Community-based population data indicates the significant alterations of insulin resistance, chronic inflammation and urine ACR in IFG combined IGT group among prediabetic population

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Abstract

Aims

To investigate alterations of insulin resistance (IR), chronic inflammation and urine albumin-to-creatinine ratio (ACR) in Chinese community-based prediabetic population.

Materials and methods

252 prediabetics [prediabetes (PD), including impaired fasting glucose (IFG), 91; impaired glucose tolerance (IGT), 123; IFG + IGT, 38] and 38 newly diagnosed-diabetics (NDDM) aged over 35 years older were screened from 2336 community individuals. 123 age and gender matched individuals with normal glucose tolerance (NGT) were selected as controls. Serum adiponectin, interleukin-6 (IL-6) levels and urine ACR were determined, HOMA-IR and Gutt's index were calculated to evaluate IR and insulin sensitivity, respectively.

Results

The data displayed significant difference of serum adiponectin, IL-6, ACR and Gutt's index among PD, NDDM and NGT groups. Adiponectin level and Gutt's index decreased, but IL-6 level and ACR increased gradually among NGT, PD and NDDM groups (P < 0.01). Unlike adiponectin and IL-6, ACR analysis indicates a gradual increase from NGT, IFG, IGT, IFG + IGT to NDDM individuals (P < 0.01). Gutt's index showed significant difference between IFG and NDDM, IFG + IGT and NDDM (P < 0.01), but HOMA-IR index did not.

Conclusions

IR, chronic inflammation and endothelial dysfunction dose exist in prediabetic individuals, especially in IFG + IGT population. Gutt's index and ACR might seem to be more sensitive than adiponectin and HOMA-IR index as IR and chronic inflammation maker in prediabetic population.

Introduction

Prediabetes (PD) is a dysmetabolic state of glucose level between diabetes mellitus and normal glucose tolerance (NGT). PD includes three types: impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and both combined (IFG + IGT) [1], which is becoming a considerable public health problem worldwide. According to data from the United States alone, about 40% of U.S. adults aged 40–74 or 54 million people had prediabetes [2]. In China, a large scale population-based study reported that 5.5% of the Chinese adults had diabetes and a further 7.3% have IGT or prediabetes [3]. A meta-analysis of 156 studies on prognosis of prediabetes conducted by Agency for Healthcare Research and Quality (AHRQ) [4] showed that a person with PD was 5–15 times more likely to develop type 2 diabetes than that without the condition. The relative risk (RR) for progression to diabetes in IFG, IGT and IFG + IGT were 6.02, 4.70 and 12.21, respectively, and accompanied by progressively increasing incidence of life-threatening cardiovascular diseases (CVD) as well.

Increased data revealed that within the PD population, the IFG + IGT subgroup exhibited the highest incidence of developing diabetes and CVD. Recent studies have shown that some long-term systemic damage to the heart and circulatory system may already be occurring during prediabetes [5], [6]. While it is widely agreed that finding more sensitive and earlier assessments of beta cells and vascular endothelial cells function in prediabetes is a critical step to prevent diabetes and other health problems, there have been limited investigations exploring the alterations and relevance of insulin resistance (IR), chronic inflammation markers and urine albumin-to-creatinine ratio (ACR) among different subtypes of PD.

In this study we conducted a community-based investigation of IFG, IGT and IFG + IGT population from Chengdu city, Sichuan Province of southwest China. Age and sex compatible NGT healthy subjects and newly diagnosed-diabetics (NDDM) were selected from the same community as controls to compare the alterations of IR, chronic inflammation and urine ACR among different prediabetic population.

Section snippets

Subjects and study protocol

A health examination was carried out among 2888 individuals older than 35 years in Yinchao community in Chengdu city, Sichuan Province of southwest China. None of these subjects received any hypoglycemic treatment. On account of poor compliance of some subjects, 2336 subjects voluntarily received 75 g glucose oral glucose tolerance test (OGTT) among the above examinees, 252 PD and 38 NDDM screened from the population were brought into our study. 123 NGT healthy age and gender matched individuals

General characteristics of study group

413 subjects, including 260 males and 153 females, were eligible for this study. Among them 91 subjects in IFG group, 123 in IGT group, 38 in IFG + IGT group, 38 in NDDM group and 123 in NGT group. General characteristics of the study population were presented in Table 1.

All indexes in Table 1 showed significant differences among each group (P < 0.05) except serum TC, HDL-C and LDL-C (P > 0.05). It also showed that IFG + IGT population had higher BMI than IFG and IGT groups, but WC, 2hINS, UA and TG of

Discussion

In this cross-sectional community-based investigation, we found that IR, chronic inflammation and vascular endothelial dysfunction did exist in prediabetic individuals, especially in IFG + IGT population. Our results also showed that Gutt's index and ACR seemed to be more sensitive than adiponectin and HOMA-IR index in detecting IR and chronic inflammation in prediabetic population.

Adiponectin is a major insulin sensitizing hormone, which activates adenosine monophosphate (AMP) kinase and

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgements

The authors gratefully acknowledge Yinchao community and its hospital in Chengdu city, Sichuan province, and also thank the Fifth People's Hospital of Chengdu. We are also supported by West China Hospital of Sichuan University.

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