Original articleIncreased 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
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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