exudates and Glucose-Intolerance

The aim of this study was to compare the glycemic response of Caucasians and Asians to two disaccharides of different glycemic index (GI), and to examine if ethnic groups that showed the largest glycemic response to sucrose would benefit the most when it is replaced with isomaltulose. Forty healthy participants (10 Chinese; 10 Malays; 10 Caucasians; and 10 Indians) consumed beverages containing 50 g of sucrose or isomaltulose on two separate occasions using a randomized crossover design. Capillary blood glucose was measured in a fasted state and at 15, 30, 45, 60, 90, and 120 min after beverage ingestion. Glycemic response to sucrose was significantly higher in Malays compared to Caucasians (

Topics: Adult; Asian People; Beverages; Blood Glucose; Cross-Over Studies; Dietary Sucrose; Female; Glucose Intolerance; Glycemic Index; Humans; Hyperglycemia; Isomaltose; Malaysia; Male; Nutritive Sweeteners; Postprandial Period; Risk; Singapore; White People; Young Adult

We assessed the impact of adopting the 2013 World Health Organization (WHO) diagnostic criteria on the rates of gestational diabetes (GDM), pregnancy outcomes and identification of women at future risk of type 2 diabetes.. During a period when the 1999 WHO GDM criteria were in effect, pregnant women were universally screened using a one-step 75 g 2-h oral glucose tolerance test at 26-28 weeks' gestation. Women were retrospectively reclassified according to the 2013 criteria, but without the 1-h glycaemia measurement. Pregnancy outcomes and glucose tolerance at 4-5 years post-delivery were compared for women with GDM classified by the 1999 criteria alone, GDM by the 2013 criteria alone, GDM by both criteria and without GDM by both sets of criteria.. Of 1092 women, 204 (18.7%) and 142 (13.0%) were diagnosed with GDM by the 1999 and 2013 WHO criteria, respectively, with 27 (2.5%) reclassified to GDM and 89 (8.2%) reclassified to non-GDM when shifting from the 1999 to 2013 criteria. Compared to women without GDM by both criteria, cases reclassified to GDM by the 2013 criteria had an increased risk of neonatal jaundice requiring phototherapy (relative risk (RR) = 2.78, 95% confidence interval (CI) 1.32, 5.86); despite receiving treatment for GDM, cases reclassified to non-GDM by the 2013 criteria had higher risks of prematurity (RR = 2.17, 95% CI 1.12, 4.24), neonatal hypoglycaemia (RR = 3.42, 95% CI 1.04, 11.29), jaundice requiring phototherapy (RR = 1.71, 95% CI 1.04, 2.82), and a higher rate of abnormal glucose tolerance at 4-5 years post-delivery (RR = 3.39, 95% CI 2.30, 5.00).. Adoption of the 2013 WHO criteria, without the 1-h glycaemia measurement, reduced the GDM rate. Lowering the fasting glucose threshold identified women who might benefit from treatment, but raising the 2-h threshold may fail to identify women at increased risk of adverse pregnancy and future metabolic outcomes.. NCT01174875 . Registered 1 July 2010 (retrospectively registered).

Topics: Adult; Asian People; China; Diabetes, Gestational; Ethnicity; Female; Glucose Intolerance; Glucose Tolerance Test; Humans; India; Malaysia; Pregnancy; Prenatal Diagnosis; Prospective Studies; Singapore; World Health Organization; Young Adult

