Insulin-Resistant Prediabetic Subjects Have More Atherogenic Risk Factors Than Insulin-Sensitive Prediabetic Subjects

Size: px
Start display at page:

Download "Insulin-Resistant Prediabetic Subjects Have More Atherogenic Risk Factors Than Insulin-Sensitive Prediabetic Subjects"

Transcription

1 Insulin-Resistant Prediabetic Subjects Have More Atherogenic Risk Factors Than Insulin-Sensitive Prediabetic Subjects Implications for Preventing Coronary Heart Disease During the Prediabetic State Steven M. Haffner, MD; Leena Mykkänen, MD; Andreas Festa, MD; James P. Burke, PhD; Michael P. Stern, MD Background Subjects who convert to type 2 diabetes mellitus have increased cardiovascular risk factors relative to nonconverters. However, it is not known whether these atherogenic changes in the prediabetic state are predominantly due to insulin resistance, decreased insulin secretion, or both. Methods and Results We examined this issue in the 7-year follow-up of the San Antonio Heart Study, in which 195 of 1734 subjects converted to type 2 diabetes. At baseline, converters had significantly higher body mass index, waist circumference, triglyceride concentration, and blood pressure and lower HDL cholesterol than nonconverters. Atherogenic changes in converters were markedly attenuated (and no longer significant) after adjustment for the homeostasis model assessment of insulin resistance (HOMA IR, a surrogate for insulin resistance); in contrast, the differences in risk factors between converters and nonconverters increased after adjustment for the ratio of early insulin increment to early glucose increment ( I 30-0 / G 30-0 ) during an oral glucose tolerance test (a surrogate for insulin secretion). We also compared converters who had a predominant insulin resistance (high HOMA IR and high I 30-0 / G 30-0 )(n 56) and converters who had a predominant decrease in insulin secretion (low HOMA IR and low I 30-0 / G 30-0 )(n 31) with nonconverters (n 1539). Only the converters who were insulin resistant had higher blood pressure and triglyceride levels and lower HDL cholesterol levels than nonconverters. Conclusions Our data suggest that atherogenic changes in the prediabetic state are mainly seen in insulin-resistant subjects and that strategies to prevent type 2 diabetes might focus on insulin-sensitizing interventions rather than interventions that increase insulin secretion because of potential effects on cardiovascular risk. (Circulation. 2000;101: ) Key Words: insulin diabetes mellitus lipids cholesterol blood pressure Type 2 diabetes mellitus is associated with a marked increase in coronary heart disease (CHD). 1 3 The relationship between glycemia and CHD in type 2 diabetes has been controversial, with some studies showing strong associations, 4 some weak associations, 5 and others no associations. 6 The recently published United Kingdom Prospective Diabetes Study (UKPDS) found a greater benefit of glycemic control on microvascular events than for CHD or stroke. 7 One explanation for the relatively weak effect of glycemia on CHD in type 2 diabetes might be the existence of a highly atherogenic state before the onset of diabetes. 8 Increased risk factors for CHD before the onset of type 2 diabetes have been shown in several populations, including Israelis, 9 elderly American subjects, 10 elderly Finnish subjects, 11 Mexican American subjects, 12 and Pima Indians. 13 The causes of increased atherogenicity of the prediabetic state are not fully understood. Both insulin resistance (measured directly 14 or through surrogates such as fasting insulin ) and decreased insulin secretion predict the development of type 2 diabetes. It is not known whether the increased atherogenicity of the prediabetic state is primarily due to increased insulin resistance or decreased insulin secretion, although increased resistance may be likely given the amount of information on the insulin-resistance syndrome. 22,23 In this report, we examine whether insulin resistance or decreased insulin secretion is responsible for the atherogenic prediabetic state. In particular, we were interested in whether cardiovascular risk factors were similar in prediabetic subjects who had a predominant insulin-secretory defect (normal Received July 12, 1999; revision received September 17, 1999; accepted October 1, From the Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio. Reprint requests to Steven M. Haffner, MD, Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX haffner@uthscsa.edu 2000 American Heart Association, Inc. Circulation is available at 975

2 976 Circulation March 7, 2000 insulin sensitivity but low insulin-secretory response) as opposed to subjects with a predominant insulin-resistance defect (insulin resistant but with good insulin-secretory response). This issue is important because recently, a number of projects to prevent type 2 diabetes have been undertaken with methods that either improve insulin sensitivity (Diabetes Prevention Project [DPP: metformin, intensive lifestyle 24 ] and STOP-NIDDM [acarbose] 25 ) or increase insulin secretion (NANSY [sulfonylurea {Amaryl}]; Arne Melander, Sweden, oral communication, 1999). If atherogenic changes in the prediabetic state are limited to subjects with insulin resistance, the use of insulin-sensitizing agents to prevent diabetes could have a beneficial effect on CHD. We used data from the San Antonio Heart Study, in which we have previously shown that both high fasting insulin (a surrogate for insulin resistance) and a decreased ratio of insulin increment (over the first 30 minutes) to glucose increment (over the first 30 minutes) during an oral glucose tolerance test ( I 30-0 / G 30-0 ) (a surrogate for insulin secretion) predict the development of type 2 diabetes in Mexican Americans. 20 Methods The San Antonio Heart Study is a population-based study of diabetes and cardiovascular disease in Mexican American and non-hispanic whites. From 1984 to 1988, we randomly selected households from low-income (barrio), middle-income (transitional), and high-income (suburban) census tracts in San Antonio, Tex. 26 All men and nonpregnant women aged 25 to 64 years who resided in the randomly sampled households were eligible to participate. Mexican Americans were defined as individuals whose ancestry derived from a Mexican national origin. Detailed descriptions of this study have been published previously. 26 This study was approved by the Institutional Review Board of the University of Texas Health Science Center at San Antonio. All subjects gave informed consent. Beginning in October 1991, we began a 7-year follow-up of the cohort. 20 The results in this report are based on risk factors for the development of type 2 diabetes. Subjects with diabetes at the baseline examination were excluded from this report. At the baseline and follow-up visits, blood specimens were obtained after a 12- to 14-hour fast for determination of plasma glucose, serum insulin, and serum lipids and lipoproteins. Methods for determination of lipids and lipoproteins and glucose have been described previously. 20 We measured serum insulin with a solidphase radioimmunoassay (Diagnostic Products Corporation) that shows a relatively high degree of cross-reactivity with proinsulin ( 70% to 100%). 26 A 75-g oral glucose load (Orangedex; Custom Laboratories) was administered, and blood specimens were obtained 30 minutes, 1 hour, and 2 hours later for plasma glucose and serum insulin concentrations. At the follow-up examination, post glucoseload specimens were obtained only at the 2-hour time point. Diabetes was diagnosed according to World Health Organization (WHO) criteria. 27 Subjects who did not meet WHO plasma glucose criteria but who were undergoing treatment with oral antidiabetic agents or insulin were considered to have diabetes. In this report, we use the homeostasis model of insulin resistance (HOMA IR) as a measure of insulin resistance and I 30-0 / G as a measure of insulin secretion (early secretory response to an oral glucose load). The formula for the HOMA IR model 28 follows: HOMA IR Fasting insulin ( U/mL) fasting glucose (mmol/l) 22.5 The correlation of HOMA IR and fasting insulin in nondiabetic subjects is Anthropometric measurements (height, weight, and waist and hip circumferences) were made after participants had removed their shoes and upper garments and donned an examination gown. Body mass index (BMI) was calculated as weight (in kilograms) divided by height (in meters squared). Waist circumference was chosen as a measure of central adiposity. The systolic (first phase) and diastolic (fifth phase) blood pressures were measured to the nearest even digit by use of a randomzero sphygmomanometer (Hawksley-Gelman). Three readings were recorded for each individual, and the average of the second and third readings was defined as the patient s blood pressure. Statistical analyses included ANCOVA performed with SAS statistic software. Two-way ANCOVA was done initially with conversion to diabetes and ethnicity (Mexican American versus non-hispanic whites as the grouping variable). The P value for these interaction terms (ethnicity times conversion status) were all Because there was no evidence of different effect of conversion status by ethnicity on variables of interest (ie, triglycerides or blood pressure), we pooled the ethnic groups with control for ethnicity to increase statistical power and to simplify the analysis. One-way ANCOVA was done with conversion to diabetes as the main effect (Tables 1 and 2). Additional analysis was done with 2-way ANCOVA among the converters to diabetes by dividing subjects by their insulinresistance or insulin-secretion status at baseline (HOMA IR above and below median of 3.0 and insulin secretion [ I 30-0 / G 30-0 in pmol/mmol] above and below median of pmol/l) (Table 3). The median was based on the overall nondiabetic population at baseline. Finally, 1-way ANCOVAs (with pairwise contrasts) were done with conversion to diabetes as the dependent variable to compare subjects with predominant insulin resistance (above median for both HOMA IR and I 30-0 / G 30-0 ) and subjects with a predominant insulin-secretory defect (below median for both fasting insulin and I 30-0 / G 30-0 ) with subjects who did not convert to type 2 diabetes (Figure 2). Triglyceride, fasting insulin, HOMA IR, and I 30-0 / G 30-0 were transformed to improve the skewness and kurtosis of their distribution for statistical testing. These variables were both back-transformed for presentation in the tables. All probability values are 2-sided. Results Table 1 shows the baseline characteristics of subjects by conversion to diabetes, adjusted for age, sex, and ethnicity. Fasting insulin and HOMA IR were higher and I 30-0 / G 30-0 was lower in converters to diabetes than in subjects who remained nondiabetic. Subjects who converted to diabetes had greater obesity and an unfavorable body fat distribution, higher blood pressure, higher prevalence of hypertension, higher glucose levels, higher triglyceride levels, and lower HDL cholesterol than subjects who did not convert to diabetes. Total and LDL cholesterol levels and smoking status were similar in converters and nonconverters. As shown in Table 2 (model A), after further adjustment for fasting glucose and waist circumference, converters continued to have higher blood pressure and higher triglyceride levels and lower HDL cholesterol levels than subjects who did not convert to diabetes. Table 2 shows the effects of additional adjustment for HOMA IR (a surrogate for insulin resistance) (model B) versus the effect of adjustment for I 30-0 / G 30-0 (model C), a surrogate for insulin secretion. Adjustment for HOMA IR attenuated the differences between converters and nonconverters, making them no longer statistically significant. In contrast, after adjustment for insulin secretion ( I 30-0 / G 30-0 ), the differences between converters and nonconverters to type 2 diabetes remained statistically significant. We next categorized the subjects simultaneously by insulin resistance (above and below the median for HOMA IR in the overall nondiabetic population at baseline) and insulin secretion (above and below the median for I 30-0 / G 30-0 ). The

