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Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women's diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one's previous diet and the number of abnormal values on the diagnostic GTT in women with GDM. We hypothesized that there would be an inverse relation between antioxidant micronutrient consumption and the number of abnormal GTT values. Methods: This cross-sectional study included 60 women diagnosed with GDM (2-h, 75 g-GTT), divided in two groups as follows: 1 abnormal glucose value and 2–3 abnormal values. Shortly after the diagnosis, participants answered a validated food frequency questionnaire to assess their food consumption in the last 6 months. The Mann–Whitney test was used to compare the dietary intake of the participants in the two groups. Results: The participant characteristics were similar. The median intake of total calories, carbohydrates, lipids, and proteins did not differ significantly between groups. Participants with 1 abnormal GTT value had significantly higher intakes of fiber (11.9 vs. 11.0 g/day p = 0.049), vitamin D (40.6 vs. 40.4 mcg/day p = 0.049), and vitamin C (180.0 vs. 151.0 mg/day p = 0.008) than those with 2–3 abnormal values. Conclusions: Our results suggest a possible association between the consumption of fiber and antioxidant micronutrients and the number of abnormal GTT values. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the use of leptin as a marker for gestational diabetes by analyzing any correlation between serum leptin levels versus oral glucose tolerance tests (at 24 to 28 weeks of pregnancy) and increased body weight (during pregnancy). A total of 110 female cases (81 pregnant and 29 non-pregnant) were included in the study. The 81 pregnant cases were divided into 3 groups according to their oral glucose tolerance test results. A chi-square test was used for categorical variables. The distribution of numerical variables was tested with the Shapiro–Wilk test. ANOVA and a post-hoc Bonferroni test was used for parametric data. Kruskal–Wallis variance analysis was used for non-parametric data. The Mann–Whitney U-test was used for pairwise comparisons. Spearman correlation analysis and multivariate regression analysis were performed for the evaluation of the correlation analysis between the parameters. Oral glucose tolerance test results were compared with leptin levels with a cut-off value of 11.43 for leptin. The ROC curve demonstrated an 83.3% sensitivity and 72.1% specificity for leptin. Leptin may play a role in the pathophysiology of gestational diabetes mellitus. However, the relationship between leptin levels and maternal weight gain during pregnancy is still unknown. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is frequently misdiagnosed during pregnancy. There is an abundance of evidence, but little is known regarding the regional prevalence estimates of GDM in India. This systematic review and meta-analysis aims to provide valuable insights into the national and regional prevalence of GDM among pregnant women in India. Methods: We conducted an initial article search on PubMed, Scopus, Google Scholar, and ShodhGanga searches to identify quantitative research papers (database inception till 15th June,2022). This review included prevalence studies that estimated the occurrence of GDM across different states in India. Results: Two independent reviewers completed the screening of 2393 articles, resulting in the identification of 110 articles that met the inclusion criteria, which collectively provided 117 prevalence estimates. Using a pooled estimate calculation (with an Inverse square heterogeneity model), the pooled prevalence of GDM in pregnant women was estimated to be 13%, with a 95% confidence interval (CI) ranging from 9 to 16%.. In India, Diabetes in Pregnancy Study of India (DIPSI) was the most common diagnostic criteria used, followed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) 1999. It was observed that the rural population has slightly less prevalence of GDM at 10.0% [6.0–13.0%, I2=96%] when compared to the urban population where the prevalence of GDM was 12.0% [9.0–16.0%, I2 = 99%]. Conclusions: This review emphasizes the lack of consensus in screening and diagnosing gestational diabetes mellitus (GDM), leading to varied prevalence rates across Indian states. It thoroughly examines the controversies regarding GDM screening by analyzing population characteristics, geographic variations, diagnostic criteria agreement, screening timing, fasting vs. non-fasting approaches, cost-effectiveness, and feasibility, offering valuable recommendations for policy makers. By fostering the implementation of state-wise screening programs, it can contribute to improving maternal and neonatal outcomes and promoting healthier pregnancies across the country. [ABSTRACT FROM AUTHOR]

Background: A variety of screening tools and criteria are used for the diagnosis of gestational diabetes mellitus (GDM). As a result, the prevalence rate of GDM varied from 4.41% to 57.90% among studies from Pakistan. Beside this disagreement, similar multi-centric studies, community surveys and pooled evidence were lacking from the country. Therefore, this first systematic review and meta-analysis aimed to measure the overall and subgroup pooled estimates of GDM and explore the methodological variations among studies for any inconsistency. Methods: Using the PRISMA guidelines, seventy studies were identified from PubMed, ScienceDirect, Google Scholar and PakMediNet database. Of them, twenty-four relevant studies were considered for systematic review and nine eligible studies selected for meta-analysis. AXIS was used for measuring quality of reporting, I^2 statistics for heterogeneity among studies and subgroups, funnel plot for reporting potential publication bias and forest plot for presenting pooled estimates. Results: The pooled sample of nine studies was 27,034 (126 – 12,450) pregnant women, of any gestational age, from all four provinces of Pakistan. Overall pooled estimate of GDM was 16.7% (95% CI 13.1 – 21.1). The highest subgroup pooled estimate of GDM observed in studies from Balochistan (35.8%), followed by Islamabad (23.9%), Khyber Pakhtunkhwa (17.2%), Sindh (13.2%), and Punjab (11.4%). The studies that adopted 75g 2-h OGTT had a little lower pooled estimate (16.3% vs. 17.3%); and that adopted diagnostic cut-off values [≥ 92 (F), ≥ 180 (1-h) and ≥ 153 (2-h)] had a greater pooled estimate (25.4% vs. 15.8%). The studies that adopted Carpenter criteria demonstrated the highest subgroup pooled estimate of GDM (26.3%), after that IADPSG criteria (25.4%), and ADA criteria (23.9%). Conclusions: Along with poor quality of reporting, publishing in non-indexed journals and significant disagreement between studies, the prevalence rate of GDM is high in Pakistan. Consensus building among stakeholders for recommended screening methods; and continuous medical education of the physicians are much needed for a timely detection and treatment of GDM. [ABSTRACT FROM AUTHOR]

Objective: To establish diagnostic criteria for the 75‐g 2‐h glucose tolerance test (GTT) to diagnose gestational diabetes and define the clinical entity of gestational hyperglycemia. Methods: A retrospective analysis was performed of the results from 500 patients who had a 75‐g 1‐h glucose challenge test (GCT) in early pregnancy as part of a two‐step approach to screening and testing for gestational diabetes. The selected cohort was considered to have normal islet β‐cell function, and upper glycemic levels of normal glucose tolerance in the third trimester were statistically calculated, taking the cutoff threshold values to be the diagnostic criteria for the 75‐g 2‐h GTT. Gestational hyperglycemia was diagnosed from the false‐positive GCT result when ≥8.0 mmol/L (144 mg/dL). Results: The diagnostic criteria for the 75‐g 2‐h GTT were calculated as follows: fasting plasma glucose ≥5.4 mmol/L (97 mg/dL); 1‐h plasma glucose ≥10.5 mmol/L (189 mg/dL); and 2‐h plasma glucose ≥8.4 mmol/L (151 mg/dL). The new criteria confirmed a prevalence of gestational diabetes of 11.1% and gestational hyperglycemia of 13.6% in the study population. Conclusion: Novel diagnostic criteria for the 75‐g 2‐h GTT were established by statistical analysis. This resulted in a more acceptable prevalence of gestational diabetes in our community and the false‐positive GCT allowed the detection of gestational hyperglycemia. Synopsis: Novel diagnostic criteria for the glucose tolerance test to diagnose gestational diabetes and gestational hyperglycemia have been established by statistical analysis. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to evaluate whether values and the shape of the glucose curve during the oral glucose tolerance test (OGTT) in pregnancy identify women at risk of developing hypertension (HTN) later in life. Study Design This category includes the secondary analysis of a follow-up from a mild gestational diabetes mellitus (GDM) study that included a treatment trial for mild GDM (n = 458) and an observational cohort of participants with abnormal 1-hour glucose loading test only (normal OGTT, n = 430). Participants were assessed at a median of 7 (IQR 6–8) years after their index pregnancy, and trained staff measured their blood pressure (systolic blood pressure [SBP]; diastolic blood pressure [DBP]). The association between values and the shape of the glucose curve during OGTT in the index pregnancy and the primary outcome defined as elevated BP (SBP ≥120, DBP ≥80 mm Hg, or receiving anti-HTN medications), and secondary outcome defined as stage 1 or higher (SBP ≥130, DBP ≥80 mm Hg, or receiving anti-HTN medications) at follow-up were evaluated using multivariable regression, adjusting for maternal age, body mass index, and pregnancy-associated hypertension during the index pregnancy. Results There was no association between fasting, 1-hour OGTT, and the outcomes. However, the 2-hour OGTT value was positively associated (adjusted odds ratio [aRR] per 10-unit increase 1.04, 95% CI 1.01–1.08), and the 3-hour was inversely associated (aRR per 10-unit increase 0.96, 95% CI 0.93–0.99) with the primary outcome. When the shape of the OGTT curve was evaluated, a monophasic OGTT response (peak at 1 hour followed by a decline in glucose) was associated with increased risk of elevated BP (41.3vs. 23.5%, aRR 1.66, 95% CI 1.17–2.35) and stage 1 HTN or higher (28.5 vs. 14.7%, aRR 1.83, 95% CI 1.15–2.92), compared with a biphasic OGTT response. Conclusion Among persons with mild GDM or lesser degrees of glucose intolerance, the shape of the OGTT curve during pregnancy may help identify women who are at risk of HTN later in life, with biphasic shape to be associated with lower risk. Key Points The shape of the Oral Glucose Tolerance Test curve may help identify patients who are at risk of having elevated BP or HTN 5 to 10 years following pregnancy. The 2-hour Oral Glucose Tolerance Test values is positively associated with elevated BP 5 to 10 years following pregnancy. This supports the concept of pregnancy as a window to future health and represents a potential novel biomarker for maternal cardiovascular health screening. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluated if fetuses of subjects with one elevated value on the 3-h GTT had a measurable physiologic difference in fetal C-peptide levels as compared to those with no elevated values on the GTT. Methods: We performed a prospective cohort study to evaluate insulin levels in singleton non-anomalous fetuses of subjects with one elevated value on the GTT as compared to subjects with no elevated values on their GTT. Fetal insulin levels were measured by fetal C-peptide in cord blood. Distribution of data was assessed and outliers representing values > the 99th and < the 1st percentiles were excluded. Data were log transformed to achieve normal distribution and univariable analyses were performed to compare fetal C-peptide levels, baseline maternal characteristics and perinatal outcomes in subjects with one elevated value as compared those with no elevated values. Results: Our analysis included 99 subjects, with 49 subjects in the one elevated value group and 50 subjects in the no elevated values group. Fetal C-peptide levels (picomoles per liters, pmol/L), were significantly higher in the elevated value group as compared to the no elevated value group (mean ± SD; 4.6 ± 0.8 vs. 4.3 ± 0.7, P = 0.046, respectively). In univariable analysis, there was no significant difference in maternal characteristics or adverse composite perinatal outcomes. Conclusion: Fetuses of subjects who had one elevated value on their GTT had a measurable physiologic difference in C-peptide levels as compared to fetuses of subjects with no elevated values on the GTT. [ABSTRACT FROM AUTHOR]

