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Diabetologia Apr 2024The concept of type 2 diabetes remission is evolving rapidly, and gaining wide public and professional interest, following demonstration that with substantial... (Review)
Review
The concept of type 2 diabetes remission is evolving rapidly, and gaining wide public and professional interest, following demonstration that with substantial intentional weight loss almost nine in ten people with type 2 diabetes can reduce their HbA level below the diagnostic criterion (48 mmol/mol [6.5%]) without glucose-lowering medications, and improve all features of the metabolic syndrome. Pursuing nomoglycaemia with older drugs was dangerous because of the risk of side effects and hypoglycaemia, so the conventional treatment target was an HbA concentration of 53 mmol/mol (7%), meaning that diabetes was still present and allowing disease progression. Newer agents may achieve a normal HbA safely and, by analogy with treatments that send cancers or inflammatory diseases into remission, this might also be considered remission. However, although modern glucagon-like peptide-1 receptor agonists and related medications are highly effective for weight loss and glycaemic improvement, and generally safe, many people do not want to take drugs indefinitely, and their cost means that they are not available across much of the world. Therefore, there are strong reasons to explore and research dietary approaches for the treatment of type 2 diabetes. All interventions that achieve sustained weight loss of >10-15 kg improve HbA, potentially resulting in remission if sufficient beta cell capacity can be preserved or restored, which occurs with loss of the ectopic fat in liver and pancreas that is found with type 2 diabetes. Remission is most likely with type 2 diabetes of short duration, lower HbA and a low requirement for glucose-lowering medications. Relapse is likely with weight regain and among those with a poor beta cell reserve. On current evidence, effective weight management should be provided to all people with type 2 diabetes as soon as possible after diagnosis (or even earlier, at the stage of prediabetes, defined in Europe, Australasia, Canada [and most of the world] as ≥42 and <48 mmol/mol [≥6.0 and <6.5%], and in the USA as HbA1c ≥39 and <48 mmol/mol [≥5.7 and <6.5%]). Raising awareness among people with type 2 diabetes and their healthcare providers that remission is possible will enable earlier intervention. Weight loss of >10 kg and remission lasting 1-2 years may also delay vascular complications, although more evidence is needed. The greatest challenge for research is to improve long-term weight loss maintenance, defining cost-effective approaches tailored to the preferences and needs of people living with type 2 diabetes.
Topics: Humans; Diabetes Mellitus, Type 2; Hypoglycemia; Prediabetic State; Glucose; Weight Loss
PubMed: 38189935
DOI: 10.1007/s00125-023-06069-1 -
Journal of Pediatric Health Care :... 2021Sugar sweetened beverage (SSB) consumption among U.S. adolescents exceeds current recommendations. This study examines relationships between SSB intake and reported...
INTRODUCTION
Sugar sweetened beverage (SSB) consumption among U.S. adolescents exceeds current recommendations. This study examines relationships between SSB intake and reported prediabetes.
METHOD
Data are from the 2019 Minnesota Student Survey (N = 125,375). Logistic regression was used to examine relationships between frequencies for SSB intake and youth reported prediabetes in analytic models adjusting for demographic and other cardiometabolic indicators. Additional analyses examined relationships between consumption of fruit juice, milk, and water, and prediabetes.
RESULTS
One in four youth reported consumption of at least one SSB daily. In fully adjusted models, a range of SSB intake frequencies were significantly associated with increased odds of reported prediabetes. All intake frequencies for water were associated with reduced odds of prediabetes.
DISCUSSION
Efforts to reduce SSB intake among adolescents are warranted to support cardiometabolic health. Study findings are consistent with current guidance identifying water as the preferred drink for adolescents' hydration needs.
Topics: Adolescent; Beverages; Humans; Logistic Models; Minnesota; Prediabetic State; Sugar-Sweetened Beverages
PubMed: 33183878
DOI: 10.1016/j.pedhc.2020.10.005 -
Experimental Biology and Medicine... May 2020Prediabetes increases the risks of future type 2 diabetes (T2D) and vascular complications, risks that can be prevented by restoring normal glucose regulation (NGR). Few... (Review)
Review
Prediabetes increases the risks of future type 2 diabetes (T2D) and vascular complications, risks that can be prevented by restoring normal glucose regulation (NGR). Few studies have pre-specified reversal of prediabetes and restoration of NGR as primary outcome, and current approaches that prevent T2D in people with prediabetes do not always reverse the prediabetes. The present review focuses on studies that have assessed reversal of the prediabetes, and discusses known and emerging predictors of prediabetes. We argue that fuller knowledge of such predictors could inform the discovery of novel, targeted interventions for reversing prediabetes.
