Elsevier

Diabetes & Metabolism

Volume 34, Issue 3, June 2008, Pages 283-289
Diabetes & Metabolism

Original article
Increased alanine aminotransferase level and future risk of type 2 diabetes and impaired fasting glucose among the employees in a university hospital in ThailandAugmentation de l’alanine-aminotransférase et risque de développer un diabète de type 2 ou une hyperglycémie modérée à jeun chez des employés d’un centre hospitalier universitaire thaïlandais

https://doi.org/10.1016/j.diabet.2008.01.009Get rights and content

Abstract

Aim

The purpose of this study was to determine the association between baseline alanine aminotransferase (ALT) levels, and future risk of impaired fasting glucose and type 2 diabetes among the employees of a university hospital in Bangkok, Thailand.

Methods

Totally, 2370 and 1619 workers without diabetes and impaired fasting glucose (IFG) at baseline, respectively, who were 35 years or older were followed during 2001–2005. Diagnosis of IFG and type 2 diabetes was based on the fasting plasma glucose levels of 100–125 and greater or equal to 126 mg/dl, respectively.

Results

Higher baseline ALT levels were associated with future diabetes risk in an obvious dose-response manner (the OR [95% CI] for the groups with baseline ALT of 17–22, 23–38, and greater than 38 mg/dl comparing to the group with baseline ALT of 1–16 mg/dl were 4.75 [1.25–18.10], 6.14 [1.54–24.45], and 7.19 [1.32–39.16], respectively). Magnitude of association were even higher among those with existing IFG at baseline. The association patterns were consistent for both genders. Concerning the IFG risk, while those who developed IFG had significantly higher baseline ALT levels than those who remained normal at the end of follow-up period, further analyses did not show that baseline ALT was significantly associated with future IFG risk.

Conclusion

Present study provided supporting evidence from a cohort of Asian subjects about the ALT and future type 2 diabetes risk.

Résumé

Objectif

La présente étude avait pour but de déterminer l’association entre l’alanine-aminotransférase (ALAT) à l’inclusion et le risque ultérieur d’hyperglycémie modérée à jeun et de diabète de type 2 chez des employés d’un centre hospitalier universitaire de Bangkok, Thaïlande.

Méthodes

Au total, 2370 sujets non diabétiques et 1119 sujets sans hyperglycémie modérée à jeun à l’inclusion âgés de plus de 35 ans ont été suivis de 2001 à 2005. Le diagnostic d’hyperglycémie modérée à jeun et celui de diabète de type 2 a été porté pour des glycémies à jeun respectivement de 100 à 125 et supérieures ou égales à 126 mg/dl.

Résultats

Une élévation de l’ALAT à l’inclusion était associée dans les deux sexes à une augmentation du risque ultérieur de diabète, comme en témoigne l’augmentation croissante des rapports de cote (OR [95 % IC]) (4,75 [1,25–18,10], 6,14 [1,54–24,42], et 7,19 [1,32–39,16]) en fonction des quartiles de l’ALAT à l’inclusion (17 à 22, 23 à 38, et supérieurs à 38 mg/dl), par rapport au groupe dont l’ALAT à l’inclusion était comprise entre 1 et 16 mg/dl. L’amplitude de cette association était encore plus nette chez les sujets qui présentaient une hyperglycémie modérée à jeun à l’inclusion. En revanche, et bien que les sujets développant ultérieurement une hyperglycémie modérée à jeun aient des taux d’ALAT à l’inclusion plus élevés que ceux des patients restés normoglycémiques, une analyse complémentaire a montré qu’il n’y avait pas d’association entre l’ALAT à l’inclusion et le risque ultérieur d’hyperglycémie modérée à jeun.

Conclusion

Cette étude permet de conclure, dans cette cohorte d’employés d’un hôpital thaïlandais, à l’association entre l’élévation de l’ALAT et le risque ultérieur de diabète de type 2.

Introduction

Growing evidence suggested the possible association between abnormal hepatocellular functions, and type 2 diabetes. Prospective studies have found that high levels of hepatic enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyltranspeptidase (GGT) are associated with the later development of diabetes [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. These enzymes — particularly the ALT — are the common markers of a syndrome called nonalcoholic fatty liver disease (NAFLD), which is related to hepatic resistance, and increased hepatic glucose output [11]. Since the measurements of these enzymes are well standardized, and routinely available in laboratories, some researchers have suggested that they could be included in future diabetes prediction algorithms [8].

However, the association patterns between these enzymes, and type 2 diabetes are complex and not consistent across different studies [5], [12]. Some researchers claimed that these discrepancies might have been due to the ethnic difference among the study populations [3]. Until now, only two studies investigated the association of hepatic enzymes, and type 2 diabetes among Asian populations. These included studies in Japanese and Korean workers with conflicting results about the association between raised ALT and future diabetes risks [6], [7].

We thus have the opportunity to conduct study to investigate such associations among Thai workers which is another Asian population. Our specific aim was to determine association between the raised ALT, AST, and alkaline phosphatase (ALP), and future development of type 2 diabetes and impaired fasting glucose (IFG) among the employees in a university hospital in Bangkok, Thailand.

Section snippets

Study population

The university hospital contained 1200 beds and employed totally 5000 workers in 2001. As the fasting plasma glucose was offered for every worker who was 35 years of age or older on annual basis, the target population for the study were those who were 35 years or older, and had participated in the annual physical checkup at least twice during years 2001–2005.

Survey procedure

Personal demographic data (such as gender, date of birth, educational level) was obtained from the computerized database of the hospital.

Subject Characteristics

Of all 3243 workers who were 35–60 years old and eligible for the annual fasting glucose examination during 2001–2005, 2790 (86.0%) participated in such examination at least once. Detailed analysis showed that while the non-participants contained higher proportion of male workers (29.0% versus 19.7%) with higher educational level (53.1% versus 50.5% for those with 13+ years of education), they were quite similar to the participants according to age and work duration. The mean age (S.D.) was

Discussion

In present study, we demonstrated the possible association between baseline ALT level and future development of type 2 diabetes among a predominantly female employee group in Thailand. Higher baseline ALT associated with future diabetes risk in an obvious dose-response manner (the odds ratios [95% CI] for the groups with baseline ALT of 17–22, 23–38, and greater than 38 mg/dl comparing to the group with baseline ALT of 1–17 mg/dl were 4.75 [1.25–18.10], 6.14 [1.54–24.45], and 7.19 [1.32–39.16])

Acknowledgement

This project was supported by Chulalongkorn Memorial Hospital and Chulalongkorn University.

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