Background and Objectives There exists a limited body of research investigating the correlation between gestational diabetes mellitus (GDM) with fetal epicardial fat thickness (FEFT). The primary objective of this study was to assess the potential of FEFT as an indicator for screening GDM in pregnant women. The study was designed as a cross-sectional analytical investigation. Materials & methods The study incorporated pregnant women who were scheduled to undergo a 75g oral glucose tolerance test (OGTT). Antenatal ultrasonography (USG) were conducted in all patients. Among the total of 200 patients, a subset of 70 patients was selected for further analysis. This subset included 35 patients with elevated results in the 75g OGTT (indicating cases of GDM) and 35 patients with normal results. Results: There was a significant increase in FEFT among pregnant women with GDM. Furthermore, the elevated FEFT demonstrated a positive correlation with 2-hour OGTT serum glucose values. The mean FEFT in mothers with GDM was found to be significantly larger compared to mothers without GDM. To assess the predictive capability of FEFT for GDM, an ROC curve was constructed which demonstrated a high sensitivity of 95.57% and specificity of 91% for FEFT as a predictor of GDM. Conclusion: Assessing the FEFT in fetuses could serve as a novel marker for diagnosing GDM. [ABSTRACT FROM AUTHOR]

The proportion of adipose depots varies considerably between fattailed (FT) and thin-tailed (TT) sheep breeds. FT breeds accumulate majority of body fat in fat-tail depot, whereas TT breeds deposit considerable proportion of body fat in visceral depots. These differences in proportion of adipose depots seem to affect body metabolism due to differences in metabolism of different depots. Hence, the current research aimed to evaluate the response of fat-tailed lambs (FTL) and thin-tailed lambs (TTL) to glucose and insulin challenges during negative energy balance (NEB) and positive energy balance (PEB). Glucose tolerance and insulin challenge tests were conducted on randomly selected lambs from each genotypes at the end of induced NEB and PEB. Glucose injection during NEB caused greater plasma glucose concentration in TTL, whereas in PEB, the enhancement in glucose concentration as a consequence of glucose injection was higher in FTL (P=0.09). The area under the glucose curve was higher in FT compared to TT lambs during glucose tolerance test regardless of energy balance (EB; P=0.03). The clearance rates of insulin (P=0.09) and glucose (P=0.006) in the respective insulin and glucose tolerance tests were higher during PEB compared to NEB regardless of the genotypes. These results demonstrated that induced NEB can enhance insulin resistance in both FT and TT lambs, severity of which is greater in FT than in TT lambs. [ABSTRACT FROM AUTHOR]

The aim of the work was to define the pattern of changes and pathogenetic mechanisms of glycemic curve shape during a glucose tolerance test in rats at 6, 15, and 21 weeks of environmental space restriction. Materials and methods. A total of 55 male Wistar rats aged 6-10 months were used and divided into 4 groups (1 - intact control, 10 rats; 2, 3 and 4 of 15 rats each, which were in conditions of restricted environmental space for 6, 15 and 21 weeks, respectively). Fasting plasma levels of glucose (test strips Test Strip II on a Glucocard glucometer (ARKRAY Inc., Japan)), insulin and corticosterone (by an immunoenzymatic method using commercial kits for rats from Monobind, USA) were measured, glucose tolerance tests (GTT) were performed, the HOMA index and the insulin/corticosterone ratio were calculated. Results. The 6-week environmental space restriction, immobility and complex communication relations resulted in a hypoinsulinemic-hypoglycemic type of the glycemic curve with high tissue glucose sensitivity in animals which were in the conditions described (the HOMA index was significantly decreased to 0.21 versus 0.55 in the control), the characteristic delayed hyperglycemic peak at the 30th min of the test slowly returned to the euglycemic level by only the 90th min against the 30th min in the controls. The 15-week restriction caused a hypoinsulinemic curve with preserved tissue glucose sensitivity (the HOMA index 0.33 versus 0.55 in the controls). Alterations in postprandial glucose absorption were manifested by the highest glucose concentration at the 15th min of the test, a very slow decrease in the glucose level in the post-absorption period not being restored to baseline values by the 90th min. The 21-week restriction shaped a diabetic type of the glycemic curve, impaired tissue glucose sensitivity (a substantial and significant increase in the calculated HOMA index from 0.55 in the controls to 0.95) and resulted in the development of insulin resistance. Conclusions. The environmental space restriction, immobility and complex communication relations gradually induce a range of disorders in animals and change the glycemic response shape to glucose load, impair prandial insulin secretion, augment hyperglycemic effects of counterinsular hormones (corticosterone), and realize dysfunctional manifestations of prandial/postprandial glycemia. 6 weeks of restrictions and challenges shape the hypoinsulinemic-hypoglycemic type of the glycemic curve with high tissue glucose sensitivity, while 15 weeks result in the hypoinsulinemic curve with preserved tissue glucose sensitivity. 21 weeks show the diabetic type of the glycemic curve with impaired tissue glucose sensitivity and the development of insulin resistance. [ABSTRACT FROM AUTHOR]

Delta-6 desaturase (D6D), encoded by the Fads2 gene, catalyzes the first step in the conversion of a-linolenic acid to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The ablation of D6D in whole body Fads2-/- knockout (KO) mice results in an inability to endogenously produce EPA and DHA. Evidence supports a beneficial role for EPA and DHA on insulin-stimulated glucose disposal in skeletal muscle in the context of a metabolic challenge; however, it is unknown how low EPA and DHA levels impact skeletal muscle fatty acid composition and insulin signaling in a healthy context. The objective of this study was to examine the impact of ablating the endogenous production of EPA and DHA on skeletal muscle fatty acid composition, whole body glucose and insulin tolerance, and a key marker of skeletal muscle insulin signaling (pAkt). Male C57BL/6J wild-type (WT), Fads2+/- heterozygous, and Fads2-/- KO mice were fed a low-fat diet (16% kcal from fat) modified to contain either 7% w/w lard or 7% w/w flaxseed for 21 wk. No differences in total phospholipid (PL), triacylglycerol, or reactive lipid content were observed between genotypes. As expected, KO mice on both diets had significantly less DHA content in skeletal muscle PL. Despite this, KO mice did not have significantly different glucose or insulin tolerance compared with WT mice on either diet. Basal pAktSer473 was not significantly different between the genotypes within each diet. Ultimately, this study shows for the first time, to our knowledge, that the reduction of DHA in skeletal muscle is not necessarily detrimental to glucose homeostasis in otherwise healthy animals. NEW & NOTEWORTHY Skeletal muscle is the primary location of insulin-stimulated glucose uptake. EPA and DHA supplementation has been observed to improve skeletal muscle insulin-stimulated glucose uptake in models of metabolic dysfunction. Fads2-/- knockout mice cannot endogenously produce long-chain n-3 polyunsaturated fatty acids. Our results show that the absence of DHA in skeletal muscle is not detrimental to whole body glucose homeostasis in healthy mice. [ABSTRACT FROM AUTHOR]

Objectives: Untreated hypoglycemia at profoundly low levels restrains the delivery of energy to vital organs and causes a series of extreme adverse events, ultimately resulting in coma and death. The purpose of the study was to determine the relationship between body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), and co-morbidities in patients experiencing hypoglycemia during an oral glucose tolerance test (OGTT). Materials and Methods: We retrospectively analyzed the medical records of all patients presented to the diet outpatient clinic between 2015 and 2020 for OGTT. After an overnight fast of 10-12 hours, the patient’s fasting insulin (HOMA-IR) and fasting glucose were recorded. A 330cc solution of glucose (containing 75 grams of dextrose anhydride) drink was used for the OGTT. Following this, blood glucose was measured at 30, 60, 120, 180, and 240 minutes. The obtained data were analyzed using descriptive and inferential statistics. Results: A total of 614 patients were analyzed. A positive correlation was found between BMI and HOMA-IR (p≤0.001), BMI and blood glucose (p≤0.001). Although hypoglycemia rates were higher in overweight and obese patients, the difference was not significant (p= 0.316). The presence of co-morbidity did not affect the incidence of hypoglycemia (p=0.413). Conclusion: We observed that increased BMI was associated with having HOMA-IR and high glucose levels at 0-30-60-120 minutes in OGTT. Although hypoglycemia during the OGTT was not associated with BMI in this study, large-scale studies are needed to reveal this relationship. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is associated with hypertension, preeclampsia, stillbirth, macrosomia, unexplained intrauterine death, instrumental and traumatic delivery leading to both maternal and foetal injuries, and increased risk of maternal and neonatal infections. The present study was conducted at Rajendra Institute of Medical Sciences, Ranchi to determine the prevalence of Gestational Diabetes Mellitus(GDM) and its associated risk factors in tribal population of Jharkhand. Aims and Objectives: The aim of the study was to determine the prevalence of GDM and to analyze its association with various risk factors. Materials and Methods: Detailed history of all patients was taken with emphasis on genetic and family history and history of the previous pregnancies. All the patients were screened by the single step 75 gm 2 hours oral glucose tolerance test (OGTT) as recommended by the World Health Organization. GDM was diagnosed if 2 hours PG is ≥140 mg/dL. Results: Most patients of GDM were from upper middle class 45.45%, followed by lower middle class (27.27%) and upper lower class (18.18%). For the non-GDM patients, most patients were from upper lower class (55.055%), followed by upper middle (24.71%). The prevalence of GDM was 12.12 % in the tribal population as compared to non-tribal population (10.44 %). In present study, in majority (89.00 %) of study subjects, result of 75 gm OGTT was negative. Result of 75 gm OGTT was positive in only 11 out of 100 study subjects (11.00 %). Conclusion: Tribal population in Jharkhand has very poor access to health-care services of the state. This study is first of its kind in our state which will set as an eye opener to further deliver better health-care facilities at grassroot level in Jharkhand. [ABSTRACT FROM AUTHOR]

