Elevated one-hour post-load plasma glucose levels identifies subjects with normal glucose tolerance but early carotid atherosclerosis
Introduction
A body of evidence suggests that individuals with impaired glucose tolerance (IGT) are not only at increased risk for progression to type 2 diabetes but should also be considered at risk for atherosclerotic cardiovascular disease [1], [2]. However, longitudinal epidemiological studies have shown that 30–40% of individuals who develop type 2 diabetes have normal glucose tolerance (NGT) at baseline [4] several reports indicate a significant risk for cardiovascular disease even in subjects with NGT [1], [5], [6]. Because lifestyle changes and pharmacological intervention in subjects at high-risk for type 2 diabetes have consistently demonstrated benefit in reducing the incidence of the disease [7], [8], [9], [10] and its associated cardiovascular complications [11], [12], it would be important to identify individuals at NGT with increased risk for both clinical outcomes. Two recent studies have shown that a cutoff point of 155 mg/dl for the 1-h post-load plasma glucose during the oral glucose tolerance test (OGTT) is able to identify subjects with NGT at high-risk for future type 2 diabetes [13], [14]. Whether these subjects also have an increased risk for atherosclerotic cardiovascular disease is still unknown. Carotid intima–media thickness (IMT) is a well-established index of early atherosclerosis and is widely used as a surrogate marker for cardiovascular disease [15]. To address the question of whether elevated 1-h post-load plasma glucose levels identify subjects with NGT at risk for cardiovascular disease, we compared clinical characteristics, including classical and inflammatory cardiovascular risk factors, and carotid IMT, in a group of non-diabetic Caucasian subjects.
Section snippets
Study participants
The study group consisted of 400 Caucasian subjects participating to the CAtanzaro MEtabolic RIsk factors Study (CATAMERIS), a metabolic disease prevention campaign for cardio-metabolic risk factors as previously reported [16], [17]. Subjects, aged 21–70 years, were excluded if they had history of cardiovascular disease including peripheral atherosclerosis, chronic gastrointestinal diseases associated with malabsorption, chronic pancreatitis, history of any malignant disease, history of alcohol
Statistical analysis
Variables with skewed distribution including triglyceride, high-sensitive C reactive protein (hsCRP), and IGF-1 were natural log transformed for statistical analyses. A general linear model with post hoc Bonferroni correction for multiple comparisons were used to compare differences of continuous variables between groups. Partial correlation coefficients adjusted for age and gender were computed between variables. Relationships between variables were sought by stepwise multivariate linear
Results
Of 400 non-diabetic subjects examined, 80 had impaired glucose tolerance (IGT). A one-hour post-load plasma glucose cutoff point of 155 mg/dl during OGTT was used to divide subjects with NGT into two groups: 231 subjects with 1-h post-load plasma glucose <155 mg/dl, and 89 individuals with 1-h post-load plasma glucose ≥155 mg/dl. Table 1 shows the clinical characteristics and laboratory findings of the three study groups. Significant differences between the three groups were observed with respect
Discussion
Increasing evidence suggest that subjects who develop type 2 diabetes and cardiovascular disease can have common antecedents of metabolic origin. The American Diabetes Association has recognized the importance of identifying individuals who are at metabolic risk for both type 2 diabetes and cardiovascular disease and released a Consensus Statement focused on the pre-diabetic states of impaired fasting glucose (IFG) and IGT [19]. However, several prospective studies have shown that a significant
Acknowledgment
This study was in part supported by the European Community's FP6 EUGENE2 n° LSHM-CT-2004-512013 grant (G. Sesti).
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2021, Diabetes Research and Clinical PracticeCitation Excerpt :To address this issue, we took advantage of a large cohort of individuals participating in the CAtanzaro MEtabolic RIsk factors (CATAMERI) study, an ongoing observational study involving adults with one or more cardio-metabolic risk factors who underwent a broad clinical characterization including an OGTT, and standard Doppler echocardiography [8–12,23]. The study cohort consisted of 1467 non-diabetic adult subjects participating in the CATAMERI study who were consecutively recruited at the Department of Medical and Surgical Sciences of the University “Magna Graecia” of Catanzaro [8–12,23]. The inclusion criteria of CATAMERI study were: Caucasian ethnicity, presence of one or more cardio-metabolic risk factors including family history of diabetes, dysglycemia, hypertension, dyslipidemia, and overweight/obesity.
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