1-h ogtt e rischio cardio-metabolico. lo studio catanzaro ... - sid … ogtt studio catameris...
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1-h OGTT e rischio cardio-metabolico.
Lo studio CAtanzaro MEtabolic RIsk factors
(CATAMERI)
Giorgio Sesti
Università “Magna Graecia” di CatanzaroDiapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Adapted from: American Diabetes Association. Diabetes Care.37 Suppl 1:S81-90., 2014
Normal
Diabetes Mellitus
PrediabetesImpaired Glucose
Tolerance
Fasting PlasmaGlucose
126 mg/dL
2-hour Plasma Glucose On OGTT
200 mg/dL
140 mg/dL
Any abnormality must be repeated and confirmed on a separate day
The diagnosis of diabetes can also be made based on unequivocal symptoms and a random glucose >200 mg/dL
100 mg/dL
PrediabetesImpaired Fasting
Glucose
What is Prediabetes?
Normal
Diabetes Mellitus
Hemoglobin A1C
6.5%
5.7%
Prediabetes
Normal
Diabetes Mellitus
Diapositiva preparata da Giorgio Sesti e
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iabetologia.
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Classification of glucose tolerance states - ADA
State FPG
(mg/dl)
2-h PG OGTT
(mg/dl)
HbA1c
(%)
NGT <100 <140 <5.7
Isolated IFG 100-125 <140 <5.7
Isolated IGT <100 140-199 <5.7
Isolated A1c <100 <140 5.7-6.4
Combined IFG/IGT
100-125 140-199 <5.7
CombinedIFG/A1c
100-125 <140 5.7-6.4
Combined
IGT/A1c
<100 140-199 5.7-6.4
Combined
IFG/IGT/A1c
100-125 140-199 5.7-6.4Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Venn diagram representing the percentage of elevated A1c, IGT, and IFG in an Italian cohort with dysglycemia (n=420)
19.0%
11.4%
10.2%
9.5%
IGT19.0%
IFG13.3%
A1c17.4%
Marini MA et al. Diabetes Care 35:1144–1149, 2012
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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50
70
90
110
130
150
170
190
210
230
250
0 30 60 90 120
NGT 1h-low
NGT 1h-high
Isolated IFG
IGT
Time (min)
Pla
sm
a g
luco
se
co
nce
ntr
ati
on
(mg
/d
l)
x
Fiorentino TV et al. J Clin Endocrinol Metab 2015
Plasma glucose levels during OGTT in subjects with NGT 1h-low, NGT 1h-high, isolated IFG and IGT
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Abdul-Ghani MA et al. Diabetes Care 31:1650–1655, 2008
Incidence of type 2 diabetes according to 1-hour post-load plasma glucose
(>155 mg/dl) in the San Antonio Heart Study (n=1610)
Incidence of type 2 diabetes according to 1-hour post-load plasma glucose (>155 mg/dl) in the Botnia Study
(n=2442)
Abdul-Ghani MA et al. Diabetes Care 32:281–286, 2009
NGT1-h PG<155
NGT1-h PG>155
NGT1-h PG<155
NGT1-h PG>155Diapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
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Abdul-Ghani MA et al. Diabetes Care 30:1544–1548, 2007
Area under the ROC curve for various predictive parameters for future development of T2DM
Parameter ROC Cutoff Sensitivity Specificity
Fasting plasma glucose 0.75
Plasma glucose at 30 min 0.77
Plasma glucose at 60 min 0.84 155 0.75 0.79
Plasma glucose at 120 min 0.79 140 0.51 0.92
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Cox regression analyses adjusted for age, gender and BMI at baseline comparing the risk of NGT 1h-high, isolated IFG and IGT to develop T2DM
HR
NGT1-h PG<155
(n=174)
NGT1-h PG>155
(n=60)
IGT(n=86)
Isolated IFG(n=72)
1.06-15.26
2.09-21.24
0.44-8.29
Fiorentino TV et al. J Clin Endocrinol Metab100:3744-3751, 2015
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Study NGT 1-hPG<155