The negative control group (NC), and those STZ-induced hyperglycemic mice gavage supplemented with dH2O (STZ group), soybean residue (SR group), short time soybean residue fermentation (SSRF group) and longtime soybean residue fermentation (LSRF group). Surprisingly, inconsistent isoflavones content in soybean residues imply the efficacy in optimizing utilization of soy isoflavones in soy products demand more investigation. Keywords: soybean residue; Rhizopus oligosporus; Lactiplantibacillus plantarum; isoflavone; -aminobutyric acid (GABA); antioxidant; hyperglycemia; kidney; histopathology; diabetic mice; solid-state fermentation; blood glucose level monitoring; glucose tolerance test; kidney histopathological examination EN soybean residue Rhizopus oligosporus Lactiplantibacillus plantarum isoflavone -aminobutyric acid (GABA) antioxidant hyperglycemia kidney histopathology diabetic mice solid-state fermentation blood glucose level monitoring glucose tolerance test kidney histopathological examination 1716 15 11/17/22 20221101 NES 221101 1. Additionally, the STZ-induced hyperglycemic mice are gavage fed dH2O (STZ group), soybean residue (SR group), short time soybean residue fermentation (SSRF group) and longtime soybean residue fermentation (LSRF group). [Extracted from the article]

Background: It is unclear whether replacing oral glucose tolerance test (OGTT) with hemoglobin A1c (HbA1c) measurement for diagnosing diabetes is justified. We aimed to assess the proportion of OGTT-diagnosed diabetes cases that can be confirmed by HbA1c and to examine whether individuals with OGTT diagnosis but nondiagnostic HbA1c are at higher risk of macrovascular and microvascular disease.Methods: Participants were 5773 men and women from the population-based Whitehall II prospective cohort study in the United Kingdom. New OGTT diabetes cases diagnosed in clinical examinations in 2002 to 2004 and 2007 to 2009 were assessed for HbA1c confirmation (≥6.5%) in these and subsequent clinical examinations in 2012 to 2013 and 2015 to 2016. All participants were followed up for major cardiovascular events through linkage to electronic health records until 2017 and for incident chronic kidney disease (estimated glomerular filtration rate <60 mL·min-1·1.73 m-2) until the last clinical examination. In analysis of vascular disease risk, new OGTT-diagnosed diabetes cases with and without diagnostic HbA1c and preexisting diabetes cases were compared with diabetes-free participants.Results: Of the 378 (59.3%) participants with OGTT-diagnosed diabetes, 224 were confirmed by HbA1c during 4.1 years (SD, 4.1 years) of follow-up. We recorded 942 cardiovascular events over 12.1 years. After adjustment for nonmodifiable risk factors and compared with the 4997 diabetes-free participants, 371 participants with new HbA1c-confirmed diabetes and 405 participants with preexisting diabetes had increased risk of cardiovascular disease (hazard ratio, 1.53 [95% CI, 1.12-2.10] and 1.85 [95% CI, 1.50-2.28], respectively). The corresponding hazard ratios in the analysis of incident chronic kidney disease (487 cases; follow-up, 6.6 years) were 1.69 (95% CI, 1.09-2.62) for 282 participants with new HbA1c-confirmed diabetes and 1.67 (95% CI, 1.22-2.28) for 276 participants with preexisting diabetes. In both analyses, OGTT cases with nondiagnostic HbA1c (n=149 and 107) had a risk (hazard ratio, 0.99-1.07) similar to that of the diabetes-free population.Conclusions: More than 40% of OGTT-diagnosed diabetes cases were not confirmed by HbA1c during an extended follow-up. However, because these individuals have a risk of cardiovascular disease and chronic kidney disease similar to that of the diabetes-free population, replacement of OGTT with HbA1c-based diagnosis appears justified. [ABSTRACT FROM AUTHOR]

Background: Pregnancy, parturition, and the onset of lactation represent an enormous physiological and hormonal challenge to the homeostasis of dairy animals, being a risk for their health and reproduction. Thus, as a part of the homothetic changes in preparturition period, goats undergo a period of IR as well as uncoupled GH/IGF-1 axis. The objective for this study was to determine the effect of berberine (BBR) during the peripartal period on hormonal alteration and somatotropic axis in dairy goats as well as glucose and insulin kinetics during an intravenous glucose tolerance test (IVGTT). At 21 days before the expected kidding date, 24 primiparous Saanen goats were assigned randomly to 4 dietary treatments. Goats were fed a basal diet from wk. 3 antepartum (AP) until wk. 3 postpartum (PP) supplemented with 0 (CTRL), 1 (BBR1), 2 (BBR2), and 4 (BBR4) g/d BBR. Blood samples were collected on days − 21, − 14, − 7, 0, 7, 14, and 21 relative to the expected kidding date. An IVGTT was also performed on day 22 PP. Results: Compared with CTRL, supplementation with either BBR2 or BBR4 increased DMI at kidding day and PP, as well as body conditional score (BCS) and milk production (p ≤ 0.05). On d 7 and 14 PP plasma glucose was higher in BBR2- and BBR4-treated than in CTRL. The glucagon concentration was not affected by BBR during the experimental period. However, supplemental BBR indicated a tendency to decrease in cortisol concentration on days 7 (p = 0.093) and 14 (p = 0.100) PP. Lower plasma GH was observed in BBR than in non-BBR goats (p ≤ 0.05). Plasma IGF-1 concentration was enhanced in both BBR2 and BBR4 at kidding and day 7 PP (p ≤ 0.05). During the IVGTT, glucose area under the curve (AUC), clearance rate (CR), T1/2, and Tbasal was lower (p ≤ 0.05) in both BBR2 and BBR4 goats as compared with CTRL. Likewise, the insulin CR was higher (p ≤ 0.05) in goats receiving either BBR2 or BBR4 which was accompanied by a lower insulin T1/2 and AUC. Conclusions: Altogether, our results indicated an improved glucose and insulin status along with the modulation of the somatotropic axis and glucose and insulin response to IVGTT in dairy goats supplemented with 2 and 4 g/d BBR. [ABSTRACT FROM AUTHOR]

Oral glucose loading may affect oxidative status during oral glucose tolerance test (OGTT). We aimed to investigate how oxidant and antioxidant markers and thiol/disulfide parameters change during OGTT. OGTT was performed to 42 volunteers who were considered risk of type 2 diabetes and were divided into three groups (normoglycemic, prediabetes, diabetes) according glucose levels during OGTT. Glucose, insulin, c-peptide, total antioxidant status (TAS), total oxidant status (TOS), total thiol and native thiol were investigated with auto-anaylzer for five-hours period. Decrease of TAS and increase of TOS levels began with the increase in glucose and insulin levels. The increase of TAS started at third hour and reached the highest levels at fifth hour. OSI levels were higher at fourth hour than fasting and first hours in normoglycemic and diabetes groups. In the prediabetic group, TAS were higher than the other groups, TOS peak was at the second hour (p < 0.05). Native thiol and total thiol levels showed variable course during OGTT, both parameters increased at the end of the process (p < 0.05). Disulfide levels showed an increase trend but it was not statistically different in normoglycemic and diabetes groups. In prediabetes group, second hour disulfide level was lower than fasting state and disulfide was significantly increased at third, fourth and fifth hours and fifth hour disulfide level was also higher than fasting. Oxidative stress parameters and thiol/disulfide balance were found to deteriorate within five-hours after glucose loading in all groups. These results indicates that oxidative stress occurs during OGTT. [ABSTRACT FROM AUTHOR]

Background: Recognizing that hyperglycemia in pregnancy can impact both individually a patient's health and collectively the healthcare system and that different levels of hyperglycemia incur different consequences, we aimed to evaluate the differences and similarities between patients who met the diagnostic criteria for gestational diabetes mellitus (GDM) or diabetes in pregnancy (DIP) according to the World Health Organization diagnostic criteria based on the 75 g oral glucose tolerance test (OGTT).Methods: This retrospective study included a cohort of 1064 women followed-up at the Gestational Diabetes Unit of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (Sao Paulo, Brazil). Patients were classified into GDM and DIP groups, according to their OGTT results. Their electronic charts were reviewed to obtain clinical and laboratory data for all participants.Results: Women in the DIP group had a higher pre-pregnancy body mass index (30.5 vs 28.1 kg/m2, odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.11), more frequently experienced GDM in a previous pregnancy (25% vs. 11%, OR 2.71, 95% CI 1.17-6.27), and were more likely to have chronic hypertension (43.1% vs. 23.5%, OR 2.46, 95% CI 1.47-4.11), a current twin pregnancy (10.8% vs. 2.9%, OR 4.04, 95% CI 1.70-9.61), or require insulin (46.1% vs. 14.3%, OR 5.14, 95% CI 3.06-8.65) than those in the GDM group. Patients in the DIP group also had a higher frequency of large-for-gestational-age infants (12.3% vs. 5.1%, OR 2.78, 95% CI 1.23-6.27) and abnormal postpartum OGTT (45.9% vs. 12.6%, OR 5.91, 95% CI 2.93-11.90) than those in the GDM group. Nevertheless, in more than half of the DIP patients, glucose levels returned to normal after birth.Conclusions: Diabetes in pregnancy is associated with an increased risk of adverse perinatal outcomes but does not equate to a diagnosis of diabetes post-pregnancy. It is necessary to identify and monitor these women more closely during and after pregnancy. Keeping patients with hyperglycemia in pregnancy engaged in healthcare is essential for accurate diagnosis and prevention of complications related to abnormal glucose metabolism. [ABSTRACT FROM AUTHOR]