3 Haffner et al Prediabetic Subjects and Atherogenic Risk 977 TABLE 1. Clinical Characteristics at Baseline (Mean SEM) According to Conversion Status at Follow-Up (Adjusted for Age, Sex, and Ethnicity) Conversion Status at Follow-Up Nondiabetic (n 1539) Type 2 Diabetes (n 195) P Age,* y Male 43% 39% 0.31 Mexican American 64% 81% Smokers 10.9% 11.4% BMI, kg/m WHR ( 100) Waist, mm Fasting glucose, mmol Fasting insulin, pmol/l HOMA IR I 30-0 / G 30-0, pmol/mmol LDL cholesterol, mmol/l HDL cholesterol, mmol/l Triglyceride, mmol/l HBP 9.9% 25.0% SBP, mm Hg DBP, mm Hg WHR indicates waist-hip ratio; HBP, prevalence of hypertension (DBP 95 mm Hg and/or presence of blood pressure medications); SBP, systolic blood pressure; and DBP, diastolic blood pressure. *Not adjusted for age; not adjusted for sex; not adjusted for ethnicity. incidence of type 2 diabetes by insulin resistance and secretion categories is shown in Figure 1. As expected, subjects with the highest rate of developing type 2 diabetes had both insulin resistance and decreased insulin secretion (31.8% in 7 years), and the lowest rate was in subjects who were insulin sensitive with good secretory capacity (1.0%). Subjects with insulin resistance but good insulin secretion had a higher conversion rate than subjects with low insulin secretion who were insulin sensitive (11.0% versus 6.2%). These results are similar to those presented for a smaller cohort of Mexican Americans only. 20 We also characterized the distribution of insulin resistance and secretory effects of converters to diabetes and insulin secretion. Fifty-four percent of converters had both an insulin secretory defect and were insulin resistant compared with 1.5% of converters who were insulin sensitive with good secretion at baseline. The subjects who were predominantly insulin resistant with good insulin secretion at baseline comprised 28.7% of all converters to type 2 diabetes compared with 15.9% of subjects who had low insulin secretion but were insulin sensitive (predominantly insulin sensitive). Table 3 shows anthropometric and cardiovascular risk factors by insulin resistance and secretion categories. Insulin resistance was associated with higher BMI, greater waist circumference, and higher blood pressure and triglyceride levels and lower HDL cholesterol levels. Insulin secretion was not related to anthropometric or cardiovascular risk factors. Fasting and 2-hour glucose levels were similar in each group. Additional adjustment for BMI or waist circumference did not appreciably change these results (data not shown). Figure 2 compares the triglyceride and HDL levels and systolic blood pressure in converters to type 2 diabetes with predominant insulin resistance (high HOMA IR and high I 30-0 / G 30-0 ), converters with a predominant insulin-secretory defect (low I 30-0 / G 30-0 and low HOMA IR), and nonconverters to type 2 diabetes. Among converters to diabetes, the only subjects with adverse cardiovascular risk factors (high systolic blood pressure and triglyceride levels and low HDL cholesterol levels) were converters to diabetes with high IR and I 30-0 / G 30-0 (insulin-resistant subjects). Subjects who converted to diabetes but had predominant insulin resistance had a BMI 3 to 4 kg/m 2 higher than subjects who did not convert to diabetes or who converted to diabetes but had a predominant insulin-secretory defect. Adjustment for differences in BMI somewhat attenuated the differences in lipoproteins or blood pressure ( 30%), but converters to diabetes who had predominant insulin resistance continued to have significantly more atherogenic risk factors than the other 2 groups (P 0.01). Discussion We have confirmed that prediabetic subjects have increased cardiovascular risk factors at baseline relative to subjects who do not convert to type 2 diabetes. These results extend previous results in earlier reports in a variety of ethnic groups, 9 13 including reports on smaller groups of Mexican Americans in the San Antonio Heart Study. 12 The increased atherogenicity of the prediabetic state was due only in part to differences in overall adiposity and upper-body adiposity between the converters and nonconverters to type 2 diabetes (Table 1).