The prevalence of diabetes in Singapore is high. Screening to facilitate early detection and intervention has been shown to be cost-effective. Current clinical practice guidelines in Singapore recommend screening with fasting plasma glucose (FPG), followed by an oral glucose tolerance test (OGTT) in those with FPG 6.1-6.9 mmol/L. Glycated haemoglobin A1c (HbA1c) has robust stability at ambient temperature, and can be performed on non-fasted capillary blood samples, making it an attractive potential alternative for screening. However, limitations of HbA1c include differential performance in different races, and its performance as a screening test has not been well characterized in Asian populations. This study compares HbA1c and FPG as diabetes screening modalities in 3540 community-dwelling Singapore residents of Chinese, Malay and Indian race to detect diabetes mellitus diagnosed based on blood glucose (FPG ≥ 7.0 mmol/L, 2 hr OGTT ≥ 11.1 mmol/L). The area under the receiver-operating-characteristic curve (AUC) was higher for FPG compared to HbA1c in the overall population and age, race and age-race strata, but these differences were not statistically significant. HbA1c > = 7.0% identified 95% of individuals with diabetes mellitus, and the remainder had impaired glucose tolerance (IGT). HbA1c cut-off at 6.1% had better sensitivity (0.825) to FPG at 6.1 mmol/L. The positive predictive value of HbA1c at 6.1% was 40-50% in different age-race combinations with a negative predictive value of about 98%. If follow-up screening with FPG is used, a lower cut-off at 5.6 mmol/L is appropriate in identifying people with pre-diabetes, as about 85% of people with HbA1c 6.1-6.9% and FPG 5.6-6.9 mmol/L had IFG/IGT or diabetes in the study sample. HbA1c is an appropriate alternative to FPG as a first-step screening test, and the combination of Hba1c > = 6.1% and FPG > = 5.6 mmol/L would improve the identification of individuals with diabetes mellitus and prediabetes.

Topics: Adult; Aged; Asian People; Blood Cell Count; Blood Glucose; Cross-Sectional Studies; Diabetes Mellitus; Fasting; Female; Glucose Intolerance; Glucose Tolerance Test; Glycated Hemoglobin; Humans; Malaysia; Male; Mass Screening; Middle Aged; Prediabetic State; ROC Curve; Sensitivity and Specificity; Singapore

Women with previous gestational diabetes mellitus (PGDM) are at increased risk of future glucose intolerance. This study aimed to determine the prevalence of prediabetes and type 2 diabetes mellitus (T2DM), and the associated antenatal and historical risk factors among women with PGDM.. This was a cross-sectional study conducted at University Malaya Medical Centre, Kuala Lumpur, Malaysia. A 75-g 2-hour oral glucose tolerance test was performed in a cohort of multiethnic women with PGDM. Body mass index, waist and hip circumferences, fasting lipid profile and blood pressure were obtained. Data pertaining to the index gestational diabetes mellitus (GDM) were obtained from medical records and interviews.. 448 women were enrolled in the study. The prevalence of prediabetes and T2DM was 26.2% and 35.5%, respectively. On multinomial logistic regression analysis, fasting plasma glucose at diagnosis of index GDM and duration lapse after index GDM were shown to be significantly higher in women with isolated impaired fasting glucose (IFG), combined IFG/impaired glucose tolerance and T2DM, as compared to women with normal glucose tolerance (p < 0.05). 2-hour plasma glucose at diagnosis of index GDM was significantly higher only in women who progressed to T2DM when compared to those that remained normal glucose tolerant (p < 0.05).. In this study, duration lapse after index GDM, fasting plasma glucose and 2-hour plasma glucose at diagnosis of index GDM were important risk factors for early identification of women at high risk for future glucose intolerance. These may be useful for developing potential preventive strategies.

Topics: Adult; Blood Glucose; Body Mass Index; Cross-Sectional Studies; Diabetes, Gestational; Female; Glucose Intolerance; Glucose Tolerance Test; Humans; Malaysia; Postpartum Period; Prediabetic State; Pregnancy; Prevalence; Risk Factors