NGT 1-h PG>155
OddsRatio
95% CI
San Antonio
Heart Study
33/250 32/1117 5,15 3,10 to 8,56
Botnia Study 15/191 12/946 6,63 3,05 to 14,41
Asian Indians 98/502 50/677 3,04 2,11 to 4,37
CATAMERI 10/60 5/170 6,60 2,15 to 20,21
Total (random effects)
156/1003 99/2910 4,51 2,97 to 6,85
Test for Heterogeneity for 4 studies:P= 0,1313, I2= 46,67%
Meta-analysis of four prospective studies
Meta-analysis
1 10 100
Odds ratio
San Antonio Heart Study
Botnia Study
Asian Indians
CATAMERI
Total (fixed effects)
Total (random effects)
Meta-analysis
1 10 100
Odds ratio
San Antonio Heart Study
Botnia Study
Asian Indians
CATAMERI
Total (fixed effects)
Total (random effects)
OR: 4.5195% CI 2.97-6.85;
P <0.001
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Fiorentino TV et al. Nutr Metab Cardiovasc Dis 2016
NGT(n=1658)
IFG/IGT combo
(n=302)
Isolated IFG
(n=401)
Isolated IGT
(n=397)
New T2DM(n=242)
%
Proportion of subjects with 1-h PG >155mg/dl across dysglycemic conditions.The CATAMERI study (n=3020)
1-h PG >155mg/dl
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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AGENDA
Clinical characteristics of NGT 1h-high individuals:
insulin sensitivity and β-cell function,
classical and non classical CV risk factors,
hepatic steatosis,
CV organ damage, and risk of CVD.
Diapositiva preparata da Giorgio Sesti e
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iabetologia.
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Insulin sensitivity is reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl or IFG
P<0.05P=0.02
Le
an
glu
co
se
dis
po
sa
l (m
g x
Kg
-1 F
FM
x m
in-1
)
P values refer to results after analyses with adjustment for age, gender, and BMI
NGT1-h PG<155
(n=344)
NGT1-h PG>155
(n=101)
IGT(n=80)
Isolated IFG
(n=70)
Fiorentino TV et al. J Clin Endocrinol Metab100:3744-3751, 2015
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Insulin secretion is reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl or IFG
P<0.05P<0.0001
Insu
lin
og
en
ic i
nd
ex
(
Ins
30/
Glu
c3
0)
P values refer to results after analyses with adjustment for age, gender, and BMI
NGT1-h PG<155
(n=344)
NGT1-h PG>155
(n=101)
IGT(n=80)
Isolated IFG
(n=70)
Fiorentino TV et al. J Clin Endocrinol Metab100:3744-3751, 2015
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Disposition index is reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl or IFG
P<0.001P<0.0001
P values refer to results after analyses with adjustment for age, gender, and BMI
NGT1-h PG<155
(n=344)
NGT1-h PG>155
(n=101)
IGT(n=80)
Isolated IFG
(n=70)
Dis
po
sit
ion
ind
ex
(In
s3
0/
Glu
c3
0x
M
FFM
)
Fiorentino TV et al. J Clin Endocrinol Metab100:3744-3751, 2015
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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P<0.0001 P<0.05
Insulin sensitivity is reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl stratified by HbA1c
HbA1c <5.7% 1-h PG<155
(n=198)
HbA1c <5.7% 1-h PG>155
(n=95)
HbA1c 5.7–6.4%1-h PG>155
(n=41)
HbA1c 5.7–6.4%1-h PG<155
(n=32)
P values refer to results after analyses with adjustment for age, gender, and BMI
Le
an
glu
co
se
dis
po
sa
l (m
g x
Kg
-1 F
FM
x m
in-1
)
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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P<0.0001 P<0.0001
Insulin secretion is reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl stratified by HbA1c
HbA1c <5.7% 1-h PG<155