4 978 Circulation March 7, 2000 TABLE 2. Clinical Characteristics of Subjects at Baseline According to Conversion Status at Follow-Up, Adjusted for Either Insulin Resistance or Insulin Sensitivity Conversion Status at Follow-Up Nondiabetic (n 1539) Type 2 Diabetes (n 195) Difference (DM Non-DM) P A. Adjusted for age, sex, ethnicity, fasting glucose, and waist circumference HDL cholesterol, mmol/l LDL cholesterol, mmol/l Triglyceride, mmol/l SBP, mm Hg DBP, mm Hg Fasting insulin, pmol/l HOMA IR I 30-0 / G 30-0, pmol/mmol B. Adjusted for age, sex, ethnicity, fasting glucose, waist circumference, and HOMA IR (surrogate for insulin resistance) HDL cholesterol, mmol/l LDL cholesterol, mmol/l Triglyceride, mmol/l SBP, mm Hg DBP, mm Hg C. Adjusted for age, sex, ethnicity, fasting glucose, waist circumference, and I 30-0 / G 30-0 (surrogate for insulin secretion) HDL cholesterol, mmol/l LDL cholesterol, mmol/l Triglyceride, mmol/l SBP, mm Hg DBP, mm Hg Values are mean SEM. DM indicates diabetes mellitus; SBP, systolic blood pressure; and DBP, diastolic blood pressure. More interesting is whether the atherogenic differences in prediabetic subjects are due to increased insulin resistance, decreased insulin secretion, or both. To address this issue, we used 2 different approaches: that of statistical adjustment (Tables 1 and 2) and that of stratification (Table 3 and Figure 2). After adjustment for HOMA IR, the differences between converters and nonconverters were attenuated and were no longer statistically significant. In contrast, after adjustment for I 30-0 / G 30-0 (a surrogate for decreased secretory response that has been shown to be a significant predictor of type 2 diabetes in this cohort 20 ), the differences between converters and nonconverters actually widened (Table 2). Figure 1. Seven-year incidence of type 2 diabetes by baseline status for insulin resistance (HOMA IR surrogate for insulin resistance) and insulin secretion ( I 30-0 / G 30-0 surrogate for insulin secretion). Subjects who converted to diabetes but were insulin resistant had significantly higher triglyceride levels, systolic blood pressure, and diastolic blood pressure and lower HDL cholesterol levels than subjects who converted to diabetes but who were insulin sensitive. The 2 groups of converters to type 2 diabetes (predominantly insulin-resistant versus insulinsensitive converters) had similar values for both fasting and 2-hour glucose levels, but the insulin-resistant converters were more obese (Table 3). After additional adjustment for BMI (data not shown), insulin-resistant converters to type 2 diabetes still had worse cardiovascular risk factors than insulin-sensitive converters. Interestingly, insulin-sensitive converters to type 2 diabetes had triglyceride and HDL cholesterol levels and systolic blood pressure similar to those of subjects who remained nondiabetic at baseline. We have thus identified different subgroups of converters to type 2 diabetes with markedly different patterns of cardiovascular risk factors. The implication is that the subjects who were insulin resistant and converted to diabetes would have more cardiovascular disease than the insulin-sensitive subjects who converted to diabetes. We should point out that the differences in lipids (triglyceride 0.9 mmol and HDL cholesterol 0.24 mmol) and systolic blood pressure (6.5 mm Hg) (Table 3) are actually larger than the differences between diabetic (n 303) and nondiabetic (n 2564) subjects in the San Antonio Heart Study (for diabetic versus nondiabetic subjects, respectively: triglyceride 2.3 versus 1.6 mmol/l, a 0.7 mmol/l difference; HDL

5 Haffner et al Prediabetic Subjects and Atherogenic Risk 979 TABLE 3. Clinical Characteristics of Subjects at Baseline Who Converted to Type 2 Diabetes by Whether They Had Predominantly Insulin Resistance, Decreased Insulin Secretion, or a Mixed Picture (Adjusted for Age, Sex, and Ethnicity) High HOMA IR ( Insulin Resistant ) Low HOMA IR ( Insulin Sensitive ) P * HOMA IR I 30-0 / G 30-0 I 30-0 / G 30-0 (insulin secretion status) High ( good ) Low ( bad ) High ( good ) Low ( bad ) n Fasting insulin, pmol/l HOMA IR I 30-0 / G 30-0, pmol/mmol Waist circumference, mm BMI, kg/m HDL cholesterol, mmol/l LDL cholesterol, mmol/l Triglyceride, mmol/l SBP, mm Hg DBP, mm Hg Fasting glucose, mmol h Glucose, mmol %IGT 54.0% 54.6% 50% 53.5% Values are mean SEM unless otherwise indicated. SBP indicates systolic blood pressure; DBP, diastolic blood pressure; and IGT, impaired glucose tolerance. *P value by 2-way ANCOVA. cholesterol 1.12 versus 1.24 mmol/l, a 0.12 mmol/l difference; and systolic blood pressure versus mm Hg, or a difference of 6.1 mm Hg). Our results may have important implications for the prevention of diabetes. Currently, a number of clinical trials on insulin-sensitizing agents are under way (DPP [metformin, intensive lifestyle 24 ] and STOPNIDDM [acarbose] 25 ). Similarly, there are prevention trials involving insulin secretagogues (NANSY [sulfonylurea {Amaryl}]). If our results are correct, they suggest that the use of a sulfonylurea to prevent diabetes might increase the risk of CHD (or at least prove less beneficial) than the use of insulin-sensitizing agents. The effects of different modalities for the prevention of diabetes on CHD will be particularly informative. However, improvement in glycemic control in diabetic subjects by sulfonylurea has led to reduction in insulin resistance in diabetic subjects, 32 Figure 2. Levels of cardiovascular risk factors by HOMA IR (fasting insulin), insulin secretion ( I 30-0 / G 30-0 ), and conversion status. suggesting that the differential between insulin sensitizers and insulin secretagogues with respect to cardiovascular risk factors could be overestimated in epidemiological studies such as the present report. However, whether insulin secretagogues would improve insulin sensitivity in nondiabetic subjects at high risk of diabetes (impaired glucose tolerance), which are the focus of the current report, is not known. In this study, we have a number of limitations. First, we have not directly measured insulin resistance or insulin sensitivity. Few studies have compared fasting insulin versus insulin resistance as a predictor of type 2 diabetes. Lillioja et al 14 showed that insulin resistance (as determined by hyperinsulinemic euglycemic clamp) was a better predictor than was fasting insulin, although both were strong predictors (hazard ratios of 30 and 15, respectively). Fasting insulin and I 30-0 / G 30-0 have been correlated with more definitive methods for assessing insulin secretion and resistance In the Mexico City Diabetes Study, HOMA IR was a slightly better predictor of the incidence of type 2 diabetes than were fasting insulin levels. 33 It is likely that more precise measurements of these variables would decrease misclassification and perhaps strengthen the present results. In conclusion, we have shown that prediabetic subjects have an atherogenic pattern of cardiovascular risk factors, and these changes are predominantly observed in prediabetic subjects with increased HOMA IR and fasting insulin ( insulin resistance ) at baseline. Insulin-sensitive converters to diabetes have a pattern of cardiovascular risk factors similar to nonconverters to diabetes. The most important possible implication of these findings is that different methods of preventing diabetes may have different effects on CHD, which is the most common cause of death in diabetic subjects. 1 3

