles (P<.001 and P=.04, respectively) than in the middle in nondiabetic subjects aged 70 and older and without stroke history or IADL impairments. The value of GHb related to the maximal IA score was 5.0% to 5.2% as the middle tertile; or 5.2%, assuming a logistic regression model including a squared term with GHb as a continuous variable. A similar relationship was observed in the whole nondiabetic sample aged 70 and older but not in the younger counterpart. Conclusion: There is an inverted U-shaped relationship between GHb and intellectual activity in older people without diabetes mellitus. One possible interpretation is that suboptimal blood glucose could contribute to intellectual inactivity in older people. [source]

Diverse Effect of Inflammatory Markers on Insulin Resistance and Insulin-Resistance Syndrome in the Elderly

Angela M. Abbatecola MD
Objectives: To evaluate the potential association between different inflammatory markers and insulin resistance (IR), as well as insulin-resistance syndrome (IRS) in a large, population-based study of older, nondiabetic persons. Design: Cross-sectional study. Setting: Outpatient clinic in Greve in Chianti and Bagno a Ripoli (Italy). Participants: One thousand one hundred forty-six nondiabetic subjects ranging in age from 22 to 104. Measurements: Anthropometric measurements; plasma fasting levels of glucose, insulin, and cholesterol (total, high-density lipoprotein, low-density lipoprotein); homeostasis model assessment to estimate degree of insulin resistance; tumor necrosis factor , (TNF-,), interleukin 6 (IL-6), soluble IL-6 receptor (sIL-6R), interleukin receptor antagonist (IL-1ra), and C-reactive protein (CRP) plasma concentrations; diastolic, systolic, and mean arterial blood pressure; and echo-color-Doppler duplex scanning examination of carotid arteries. Results: Insulin resistance correlated with age (r=0.102; P<.001) and plasma levels of TNF-, (r=0.082; P=.007), IL-1ra (r=0.147; P<.001), IL-6 (r=0.133; P<.001), sIL-6R (r=,0.156; P<.001), and CRP (r=0.83; P<.001). Subjects in the upper tertile of IR degree were older and had higher serum levels of TNF-,, IL-1ra, and IL-6 and lower levels of sIL-6R than subjects in the lowest tertile. Independent of age, sex, body mass index, waist-to-hip ratio, triglycerides, drug intake, diastolic blood pressure, smoking habit, and carotid atherosclerotic plaques, higher IL-6 (t=2.987; P=.003) serum concentrations were associated with higher IR, whereas sIL-6R levels (t=,5.651; P<.001) were associated with lower IR. Furthermore, IL-1ra concentrations (t=2.448; P=.015) were associated with IRS, and higher sIL-6R plasma levels continued to correlate negatively with IRS. Conclusion: Different inflammatory markers are associated with a diverse effect on IR and IRS in elderly nondiabetic subjects. [source]

An audit of diabetes control, dietary management and quality of life in adults with type 1 diabetes mellitus, and a comparison with nondiabetic subjects

F. Tahbaz
Abstract Objectives, The study's objective was to audit current diet and disease management in a community-based sample of people with type 1 diabetes. Methods, The study involved adults with type 1 diabetes and control subjects. Reported amounts of dietary intake were collected. Indices of diabetes control were determined by standard methods. Quality of life of both groups was assessed with appropriate measures. Results were compared between two groups. Results, Mean HbA1c concentration was 8.5% (SD 2.21%) for women with diabetes and 8.6% (SD 1.91%) for men. There was no significant difference between the diabetic and control subjects in self-reported energy intake and macronutrient intake, with the exception that the contribution of saturated fatty acid to energy intake was higher in male controls than in male diabetics. There was no association between dietary intakes and glycemic control in diabetic subjects. Anthropometric measurements, blood pressure and plasma lipids in patients were within normal range and not significantly different from the controls. Plasma fibrinogen concentration was higher in patients. Diabetic subjects did not have a diminished quality of life. Conclusions, Dietary management in these patients was generally focused on controlling carbohydrate intake. Most had suboptimal diabetes control. [source]

The Impact of Diabetes Mellitus on Two-Year Mortality Following Contemporary Percutaneous Coronary Intervention: Implications for Revascularization Practice