(n=602)
HbA1c <5.7% 1-h PG>155
(n=418)
HbA1c 5.7–6.4%1-h PG>155
(n=292)
HbA1c 5.7–6.4%1-h PG<155
(n=119)
P values refer to results after analyses with adjustment for age, gender, and BMI
Insu
lin
og
en
ic i
nd
ex
(
Ins
30/
Glu
c3
0)
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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P<0.0001
P<0.0001
Disposition index is reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl stratified by HbA1c
HbA1c <5.7% 1-h PG<155
(n=602)
HbA1c <5.7% 1-h PG>155
(n=418)
HbA1c 5.7–6.4%1-h PG>155
(n=292)
HbA1c 5.7–6.4%1-h PG<155
(n=119)
P values refer to results after analyses with adjustment for age, gender, and BMI
Dis
po
sit
ion
in
de
x(
Ins
30/
Glu
c3
0x
M
ats
ud
a i
nd
ex
)
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Insulin clearance is reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
NGT1-h PG<155
(n=278)
P=0.006
P=0.01
NGT1-h PG>155
(n=96)
IGT(n=64)
Marini MA. et al. PLoS One 8: e77440, 2013
Insu
lin
cle
ara
nce
(m
l/m
in x
m2)
P values refer to results after analyses with adjustment for age, gender, and BMI
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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2h-Insulin levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
NGT1-h PG<155
(n=278)
P<0.001
P<0.0001
NGT1-h PG>155
(n=96)
IGT(n=64)
Marini M.A. et al. PLoS One 8: e77440, 2013
2-h
in
su
lin
(p
mo
l/l)
P values refer to results after analyses with adjustment for age, gender, and BMI
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Insulin clearance correlates with 2h insulin levels
Marini M.A. et al. PLoS One 8: e77440, 2013
Insulin clearance (ml/min x m2)
r = -26; P<0.0001
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Correlation between minutes spent in hypoglycemia and 2-h post-load insulin levels
Min
ute
s p
er
da
y i
n h
yp
og
lyce
mia
2-h Insulin levels (µU/ml)
r =0.27P=0.02
Castaldo E. et al. PLoS ONE 6 (12): e28312, 2011
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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SGLT1
β-actin
SG
LT
1 p
rote
in l
eve
ls(%
ove
r N
GT
1h
-lo
w)
NGT1-h PG<155
(n=12)
NGT1-h PG>155
(n=12)
IGT(n=11)
DM2(n=9)
Intestinal SGLT1 protein levels are increased in subjects with post-load hyperglycemia
P=0.003
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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L’espressione di SGTL1 non correla con la glicemia a digiuno
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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L’espressione di SGTL1 correla con la glicemia a 1 ora post-carico
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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L’espressione di SGTL1 non correla con la glicemia a 2 ore post-carico
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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GLU
T2
pro
tein
le
ve
ls
(% o
ve
r N
GT
1h
-lo
w)
GLUT2
β-actin
IGT(n=11)
DM2(n=9)
Intestinal GLUT2 expression is increased in subjects with type 2 diabetes
NGT1-h PG<155
(n=12)
NGT1-h PG>155
(n=12)
P=0.007
Sesti et al.unplublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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AGENDA
Clinical characteristics of NGT 1h-high individuals:
insulin sensitivity and β-cell function,
classical and non classical CV risk factors,
hepatic steatosis,
CV organ damage, and risk of CVD.