Objectives: Gestational diabetes mellitus (GDM) affects about 15% of pregnancies in Australia, with approximately 30% of those diagnosed with GDM requiring insulin therapy. There are several established risk factors for developing GDM, however limited studies show how these can be used to predict need for insulin treatment. The aim of this study is to identify predictors of insulin therapy in women diagnosed with GDM once an oral glucose tolerance test (OGTT) is performed during pregnancy.Study Design: This is a retrospective cohort study of women with singleton pregnancies complicated by GDM between 2016 and 2017 at a single, large health network in Melbourne, Australia. Data were obtained from hospital record and pathology result systems. Univariable and multivariable logistic regression models were fit to the data to obtain crude and adjusted odds ratios.Results: Of 2,048 women diagnosed with GDM, 647 (31.6%) required insulin therapy. Positive predictors included in the final multivariable model after backwards, stepwise elimination were an elevated fasting result on an OGTT (adjusted odds ratio (AOR) 2.93 [95% CI 2.34-3.66]), previous birth weight greater than 90th% (AOR 2.04 [95% CI 1.412.94]), previous diagnosis of GDM (AOR 1.68 [95% CI 1.28-2.21]), being born in the South Asian region (AOR 1.58 [95% CI 1.27-1.98]), the 2hr OGTT result (AOR 1.14 [95% CI 1.05-1.24]), body mass index (BMI; AOR 1.13 [95% CI 1.04-1.23]) and age (AOR 1.03 [95% CI 1.00-1.05]) The final predictive model had an area under the receiver-operating characteristics (ROC) curve of 0.744 (95% CI 0.720-0.767).Conclusions: This study highlights the possible predictors of insulin use, informing counselling for women who are newly diagnosed with gestational diabetes. [ABSTRACT FROM AUTHOR]

This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy. [ABSTRACT FROM AUTHOR]

Objective We aimed to explore the relationship between the change amplitude of glycemic and metabolic syndrome after glucose load in normal glucose tolerance (NGT) people. Methods According to the World Health Organization diabetes diagnostic criteria, a total of 22 302 NGT subjects with complete data were screened from the China National Diabetes and Metabolic Disorders Study (CNDMDS) from 2007 to 2008. The absolute difference between 2 h post-load glucose (2hPG) and fasting plasma glucose (FPG) during oral glucose tolerance test (OGTT) was used to reflect the change amplitude of glycemic, and compare the differences of metabolic indices and the prevalence of metabolic syndrome between different change amplitude. As a part of CNDMDS, 3 247 subjects completed the baseline survey from 2007 to 2008 in Shaanxi Province, in the retrospective cohort to 2016 and 2017, a total of 678 NGT subjects with complete data were included in the confirmatory analysis. According to the cut-off point of the change amplitude of glycemic related to metabolic diseases from the receiver operating characteristic curve (ROC) in the cross-sectional analysis, subjects were divided into two groups to compare the incidence risk of diabetes after 9 years of follow-up. The t test, analysis of variance and chi-square test were used to compare the differences in clinical characteristics and metabolic indices among different groups, and Logistic regression analysis was used to evaluate the influence of different groups on the prevalence of MS and the incidence of diabetes. Results We divided the change amplitude of glycemic after glucose load of 22 302 subjects into quartiles, among which the change amplitude were as follows: Q1 group (<0.45 mmol/L, 5 593 subjects), Q2 group (0.45 to 0.93 mmol/L, 5 603 subjects), Q3 group (0.94 to 1.60 mmol/L, 5 636 subjects), Q4 group (>1.60 mmol/L, 5 470 subjects); the body mass index (BMI), waist circumference, blood pressure, total cholesterol, triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were increased significantly with the increasement of the change amplitude of glycemic, while high-density lipoprotein cholesterol (HDL-C) decreased significantly, the prevalence of metabolic syndrome (MS) and the proportion of subjects with middle or high risk for developing coronary heart disease in 10 years [Framingham risk score (FRS) ≥10%] were increased significantly. Logistic regression analysis showed that the large change amplitude of glycemic after glucose load was a risk factor for MS. Use MS and FRS ≥10% as the outcome variables, the change amplitude of glycemic as the independent variable, the cut-off point of the change amplitude of glycemic both were 1.09. Among 678 NGT subjects in the retrospective cohort, the incidence of diabetes in the group with small change amplitude of glycemic (the change amplitude of glycemic ≤1.09 mmol/L) and large change amplitude of glycemic (the change amplitude of glycemic >1.09 mmol/L) were 7.2% (28/388) and 13.1% (38/290), respectively, the difference was statistically significant (P=0.011). Logistic regression analysis showed that the change amplitude of glycemic after glucose load >1.09 mmol/L was a risk factor for diabetes, after adjusting for age, gender, BMI, smoking, drinking, exercise and family history of diabetes, the risk ratio was 1.829 (95%CI 1.079 to 3.101, P=0.025). Conclusion In NGT people, the large change amplitude of glycemic after glucose load was a risk factor for metabolic diseases and could predict the occurrence of diabetes. [ABSTRACT FROM AUTHOR]

Introduction: This prospective multicenter study aimed at investigating the safety and metabolic advantages of steroid withdrawal (SW) therapy in kidney transplant recipients with tacrolimus–mycophenolate mofetil‐based immunosuppression. Methods: We analyzed 179 recipients who received kidney transplantation from March 2016 and September 2018. In 179 recipients, 114 patients maintained an immunosuppressive regimen including steroids (steroid continuation [SC] group). The remaining 65 patients were determined to withdraw steroid therapy after 6 months posttransplant (SW group). Metabolic parameters and graft functions of the two groups were evaluated. Results: The estimated glomerular filtration rates at 12 months posttransplant were 67.29 ± 20.29 ml/min/1.73 m2 in SC group and 73.72 ± 17.57 ml/min/1.73 m2 in SW group (p <.001). The acute rejection occurred to four recipients in the SC group (3.5%) and no acute rejection occurred to SW group recipients during the 6–2 months posttransplant period. Oral glucose tolerance tests revealed that recipients in the SW group were more improved in glucose metabolism than the SC group during 6–12 months posttransplant. In addition, cholesterol levels and blood pressure decreased after the withdrawal of steroids in the SW group. Conclusion: In conclusion, a 6‐month withdrawal of steroids in recipients with low immunological risk and stable graft function can be safely conducted and result in improvement of metabolic profiles. Stable recipients without biopsy‐proven acute rejection and proteinuria can safely withdraw from steroids out of a maintenance immunosuppressive regimen 6‐months posttransplant. A long‐term follow‐up study is needed to verify our results. [ABSTRACT FROM AUTHOR]

Aims: Liver cirrhosis increases the risk of developing dysglycaemia (pre-diabetes and diabetes), thus people with cirrhosis should undergo regular screening for dysglycaemia. The utility of screening using the laboratory glycated haemoglobin (HbA1c) test has been questioned in this setting. This study examines the relationship between different potential screening modalities: 75 g oral glucose tolerance test (OGTT) and HbA1c, using continuous glucose monitoring (CGM) as a comparator. Methods: Participants ≥18 years with no known diabetes, were recruited from a gastroenterology cirrhosis surveillance register. Study measurements included a 75 g OGTT, laboratory HbA1c and two weeks of 'blinded' CGM (Freestyle Libre Pro). The possibility of intravascular haemolysis affecting HbA1c interpretation was also assessed. Results: All 20 participants had compensated cirrhosis. OGTT tended to diagnose more dysglycaemia (N = 7) than did HbA1c (N = 4). Bland-Altman analysis showed laboratory and CGM-estimated HbA1c were broadly comparable, with a difference of 4mmol/mol (95% CI -3 to 12), or 0.4% (95% CI -0.3 to 1.1). Laboratory HbA1c tended to be higher than the CGM-estimated HbA1c, perhaps reflecting positive lifestyle changes in participants during their two weeks of wearing 'blinded' CGM (Hawthorne effect). In the population studied, there was no evidence that haemolysis affected interpretation of HbA1c results. Conclusions: In the setting of compensated cirrhosis, the OGTT and HbA1c remain standard screening test for diabetes, but multiple studies show the OGTT diagnoses more people with dysglycaemia than does the HbA1c. Blinded CGM in an ambulatory, real world setting provides additional insights into glycaemic excursions but cannot be used to diagnose dysglycaemia. [ABSTRACT FROM AUTHOR]

Leptin is best known for its role in adipostasis, but it also regulates blood glucose levels. The molecular mechanism by which leptin controls glucose homeostasis remains largely unknown. Here, we use a zebrafish model to show that Wnt signaling mediates the glucoregulatory effects of leptin. Under normal feeding conditions, leptin regulates glucose homeostasis but not adipostasis in zebrafish. In times of nutrient excess, however, we found that leptin also regulates body weight and size. Using a Wnt signaling reporter fish, we show that leptin activates the canonical Wnt pathway in vivo. Utilizing two paradigms for hyperglycemia, it is revealed that leptin regulates glucose homeostasis via the Wnt pathway, as pharmacological inhibition of this pathway impairs the glucoregulatory actions of leptin. Our results may shed new light on the evolution of the physiological function of leptin. [ABSTRACT FROM AUTHOR]

