Background
Diabetes and periodontitis are chronic non‐communicable diseases independently associated with mortality and have a bidirectional relationship.
Aims
To update the evidence for their ...epidemiological and mechanistic associations and re‐examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C).
Epidemiology
There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes.
Mechanisms
Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)‐1‐β, tumour necrosis factor‐α, IL‐6, receptor activator of nuclear factor‐kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll‐like receptor (TLR) 2/4 expression.
Interventions
Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27–0.48% after 3 months, although studies involving longer‐term follow‐up are inconclusive.
Conclusions
The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.
Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship.
To update the evidence for their epidemiological and ...mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C).
There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes.
Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression.
Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27–0.48% after 3 months, although studies involving longer-term follow-up are inconclusive.
The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.
•A 1-hour plasma glucose (1-h PG) ≥ 155 mg/dl (8.6 mmol/L) during an oral glucose tolerance test (OGTT) can identify normal glucose tolerant (NGT) individuals at high-risk for type 2 diabetes ...(T2D).•A 1-hour, non-fasting, 50 g Glucose Challenge Test (GCT) performed during a routine health care visit has potential for practical screening of glucose disorders.•The shape of the glucose curve reflects the cumulative effect of insulin sensitivity and response on glucose concentrations with prospective studies warranted to evaluate its prognostic utility.•The continuous glucose monitor (CGM) has facilitated insight into the pathophysiology of prediabetes and phenotypes of T2D and holds promise for detecting glycemic disorders.•Metabolomic profiling including amino acids, lipids, carbohydrates and other metabolites may be useful for early diagnosis of glycemic disorders.•Non-classical markers for assessing glycemic disorders including fructosamine, glycated albumin, and 1,5-anhydroglucitol that evaluate shorter periods of glucose exposure than HbA1c have potential use as adjunctive tools.
Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity.
Definition of prediabetes Buysschaert, Martin; Bergman, Michael
The Medical clinics of North America,
03/2011, Volume:
95, Issue:
2
Journal Article
Peer reviewed
Diabetes evolves through prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Subjects with IFG/IGT have an increased risk of developing diabetes and a ...higher prevalence of cardiovascular disease than normoglycemic individuals. However, there is considerable evidence that glucose levels lower than those meeting the current definition of prediabetes may also be associated with similar concerns, particularly in high-risk individuals in accordance with a continuous glycemic risk perspective. Therefore, an absolute definition of prediabetes may underestimate the implications and vastness of this disorder. Research should focus on these aspects to minimize the risk of developing a preventable condition.
Diagnosis of type 2 diabetes and prediabetes is mandatory. Chronic hyperglycemia in diabetes is associated with long-term micro- and macrovascular as well as with neurological complications. ...Prediabetes predisposes patients to develop diabetes and macrovascular disease. Diagnosis of diabetes is established on (at least) one of the following criteria: a fasting plasma glucose ≥ 126 mg/dl (7.0 mmol/l), a casual plasma glucose ≥ 200 mg/dl (11.1 mmol/l) in the presence of symptoms, a 2-h plasma glucose during the 75-g oral glucose tolerance test (OGTT) ≥ 200 mg/dl (11.1 mmol/l) and/or an HbA1c ≥ 6.5%. Prediabetes is defined by the Position Statement of the American Diabetes Association as a fasting plasma glucose between 100 and 125 mg/dl (5.6 - 6.9 mmol/l) a condition called Impaired Fasting Glucose and/or by a 2-h plasma glucose during OGTT 140 - 199 mg/dl (7.8 - 11.0 mmol) Impaired Glucose Tolerance and/or a HbA1c level 5.7 - 6.4%, with however some potential discordance between tests. The threshold of fasting plasma glucose defining Impaired Fasting Glucose as well as the adequacy of HbA1c as a correct diagnostic tool for prediabetes is still debated.
OBJECTIVE:--We sought to determine the clinical phenotype of adolescent/adult patients with cystic fibrosis, according to heterozygosity or homozygosity for cystic fibrosis transmembrane regulator ...(CFTR) ΔF508 mutation, and to analyze their characteristics according to glucose tolerance status. RESEARCH DESIGN AND METHODS--A total of 76 cystic fibrosis patients with CFTR ΔF508 mutation (33 heterozygous and 43 homozygous) stratified according to normal glucose tolerance (NGT) (n = 51) or abnormal glucose homeostasis (AGH) (impaired fasting glucose, impaired glucose tolerance, or diabetes; n = 25) had their homeostasis model assessment (HOMA) of β-cell function and of insulin sensitivity and hyperbolic product (β-cell function x insulin sensitivity B x S) measured. Pancreatic exocrine insufficiency was inferred from pancreatine requirements. Clinical effects of insulin therapy on weight and lung function were recorded. RESULTS:--AGH was observed in 24 and 40% of heterozygous and homozygous subjects, respectively. AGH patients were older than NGT patients (mean ± SD age 29 ± 10 vs. 23 ± 8 years, P = 0.006), and their β-cell function was lower (93 ± 49 vs. 125 ± 51%, P = 0.011). Insulin sensitivity values were comparable in NGT and AGH patients. A lower B x S product was observed in AGH, although it was nonsignificant when adjusted for error propagation. Pancreatic insufficiency was observed in 52 and 100% of heterozygous and homozygous patients (P = 0.001). CONCLUSIONS:--Pre-diabetes and diabetes represent frequent comorbidities in CFTR ΔF508 mutation in the homozygous or heterozygous states. Impairment of insulin secretion, as shown by HOMA, is an important determinant when compared with the magnitude of compensation from insulin sensitivity. Given the high prevalence of abnormal glucose tolerance, screening for (pre-)diabetes is mandatory. Insulin supplementation in diabetic subjects with CFTR ΔF508 mutation seems a rational therapy for consideration, although this does not preclude that therapy directed toward insulin resistance could also interact.