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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HDL levels are reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
HD
L(m
g/d
L)
NGT1-h PG<155
(n=295)
P=0.006
P=0.02
NGT1-h PG>155
(n=109)
IGT(n=202)
Isolated IFG
(n=104)
Sesti et al. BMJ Open Diab Res Care 2:e000016, 2014
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Triglycerides levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
Tri
gly
ce
rid
es
(mg
/d
L)
NGT1-h PG<155
(n=295)
P<0.0001
P=0.05
NGT1-h PG>155
(n=109)
IGT(n=202)
Isolated IFG
(n=104)
Sesti et al. BMJ Open Diab Res Care 2:e000016, 2014
P=0.02
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Apolipoprotein B levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
Ap
oli
po
pro
tein
B
(mg
/d
L)
NGT1-h PG<155
(n=510)
P=0.02
NGT1-h PG>155
(n=211)
New T2DM(n=58)
IGT(n=233)
Sesti et al.unplublished
P=0.05
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Apolipoprotein B/ Apolipoprotein A1 ratio is increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
Ap
oli
po
pro
tein
B/
Ap
oli
po
pro
tein
A1
NGT1-h PG<155
(n=510)
P=0.02
NGT1-h PG>155
(n=211)
New T2DM(n=58)
IGT(n=233)
Sesti et al.unplublished
P=0.04
P values refer to results after analyses with adjustment for age, gender, and BMI
P=0.04
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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LDL cholesterol/Apolipoprotein B ratio is increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
LD
L/A
po
lip
op
rote
in B
rati
o
NGT1-h PG<155
(n=510)
P=0.04
NGT1-h PG>155
(n=211)
New T2DM(n=58)
IGT(n=233)
Sesti et al.unplublished
P=0.006
P values refer to results after analyses with adjustment for age, gender, and BMI
P=0.003
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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hsCRP levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl - the CATAMERI study
hsC
RP
(m
g/l)
NGT1-h PG<155
(n=497)
P<0.0001
P<0.0001
NGT1-h PG>155
(n=154)
IGT(n=290)
Sesti et al. Acta Diabetol 51:927-93 , 2014
Isolated IFG
(n=158)
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Complement C3 levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl - the CATAMERI study
Co
mp
lem
en
t C
3 (
g/l)
P<0.0001
P<0.001
NGT1-h PG<155
(n=497)
NGT1-h PG>155
(n=154)
IGT(n=290)
Isolated IFG
(n=158)
Sesti et al. Acta Diabetol 51:927-93 , 2014
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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ESR levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl - the CATAMERI study
ES
R (
mm
/h
)P=0.002
P=0.04
NGT1-h PG<155
(n=497)
NGT1-h PG>155
(n=154)
IGT(n=290)
Isolated IFG
(n=158)
Sesti et al. Acta Diabetol 51:927-93 , 2014
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Fibrinogen levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl - the CATAMERI study
Fib
rin
og
en
(m
g/d
l)P=0.02
P=0.01
NGT1-h PG<155
(n=497)
NGT1-h PG>155
(n=154)
IGT(n=290)
Isolated IFG
(n=158)
Sesti et al. Acta Diabetol 51:927-93 , 2014
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Uric acid levels are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
UA
(m
g/d
L)
NGT1-h PG<155
(n=488)
P<0.0001
NGT1-h PG>155
(n=191)
IGT(n=214)
Perticone F. et al. Diabetes Care 35:153–157, 2012
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Fructose consumption is increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
Fru
cto
se
(g
)
NGT1-h PG<155
(n=188)
P<0.0001
NGT1-h PG>155
(n=94)
Sciacqua A et al. Nutr Metab Cardiovasc Dis 24, 547-553, 2014
Dietary intake was quantified by a semiquantitative food frequency questionnaire (FEQ) validated in the European Investigation into Cancer and Nutrition (EPIC) study.
Diapositiva preparata da Giorgio Sesti e
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iabetologia.
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Sciacqua A et al. Int J Cardiol 197:271-275, 2015
Uric acid is an independent predictor of cardiovascular events in post-menopausal women (n=645)
*3° tertile vs. 1° tertile
HR=1.903, P=0.021
*Multivariable Cox regression model including age, smoking, LDLcholesterol, pulse pressure, fasting glucose and BMI
Diapositiva preparata da Giorgio Sesti e
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iabetologia.