Introduction Skeletal muscle is a major site for whole-body glucose disposal, and determination of skeletal muscle glucose uptake is an important metabolic measurement, particularly in research focussed on interventions that impact muscle insulin sensitivity. Calculating arterial-venous difference in blood glucose can be used as an indirect measure for assessing glucose uptake. However, the possibility of multiple tissues contributing to the composition of venous blood, and the differential in glucose uptake kinetics between tissue types, suggests that sampling from different vein sites could influence the estimation of glucose uptake. This study aimed to determine the impact of venous cannula position on calculated forearm glucose uptake following an oral glucose challenge in resting and post-exercise states. Materials and Methods In 9 young, lean, males, the impact of sampling blood from two antecubital vein positions; the perforating vein ('perforating' visit) and, at the bifurcation of superficial and perforating veins ('bifurcation' visit), was assessed. Brachial artery blood flow and arterialised-venous and venous blood glucose concentrations were measured in 3 physiological states; resting-fasted, resting-fed, and fed following intermittent forearm muscle contraction (fed-exercise). Results Following glucose ingestion, forearm glucose uptake area under the curve was greater for the 'perforating' than for the 'bifurcation' visit in the resting-fed (5.92±1.56 vs. 3.69±1.35 mmol/60 min, P<0.01) and fed-exercise (17.38±7.73 vs. 11.40±7.31 mmol/75 min, P<0.05) states. Discussion Antecubital vein cannula position impacts calculated postprandial forearm glucose uptake. These findings have implications for longitudinal intervention studies where serial determination of forearm glucose uptake is required. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and longterm complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM. [ABSTRACT FROM AUTHOR]

Monitoring the concentration of plasma glucose is very important to diagnose individuals with diabetes early so that the treatment of diabetes can be done early as well. The earlier diagnosis of the disease allows for better control. In general, the diagnostic determination of subjects with prediabetes or diabetes is based on the criteria of the basal threshold of measured plasma glucose statically. However, using the development of alternative diagnostic methods, the dynamic model of glucose-insulin homeostasis has become an alternative model to be used as a diagnostic model. In this study, the diagnostic model should be modified by adding the function of oral glucose absorption to the change rate of plasma glucose concentration. The modified model will adapt to the subject's diagnostic determination based on the oral glucose tolerance test (OGTT), and then the estimation of the diagnostic parameters of the model that fits the OGTT experimental data can be obtained using a modified gravitational search algorithm (GSA). The modified GSA was used to estimate the model parameters to diagnose subjects with characteristics of subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or prediabetes, and type 2 diabetes mellitus (T2DM). The suitability of the simulation results and the OGTT experimental data is shown by the suitability of the correlation curve results which are assessed based on the coefficient of determination (R2). If the value of R2 is above 0.90, it means that the simulation results are said to have a good match with the experimental data. Two parameters that are commonly used as a diagnostic determination are glucose effectiveness which indicates the ability to decrease plasma glucose concentration by itself and insulin sensitivity which measures the effect of interstitial plasma insulin response when plasma glucose concentration increases. In addition, metabolic disorders caused by insulin resistance in diabetes will also be characterized by an increase in plasma glucose. Therefore, the modified model will also be used to diagnose insulin resistance based on OGTT. This diagnostic study shows good compatibility because it is evident that the parameter results obtained from the modified model are within the criteria range of subjects with NGT, IGT, and T2DM based on the literature. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) is one of the most common morbidities associated with diabetes mellitus. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are precursors to diabetes and major risk factors for atherosclerosis. The study aimed to evaluate the prevalence of IFG and IGT in nondiabetic patients with CAD. Methods: The study was performed on 100 non-diabetic patients with CAD and 50 healthy age- and sex-matched controls. Data were collected via detailed medical history taking, clinical examination, routine blood chemistry tests, fasting blood sugar test, 2-hour post-prandial blood sugar test, lipid profile, electrocardiogram, 2D-echocardiogram, and carotid Doppler. Results: Dyslipidemia was more prevalent among the patients. The mean carotid intima-media thickness was higher in the patients. Overall, IFG was found in 9 (15%) cases and IGT was found in 13 (22%) cases. The co-existence of IFG and IGT was detected in 3 (5%) cases. Abnormal glucose regulation was found in 42% of patients. Conclusion: The findings indicate the need for early screening and management of prediabetes for the prevention of further progression to diabetes. [ABSTRACT FROM AUTHOR]

Objective: To develop twin‐specific outcome‐based oral glucose tolerance test (OGTT) diagnostic thresholds for GDM based on the risk of future maternal type‐2 diabetes. Design: A population‐based retrospective cohort study (2007–2017). Setting: Ontario, Canada. Methods: Nulliparous women with a live singleton (n = 55 361) or twin (n = 1308) birth who underwent testing for gestational diabetes mellitus (GDM) using a 75‐g OGTT in Ontario, Canada (2007–2017). We identified the 75‐g OGTT thresholds in twin pregnancies that were associated with similar incidence rates of future type‐2 diabetes to those associated with the standard OGTT thresholds in singleton pregnancies. Results: For any given 75‐g OGTT value, the incidence rate of future maternal type‐2 diabetes was lower for women with a twin than women with a singleton pregnancy. Using women with a negative OGTT as reference, the risk of future maternal type‐2 diabetes in twin pregnancies with a positive OGTT based on the standard OGTT thresholds (9.86 per 1000 person years, adjusted hazard ratio (aHR) 4.79, 95% CI 2.69–8.51) was lower than for singleton pregnancies with a positive OGTT (18.74 per 1000 person years, aHR 8.22, 95% CI 7.38–9.16). The twin‐specific OGTT fasting, 1‐hour and 2‐hour thresholds identified in the current study based on correlation with future maternal type‐2 diabetes were 5.8 mmol/l (104 mg/dl), 11.8 mmol/l (213 mg/dl) and 10.4 mmol/l (187 mg/dl), respectively. Conclusions: We identified potential twin‐specific OGTT thresholds for GDM that are associated with a similar risk of future type‐2 diabetes to that observed in women diagnosed with GDM in singleton pregnancies based on standard OGTT thresholds. Potential twin‐specific OGTT thresholds for GDM were identified. Potential twin‐specific OGTT thresholds for GDM were identified. [ABSTRACT FROM AUTHOR]

This is a retrospective analysis of mothers with abnormal 1-hour, 50-grams glucose challenge test (GCT) who did not take a 3-hour, 100-gram oral glucose tolerance test (OGTT). This study group of women was compared to three control groups, based on an OGTT diagnostic test- normal OGTT, single pathological value and gestational diabetes mellitus. Overall- 4,185 women were included and sub-divided accordingly into four groups: Group A-340 (8.12%)- no OGTT; Group B-2,585 (61.77%)- Norm OGTT (All values normal); Group C- 564 (13.48%)- SinOGTT (single pathological value) and Group D- 696 (16.63%)- Gestational Diabetes Mellitus (GDM, ≥ 2 pathological values). Groups A, C and D had higher rates of intrapartum Caesarean Delivery (10.29%, 11.52% and 10.19% vs. 8.43%, p <.0001). Group A had highest rates of neonatal adverse outcomes, as neonatal intensive care unit (NICU) admission (12.4% vs. 8.4%, 11.0% and 10.0%, p =.039), small for gestational age (SGA) neonates (7.0% vs. 5.3%, 3.7% and 6.0%, p =.0092) and neonatal hypoglycaemia (3.5% vs. 1.3%, 3.2% and 2.9%, p =.007). A multivariable regression revealed that having an abnormal GCT without an OGTT was an independent risk factor for neonatal intensive care unit admission, neonatal hypoglycaemia and intrapartum caesarean delivery. We concluded that women with pathological GCT who did not complete OGTT have higher rates of obstetric adverse outcomes. They should be closely monitored during delivery and should not be overlooked. What is already known on this subject? Adverse outcomes of gestational diabetes mellitus are well established. But, the group of women who fail to complete a confirmatory OGTT following a pathological GCT is not well described. What the results of this study add? Our results point out that women who fail to complete an OGTT, suffer from higher rates of obstetric complications, presumably attributed to disrupted glucose values, but also to poor prenatal care. What the implications are of these findings for clinical practice and/or further research? These women should not be overlooked. They should be closely monitored during labour and delivery. [ABSTRACT FROM AUTHOR]

Objective: South Africa has a high burden of HIV infection and anaemia. These conditions may cause HbA1c to over‐ or underestimate glycaemia; however, this has not been comprehensively investigated in African populations. We assessed the association of anaemia, HIV infection and antiretroviral therapy (ART) with HbA1c, and implications for the detection and diagnosis of diabetes, in a black South African population. Research design and methods: In this population‐based cross‐sectional study in eThekwini municipality (Durban), South Africa, we assessed HbA1c and conducted oral glucose tolerance tests (OGTTs), HIV diagnostic tests and full blood count measurements among 1067 participants without a history of diabetes diagnosis. Linear regression was used to examine differences in HbA1c by anaemia (comparator: no anaemia), or HIV and ART (comparator: no HIV) status. HbA1c‐based diabetes prevalence was compared with OGTT‐based prevalence among individuals with anaemia and with untreated and ART‐treated HIV. Results: In adjusted analyses, normocytic and microcytic anaemia were associated with higher HbA1c compared with no anaemia, whereas macrocytic anaemia and ART‐treated HIV were associated with lower HbA1c compared with no anaemia and no HIV, respectively. However, magnitudes of association were small (range: β = −3.4 mmol/mol or −0.31%, p < 0.001 [macrocytic anaemia] to β= 2.1 mmol/mol or 0.19%, p < 0.001 [microcytic anaemia]). There was no significant difference in diabetes prevalence based on HbA1c or OGTT among individuals with anaemia (2.9% vs. 3.3%, p = 0.69), untreated HIV (1.6% vs. 1.6% p = 1.00) or ART‐treated HIV (2.9% vs. 1.2%, p = 0.08). Conclusions: Our results suggest that anaemia and HIV status appear unlikely to materially affect the utility of HbA1c for diabetes detection and diagnosis in this population. Further studies are needed to examine these associations in sub‐Saharan African populations. [ABSTRACT FROM AUTHOR]

To estimate the metformin failure rate in women with gestational diabetes. The study was designed as a retrospective cohort of women diagnosed with gestational diabetes by the 75 g 2 h oral glucose tolerance test. Women were placed into two groups: metformin success (107 patients not requiring insulin therapy) or metformin failure (15 patients requiring the addition of, or, transition to insulin). Primary outcome: rate of metformin failure. Secondary outcomes: maternal and neonatal factors. The failure rate of metformin was 15% (19/122 women) in the study. The failure group was more likely to have 3 abnormal values on a 2-h 75 g oral glucose tolerance test (37% (n=7/19) vs. 15% (n=15/103), p=0.02). Patients who failed had higher average fasting blood glucose levels on the glucose tolerance test as well as on pretreatment fasting finger stick values. Those who failed metformin were diagnosed with gestational diabetes and started on metformin earlier in gestation. Overall low rate of metformin failure in treatment of gestational diabetes. [ABSTRACT FROM AUTHOR]