A total of 4428 adults (>18 years old) from 5 different selected regions in Peninsular and East Malaysia participated in this health survey. Using World Health Organization recommendations for body mass index (BMI), the prevalence of overweight and obesity were found to be 33.6% (95% CI= 32.2, 35.0) and 19.5% (95% CI= 18.3, 20.7) respectively. There were more females who were obese (22.5%, 95% CI=20.9, 24.0) compared to males (14.1%, 95% CI=12.3, 15.9). Highest prevalence of obesity were among the Indians (24.6%, 95% CI=20.3, 29.3), followed closely by the Malays (23.2%, 95% CI=21.6, 24.8%) and lowest prevalence was among the Chinese subjects (8.2%, 95% CI=6.2, 10.6). More than 43% of the 531 younger subjects (<30 years old) were either overweight (20%, 95% CI=16.6, 23.6) or obese (13.9%, 95% CI=11.1, 17.2%). All subjects who claimed to be non-diabetes were required to undergo 75 g glucose tolerance test. Compared to subjects with normal BMI (18.5-24.9 kg/m2), there was a 3- and 2-folds increase in the prevalence of newly diagnosed diabetes and impaired glucose tolerance respectively, among obese subjects (BMI>30 kg/m2) who initially claimed to have no diabetes. This study highlights a need for more active, inter-sectoral participation advocating a health-promoting environment in order to combat obesity in this country.

Topics: Adult; Aged; Body Mass Index; Cross-Sectional Studies; Diabetes Mellitus; Ethnicity; Female; Glucose Intolerance; Humans; Malaysia; Male; Middle Aged; Obesity; Odds Ratio; Overweight; Sex Factors

To determine the prevalence of prediabetes and diabetes among rural and urban Malaysians.. This cross-sectional survey was conducted among 3,879 Malaysian adults (1,335 men and 2,544 women). All subjects underwent the 75-g oral glucose tolerance test (OGTT).. The overall prevalence of prediabetes was 22.1% (30.2% in men and 69.8% in women). Isolated impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were found in 3.4 and 16.1% of the study population, respectively, whereas 2.6% of the subjects had both IFG and IGT. Based on an OGTT, the prevalence of newly diagnosed type 2 diabetes was 12.6% (31.0% in men and 69.0% in women). The prediabetic subjects also had an increased prevalence of cardiovascular disease risk factors.. The large proportion of undiagnosed cases of prediabetes and diabetes reflects the lack of public awareness of the disease.

Topics: Adult; Age of Onset; Blood Glucose; Cardiovascular Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2; Fasting; Female; Glucose Intolerance; Glucose Tolerance Test; Humans; Malaysia; Male; Middle Aged; Prediabetic State; Prevalence; Risk Factors; Rural Population; Urban Population

Type II diabetes patients have increased risk of macrovascular complications compared with the general population. Arterial stiffness is considered as an independent predictor of macrovascular events. This study investigated arterial stiffness in newly diagnosed never treated diabetes and impaired glucose tolerance (IGT) patients without any traditional cardiovascular diseases (CVD) risk factors. After preliminary screening of 1620 individuals, 30 diabetic and 30 IGT patients were recruited and compared with age- and sex-matched 30 normoglycaemic subjects. The subjects were newly diagnosed, never treated, normotensive, non-obese, non-hyperlipidaemic and non-smoker. Haemodynamic variables, pulse wave velocity (PWV) and augmentation index (AI) were measured. The PWV was significantly higher in diabetic patients (10.37+/-2.64m/s vs. 8.70+/-1.29m/s; p=0.035) and was of borderline significant in IGT subjects (9.54+/-1.56m/s vs.8.70+/-1.29m/s, p=0.078) compared to normoglycaemic individuals. Augmentation index was higher of borderline significant in diabetic (134.53+/-17.32% vs. 129.17+/-11.18%, p=0.055) and IGT patients (132.02+/-16.11% vs. 129.17+/-11.18%, p=0.059) compared to normoglycaemic individuals. The study demonstrated that newly diagnosed never treated diabetic patients without any CV complications had early manifestation of macrovascular diseases as evident by increased arterial stiffness. The findings also revealed early manifestations of preclinical vasculopathy and potentially increased risk for development of macrovascular diseases at an early age in diabetic patients.