6 980 Circulation March 7, 2000 Acknowledgments This work was supported by grants RO1HL24799 and R37HL36820 from the National Heart, Lung, and Blood Institute. Dr Burke was supported by the American Diabetes Association s mentor-based postdoctoral fellowship program. References 1. Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham Study. Diabetes Care. 1979; 2: Wingard DL, Barrett-Connor E. Heart disease and diabetes. In: Harris MI, ed. Diabetes in America. 2nd ed. Bethesda, Md: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Diabetes Data Group; 1995: Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339: Kuusisto J, Mykkänen L, Pyörälä K, Laakso M. NIDDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes. 1994;43: Klein R. Kelly West Lecture 1994: hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care. 1995;18: West KM, Ahuja MMS, Bennett PH, Czyzyk A, DeAcosta OM, Fuller JH, Grab B, Bragauskas V, Jarrett RJ, Kosaka K. The role of circulating glucose and triglyceride concentrations and their interactions with other risk factors as determinants of arterial disease in nine diabetic population samples from the WHO Multinational Study. Diabetes Care. 1983; 6: UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352: Haffner SM. Management of dyslipidemia in adults with diabetes. Diabetes Care. 1998;21: Medalie JH, Papier DM, Goldbourt U, Herman JB. Major factors in the development of diabetes mellitus in men. Arch Intern Med. 1975; 135: McPhillips JB, Barrett-Connor E, Wingard DL. Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non-insulin dependent diabetes mellitus in a community of older adults. Am J Epidemiol. 1990;131: Mykkänen L, Kuusisto J, Pyörälä K, Laakso M. Cardiovascular disease risk factors as predictors of type II (non-insulin-dependent) diabetes mellitus in elderly subjects. Diabetologia. 1993;36: Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK. Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA. 1990;263: Fagot-Campagna A, Narayan KM, Hanson RL, Imprematore G, Howard BV, Nelson RG, Pettitt DJ, Knowler WC. Plasma lipoproteins and incidence of non-insulin-dependent diabetes mellitus in Pima Indians: protective effect of HDL cholesterol in women. Atherosclerosis. 1997; 128: Lillioja S, Mott DM, Spraul M, Ferraro R, Foley JE, Ravussin E, Knowler WC, Bennett PH, Bogardus C. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus: prospective studies of Pima Indians. N Engl J Med. 1993;329: Haffner SM, Stern MP, Mitchell BD, Hazuda HP, Patterson JK. Incidence of type II diabetes in Mexican Americans predicted by fasting insulin and glucose levels, obesity, and body fat distribution. Diabetes. 1990;39: Bergstrom RW, Newell-Morris LL, Leonetti DL, Shuman WP, Wahl PW, Fujimoto WY. Association of elevated fasting C-peptide levels and increased intra-abdominal fat distribution with development of NIDDM in Japanese American men. Diabetes. 1990;39: Sicree RA, Zimmet PZ, King HOM, Coventry JS. Plasma insulin response among Nauruans: prediction of deterioration in glucose tolerance over 6 years. Diabetes. 1987;36: Kadowaki T, Miyake Y, Hagura R, Akanuma Y, Kajinuma H, Kuzuya N, Takaku F, Kosaka K. Risk factors for worsening to diabetes in subjects with impaired glucose tolerance. Diabetologia. 1984;26: Chen KW, Boyko EJ, Bergstrom RW, Leonetti DL, Newell-Morris L, Wahl PW, Fujimoto WY. Earlier appearance of impaired insulin secretion than of visceral adiposity in the pathogenesis of NIDDM: 5 year follow-up of initially non-diabetic Japanese American men. Diabetes Care. 1995;18: Haffner SM, Miettinen H, Gaskill SP, Stern MP. Decreased insulin secretion and increased insulin resistance are independently related to the 7-year risk of non-insulin dependent diabetes mellitus. Diabetes. 1995; 44: Lundgren H, Bengtsson C, Blohme G, Lapidus L, Waldenstrom J. Fasting serum insulin concentrations and early insulin response as risk determinants for developing diabetes. Diabet Med. 1990;7: Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37: Haffner SM, Miettinen H. Insulin resistance implications for type II diabetes mellitus and coronary heart disease. Am J Med. 1997;193: The Diabetes Prevention Program Research Group. The Diabetes Prevention Program: design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care. 1999;22: Chiasson JL, Gomis R, Hanefeld M, Josse RG, Karasik A, Laakso M, the STOP-NIDDM Trial Research Group. The STOP-NIDDM trial: an international study on the efficacy of an -glucosidase inhibitor to prevent type 2 diabetes in a population with impaired glucose tolerance: rationale, design, and preliminary screening data. Diabetes Care. 1998;21: Haffner SM, Stern MP, Hazuda HP, Pugh J, Patterson J. Hyperinsulinemia in a population at high risk for non-insulin dependent diabetes mellitus. N Engl J Med. 1986;315: World Health Organization Study Group on Diabetes Mellitus. Diabetes Mellitus: Report of a WHO Study Group. Geneva, Switzerland: World Health Organization (Technical Report Series, No. 727); 1985: Matthews DR, Hosker JP, Rudenski AS, Naylor GA, Treacher DF, Turner RL. Homeostasis model assessment: insulin resistance and -cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28: Laakso M. How good a marker is insulin level for insulin resistance? Am J Epidemiol. 1993;137: Saad MF, Anderson RL, Laws A, Watanabe RM, Kades WW, Chen YD, Sands RE, Pei D, Savage PJ, Bergman RN. A comparison between the minimal model and the glucose clamp in the assessment of insulin sensitivity across the spectrum of glucose tolerance: Insulin Resistance Atherosclerosis Study. Diabetes. 1994;43: Philips DI, Clark PM, Hales CN, Osmond C. Understanding oral glucose tolerance: comparison of glucose and insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and secretion. Diabet Med. 1994;11: Groop LC. Sulfonylureas in NIDDM. Diabetes Care. 1992;15: Haffner SM, Miettenen H, Stern MP. The homeostasis model in the San Antonio Heart Study. Diabetes Care. 1997;20:

Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men

Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men Diabetologia (1997) 40: 711 717 Springer-Verlag 1997 Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men S. M. Haffner 1, H. Miettinen 1,2, M. P.Stern

More information

Are risk factors for conversion to NIDDM similar in high and low risk populations?

Are risk factors for conversion to NIDDM similar in high and low risk populations? Diabetologia (1997) 40: 62 66 Springer-Verlag 1997 Are risk factors for conversion to NIDDM similar in high and low risk populations? S.M. Haffner, H. Miettinen, M. P. Stern Department of Medicine, Division

More information

Specific insulin and proinsulin in normal glucose tolerant first-degree relatives of NIDDM patients

Specific insulin and proinsulin in normal glucose tolerant first-degree relatives of NIDDM patients Brazilian Journal of Medical and Biological Research (1999) 32: 67-72 Insulin and proinsulin in first-degree relatives of NIDDM ISSN 1-879X 67 Specific insulin and proinsulin in normal glucose tolerant

More information

Elevated Incidence of Type 2 Diabetes in San Antonio, Texas, Compared With That of Mexico City, Mexico

Elevated Incidence of Type 2 Diabetes in San Antonio, Texas, Compared With That of Mexico City, Mexico Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E Elevated Incidence of Type 2 Diabetes in San Antonio, Texas, Compared With That of Mexico City, Mexico JAMES P. BURKE, PHD

More information

Diabetes Care 24:89 94, 2000

Diabetes Care 24:89 94, 2000 Pathophysiology/Complications O R I G I N A L A R T I C L E Insulin Resistance and Insulin Secretory Dysfunction Are Independent Predictors of Worsening of Glucose Tolerance During Each Stage of Type 2

More information

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD

More information

Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes

Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes FRANK B. HU, MD 1,2,3 MEIR J. STAMPFER,

More information

The American Diabetes Association estimates

The American Diabetes Association estimates DYSLIPIDEMIA, PREDIABETES, AND TYPE 2 DIABETES: CLINICAL IMPLICATIONS OF THE VA-HIT SUBANALYSIS Frank M. Sacks, MD* ABSTRACT The most serious and common complication in adults with diabetes is cardiovascular

More information

Östgren, Carl Johan; Lindblad, Ulf; Ranstam, Jonas; Melander, Arne; Råstam, Lennart

Östgren, Carl Johan; Lindblad, Ulf; Ranstam, Jonas; Melander, Arne; Råstam, Lennart Glycaemic control, disease duration and beta-cell function in patients with Type 2 diabetes in a Swedish community. Skaraborg Hypertension and Diabetes Project. Östgren, Carl Johan; Lindblad, Ulf; Ranstam,

More information

Development of type 2 diabetes is, to some

Development of type 2 diabetes is, to some Mode of Onset of Type 2 Diabetes from Normal or Impaired Glucose Tolerance Ele Ferrannini, 1 Monica Nannipieri, 1 Ken Williams, 2 Clicerio Gonzales, 3 Steve M. Haffner, 2 and Michael P. Stern 2 Fasting

More information

On May 2001, the Third Adult

On May 2001, the Third Adult THE RISK OF DIABETES: CAN WE IMPACT CHD THROUGH THE ATP III CHOLESTEROL GUIDELINES? * Based on a presentation given by Steven M. Haffner, MD, MPH ABSTRACT Diabetes has been recognized among diabetologists

More information

Insulin resistance and insulin secretory dysfunction as precursors of non- insulin-dependent diabetes mellitus: Prospective studies of Pima Indians

Insulin resistance and insulin secretory dysfunction as precursors of non- insulin-dependent diabetes mellitus: Prospective studies of Pima Indians University of Wollongong Research Online Graduate School of Medicine - Papers (Archive) Faculty of Science, Medicine and Health 1993 Insulin resistance and insulin secretory dysfunction as precursors of

More information

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk Metabolic Syndrome Update 21 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes University of Colorado Denver Denver Health Medical Center The Metabolic

More information

Cardiovascular disease (CVD) accounts

Cardiovascular disease (CVD) accounts Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E Homeostasis Model Assessment of Insulin Resistance in Relation to the Incidence of Cardiovascular Disease The San Antonio

More information

Does the ticking clock go backward as well as forward?