Objective:To assess the impact of diabetes on 2-year mortality in current PCI practice. Background:In patients with coronary artery disease undergoing revascularization, diabetes mellitus is associated with higher mortality. Methods:A retrospective analysis was done of all patients undergoing PCI at our tertiary center between January 2000 and December 2004. There were 6,160 PCI procedures performed in 5,759 patients who received at least one stent. Of these patients, 801 (13.9%) were diabetic and 4,958 (86.1%) were nondiabetic. The primary outcome measure of the study was all-cause mortality. All patients were followed up for a period of 2 years. Multivariate logistic regression analysis was used to test for a potential independent association between diabetic status and follow-up mortality. Results:Before adjustment, a trend toward higher mortality was observed in diabetic patients compared to non-diabetics at 1 year (3.2% vs 2.4%) and 2 years (5.1% vs 3.8%), P = 0.12. Independent predictors for mortality were increasing age, renal dysfunction, peripheral vascular disease, NYHA class >2, urgent PCI, treating left main stem lesions, vessel diameter , 2.5 mm, and 3-vessel disease. The use of drug-eluting stent was associated with a reduction in mortality. Diabetes was found to have no independent impact on mortality following PCI (odds ratio = 1.08; 95% confidence intervals = 0.73,1.60; P = 0.71). Conclusion:The presence of diabetes was not an independent predictor of mortality following PCI. A diabetic patient that does not require insulin treatment and has no evidence of macro- or microvascular diabetic disease could enjoy a PCI outcome similar to nondiabetic subjects. [source]

Relationship Between Periodontal Status and HbA1c in Nondiabetics

Hideaki Hayashida DDS
Abstract Objectives: Many studies have reported an association between diabetes and periodontitis. We analyzed the periodontal status and glycosylated hemoglobin (HbA1c) level in nondiabetic subjects to investigate the relationship between periodontitis and glucose control in nondiabetics. Methods: Periodontal status, HbA1c, serum cholesterol, triglyceride, body mass index (BMI), and demographic variables were assessed in 141 Japanese adults. The difference in the HbA1c level was evaluated among subjects according to periodontal status. Results: After adjusting for age, gender, BMI, and smoking, alcohol, and exercise habits as covariates, the mean HbA1c was significantly elevated with periodontal deterioration (P = 0.023). Conclusions: There was a significant relationship between periodontal status and HbA1c levels in nondiabetics. [source]

Impaired Proinsulin Processing is a Characteristic of Transplanted Islets

A. M. Klimek
We sought to determine whether recipients of islet transplants have defective proinsulin processing. Individuals who had islet allo- or autotransplantation were compared to healthy nondiabetic subjects. Insulin (I), total proinsulin (TP), intact proinsulin and C-peptide (CP) were measured in samples of fasting serum by immunoassay, and the ratios of TP/TP+I and TP/CP were calculated. Islet allotransplant recipients had elevated TP levels relative to nondiabetic controls (16.8 [5.5,28.8] vs. 8.4 [4.0,21.8] pmol/L; p < 0.05) and autologous transplant recipients (7.3 [0.3,82.3] pmol/L; p < 0.05). Islet autotransplant recipients had significantly higher TP/TP+I ratios relative to nondiabetic controls (35.9 6.4 vs. 13.9 1.4%; p < 0.001). Islet allotransplant recipients, some of whom were on insulin, tended to have higher TP/TP+I ratios. The TP/CP ratio was significantly higher in both islet autotransplant (8.9 [0.6,105.2]; p < 0.05) and allotransplant recipients (2.4 [0.8,8.8]; p < 0.001) relative to nondiabetic controls (1.4 [0.5,2.6]%). Consistent with these findings, TP/TP+I and TP/CP values in islet autotransplant recipients increased significantly by 1-year posttransplant compared to preoperative levels (TP/CP: 3.8 0.6 vs. 23.3 7.9%; p < 0.05). Both allo- and autotransplant subjects who received <10 000 IE/kg had higher TP/CP ratios than those who received >10 000 IE/kg. Islet transplant recipients exhibit defects in the processing of proinsulin similar to that observed in subjects with type 2 diabetes manifest as higher levels of total proinsulin and increased TP/TP+I and TP/CP ratios. [source]

Antihypertensive Drugs and New-Onset Diabetes: A Retrospective Longitudinal Cohort Study

Gwo-Ping Jong
Antihypertensive drugs have been linked to new-onset diabetes (NOD); however, data on the effect of these drugs on the development of NOD in hypertensive patients has not been well determined. We aimed to investigate the association between antihypertensive drugs and NOD. This was a retrospective cohort study performed using data from claim forms provided to the central region branch of the Bureau of National Health Insurance in Taiwan from January 2002 to December 2007. Prescriptions for antihypertensive drugs before the index date were retrieved from a prescription database. We estimated the odds ratios (ORs) of NOD associated with antihypertensive drug use; nondiabetic subjects served as the reference group. A total of 4233 NOD cases were identified in 24,688 hypertensive patients during the study period. The risk of NOD after adjusting for sex and age was higher among users of diuretics (OR = 1.10, 95% confidence interval [CI]= 1.01,1.20), beta-blockers (BBS; OR = 1.12, 95% CI = 1.04,1.21), and calcium channel blockers (CCBs; OR = 1.10, 95% CI = 1.02,1.18) than among nonusers. Patients who take angiotensin-converting enzyme (ACE) inhibitors (OR = 0.92, 95% CI = 0.84,1.00), angiotensin receptor blockers (ARB; OR = 0.90, 95% CI = 0.81,0.98), or alpha-blockers (OR = 0.88, 95% CI = 0.80,0.98) are at a lower risk of developing NOD than nonusers. Vasodilators were not associated with the risk of NOD. The results of this study suggest that hypertensive patients who take ACE inhibitors, ARBs, or alpha-blockers are at a lower risk of NOD. Diuretics, BBs, and CCBs were associated with a significant increase in the risk of NOD. [source]

Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity

L. Yang
Summary Objective, Although associations between visceral adiposity (intra-abdominal fat mass) and insulin resistance are well established, previous data include few subjects with WHO grade III obesity [body mass index (BMI) > 40 kg/m2]. We have investigated the relationship between visceral adiposity and insulin resistance using computed tomography (CT)-quantified fat mass and the homeostasis model assessment for insulin resistance (HOMA-IR) in patients with severe obesity. Patients and methods, Eighteen nondiabetic subjects with BMI > 40 kg/m2 were recruited. BMI, and waist, hip and neck circumferences were measured. Fasting plasma insulin and glucose were measured to calculate HOMA-IR. A single slice CT scan was taken at L4 and visceral and abdominal subcutaneous adipose tissue (VAT and ASAT, respectively) quantified using ,SliceOmatic' image analysis software. Results, A close correlation was demonstrated between VAT and HOMA-IR (r2 = 046, P = 0002), whereas ASAT showed no relationship. Neck circumference correlated with both VAT (r2 = 067, P < 00001) and HOMA-IR (r2 = 035, P = 001). Waist circumference only correlated significantly with VAT (r2 = 025, P = 003). Conclusions, Visceral adiposity remains a strongly significant indicator of insulin resistance in WHO grade III obesity. Neck circumference surpasses other anthropometric measurements as a powerful marker of both VAT and insulin resistance. [source]

Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis

Chao-Ping Wang
Summary Objective, Epicardial adipose tissue (EAT) is a part of visceral fat deposited around the heart between the pericardium and myocardium along the distribution of coronary arteries. EAT thickness is reported to be associated with coronary atherosclerosis; however, no study has measured EAT volume in patients with type 2 diabetes or investigate its association with coronary artery disease. Design, A hospital-based case control study. Patients, A total of 49 patients with type 2 diabetes mellitus (T2DM) and 78 nondiabetic controls were studied. Measurements, Cardiac multislice computed tomography was used to measure EAT volume, Gensini score, coronary artery calcium score and, coronary lesions. The relationships between EAT volume, markers of coronary atherosclerosis and anthropometric and biochemical parameters of metabolic syndrome (MetS) were investigated. Results, EAT volume was significantly higher in patients with T2DM than in nondiabetic subjects (1661 606 cm3 vs. 1234 418 cm3, P < 00001). Logistic regression analysis revealed independent and significant associations between EAT and diabetic status. EAT volume was significantly associated with components of MetS (BMI, waist circumference, fasting serum glucose, total cholesterol, HDL-cholesterol, and triglycerides levels), Gensini score, coronary lesions, coronary disease and coronary calcium scores. Univariate, multivariate and trend analyses confirmed that EAT volume was associated with MetS component clustering and the coronary atherosclerosis index. Conclusions, The analytical results indicate that EAT volume is increased in T2DM patients and is associated with unfavourable components of MetS and coronary atherosclerosis. The close anatomical relationship between EAT and the coronary arteries, combined with other evidence indicating that EAT is a biologically active adipokine-secreting tissue, suggest that EAT participates in the pathogenesis of diabetic coronary atherosclerosis. [source]

Polymorphisms of ADIPOR1 and ADIPOR2 are associated with phenotypes of type 2 diabetes in Koreans

Jin Taek Kim
Summary Objective, Adiponectin receptors 1 and 2 (ADIPOR1 and ADIPOR2) are considered as candidate genes for type 2 diabetes because they mediate the metabolic effects of adiponectin on target tissues. We investigated whether common polymorphisms of ADIPOR1 and ADIPOR2 are associated with type 2 diabetes or its related phenotypes in Koreans. Design and patients, By sequencing of the DNA samples from 24 unrelated Korean subjects, we selected seven single nucleotide polymorphisms (SNPs) from ADIPOR1 and four SNPs from ADIPOR2 for genotyping in 757 type 2 diabetic patients and 644 nondiabetic subjects. Results, None of the SNPs were associated with the risk of type 2 diabetes. However, g.,7309A>G (rs75172865) in ADIPOR1 was associated with lower insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Thereafter, we transfected three different human cell lines with plasmids harbouring g.,7309A>G and found that this variant reduced the promoter activity of ADIPOR1. In ADIPOR2, g.,63442G (novel SNP) and g.33447T (rs1044471) were associated with smaller waist circumference. Conclusions, None of the SNPs in either ADIPOR1 or ADIPOR2 were associated with the risk of type 2 diabetes in Koreans. However, the altered activity of the ADIPOR1 promoter was associated with insulin resistance and SNPs of ADIPOR2 were associated with waist circumference. [source]