Background: We investigated how 100-g oral glucose tolerance test (OGTT) results can be used to predict adverse pregnancy outcomes in gestational diabetes mellitus (GDM) patients. Methods: We analyzed 1,059 pregnant women who completed the 100-g OGTT between 24 and 28 weeks of gestation. We compared the risk of adverse pregnancy outcomes according to OGTT patterns by latent profile analysis (LPA), numbers to meet the OGTT criteria, and area under the curve (AUC) of the OGTT graph. Adverse pregnancy outcomes were defined as a composite of preterm birth, macrosomia, large for gestational age, low APGAR score at 1 minute, and pregnancy-induced hypertension. Results: Overall, 257 participants were diagnosed with GDM, with a median age of 34 years. An LPA led to three different clusters of OGTT patterns; however, there were no significant associations between the clusters and adverse pregnancy outcomes after adjusting for confounders. Notwithstanding, the risk of adverse pregnancy outcome increased with an increase in number to meet the OGTT criteria (P for trend=0.011); odds ratios in a full adjustment model were 1.27 (95% confidence interval [CI], 0.72 to 2.23), 2.16 (95% CI, 1.21 to 3.85), and 2.32 (95% CI, 0.66 to 8.15) in those meeting the 2, 3, and 4 criteria, respectively. The AUCs of the OGTT curves also distinguished the patients at risk of adverse pregnancy outcomes; the larger the AUC, the higher the risk (P for trend=0.007). Conclusion: The total number of abnormal values and calculated AUCs for the 100-g OGTT may facilitate tailored management of patients with GDM by predicting adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background and objectives: Diagnosis glucose intolerance in pregnancy is very important in preventing maternal and fetal complications. In this study, we compared hematological and biochemical characteristics of healthy pregnant women and women with gestational diabetes mellitus (GDM) to find predisposing and prognostic variables of GDM. Methods: In this study, 80 pregnant women (at 24-28 weeks of pregnancy) were divided into a GDM group and nonGDM group by performing oral glucose tolerance test using 75 g glucose according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Results: The mean age of women with GDM was significantly higher than those without GDM (p=0.048). Other variables including body mass index, gestational age and daily sleep duration did not differ significantly between the two groups (P>0.05). There was a significant association between family history of diabetes and incidence of GDM (p=0.040). In addition, the C-peptide level was significantly higher in pregnant women with GDM (p=0.004). Conclusion: Considering the role of C-peptide in predicting metabolic syndrome, it is suggested to use this factor for identification of GDM patients. [ABSTRACT FROM AUTHOR]

Introduction: The association between hepatitis B virus (HBV) infection and the development of diabetes remains controversial. This study examined the effect of HBV infection on glucose homeostasis using a duck HBV (DHBV) model. Methods: Plasma DHBV DNA was detected by quantitative polymerase chain reaction (PCR). Tissue infection of DHBV was determined by detecting DHBV covalently closed circular DNA (cccDNA) with a method of rolling circle amplification combined with cross-gap PCR, and verified by fluorescence in situ hybridization assay. An intravenous injection glucose tolerance test (GTT) was used to analyze the effect of DHBV infection on glucose tolerance. Results: Of the finally included 97 domestic ducks, 53 (54.6%) were congenitally infected by DHBV. The positive rate of DHBV cccDNA in the liver, kidney, pancreas, and skeletal muscle of the infected ducks was 100, 75.5, 67.9, and 47.2%, respectively. The DHBV-infected ducks had higher blood glucose levels at 15 and 30 min post-load glucose (p < 0.01 and p < 0.001, respectively) in the GTT, much more individuals with greater glucose area under curve (p < 0.01), and a 57% impaired glucose tolerance (IGT) rate, as compared with noninfected controls. In addition, the subgroups of the infected ducks with DHBV cccDNA positive in skeletal muscle maintained the higher blood glucose level up to 2 h post-load glucose during the GTT and had a 76% IGT rate. Conclusion: These results suggest that DHBV intrahepatic and extrahepatic infection impairs glucose tolerance, and thus evidence the association of DHBV infection with the dysregulation of glucose metabolism. [ABSTRACT FROM AUTHOR]

Objectives: Glucose testing at six weeks after delivery has been recommended by the World Health Organization as the earliest period to detect abnormal glucose tolerance among women with gestational diabetes mellitus (GDM). However, the rate of postpartum glucose testing in many parts of the world is low, between 30-60%. Therefore, we sought to determine the proportion of women with GDM who underwent glucose testing at six weeks postpartum and the factors associated with the compliance to the test. Methods: We conducted a cross-sectional study between January and April 2017 in 13 governmental primary health care clinics in the southern part of Peninsular Malaysia. All eligible postpartum women registered from January to June 2016 who had GDM during their most recent pregnancy were included. Descriptive and multiple logistic regression analyses were performed. Results: Out of 341 women, 35.8% attended primary health care clinics for glucose testing six weeks postpartum. The factors significantly associated with the compliance to postpartum glucose testing were GDM diagnosis in previous pregnancy (adjusted odds ratio (AOR) = 1.76; 95% confidence interval (CI): 1.04-2.99; p = 0.036) and normal level of glycated hemoglobin during the most recent pregnancy (AOR = 2.49; 95% CI: 1.06-5.86; p = 0.036). Conclusions: The proportion of women with GDM who underwent postpartum glucose testing remained low. Hence, strategies should be reinforced to encourage all women with GDM to undergo postpartum glucose testing. [ABSTRACT FROM AUTHOR]

Introduction. Timely detection of insulin resistance is of great importance and a number of indices have been developed for its evaluation, among which the homeostasis model assessment of insulin resistance index is the most commonly used in clinical practice. However, it can be calculated via two different models – homeosta- sis model assessment 1 and homeostasis model assessment 2. Most studies determine the cut-off values of the study population using the homeostasis model assessment 1, while recently most physicians use homeostasis model assessment 2 in everyday clinical practice. The aim of our study was to examine whether there was a difference in the values of homeostasis model assessment of insulin resistance and homeostasis model assessment of panceratic beta cells function calculated using these two models. Material and Methods. Labora- tory findings of 42 patients who were diagnosed with glycemia and insulinemia were used in this study. Fasting and postprandial glycemia and insulinemia were used to calculate homeostasis model assessment indices using homeostasis model assessment 1 and homeostasis model assessment 2. Results. When comparing the values of the homeostasis model assessment of insulin resistance and homeostasis model assessment B indices, calculated via homeostasis model assessment 1 and homeostasis model assessment 2, we found a statistically significant difference (p < 0.001) which was also obtained when comparing the values of the homeostasis model assessment B index. Linear correlation analysis showed a significant positive correlation between the measured values of the homeostasis model assessment of insulin resistance (calculated via both models) and postprandial insulinemia at 120 minutes (p < 0.005). Conclusion. The results indicate that homeostasis model assessment 2 yields significantly lower homeostasis model assessment of insulin resistance and homeostasis model assessment B index values than when calculated by the homeostasis model assessment, which may be a stumbling block in the use of homeostasis model assessment index. It is necessary to pay attention which homeostasis model assessment model was used to define the cut-off values of these indices, and to use the same model in the diagnosis of insulin resistance in each patient in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To compare the prevalence, risk factors and perinatal outcomes of gestational diabetes mellitus (GDM) for Mexican adolescent population when applying different diagnostic criteria based on the 2-h 75-g oral glucose tolerance test, as established by three international guidelines. Materials and methods: Comparative, observational, and retrospective study, which included pregnant women under 19 years, who underwent screening for GDM in our center. Data were obtained from the hospital's electronic records and were analyzed using descriptive statistics. The X2 test was used to compare group proportions. Statistical significance was set at p ≤ 0.05. Results: A total of 999 adolescents were screened for GDM. The observed prevalence was 3%, 14.4%, and 29.3% when using the Fifth International Workshop-Conference on Gestational Diabetes Mellitus (FIWC), National Institute for Health and Care Excellence (NICE-2015), and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, respectively. Of our sample, 42.5% presented at least one risk factor. An association was observed regarding the need for cesarean section in patients with GDM diagnosed through IADPSG criteria (OR = 1.35, p = 0.04). On the other hand, the use of the FIWC and NICE standards showed an association between GDM and obstetric hemorrhage (OR = 17.8, p = 0.000, and OR = 4.8, p = 0.01, respectively) and preeclampsia with severity criteria (OR = 5.1, p = 0.001, and OR = 2.4, P = 0.025, respectively). Conclusions: The prevalence of GDM in adolescents is high, and we can conclude that the prevalence varies based on which international diagnostic guideline is applied. While there is an association with adverse pregnancy outcomes such as hypertensive disorders of pregnancy, obstetric hemorrhage, and the need for cesarean section, this requires further evaluation. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the predictive capability of fasting-state measurements of glucose and insulin levels alone for abnormal glucose tolerance in women with polycystic ovary syndrome (PCOS). Methods: In total, 153 Korean women with PCOS were included in this study. The correlations between the 2-hour postload glucose (2-hr PG) level during the 75-g oral glucose tolerance test (OGTT) and other parameters were evaluated using Pearson correlation coefficients and linear regression analysis. The predictive accuracy of fasting glucose and insulin levels and other fasting-state indices for assessing insulin sensitivity derived from glucose and insulin levels for abnormal glucose tolerance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Significant correlations were observed between the 2-hr PG level and most fasting-state parameters in women with PCOS. However, the area under the ROC curve values for each fasting-state parameter for predicting abnormal glucose tolerance were all between 0.5 and 0.7 in the study participants, which falls into the "less accurate" category for prediction. Conclusion: Fasting-state measurements of glucose and insulin alone are not enough to predict abnormal glucose tolerance in women with PCOS. A standard OGTT is needed to screen for impaired glucose tolerance and type 2 diabetes mellitus in women with PCOS. [ABSTRACT FROM AUTHOR]