Does the ticking clock go backward as well as forward? Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E The Singapore Impaired Glucose Tolerance Follow-Up Study Does the ticking clock go backward as well as forward? MOH-SIM

More information

The Metabolic Syndrome: Is It A Valid Concept? YES

The Metabolic Syndrome: Is It A Valid Concept? YES The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA

More information

Incidence of NIDDM and the effects of gender, obesity and hyperinsulinaemia in Taiwan

Incidence of NIDDM and the effects of gender, obesity and hyperinsulinaemia in Taiwan Diabetologia (1997) 40: 1431±1438 Springer-Verlag 1997 Incidence of NIDDM and the effects of gender, obesity and hyperinsulinaemia in Taiwan S.-L. Wang 1, W.-H. Pan 1, C.-M. Hwu 2,4, L.-T. Ho 2±4, C.-H.

More information

A study to find out the relationship between insulin resistance and hypertension

A study to find out the relationship between insulin resistance and hypertension International Journal of Advances in Medicine http://www.ijmedicine.com pissn 49-95 eissn 49-9 Original Research Article DOI: http://dx.doi.org/.10/49-9.ijam01771 A study to find out the relationship between

More information

The term impaired glucose tolerance

The term impaired glucose tolerance Cardiovascular and Metabolic Risk O R I G I N A L A R T I C L E Risk of Progression to Type 2 Diabetes Based on Relationship Between Postload Plasma Glucose and Fasting Plasma Glucose MUHAMMAD A. ABDUL-GHANI,

More information

Abdominal volume index and conicity index in predicting metabolic abnormalities in young women of different socioeconomic class

Abdominal volume index and conicity index in predicting metabolic abnormalities in young women of different socioeconomic class Research Article Abdominal volume index and conicity index in predicting metabolic abnormalities in young women of different socioeconomic class Vikram Gowda, Kripa Mariyam Philip Department of Physiology,

More information

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories

More information

Diabetes: Staying Two Steps Ahead. The prevalence of diabetes is increasing. What causes Type 2 diabetes?

Diabetes: Staying Two Steps Ahead. The prevalence of diabetes is increasing. What causes Type 2 diabetes? Focus on CME at the University of University Manitoba of Manitoba : Staying Two Steps Ahead By Shagufta Khan, MD; and Liam J. Murphy, MD The prevalence of diabetes is increasing worldwide and will double

More information

Serum true insulin concentration and the risk of clinical non-insulin dependent diabetes during long-term follow-up

Serum true insulin concentration and the risk of clinical non-insulin dependent diabetes during long-term follow-up International Epidemiological Association 1999 Printed in Great Britain International Journal of Epidemiology 1999;28:735 741 Serum true insulin concentration and the risk of clinical non-insulin dependent

More information

Hyperlipidemia and Cardiovascular Risk Factors in Patients With Type 2 Diabetes

Hyperlipidemia and Cardiovascular Risk Factors in Patients With Type 2 Diabetes ...PRESENTATIONS... Hyperlipidemia and Cardiovascular Risk Factors in Patients With Type 2 Diabetes Based on a presentation by Ronald B. Goldberg, MD Presentation Summary Atherosclerosis accounts for approximately

More information

Cut-Off Fasting Plasma Glucose Level To Determine Impaired Glucose Metabolism In Obesity

Cut-Off Fasting Plasma Glucose Level To Determine Impaired Glucose Metabolism In Obesity ISPUB.COM The Internet Journal of Internal Medicine Volume 4 Number 1 Cut-Off Fasting Plasma Glucose Level To Determine Impaired Glucose Metabolism In Obesity S Guldiken, A Tugrul, G Ekuklu, E Arikan,

More information

Association between Raised Blood Pressure and Dysglycemia in Hong Kong Chinese

Association between Raised Blood Pressure and Dysglycemia in Hong Kong Chinese Diabetes Care Publish Ahead of Print, published online June 12, 2008 Raised Blood Pressure and Dysglycemia Association between Raised Blood Pressure and Dysglycemia in Hong Kong Chinese Bernard My Cheung,

More information

Journal of the American College of Cardiology Vol. 48, No. 2, by the American College of Cardiology Foundation ISSN /06/$32.

Journal of the American College of Cardiology Vol. 48, No. 2, by the American College of Cardiology Foundation ISSN /06/$32. Journal of the American College of Cardiology Vol. 48, No. 2, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.03.043

More information

Isolated Post-challenge Hyperglycemia: Concept and Clinical Significance

Isolated Post-challenge Hyperglycemia: Concept and Clinical Significance CLINICAL PRACTICE Isolated Post-challenge Hyperglycemia: Concept and Clinical Significance John MF. Adam*, Daniel Josten** ABSTRACT The American Diabetes Association has strongly recommended that fasting

More information

How to Reduce CVD Complications in Diabetes?

How to Reduce CVD Complications in Diabetes? How to Reduce CVD Complications in Diabetes? Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Framingham Heart Study 30-Year

More information

Fasting Glucose, Obesity, and Metabolic Syndrome as Predictors of Type 2 Diabetes: The Cooper Center Longitudinal Study

Fasting Glucose, Obesity, and Metabolic Syndrome as Predictors of Type 2 Diabetes: The Cooper Center Longitudinal Study Fasting Glucose, Obesity, and Metabolic Syndrome as Predictors of Type 2 Diabetes: The Cooper Center Longitudinal Study Laura F. DeFina, MD,* Gloria Lena Vega, PhD,Þ David Leonard, PhD,Þ and Scott M. Grundy,

More information

Diabetes increases the risk of both

Diabetes increases the risk of both Pathophysiology/Complications O R I G I N A L A R T I C L E Insulin Resistance, the Metabolic Syndrome, and Risk of Incident Cardiovascular Disease in Nondiabetic American Indians The Strong Heart Study

More information

Leptin Concentrations in Women in the San Antonio Heart Study: Effect of Menopausal Status and Postmenopausal Hormone Replacement Therapy

Leptin Concentrations in Women in the San Antonio Heart Study: Effect of Menopausal Status and Postmenopausal Hormone Replacement Therapy American Journal of EpWemtokagy Copyright O 1997 by The Johns Hopkins University School of Hygiene and Public Health All rights reserved Vol. 146, No. 7 Printed In USA. A BRIEF ORIGINAL CONTRIBUTION Leptin

More information

Cardiovascular disease (CVD) is the

Cardiovascular disease (CVD) is the Cardiovascular and Metabolic Risk O R I G I N A L A R T I C L E Effect of Progression From Impaired Glucose Tolerance to Diabetes on Cardiovascular Risk Factors and Its Amelioration by Lifestyle and Metformin

More information

PREVALENCE OF INSULIN RESISTANCE IN FIRST DEGREE RELATIVES OF TYPE-2 DIABETES MELLITUS PATIENTS: A PROSPECTIVE STUDY IN NORTH INDIAN POPULATION