Topics: Animals; Blood Glucose; Diabetes Mellitus, Type 2; Disease Progression; Glucose Intolerance; Humans; Prediabetic State
PubMed: 32212859
DOI: 10.1177/1535370220915644 -
Diabetes, Obesity & Metabolism Sep 2020Various intermittent fasting (IF) dietary plans have gained popularity among obese individuals in recent years as a means of achieving weight loss. However, studies... (Review)
Review
Various intermittent fasting (IF) dietary plans have gained popularity among obese individuals in recent years as a means of achieving weight loss. However, studies evaluating the effect of IF regimens in people with metabolic syndrome, prediabetes and type 2 diabetes (T2D) are limited. The aim of the present review was to briefly elucidate the biochemical and physiological mechanisms underlying the positive effects of IF, especially the effect of the proposed 'metabolic switch' on metabolism. Next, we examined the efficacy and safety of IF regimens in individuals with metabolic syndrome, prediabetes and T2D. To achieve this, we performed a MEDLINE PubMed search using combinations of various IF terms, including trials in which participants met the additional criteria for metabolic syndrome, prediabetes or T2D. We found four studies in individuals with metabolic syndrome, one study in people with prediabetes, and eight studies in people with T2D evaluating the effects of different IF regimens. The limited available evidence, with small sample sizes and short trial durations, suggests that IF regimens have a similar effectiveness compared with calorie-restriction diets for weight loss and improvement in glycaemic variables. In general, most IF regimens are effective and safe. However, there is an increased risk of hypoglycaemia in patients with T2D who are treated with insulin or sulphonylureas. Moreover, long-term adherence to these regimens appears uncertain. There is a need for large controlled randomized trials to evaluate the efficacy of IF regimens, especially in individuals with metabolic syndrome and prediabetes. If proven to be sustainable and efficacious for prolonged periods, IF could offer a promising approach to improving health at the population level, and would result in multiple public health benefits.
Topics: Diabetes Mellitus, Type 2; Fasting; Humans; Insulin; Metabolic Syndrome; Prediabetic State
PubMed: 32372521
DOI: 10.1111/dom.14080 -
Metabolic Syndrome and Related Disorders Oct 2019To study the prevalence of metabolic syndrome and its components in prediabetes and to compare the anthropometric indices [waist circumference (WC), hip circumference,...
To study the prevalence of metabolic syndrome and its components in prediabetes and to compare the anthropometric indices [waist circumference (WC), hip circumference, waist-hip ratio, waist-height ratio] as predictors of metabolic syndrome in prediabetes. A total of 300 subjects (200 prediabetic cases and 100 matched normoglycemic controls) in the age group of 18-70 years were recruited for the study. Among the cases, there were 38% of males and 62% of females; and there were 33% of males and 67% of females in the control group. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria, and metabolic syndrome was diagnosed using the International Diabetes Federation criteria. Prevalence of metabolic syndrome was 63% among the cases and 26% among the normoglycemic controls. Among cases, 56.5% of males and 66.9% of females, and among the controls, 36.3% of males and 20.9% of females had metabolic syndrome. The prevalence of metabolic syndrome increased with age and increasing body mass index among both the cases and controls. Central obesity was found to be the most common component of metabolic syndrome among prediabetic males (80.2%) and females (82.2%). The most common cluster of abnormality among the cases and controls was found to be increased WC plus low high-density lipoprotein plus increased triglycerides. Logistic regression analysis was applied to anthropometric indices, and it was found that increased WC had the maximum predictive power for metabolic syndrome among the subjects with prediabetes. Metabolic syndrome was more prevalent in the prediabetic population in comparison to the normoglycemic individuals with increased WC being the most prevalent component. Increased WC had the maximum predictive power for occurrence of metabolic syndrome among prediabetic subjects.
Topics: Adolescent; Adult; Aged; Case-Control Studies; Cross-Sectional Studies; Female; Humans; India; Male; Metabolic Syndrome; Middle Aged; Obesity; Prediabetic State; Prevalence; Waist Circumference; Young Adult
PubMed: 31305207
DOI: 10.1089/met.2019.0010 -
Revista Espanola de Cardiologia... May 2020
Topics: Cardiovascular Diseases; Diabetes Mellitus; Humans; Prediabetic State; Risk Factors
PubMed: 32205102
DOI: 10.1016/j.rec.2019.11.018 -
BMJ (Clinical Research Ed.) Sep 2019
Topics: Blood Glucose; Data Interpretation, Statistical; Diabetes Mellitus, Type 2; Global Burden of Disease; Glycated Hemoglobin; Humans; Incidence; Prediabetic State; Prevalence
PubMed: 31511237
DOI: 10.1136/bmj.l5407 -
Association between magnesium concentrations and prediabetes: a systematic review and meta-analysis.Scientific Reports Dec 2021Studies on the association between serum magnesium level and prediabetes yielded inconsistent results. Therefore, the present meta-analysis was designed to examine the... (Meta-Analysis)
Meta-Analysis
Studies on the association between serum magnesium level and prediabetes yielded inconsistent results. Therefore, the present meta-analysis was designed to examine the association between serum magnesium levels and prediabetes. Online databases including PubMed, Embase, Scopus and Google Scholar were searched up to October, 2020. A total of 10 studies that reported mean and standard deviation (SD) of magnesium levels in prediabetes and healthy control group were identified. Random effects models were used to pool weighted mean differences (WMDs) of serum magnesium levels. Pooled-analysis showed that subjects with prediabetes had significantly lower serum magnesium levels compared with healthy controls (WMD = - 0.07 mmol/L; 95% CI - 0.09, - 0.05 mmol/L, P < 0.001). A significant heterogeneity observed across included studies (I = 95.6%, P < 0.001). However, different subgroup analysis did not detect the potential source of observed heterogeneity. Withdrawal of each individual study had no effect on the overall results. The present meta-analysis showed that circulating magnesium levels in people with prediabetes were significantly lower than healthy controls, confirming that magnesium deficiency may play a role in development and progression of prediabetes. Further studies with larger sample size and robust design are warranted to confirm present results.