Objective: To observe maternal and fetal outcome in pregnant patients with diabetes. Aim of my study is to access the poor fetal maternal outcome with diabetes so that we can focus more on early and proper disease and have fair management throughout the pregnancy. Study Design: Descriptive study. Setting: Independent University Hospital Faisalabad. Period: January 2017 to January 2019. Material & Methods: It is descriptive study, 200 patients were selected who were pregnant with diabetes. The patients included who were newly diagnosed by glucose challenge test (GCT) or by glucose tolerance test (GTT) or who already had elevated HbA1c. The study was started after acquiring permission from ethical committee. Result: The above study concluded that the adverse outcome with diabetes is increased in terms of congenital malformation, miscarriage, preterm labour, pre eclampsia and postpartum haemorrhage. There is dire need to concentrate more on early diagnosis and timely management of diabetes with pregnancy. The tenet of management is to maintain euglycemic state throughout pregnancy. Conclusion: Prepregnancy care was associated with improved glycemic control in early pregnancy and significant reductions in adverse pregnancy outcome (malformation, stillbirth, and neonatal death) and very premature delivery. However, prepregnancy care failed to have an impact on glycemic control in later pregnancy or to reduce the risk of macrosomia and preeclampsia. [ABSTRACT FROM AUTHOR]

Background/Aim. Insulin resistance occurs in approximately 60-80% of women with polycystic ovary syndrome (PCOS) and in 95% of obese women with PCOS. Previous studies have shown that the shape of the glucose curve obtained during an oral glucose tolerance test (OGTT) may be useful as a metabolic screening parameter and could give insight into the future risk of diabetes mellitus type II. The aim of this study was to determine the frequency of insulin resistance according to the Homeostasis model assessment of insulin resistance (HOMA-IR) and indirect assessment method of insulin resistance based on insulinemias during the oral glucose tolerance test (OGTT) (here in after "insulinemias during the OGTT"), as well as, frequency of glucose curve shapes (monophasic, biphasic, triphasic) in patients with PCOS. Also, the aim of research was testing the correlation between glucose curve shape and peak time of glucose during the OGTT with presence of insulin resistance in patients with PCOS. Methods. Patients were observed according to the following parameters: presence of insulin resistance, glucose curve shape and peak time of glucose and insulin during the OGTT. Results. The observed prevalence of insulin resistance in the PCOS group according to the HOMA-IR > 2.5 was 66.19% and according to insulinemias during the OGTT was 78.42%. The shape of the glucose curve was monophasic in 293 (70.26%), biphasic in 56 (13.43%) and triphasic in 68 (16.31%) of patients. There was statistically significant difference in the frequency of insulin resistance, according to glucose curve shape, only when it was defined by insulinemias during the OGTT (p = 0.005). Conclusion. According to results of the study, the most patients with PCOS have a monophasic shape of glucose curve. When we take frequency of insulin resistance in account, we notice approximately the same frequency in all types of curves, when it is defined by the HOMA-IR. On the other hand, when insulin resistance is defined by insulinemias during the OGTT, resistant patients with PCOS mostly have triphasic glucose curve shape. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is a prevalent and potentially serious condition which may put both mothers and neonates at risk. The current recommendation for diagnosis is the oral glucose tolerance test (OGTT). OGTT is a cumbersome test that is time consuming. So we want to test the utility of HbA1c as a screening tool in pregnancy for GDM. Aim: This study aimed to determine the usefulness of HbA1c test as a diagnostic tool for GDM as compared to the traditional criteria based on the OGTT. Materials and Methods: This study was done among 156 pregnant women of the age group of 20-40 years with gestational period of 24-28 weeks attending the Obstetrics and Gynecology OPD of Chettinad Hospital and Research Institute, Chengalpattu from July 2019 to December 2019. Results: The HbA1c values will be correlated with OGTT values using Pearson's correlation analysis and there was significant correlation between HbA1c and post glucose values (p value<0.05). ROC curve analysis done for HbA1c showed an area under the curve of 0.569. Conclusions: HbA1c may have a role in the diagnosis of GDM, but further studies among large populations might be required to approve the use of HbA1c instead of OGTT in the diagnosis of GDM. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of normoglycemia (NG), prediabetes and diabetes mellitus (DM) among patients having impaired random glucose (IRG) and establish the optimum cutoff of impaired random glucose for the diagnosis of diabetes and prediabetes. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Pathology Rawalpindi and Combined Military Hospital Quetta, from Nov 2016 to Nov 2018. Methodology: Healthy individuals of both genders undergoing investigation for diabetes mellitus were enrolled through non probability consecutive sampling while patients with diabetes, pregnant, hospitalized, using concomitant medications (corticosteroids, immunosuppressive, chemotherapy) and those unable to complete oral glucose tolerance test (OGTT) were excluded. Random plasma glucose (RPG) was determined and patients having impaired random glucose underwent oral glucose tolerance test, analysis being done on ADVIA1800® using hexokinase methodology. Results: Among the 280 study participants, majority were female {156 (57.5%) vs 124 (44.3%) male}. Mean age in male and female patients was 33.625 ± 3.34 years vs 35.150 ± 2.79 years with p-value 0.50 while mean IRG was 7.12 ± 1.47 vs 6.90 ± 1.17 mmol/L respectively with p-value 0.16 (statistically insignificant). Oral glucose tolerance test results showed NG in 61.8% (173), prediabetes in 24.6% (69) while diabetes was found in 38 (13.6%) patients. Optimal impaired random glucose cutoff value for diagnosis of diabetes was found 7.45 mmol/L (AUC 0.956 [CI 0.927-0.984], p<0.001, sensitivity 94.7%, specificity 74.4%), however, same cut-off value showed impaired random glucose as fair diagnostic test for prediabetes (AUC 0.771 [CI 0.717-0.825], p<0.001, sensitivity 72.5%, specificity 77.3%). Conclusion: Random plasma glucose helps diagnose patients at risk of prediabetes and diabetes who may otherwise not be identified. Impaired random glucose ≥7.45 mmol/L was found optimal to initiate definitive testing. [ABSTRACT FROM AUTHOR]

Aims: Conflicting results have been reported on the association of fat-free mass (FFM) and insulin resistance (IR). This study sought to test the association of FFM and IR by indexing FFM to avoid collinearity with fat mass. Methods: This cross-sectional study comprised 11,284 volunteers, aged 38–79 years. Body composition was assessed by multi-frequency bioelectrical impedance. FFM indexed to body surface area (FFMbsa) was calculated. IR and impaired glucose tolerance (IGT) were estimated with homeostatic model assessment of insulin resistance index (HOMA-IR) and 2-h oral glucose tolerance test (2h-OGTT), respectively. Results: Percent body fat decreased from the 1st to the 5th quintile of FFMbsa in both women (Eta2 = 0.166) and men (Eta2 = 0.133). In women, fasting insulin (Eta2 = 0.002), glucose (Eta2 = 0.006), and HOMA-IR (Eta2 = 0.007) increased slightly, but 2-h plasma glucose (2-h PG) was similar across the quintiles of FFMbsa. In men, fasting insulin and HOMA-IR were similar across the quintiles of FFMbsa, whereas fasting glucose increased slightly (Eta2 = 0.002) and 2-h PG decreased (Eta2 = 0.005) toward the highest quintile of FFMbsa. The higher the odds ratio for IR, the greater the FFMbsa in both sexes. Differently, FFMbsa did not affect the odds of IGT in women, while in men the odds ratio for IGT was lower in the 5th quintile compared with the 1st quintile of FFMbsa. Conclusions: Higher odds of IR associated with greater FFMbsa contrasted with lower odds of IGT associated with greater FFMbsa. IR may be misdiagnosed by HOMA-IR in adults with greater fat-free mass. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate glucose and insulin metabolism of cows receiving a supplementation of biotin (B 8), folic acid (B 9), and vitamin B 12 (B 12) during the transition period. According to a 2 × 2 factorial arrangement, 32 cows were randomly assigned to 9 incomplete blocks according to their previous 305-d milk yield. Within each block, cows were randomly assigned to 1 of the following levels of biotin from −27 to 28 d relative to the parturition: (1) no biotin supplement (B 8 −) or (2) 20 mg/d of dietary biotin (B 8 +). Within each level of biotin, the cows received either (1) 2-mL weekly intramuscular injections of saline 0.9% NaCl (B 9 B 12 −) or (2) 2.6 g/d of dietary folic acid and 2-mL weekly intramuscular injections of 10 mg of vitamin B 12 (B 9 B 12 +). An intravenous glucose tolerance test was performed at 25 d in milk. Baseline plasma glucagon, glucose, and nonesterified fatty acid concentrations did not differ among treatments. For B 9 B 12 + cows, baseline plasma insulin concentration and maximal glucose concentration after glucose administration were greater when also combined with biotin compared with no biotin combination, whereas there was no effect in B 9 B 12 − cows. There was no treatment effect on time to reach half-maximal glucose and insulin concentrations, glucose positive incremental area under the curve, and glucose and insulin clearance rates. Regarding insulin results, maximal plasma concentration and positive incremental area under the curve were respectively 51 and 74% greater for cows receiving the B 8 supplement than for cows who did not. Moreover, plasma nonesterified fatty acid concentration nadir tended to be reached later for B 8 cows. Insulin peak was reached earlier for cows in the group B 9 B 12 + than cows in B 9 B 12 −, regardless of B 8 supplementation. Under the current conditions, our results suggested that cows receiving a B 8 supplement had a reduced insulin sensitivity in early lactation. Insulin response was faster for B 9 B 12 + cows, but this was not translated into further improvements following the glucose administration challenge. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the glucose tolerance of the giant freshwater prawn, Macrobrachium rosenbergii , and investigate the underlying mechanisms that regulate glucose homeostasis. A glucose tolerance test was conducted by fasting the giant freshwater prawns for 24 h, followed by an intraperitoneal injection of 1 mg of glucose per gram of body weight. The content of glucose, trehalose (disaccharide composed of two glucose molecules), glycogen, triglyceride, and protein levels in the plasma, hepatopancreas and muscle, as well as the transcriptional level of metabolism-related genes, were examined. Besides, the potential damage caused by glucose injection was evaluated by histological examination. Results showed that plasma glucose and trehalose levels peaked at 0.5 and 1 h after injection, respectively, and returned to baseline levels between 2 and 4 h, indicating a rapid clearance of exogenous glucose. The content of trehalose, glycogen, and triglyceride in both the hepatopancreas and muscle significantly increased at a relatively high speed after the glucose load, while the protein levels remained unchanged. Transcriptional levels of a rate-limiting enzyme in gluconeogenesis (phosphoenolpyruvate carboxykinase), and several enzymes involved in catabolism of trehalose (trehalase), glycogen (glycogen debranching enzyme), and triglyceride (adipose triglyceride lipase), were observed to be downregulated immediately following the glucose injection. In contrast, glycolysis and anabolism were stimulated, as indicated by increased mRNA levels of glucokinase, trehalose-6-phosphate synthase, glycogen branching enzyme, and diacylglycerol acyltransferase. Furthermore, the glucose injection decreased the expression of crustacean hyperglycemic hormone (CHH) and increased the expression of insulin-like peptide 1 (ILP1), while insulin-like peptide 2 (ILP2) expression remained unchanged. No noticeable histopathological damage to the hepatopancreas and muscle was observed after glucose injection. These findings suggest that M. rosenbergii demonstrated a rapid clearance of exogenous glucose. A glucose load may induce the expression of ILP1 , stimulate glycolysis and the conversion of glucose to trehalose, glycogen, and triglyceride, while decreasing the expression of CHH and inhibiting gluconeogenesis to aid in the efficient regulation of glucose homeostasis in M. rosenbergii. • M. rosenbergii rapidly clears exogenous glucose within 4 h. • Glucose load boosts conversion to trehalose, glycogen, and lipids. • Glycolysis stimulation and gluconeogenesis inhibition aid to clear glucose load. • ILP 1 and CHH are crucial for glucose homeostasis. • Study unveils M. rosenbergii 's glucose tolerance and regulatory mechanisms. [ABSTRACT FROM AUTHOR]