PREVALENCE OF INSULIN RESISTANCE IN FIRST DEGREE RELATIVES OF TYPE-2 DIABETES MELLITUS PATIENTS: A PROSPECTIVE STUDY IN NORTH INDIAN POPULATION PREVALENCE OF INSULIN RESISTANCE IN FIRST DEGREE RELATIVES OF TYPE-2 DIABETES MELLITUS PATIENTS: A PROSPECTIVE STUDY IN NORTH INDIAN POPULATION Arvind Kumar, Poornima Tewari, Sibasis S. Sahoo and Arvind

More information

The concept of a cluster of metabolic disorders

The concept of a cluster of metabolic disorders Prevalence and Characteristics of the Metabolic Syndrome in the San Antonio Heart and Framingham Offspring Studies James B. Meigs, 1 Peter W.F. Wilson, 2 David M. Nathan, 3 Ralph B. D Agostino, Sr., 4

More information

Diabetes Mellitus Type 2 Evidence-Based Drivers

Diabetes Mellitus Type 2 Evidence-Based Drivers This module is supported by an unrestricted educational grant by Aventis Pharmaceuticals Education Center. Copyright 2003 1 Diabetes Mellitus Type 2 Evidence-Based Drivers Driver One: Reducing blood glucose

More information

Although medical advances have curbed

Although medical advances have curbed PREVENTION OF CORONARY HEART DISEASE IN THE METABOLIC SYNDROME AND DIABETES MELLITUS * Sherita Hill Golden, MD, MHS ABSTRACT The leading cause of death in patients with diabetes is cardiovascular disease.

More information

Total risk management of Cardiovascular diseases Nobuhiro Yamada

Total risk management of Cardiovascular diseases Nobuhiro Yamada Nobuhiro Yamada The worldwide burden of cardiovascular diseases (WHO) To prevent cardiovascular diseases Beyond LDL Multiple risk factors With common molecular basis The Current Burden of CVD CVD is responsible

More information

Prediction of Homeostasis Model Assessment of Insulin Resistance in Japanese Subjects

Prediction of Homeostasis Model Assessment of Insulin Resistance in Japanese Subjects Tokai J Exp Clin Med., Vol. 37, No. 4, pp. 12-16, 212 Prediction of Homeostasis Model Assessment of Insulin Resistance in Japanese Subjects Masako NEGAMI, Eiko TAKAHASHI, Hiroki OTSUKA and Kengo MORIYAMA

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

There is abundant evidence that insulin resistance

There is abundant evidence that insulin resistance Perspectives in Diabetes Identification of Individuals With Insulin Resistance Using Routine Clinical Measurements Steven E. Stern, 1 Ken Williams, 2 Eleuterio Ferrannini, 3 Ralph A. DeFronzo, 4 Clifton

More information

SCIENTIFIC STUDY REPORT

SCIENTIFIC STUDY REPORT PAGE 1 18-NOV-2016 SCIENTIFIC STUDY REPORT Study Title: Real-Life Effectiveness and Care Patterns of Diabetes Management The RECAP-DM Study 1 EXECUTIVE SUMMARY Introduction: Despite the well-established

More information

Hypertension is an important factor in premature death,

Hypertension is an important factor in premature death, Effect of Hypertension on Mortality in Pima Indians Maurice L. Sievers, MD; Peter H. Bennett, MB, MRCP, FFCM; Janine Roumain, MD, MPH; Robert G. Nelson, MD, PhD Background The effect of hypertension on

More information

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System

More information

The Adult Treatment Panel (ATP) III of the National

The Adult Treatment Panel (ATP) III of the National Metabolic Syndrome With and Without C-Reactive Protein as a Predictor of Coronary Heart Disease and Diabetes in the West of Scotland Coronary Prevention Study Naveed Sattar, MD; Allan Gaw, MD; Olga Scherbakova,

More information

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Elliot Sternthal, MD, FACP, FACE Chair New England AACE Diabetes Day Planning Committee Welcome and Introduction This presentation will:

More information

The New England Journal of Medicine PREVALENCE OF IMPAIRED GLUCOSE TOLERANCE AMONG CHILDREN AND ADOLESCENTS WITH MARKED OBESITY.

The New England Journal of Medicine PREVALENCE OF IMPAIRED GLUCOSE TOLERANCE AMONG CHILDREN AND ADOLESCENTS WITH MARKED OBESITY. PREVALENCE OF IMPAIRED GLUCOSE TOLERANCE AMONG CHILDREN AND ADOLESCENTS WITH MARKED OBESITY RANJANA SINHA, M.D., GENE FISCH, PH.D., BARBARA TEAGUE, R.N., WILLIAM V. TAMBORLANE, M.D., BRUNA BANYAS, R.N.,

More information

Metabolic Syndrome: Why Should We Look For It?

Metabolic Syndrome: Why Should We Look For It? 021-CardioCase 29/05/06 15:04 Page 21 Metabolic Syndrome: Why Should We Look For It? Dafna Rippel, MD, MHA and Andrew Ignaszewski, MD, FRCPC CardioCase presentation Andy s fatigue Andy, 47, comes to you

More information

Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi- Libya: A pilot study. Arab Medical University. Benghazi, Libya

Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi- Libya: A pilot study. Arab Medical University. Benghazi, Libya Original Article Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi- Libya: A pilot study Alshkri MM 1, Elmehdawi RR 2 1 Benghazi Diabetes Center. 2 Medical Department, Faculty of Medicine,

More information

Energy Balance Equation

Energy Balance Equation Energy Balance Equation Intake Expenditure Hunger Satiety Nutrient Absorption Metabolic Rate Thermogenesis Activity Eat to Live! Live to Eat! EAT TO LIVE Intake = Expenditure Weight Stable LIVE TO EAT

More information

The frequent simultaneous presence of obesity,

The frequent simultaneous presence of obesity, NCEP-Defined Syndrome,, and Prevalence of Coronary Heart Disease Among NHANES III Participants Age 50 Years and Older Charles M. Alexander, 1 Pamela B. Landsman, 1 Steven M. Teutsch, 1 and Steven M. Haffner

More information

ARIC Manuscript Proposal # 985. PC Reviewed: 12/15/03 Status: A Priority: 2 SC Reviewed: 12/16/03 Status: A Priority: 2

ARIC Manuscript Proposal # 985. PC Reviewed: 12/15/03 Status: A Priority: 2 SC Reviewed: 12/16/03 Status: A Priority: 2 ARIC Manuscript Proposal # 985 PC Reviewed: 12/15/03 Status: A Priority: 2 SC Reviewed: 12/16/03 Status: A Priority: 2 1.a. Full Title: Association between family history of type 2 Diabetes Mellitus, the

More information

Early-Adulthood Cardiovascular Disease Risk Factor Profiles Among Individuals With and Without Diabetes in the Framingham Heart Study

Early-Adulthood Cardiovascular Disease Risk Factor Profiles Among Individuals With and Without Diabetes in the Framingham Heart Study Early-Adulthood Cardiovascular Disease Risk Factor Profiles Among Individuals With and Without Diabetes in the Framingham Heart Study The Harvard community has made this article openly available. Please

More information

Welcome and Introduction

Welcome and Introduction Welcome and Introduction This presentation will: Define obesity, prediabetes, and diabetes Discuss the diagnoses and management of obesity, prediabetes, and diabetes Explain the early risk factors for

More information

Cardiovascular Complications of Diabetes

Cardiovascular Complications of Diabetes VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary

More information

The Efficacy and Cost of Alternative Strategies for Systematic Screening for Type 2 Diabetes in the U.S. Population Years of Age

The Efficacy and Cost of Alternative Strategies for Systematic Screening for Type 2 Diabetes in the U.S. Population Years of Age Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E The Efficacy and Cost of Alternative Strategies for Systematic Screening for Type 2 Diabetes in the U.S. Population 45 74

More information

Established Risk Factors for Coronary Heart Disease (CHD)