Topics: Humans; Magnesium; Magnesium Deficiency; Prediabetic State
PubMed: 34937856
DOI: 10.1038/s41598-021-03915-3 -
Frontiers in Endocrinology 2021Thyroid hormone influences glucose homeostasis through central and peripheral regulations. To date, the link between sensitivity to thyroid hormones and prediabetes...
CONTEXT
Thyroid hormone influences glucose homeostasis through central and peripheral regulations. To date, the link between sensitivity to thyroid hormones and prediabetes remains unknown. We aimed to investigate the association between thyroid hormones sensitivity and risk of prediabetes in both general and euthyroid populations.
METHODS
Participants with serum free triiodothyronine (FT3), free thyroxine (FT4), and thyrotropin (TSH) measurements from the health checkup programs of the First Hospital of China Medical University were collected. We measured the parameters representing central and peripheral sensitivities to thyroid hormones (central sensitivity, assessed by calculating Thyroid Feedback Quantile-based Index (TFQI), TSH Index (TSHI), and Thyrotroph Thyroxine Resistance Index (TT4RI); peripheral sensitivity, evaluated by FT3/FT4 ratio). Associations between thyroid hormones sensitivities and risk of prediabetes were assessed with logistic regression.
RESULTS
A total of 4378 participants (mean age ± SD, 49 ± 11 years) were included, with 1457 (33%) subjects had prediabetes. The risk of prediabetes was negatively associated with levels of TSHI (odds ratio [OR] 0.91; 95% confidence interval [CI], 0.85-0.97), TT4RI (OR 0.91; 95% CI, 0.84-0.99) and Parametric TFQI (PTFQI) (OR 0.89; 95% CI, 0.83-0.95) among all subjects. The association remained significant in euthyroid subjects and euthyroid subjects with negative thyroid autoimmunity. Higher FT3/FT4 ratio was associated with a mild increased risk of prediabetes (95% CI 1.09; 1.02-1.16). Compared with subjects in the lowest quartile of PTFQI, those in the highest quartile had lower risk of prediabetes (0.70; 95% CI, 0.58-0.84).
CONCLUSIONS
Decreased central sensitivity to thyroid hormones is associated with lower risk of prediabetes. This demonstrates the complex interaction between thyroid system and glucose metabolism. Future studies are warranted to confirm our findings and underlying mechanisms.
Topics: Biomarkers; Blood Glucose; Case-Control Studies; China; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prediabetic State; Prognosis; Thyroid Function Tests; Thyroid Hormones
PubMed: 34017311
DOI: 10.3389/fendo.2021.657114 -
Annual Review of Public Health May 2024The term prediabetes describes blood glucose levels above the normal range but below the threshold to diagnose type 2 diabetes. Several population health initiatives... (Review)
Review
The term prediabetes describes blood glucose levels above the normal range but below the threshold to diagnose type 2 diabetes. Several population health initiatives encourage a test and treat approach for prediabetes. In this approach, screening and identification of individuals with prediabetes should be followed by prompt referral to structured lifestyle modification programs or pharmacologic interventions that have been shown to prevent or delay the progression to type 2 diabetes in clinical trials. Here we provide a critical review of evidence for this test and treat approach by examining health outcomes associated with prediabetes and the availability and effectiveness of lifestyle modification approaches that target prediabetes. We also describe current limitations to the reach and uptake of evidence-based treatment options for prediabetes. Finally, we highlight lessons learned from identifying and labeling other preconditions to consider challenges and opportunities that may arise with increasing awareness of prediabetes as part of routine preventive care.
Topics: Humans; Prediabetic State; Diabetes Mellitus, Type 2; Mass Screening; Life Style; Risk Reduction Behavior; Blood Glucose
PubMed: 38109519
DOI: 10.1146/annurev-publhealth-060222-023417