The present study was conducted to investigate the effects of partial replacement of inorganic minerals (IM) with advanced chelated minerals (ACMS) in the starter diets of calves of different birth body weights (BBW) on metabolic indices and glucose tolerance test. Fifty-two Holstein calves were assigned to one of 4 treatments in a 2 × 2 factorial arrangement with two mineral sources (IM or ACMS) and two BBW (low or normal birth weight; LBW or NBW). Calves were weaned on day 56 and remained in the study until day 71 of the study. Blood samples for blood metabolite analysis were collected from the jugular vein on days 30, 60, and 70 of the study, and for hematology on days 36, 56, and 70. The results showed that the interaction of starter mineral sources (MS) and BBW affected the overall plasma concentration of β-hydroxybutyrate (BHB), with the highest value being obtained during treatment with LBW-ACMS. In addition, an interaction between MS and BBW was observed in plasma insulin concentrations, with LBW-IM calves having the lowest concentrations compared to the other treatments. Plasma albumin concentrations were lower in LBW calves than in NBW calves. In addition, NBW calves had greater plasma concentrations of glucose (day 60), insulin (day 30), BHB (day 30), and malondialdehyde (MDA; day 60 and the overall period) than LBW calves, while total antioxidant capacity (TAC) tended to reverse at day 70. The ACMS starter increased plasma glucose concentration at day 30 and tended to increase plasma BHB concentration in the overall period. In addition, plasma MDA concentrations were lower in calves receiving ACMS than in calves receiving IM during the overall period. NBW calves tended to have more eosinophils (day 70), basophils (day 36), and erythrocytes (RBC, day 56, and the overall period) in plasma than LBW calves. Regardless of BBW, feeding ACMS starter increased white blood cells (WBC), neutrophils, and eosinophils at day 70 and also tended to increase neutrophils during the overall period compared with the IM groups. Red blood cell concentrations were greater in calves fed ACMS than in calves fed IM during the overall period. Glucose tolerance test showed that basal glucose concentration and clearance rate (CR) of glucose tended to be lower and higher, respectively, in calves fed ACMS than in calves fed IM. ACMS supplementation increased basal concentrations and also tended to increase maximum insulin concentrations compared with IM supplementation. In addition, calves receiving ACMS starter had greater plasma insulin area under the curve (AUC) and CR compared with calves receiving IM. Feeding ACMS tended to increase the ratio CR of insulin to CR of glucose and increased the AUC of insulin to AUC of glucose compared with feeding IM. Overall, feeding ACMS resulted in a decrease in plasma MDA concentration and an increase in neutrophil concentration, suggesting that ACMS may improve immune function in these calves. A potential insulinotropic effect was noted with ACMS feeding, which was accompanied by an improvement in glucose control rate. This is likely due to higher bioavailability of chelated minerals such as Zn and should be further investigated. • Organic mineral may strengthen immune function in calves. • Supplementation with organic mineral was associated with a potential insulinotropic effect. • The plasma malondialdehyde was lower and red blood cell was greater in normal vs. low BW calves. [ABSTRACT FROM AUTHOR]

Background: To examine whether glycated hemoglobin (HbA1c) test would be a suitable screening tool for detecting high-risk subjects for diabetes compared to oral glucose tolerance test (OGTT) according to accompanied central obesity. Methods: In this prospective population-based cohort study, both OGTT and HbA1c tests were performed and continued every 2 years up to 12 years among individuals with non-diabetic state at baseline (aged 40 to 69 years, n=7,512). Incident diabetes was established by a doctor, HbA1c ≥6.5%, and/or fasting plasma glucose (FPG) ≥126 mg/dL, and/or 2-hour postprandial glucose (2hPG) level based on OGTT ≥200 mg/dL. Discriminative capacities of high HbA1c (≥5.7%) versus high 2hPG (≥140 mg/dL) for predicting incident diabetes were compared using Cox-proportional hazard regression and C-index. Results: During the median 11.5 years of follow-up period, 1,341 (17.6%) developed diabetes corresponding to an incidence of 22.1 per 1,000 person-years. Isolated high 2hPG was associated with higher risk for incident diabetes (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.56 to 5.17) than isolated high HbA1c (HR, 2.79; 95% CI, 2.40 to 3.26; P<0.05). In addition, high 2hPG provided better discriminatory capacity than high HbA1c (C-index 0.79 vs. 0.75, P<0.05). Meanwhile, in subjects with central obesity, the HR (3.95 [95% CI, 3.01 to 5.18] vs. 2.82 [95% CI, 2.30 to 3.46]) and discriminatory capacity of incident diabetes (C-index 0.75 vs. 0.75) between two subgroups became comparable. Conclusion: Even though the overall inferior predictive capacity of HbA1c test than OGTT, HbA1c test might plays a complementary role in identifying high risk for diabetes especially in subjects with central obesity with increased sensitivity. [ABSTRACT FROM AUTHOR]

Background: We investigated the changing patterns of insulin secretion and resistance and risk factors contributing to the development of post-transplant diabetes mellitus (PTDM) in kidney recipients under tacrolimus-based immunosuppression regimen during 1 year after transplantation. Methods: This was a multicenter prospective cohort study. Of the 168 subjects enrolled in this study, we analyzed a total 87 kidney transplant recipients without diabetes which was assessed by oral glucose tolerance test before transplantation. We evaluated the incidence of PTDM and followed up the index of insulin secretion (insulinogenic index [IGI]) and resistance (homeostatic model assessment for insulin resistance [HOMA-IR]) at 3, 6, 9 months, and 1 year after transplantation by oral glucose tolerance test and diabetes treatment. We also assessed the risk factors for incident PTDM. Results: PTDM developed in 23 of 87 subjects (26.4%) during 1 year after transplantation. More than half of total PTDM (56.5%) occurred in the first 3 months after transplantation. During 1 year after transplantation, insulin resistance (HOMA-IR) was increased in both PTDM and no PTDM group. In no PTDM group, the increase in insulin secretory function to overcome insulin resistance was also observed. However, PTDM group showed no increase in insulin secretion function (IGI). Old age, status of prediabetes and episode of acute rejection were significantly associated with the development of PTDM. Conclusion: In tacrolimus-based immunosuppressive drugs regimen, impaired insulin secretory function for reduced insulin sensitivity contributed to the development of PTDM than insulin resistance during 1 year after transplantation. [ABSTRACT FROM AUTHOR]

Background: We evaluated the diagnostic performance of HbA1c in diabetes and prediabetes and compared its efficiency in a model where HbA1c is used as a screening test. Material and method: Records of 945 patients who had undergone simultaneous OGTT and HbA1c were evaluated. American Diabetes Association (ADA) criteria were used for diagnosis. Agreement between OGTT and HbA1c was evaluated. Using OGTT as the gold standard, the diagnostic performance of HbA1c was evaluated with ROC analysis and optimum cutoffs were determined. Then, the group was rearranged as if HbA1c was performed first as a screening test with new cutoffs and if OGTT was performed for diagnosis among suspected individuals. Results: According to OGTT, 53 (5.6%) patients were diabetic and 247 were prediabetic; 18 of diabetics (34%) and 94 of prediabetics (38%) were diagnosed by HbA1c with present ADA cutoffs. The kappa coefficient for agreement between OGTT and HbA1c was 0.756 for diabetes and 0.336 for prediabetes. In ROC analysis, optimal HbA1c cutoff points were 38 mmol/mol (AUC 0.953) for diabetes and 35.5 mmol/mol (AUC 0.673) for prediabetes. In a new model after initial screening with HbA1c, 398 patients with HbA1c > 35.5 mmol/mol were taken for further OGTT. Fifty-three of diabetics (100%) and 199 of prediabetics (81%) were diagnosed. Prediabetic 48 patients (19%) were missed. Conclusion: HbA1c showed poor performance in diagnosis of diabetes and prediabetes. Instead, using HbA1c as a screening test with well-defined cutoff may offer practical and economical advantages greatly reducing the number of OGTTs required. [ABSTRACT FROM AUTHOR]