Established Risk Factors for Coronary Heart Disease (CHD) Getting Patients to Make Small Lifestyle Changes That Result in SIGNIFICANT Improvements in Health - Prevention of Diabetes and Obesity for Better Health Maureen E. Mays, MD, MS, FACC Director ~ Portland

More information

Mafauzy Mohamed, Than Winn, GR Lekhraj Rampal*, Abdul Rashid AR, Mustaffa BE

Mafauzy Mohamed, Than Winn, GR Lekhraj Rampal*, Abdul Rashid AR, Mustaffa BE Malaysian Journal of Medical Sciences, Vol. 12, No. 1, January 2005 (20-25) ORIGINAL ARTICLE A PRELIMENARY RESULT OF THE CARDIOVASCULAR RISK FACTORS INTERVENTION STUDY (PIKOM STUDY): DIABETES MELLITUS,

More information

METABOLIC SYNDROME IN TYPE-2 DIABETES MELLITUS

METABOLIC SYNDROME IN TYPE-2 DIABETES MELLITUS METABOLIC SYNDROME IN TYPE-2 DIABETES MELLITUS S.M. Sohail Ashraf 1, Faisal Ziauddin 2, Umar Jahangeer 3 ABSTRACT Objective: To find out the prevalence of metabolic syndrome in type-2 Diabetes Mellitus

More information

ARIC Manuscript Proposal #1233. PC Reviewed: 4_/_10/07 Status: _A Priority: 2_ SC Reviewed: Status: Priority:

ARIC Manuscript Proposal #1233. PC Reviewed: 4_/_10/07 Status: _A Priority: 2_ SC Reviewed: Status: Priority: ARIC Manuscript Proposal #1233 PC Reviewed: 4_/_10/07 Status: _A Priority: 2_ SC Reviewed: Status: Priority: 1.a. Full Title: Subclinical atherosclerosis precedes type 2 diabetes in the ARIC study cohort

More information

Both type 2 diabetes and cardiovascular disease

Both type 2 diabetes and cardiovascular disease Identification of Subjects with Insulin Resistance and -Cell Dysfunction Using Alternative Definitions of the Metabolic Syndrome Anthony J.G. Hanley, 1,2 Lynne E. Wagenknecht, 3 Ralph B. D Agostino, Jr.,

More information

Discussion points. The cardiometabolic connection. Cardiometabolic Risk Management in the Primary Care Setting

Discussion points. The cardiometabolic connection. Cardiometabolic Risk Management in the Primary Care Setting Session #5 Cardiometabolic Risk Management in the Primary Care Setting Sonja Reichert, MD MSc FCFP FACPM Betty Harvey, RNEC BScN MScN Amanda Mikalachki, RN BScN CDE S Discussion points Whom should we be

More information

Changes and clinical significance of serum vaspin levels in patients with type 2 diabetes

Changes and clinical significance of serum vaspin levels in patients with type 2 diabetes Changes and clinical significance of serum vaspin levels in patients with type 2 diabetes L. Yang*, S.J. Chen*, G.Y. Yuan, D. Wang and J.J. Chen Department of Endocrinology, Affiliated Hospital of Jiangsu

More information

Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk. Eberhard Standl

Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk. Eberhard Standl Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk Eberhard Standl European Heart House Sophia Antipolis Thursday, June 17, 2010 IDF Diabetes Atlas 2009: Global Numbers Still

More information

Normal Fasting Plasma Glucose and Risk of Type 2 Diabetes Diagnosis

Normal Fasting Plasma Glucose and Risk of Type 2 Diabetes Diagnosis CLINICAL RESEARCH STUDY Normal Fasting Plasma Glucose and Risk of Type 2 Diabetes Diagnosis Gregory A. Nichols, PhD, Teresa A. Hillier, MD, MS, Jonathan B. Brown, PhD, MPP Center for Health Research, Kaiser

More information

Prevention of diabetes and its associated

Prevention of diabetes and its associated Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes O R I G I N A L A R T I C L E Identifying Individuals at High Risk for Diabetes The Atherosclerosis Risk in Communities study MARIA INÊS SCHMIDT,

More information

Impact of Chronicity on Lipid Profile of Type 2 Diabetics

Impact of Chronicity on Lipid Profile of Type 2 Diabetics Impact of Chronicity on Lipid Profile of Type 2 Diabetics Singh 1, Gurdeep & Kumar 2, Ashok 1 Ph.D. Research Scholar, Department of Sports Science, Punjabi University Patiala, India, Email: drgurdeep_sahni@yahoo.co.in

More information

Know Your Number Aggregate Report Single Analysis Compared to National Averages

Know Your Number Aggregate Report Single Analysis Compared to National Averages Know Your Number Aggregate Report Single Analysis Compared to National s Client: Study Population: 2242 Population: 3,000 Date Range: 04/20/07-08/08/07 Version of Report: V6.2 Page 2 Study Population Demographics

More information

A Comparison of the Prevalence of the Metabolic Syndrome Using Two Proposed Definitions

A Comparison of the Prevalence of the Metabolic Syndrome Using Two Proposed Definitions Clinical Care/Education/Nutrition O R I G I N A L A R T I C L E A Comparison of the Prevalence of the Metabolic Syndrome Using Two Proposed Definitions EARL S. FORD, MD, MPH 1 WAYNE H. GILES, MD, MSC 2

More information

WORLDWIDE, THE PREVAlence

WORLDWIDE, THE PREVAlence ORIGINAL CONTRIBUTION Relation of Impaired Fasting and Postload Glucose With Incident Type 2 Diabetes in a Dutch Population The Hoorn Study Femmie de Vegt, PhD Jacqueline M. Dekker, PhD Agnes Jager, MD,

More information

The investigation of serum lipids and prevalence of dyslipidemia in urban adult population of Warangal district, Andhra Pradesh, India

The investigation of serum lipids and prevalence of dyslipidemia in urban adult population of Warangal district, Andhra Pradesh, India eissn: 09748369, www.biolmedonline.com The investigation of serum lipids and prevalence of dyslipidemia in urban adult population of Warangal district, Andhra Pradesh, India M Estari, AS Reddy, T Bikshapathi,

More information

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the

More information

Identification of subjects at high risk for cardiovascular disease

Identification of subjects at high risk for cardiovascular disease Master Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April 14 2011 Identification of subjects at high risk for cardiovascular disease Lars Rydén Karolinska Institutet

More information

Diabetologia 9 Springer-Verlag 1995

Diabetologia 9 Springer-Verlag 1995 Diabetologia (1995) 38:487-493 Diabetologia 9 Springer-Verlag 1995 Does NIDDM increase the risk for coronary heart disease similarly in both low- and high-risk populations? M. Laakso 1, T. R6nnemaa 2'

More information

Is socioeconomic position related to the prevalence of metabolic syndrome? Influence of

Is socioeconomic position related to the prevalence of metabolic syndrome? Influence of Is socioeconomic position related to the prevalence of metabolic syndrome? Influence of social class across the life-course in a population-based study of older men Sheena E Ramsay, MPH 1, Peter H Whincup,

More information

DOI: /01.CIR C6

DOI: /01.CIR C6 Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition Scott M. Grundy, H. Bryan Brewer,

More information

T he prevalence of type 2 diabetes

T he prevalence of type 2 diabetes Cardiovascular and Metabolic Risk O R I G I N A L A R T I C L E Two-Step Approach for the Prediction of Future Type 2 Diabetes Risk MUHAMMAD A. ABDUL-GHANI, MD, PHD 1 TAMAM ABDUL-GHANI, MSC 1 MICHAEL P.