Background As the result of the high prevalence of comorbidities and conventional risk factors among patients with type 2 diabetes (T2DM), most patients belong to the highest cardiovascular disease ...risk category, and have a target low-density lipoprotein cholesterol (LDL-C) of <70 mg/dL. Because substantial residual risk persists at LDL-C <70 mg/dL, a more comprehensive control of non-LDL-C and particles was recommended in the joint 2008 American Diabetes Association/American College of Cardiology Consensus. Objective To ascertain, in statin-treated T2DM patients belonging to this greatest-risk group, with on-statin LDL-C <70 mg/dL, (1) the proportion of patients meeting all three critical levels (LDL-C <70 mg/dL, non-high-density lipoprotein cholesterol HDL-C <100 mg/dL, apoB <80 mg/dL) and (2) the variables associated with target attainment versus nonattainment. Patients and Methods Among 675 unselected patients with T2DM, 367 were both at very high cardiometabolic risk and taking statins; 118 of these patient had LDL-C levels <70 mg/dL. Patients meeting all three criteria (LDL-C, non-HDL-C, and apoB; n = 79; all three at goal group) were compared with those only reaching LDL-C ( n = 49; only LDL-C at goal group). Results LDL-C was 54 (12) for the all three at goal group versus 57 (10) mg/dL for the only LDL-C at goal group (NS). The two groups were similar regarding age, gender, diabetes duration, body mass index, waist circumference, blood pressure, renal function and micro-/macroangiopathy prevalence. A statin plus fibrate was given to 16% of patients in the all three at goal group and 32% in the only LDL-C at goal group. The two groups did not differ in baseline (prestatin) LDL-C, HDL-C, and non-HDL-C, except for pre-/post-lipid-lowering drug(s) triglycerides (TG): 177 (95)/118 (56) for all three at goal versus 279 (134)/ 241 (103) mg/dL for only LDL-C at goal ( P = .0230 and P = .0001). The only LDL-C at goal group had lower HDL-C (vs. all three at goal): 41 (12) vs. 47 (14) mg/dL ( P = .0237), with atherogenic dyslipidemia hypo-HDL-C + hyper-TG prevalence of 35% in the all three at goal versus 56% in the only LDL-C at goal group ( P < .0001). log (TG)/HDL-C was 0.049 (0.021) for all three at goal versus 0.063 (0.021) for only LDL-C at goal ( P < .0001). The LDL-C/apoB ratio was 0.92 (0.24) for all three at goal vs. 0.67 (0.18) for only LDL-C at goal ( P < .0001), suggestive of smaller/denser LDL. Conclusion The presence of atherogenic dyslipidemia was associated with a failure to meet all three critical modifiable targets for hypercholesterolemia, such a nonachievement being found in a large proportion (one-third) of very-high risk T2DM patients with very-low on-statin LDL-C. Attainment of all three targets will require (1) titration/permutation of statins, (2) lifestyle (re)inforcement; and/or (3) statin-fibrate bitherapy.
Prediabetes and associated disorders Buysschaert, Martin; Medina, José Luís; Bergman, Michael ...
Endocrine,
03/2015, Volume:
48, Issue:
2
Journal Article
Peer reviewed
Prediabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Prediabetes includes individuals with IFG, IGT, IFG with IGT and elevated HbA1c ...levels. Insulin resistance and β-cell dysfunction are characteristic of this disorder. The diagnosis of prediabetesis is vital as both IFG and IGT are indeed well-known risk factors for type 2 diabetes with a greater risk in the presence of combined IFG and IGT. Furthermore, as will be illustrated in this review, prediabetes is associated with associated disorders typically only considered in with established diabetes. These include cardiovascular disease, periodontal disease, cognitive dysfunction, microvascular disease, blood pressure abnormalities, obstructive sleep apnea, low testosterone, metabolic syndrome, various biomarkers, fatty liver disease, and cancer. As the vast majority of individuals with prediabetes are unaware of their diagnosis, it is therefore vital that the associated conditions are identified, particularly in the presence of mild hyperglycemia, so they may benefit from early intervention.
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