Topics: Adult; Aged; Blood Pressure; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Female; Glucose Intolerance; Glucose Tolerance Test; Heart Rate; Humans; Lipids; Malaysia; Male; Mass Screening; Middle Aged; Risk Factors; Surveys and Questionnaires; Vascular Diseases

Bimodality in blood glucose (BG) distribution has been demonstrated in several populations with a high prevalence of diabetes and obesity. However, other population studies had not found bimodality, thus casting doubt on its universality. We address this question in four ethnic populations-namely Malay, Chinese, Indian, and the indigenous people of Borneo.. A national health survey was conducted in Malaysia in 1996. A total of 18,397 subjects aged > or =30 years had post-challenge BG measurements taken. To test whether BG was consistent with a bimodal distribution, we fitted unimodal normal and skewed distribution as well a mixture of two normal distributions to the data by age and ethnic groups.. Age-specific prevalence of diabetes varied from 1.3 to 26.3%. In all ethnic/age groups, the bimodal model fitted the log BG data better (likelihood ratio tests, all P values <0.001).. Bimodality in BG distribution is demonstrable even in populations with a very low prevalence of diabetes and obesity. Previous studies that found unimodality had failed to detect the second mode because of inadequate sample size, bias due to treatment of subjects with known diabetes, and inclusion of subjects with type 1 diabetes in the sample. Bimodality implies that diabetes is a distinct entity rather than an arbitrarily defined extreme end of a continuously distributed measurement.

Topics: Adult; Blood Glucose; Body Mass Index; Diabetes Mellitus; Ethnicity; Female; Glucose Intolerance; Health Surveys; Humans; Incidence; Malaysia; Male; Middle Aged; Obesity; Reference Values; Sex Characteristics

We studied insulin resistance and beta-cell function with reference to ethnic group, glucose tolerance and other coronary artery disease risk factors in a cross section of the Singapore population which comprises Chinese, Malays and Asian Indians. 3568 individuals aged 18-69 were examined. Blood pressure, anthropometric data, blood lipids, glucose and insulin were assayed in the fasting state. Glucose and serum insulin were measured 2 h after an oral glucose challenge. Insulin resistance and beta-cell function were calculated using homeostasis model assessment. Asian Indians had higher insulin resistance than Chinese or Malays. Impaired glucose tolerance (IGT) and diabetes mellitus (DM) were associated with greater insulin resistance and impaired beta-cell function compared to normal glucose tolerance (NGT). Insulin resistance was positively correlated with blood pressure in women and total cholesterol, LDL cholesterol and triglyceride in both men and women. It was negatively correlated with HDL cholesterol and LDL/apolipoprotein B ratio. beta-cell function showed no significant correlations with the cardiovascular risk factors studied. It appears that both impaired beta-cell function and insulin resistance are important for the development of hyperglycemia whereas insulin resistance alone seems more important in the development of coronary artery disease as it correlates with several known coronary artery disease risk factors.

Topics: Adolescent; Adult; Age Factors; Aged; Blood Glucose; Blood Pressure; China; Coronary Disease; Cross-Sectional Studies; Diabetes Mellitus; Ethnicity; Female; Glucose Intolerance; Glucose Tolerance Test; Health Surveys; Humans; India; Insulin Resistance; Islets of Langerhans; Malaysia; Male; Middle Aged; Racial Groups; Risk Factors; Sex Characteristics; Singapore

Topics: Adult; Asian People; Blood Glucose; Brunei; Female; Glucose Intolerance; Glucose Tolerance Test; Humans; Malaysia; Male; Middle Aged; Prevalence

Topics: Adolescent; Adult; Age Distribution; Aged; Aging; Asian People; Confidence Intervals; Diabetes Mellitus; Diabetes Mellitus, Type 2; Female; Glucose Intolerance; Glucose Tolerance Test; Guyana; Humans; India; Linear Models; Malaysia; Male; Middle Aged; Odds Ratio; Prevalence; Risk Factors; Sex Distribution; Survival Analysis; White People