More information

Statistical Fact Sheet Populations

Statistical Fact Sheet Populations Statistical Fact Sheet Populations At-a-Glance Summary Tables Men and Cardiovascular Diseases Mexican- American Males Diseases and Risk Factors Total Population Total Males White Males Black Males Total

More information

The IDF consensus worldwide definition of the metabolic syndrome

The IDF consensus worldwide definition of the metabolic syndrome International Diabetes Federation Avenue Emile De Mot 19 B-1000 Brussels, Belgium Telephone +32-2-5385511 Telefax +32-2-5385114 info@idf.org www.idf.org VAT BE433.674.528 The IDF consensus worldwide definition

More information

The promise of the thiazolidinediones in the management of type 2 diabetes-associated cardiovascular disease

The promise of the thiazolidinediones in the management of type 2 diabetes-associated cardiovascular disease The promise of the thiazolidinediones in the management of type 2 diabetes-associated cardiovascular disease Steve Smith, Group Director Scientific Affairs, Diabetes & Metabolism GlaxoSmithKline R & D

More information

Myocardial Infarction in Mexican-Americans

Myocardial Infarction in Mexican-Americans 45 Myocardial Infarction in Mexican-Americans and Non-Hispanic Whites The San Antonio Heart Study Braxton D. Mitchell, PhD; Helen P. Hazuda, PhD; Steven M. Haffner, MD; Judith K. Patterson, PhD; and Michael

More information

Metabolic syndrome and insulin resistance in an urban and rural adult population in Sri Lanka

Metabolic syndrome and insulin resistance in an urban and rural adult population in Sri Lanka Original Metabolic paper syndrome and insulin resistance in an urban and rural adult population in Sri Lanka Metabolic syndrome and insulin resistance in an urban and rural adult population in Sri Lanka

More information

Although the pathogenesis of the metabolic syndrome

Although the pathogenesis of the metabolic syndrome Visceral Adiposity, Not Abdominal Subcutaneous Fat Area, Is Associated With an Increase in Future Insulin Resistance in Japanese Americans Tomoshige Hayashi, 1,2 Edward J. Boyko, 1,3 Marguerite J. McNeely,

More information

ARIC Manuscript Proposal # 979. PC Reviewed: 11/21/03 Status: Rejected Priority: SC Reviewed: Status: Priority:

ARIC Manuscript Proposal # 979. PC Reviewed: 11/21/03 Status: Rejected Priority: SC Reviewed: Status: Priority: ARIC Manuscript Proposal # 979 PC Reviewed: 11/21/03 Status: Rejected Priority: SC Reviewed: Status: Priority: 1.a. Full Title: Factors of the metabolic syndrome and incidence of coronary heart disease,

More information

Associations among Body Mass Index, Insulin Resistance, and Pancreatic ß-Cell Function in Korean Patients with New- Onset Type 2 Diabetes

Associations among Body Mass Index, Insulin Resistance, and Pancreatic ß-Cell Function in Korean Patients with New- Onset Type 2 Diabetes ORIGINAL ARTICLE korean j intern med 2012;27:66-71 pissn 1226-3303 eissn 2005-6648 Associations among Body Mass Index, Insulin Resistance, and Pancreatic ß-Cell Function in Korean Patients with New- Onset

More information

Aging is associated with a deterioration of glucose

Aging is associated with a deterioration of glucose Prevalence of Diabetes and Impaired Glucose Tolerance in Elderly Subjects and Their Association With and Family History of Diabetes Leena Mykkanen, MD Markku Laakso, MD Matti Uusitupa, MD Kalevi Pyorala,

More information

Metabolic Syndrome: What s in a name?

Metabolic Syndrome: What s in a name? Commentary Metabolic Syndrome: What s in a name? Deborah P. Wubben, MD, MPH; Alexandra K. Adams, MD, PhD Abstract The term metabolic syndrome has recently become en vogue. But is the definition realistic,

More information

METABOLIC SYNDROME IN OBESE CHILDREN AND ADOLESCENTS

METABOLIC SYNDROME IN OBESE CHILDREN AND ADOLESCENTS Rev. Med. Chir. Soc. Med. Nat., Iaşi 2012 vol. 116, no. 4 INTERNAL MEDICINE - PEDIATRICS ORIGINAL PAPERS METABOLIC SYNDROME IN OBESE CHILDREN AND ADOLESCENTS Ana-Maria Pelin 1, Silvia Mǎtǎsaru 2 University

More information

Patterns of Insulin Concentration During the OGTT Predict the Risk of Type 2 Diabetes in Japanese Americans

Patterns of Insulin Concentration During the OGTT Predict the Risk of Type 2 Diabetes in Japanese Americans Epidemiology/Health Services Research O R I G I N A L A R T I C L E Patterns of Insulin Concentration During the OGTT Predict the Risk of Type 2 Diabetes in Japanese Americans TOMOSHIGE HAYASHI, MD, PHD

More information

Diabetologia 9 Springer-Verlag 1995

Diabetologia 9 Springer-Verlag 1995 Diabetologia (1995) 38:1218-1222 Diabetologia 9 Springer-Verlag 1995 Albumin excretion rate levels in non-diabetic offspring of NIDDM patients and out nephropathy G. Gruden, P. Cavallo-Perin, C. Olivetti,.

More information

Clinical Investigation and Reports

Clinical Investigation and Reports Clinical Investigation and Reports Cardiovascular Events and Their Reduction With Pravastatin in Diabetic and Glucose-Intolerant Myocardial Infarction Survivors With Average Cholesterol Levels Subgroup

More information

The Burden of the Diabetic Heart

The Burden of the Diabetic Heart The Burden of the Diabetic Heart Dr. Ghaida Kaddaha (MBBS, MRCP-UK, FRCP-london) Diabetes Unit Rashid Hospital Dubai U.A.E Risk of CVD in Diabetes Morbidity and mortality from CVD is 2-4 fold higher than

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Kavousi M, Leening MJG, Nanchen D, et al. Comparison of application of the ACC/AHA guidelines, Adult Treatment Panel III guidelines, and European Society of Cardiology guidelines

More information

( Diabetes mellitus, DM ) ( Hyperlipidemia ) ( Cardiovascular disease, CVD )

( Diabetes mellitus, DM ) ( Hyperlipidemia ) ( Cardiovascular disease, CVD ) 005 6 69-74 40 mg/dl > 50 mg/dl) (00 mg/dl < 00 mg/dl(.6 mmol/l) 30-40% < 70 mg/dl 40 mg/dl 00 9 mg/dl fibric acid derivative niacin statin fibrate statin niacin ( ) ( Diabetes mellitus,

More information

THE METABOLIC SYNDROME, A

THE METABOLIC SYNDROME, A ORIGINAL CONTRIBUTION The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men Hanna-Maaria Lakka, MD, PhD David E. Laaksonen, MD, MPH Timo A. Lakka, MD, PhD Leo K. Niskanen,

More information

Improvement of BMI, Body Composition, and Body Fat Distribution With Lifestyle Modification in Japanese Americans With Impaired Glucose Tolerance

Improvement of BMI, Body Composition, and Body Fat Distribution With Lifestyle Modification in Japanese Americans With Impaired Glucose Tolerance Clinical Care/Education/Nutrition O R I G I N A L A R T I C L E Improvement of BMI, Body Composition, and Body Fat Distribution With Lifestyle Modification in Japanese Americans With Impaired Glucose Tolerance

More information

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of

More information

Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes

Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes Genetics, environment, and lifestyle (obesity, inactivity, poor diet) Impaired fasting glucose Decreased β-cell

More information

High Incidence of Glucose Intolerance in Asian-Indian Subjects With Acute Coronary Syndrome

High Incidence of Glucose Intolerance in Asian-Indian Subjects With Acute Coronary Syndrome Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes O R I G I N A L A R T I C L E High Incidence of Glucose Intolerance in Asian-Indian Subjects With Acute Coronary Syndrome AMBADY RAMACHANDRAN,

More information

Metabolic Syndrome in Asians

Metabolic Syndrome in Asians Metabolic Syndrome in Asians Alka Kanaya, MD Asst. Professor of Medicine, UCSF Asian CV Symposium, November 17, 2007 The Metabolic Syndrome Also known as: Syndrome X Insulin Resistance Syndrome The Deadly

More information