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Plasma IGF-1 levels are reduced in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
IGF-1
(n
g/m
l)
NGT1-h PG<155
(n=521)
P<0.0001
P<0.0001
NGT1-h PG>155
(n=243)
IGT(n=263)
Perticone F et al. Eur J Clin Invest 42: 1325–1331, 2012
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iabetologia.
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1st quartile(n=141)
2nd quartile(n=140)
4° quartile(n=139)
3° quartile(n=142)
P values refer to results after analyses with adjustment for age, gender, and BMI
Risk of developing type-2 diabetes by baseline IGF-I concentrations for 567 nondiabetic individuals, The CATAMERI Study (mean follow-up 5,7 years)
IGF-1
(n
g/m
l)
Sesti G. unpublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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1st quartile(n=141)
2nd quartile(n=140)
4° quartile(n=139)
3° quartile(n=142)
Ha
za
rd r
ati
o
P values refer to results after analyses with adjustment for age, gender, and BMI
Risk of developing type-2 diabetes by baseline IGF-I concentrations for 567 nondiabetic individuals, The CATAMERI Study (mean follow-up 5,7 years)
CI95%( 1.6-16.7)
CI95%(1.1-11.4)
CI95%(1.2-12.7)
Sesti G. unpublished
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Svensson,J et al. J Clin Endocrinol Metab 97: 4623–4630, 2012
Kaplan-Meier survival curves for CVD mortality by serum IGF-I concentration
Quintile 1
Quintile 5
Quintile 2-4
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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AGENDA
Clinical characteristics of NGT 1h-high individuals:
insulin sensitivity and β-cell function,
classical and non classical CV risk factors,
hepatic steatosis,
CV organ damage, and risk of CVD.
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Sesti et al. BMJ Open Diab Res Care 2:e000016, 2014
NGT1-h PG<155
(n=295)
NGT1-h PG>155
(n=109)
IGT(n=202)
Isolated IFG
(n=104)
ALT
(U
I/l)
Liver enzymes are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
P<0.0001
P=0.03
P values refer to results after analyses with adjustment for age, gender, and BMIDiapositiv
a preparata da Giorgio Sesti e ceduta alla Società Ita
liana di Diabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Sesti et al. BMJ Open Diab Res Care 2:e000016, 2014
NGT1-h PG<155
(n=295)
NGT1-h PG>155
(n=109)
IGT(n=202)
Isolated IFG
(n=104)
Liver enzymes are increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
P<0.0001
P=0.03
P values refer to results after analyses with adjustment for age, gender, and BMI
GG
T (
UI/
l)
Diapositiva preparata da Giorgio Sesti e
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iabetologia.
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Liver IR index is increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl - the CATAMERI study
Liv
er
IR i
nd
ex
The liver IR index was calculated using the formula: -0.091 + (log insulin AUC 0-120 min × 0.400) + (log fat mass % × 0.346) -(log HDL Cholesterol × 0.408) + (log BMI × 0.435)
Sesti et al. BMJ Open Diab Res Care 2:e000016, 2014
NGT1-h PG<155
(n=295)
NGT1-h PG>155
(n=109)
IGT(n=202)
Isolated IFG
(n=104)
P<0.0001
P<0.0001
P=0.01
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Logistic regression analyses adjusted for age, and gender of the association between study group subjects and hepatic steatosis
OR
Sesti et al. BMJ Open Diab Res Care 2:e000016, 2014
NGT1-h PG<155
(n=295)
NGT1-h PG>155
(n=109)
IGT(n=202)
Isolated IFG
(n=104)
95% CI 1.55 -3.46
95% CI 1.07 -2.71
95% CI 0.69-1.80
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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AGENDA
Clinical characteristics of NGT 1h-high individuals:
insulin sensitivity and β-cell function,
classical and non classical CV risk factors,
hepatic steatosis,
CV organ damage, and risk of CVD.
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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A higher proportion of NGT subjects with 1-h PG>155 mg/dl have stage 2 or stage 3 disease as compared with individuals with 1-h PG<155 mg/dl
% P=0.002
1 2 3 1 2 3
Succurro E. et al. Clin J Am Soc Nephrol 5: 1922–1927, 2010
Stages of chronic kidney disease
NGT1-h PG<155
(n=518)
NGT1-h PG>155
(n=250)
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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IMT is increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
IMT
(mm
)
NGT1-h PG<155
(n=231)
P=0.006
NGT1-h PG>155
(n=89)
IGT(n=80)
Succurro E. et al. Atherosclerosis 207 : 245–249, 2009
P=0.03
Diapositiva preparata da Giorgio Sesti e
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iabetologia.
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Pulse wave velocity is increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
Pu
lse
wa
ve
ve
locit
y(m
/s)
NGT1-h PG<155
(n=278)
P<0.0001
NGT1-h PG>155
(n=146)
IGT(n=160)
Sciacqua A. et al. Plos ONE 7, e44470, 2012
P<0.0001
Diapositiva preparata da Giorgio Sesti e
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iabetologia.
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Left ventricular mass is increased in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl - the CATAMERI study
LV
MI
(g/m
2)
NGT1-h PG<155
(n=356)
P<0.002
P=0.002
NGT1-h PG>155
(n=158)
IGT(n=168)
Sciacqua A. et al. Diabetes Care 34:1406–1411, 2011
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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Impairment of left ventricular diastolic function in NGT subjects with 1-h PG >155mg/dl as compared with individuals with 1-h PG<155 mg/dl
E-t
o-A
ra
tio
NGT1-h PG<155
(n=90)
P<0.0001
NGT1-h PG>155
(n=30)
IGT(n=26)
Sciacqua A. et al. Diabetes Care 34:2291–2296, 2011
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]
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Total mortality is increased in subjects with 1-h PG >161 mg/dl as compared with individuals with 1-h PG<161 mg/dl - the Helsinki Businessmen Study
Ha
za
rd R
ati
os
ad
juste
d f
or
ag
e a
nd
sm
ok
ing
1-h Glucose <161mg/dL and BMI <25
P<0.001
P<0.001
1-h Glucose >161mg/dL and BMI <30
1-h Glucose >161mg/dL and BMI >30
Strandberg TE et al. Arch Intern Med 171: 941-3, 2011
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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2h PG <140 and 1-h PG<155
(n=1112)
2h PG <140 1-h PG>155
(n=449)
2h PG 140-199 and1-h PG>155
(n=301)
2h PG 140-199 and1-h PG<155
(n=83)
P values refer to results after analyses with adjustment for sex, age, smoking, BMI, systolic and diastolic blood pressure and fasting blood glucose
HR
(9
5%
CI)
Bergman M et al. Diabet. Med. 2016
Total mortality is increased in subjects with 1-h PG >155 mg/dl as compared with individuals with 1-h PG<155 mg/dl - the Israel Study of Glucose
Intolerance, Obesity and Hypertension (n= 1942)
(1.12 to 1.56)
(1.20 to 2.15)
(1.54 to 2.23)
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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NGT 1h-high individuals may represent an intermediate state of glucose
intolerance between NGT and type 2 diabetes characterized by insulin
resistance, and reduced β-cell function, the two main pathophysiological
defects responsible for the development of type 2 diabetes.
NGT 1h-high individuals exhibit a worse cardio-metabolic risk profile.
A high level of 1hPG during OGTT may be helpful in the identification of
subjects with normal glucose tolerance, but at increased risk for T2DM
and CVD.
Summary
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
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THANK YOU !
Now it’s time for discussion.
Sesti lecture
Diapositiva preparata da Giorgio Sesti e
ceduta alla Società Italiana di D
iabetologia.
Per avere una versione originale si prega di scrivere a [email protected]