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Predicting the Risk of Future Type 2 Diabetes

Predicting the Risk of Future Type 2 Diabetes. Muhammad A Abdul-Ghani MD. PhD Diabetes Division UTHSCSA. Diabetes Prevention Studies. ADA Criteria. Incidence of T2DM at SAHS. Basal State. 50-60% (1.2 mg/kg•min). Brain. (2.2 mg/kg•min) Release. 20-25% (0.5 mg/kg•min). Glucose.

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Predicting the Risk of Future Type 2 Diabetes

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  1. Predicting the Risk of Future Type 2 Diabetes Muhammad A Abdul-Ghani MD. PhD Diabetes Division UTHSCSA

  2. Diabetes Prevention Studies

  3. ADA Criteria

  4. Incidence of T2DM at SAHS

  5. Basal State 50-60% (1.2 mg/kg•min) Brain (2.2 mg/kg•min)Release 20-25% (0.5 mg/kg•min) Glucose 20-25% (0.5 mg/kg•min) 127401-4/04

  6. Oral Glucose Ingestion Brain 100 gramsGlucose 70-80 g 20-30 g

  7. Patients Characteristics

  8. Insulin Resistance in IGT &IFG

  9. ΔI/ΔG

  10. 12 10 8 6 4 2 0 1 2 3 4 INSULIN-MEDIATED GLUCOSE DISPOSAL Glucose Uptake (mg/kg•min) Quartile 127401-4/04

  11. ΔI/ΔG ÷ IR Insulin Secretion/Insulin Resistance (Disposition) Index

  12. Hyperglycemic Clamp

  13. Metabolic Characteristics of IFG and IGT • Subjects with IFG have marked increase in hepatic insulin resistance with near normal insulin sensitivity in skeletal muscle • Subjects with IGT have marked increase in muscle insulin resistance and moderate increase in hepatic insulin resistance • First phase insulin secretion is markedly decreased in both groups • Second phase insulin secretion decreased only in subjects with IGT

  14. Basal State 50-60% (1.2 mg/kg•min) Brain (2.2 mg/kg•min)Release 20-25% (0.5 mg/kg•min) Glucose 20-25% (0.5 mg/kg•min) 127401-4/04

  15. Relationship Between HGP and FPG

  16. Basal State 50-60% (1.2 mg/kg•min) Brain (2.2 mg/kg•min)Release 20-25% (0.5 mg/kg•min) Glucose 20-25% (0.5 mg/kg•min) 127401-4/04

  17. Relationship Between Glucose Clearance and FPG

  18. Relationship Between FPI and FPG

  19. The combination of decreased non-insulin dependent glucose uptake and increased hepatic insulin resistance leads to the increase in FPG in the non-diabetic range

  20. Incidence of T2DM at SAHS

  21. Relationship Between Beta Cell Function and FPG

  22. 1/0.044 = 23 Y = a exp(-bX) ISIR Index = 50 exp(-0.044FPG) For x=1/b y=y0/e FPGISIR Index 70 mg/dl 100%93 mg/dl 37%116mg/dl 14%

  23. 40 30 20 10 0 <240 <100 <120 <200 <280 <320 <360 <400 >400 <140 <170 NGT IGT T2DM INSULIN SECRETION / INSULINRESISTANCE INDEX DURING OGTT ∆ INS/ ∆ GLU ÷IR Obese Lean (0-120 min)

  24. aROC for FPG

  25. aROC for Plasma Glucose Concentration During the OGTT

  26. SADPM • Age • Sex • BMI • Ethnicity • Blood pressure • Family History of DM • HDL Cholesterol • FPG

  27. NGT 65/1301 (5.0%) 1 h PG < 1551h PG > 155 32/1085 (2.9%) 33/217 (15.3%) MS - M S + 18/57 (32.1%) 15/160 (9.4%)

  28. Total Population182/1611 • 1h PG < 155 1h PG > 155 136/439 (31.0%) 46/1173 (3.9%) MS- M S + MS- MS + 33/1006 (3.2%) 96/186 (51.6%) 40/251 (15.9%) 13/167 (7.8%) FPG <95FPG > 95 23/213 (10.8%) 17/38 (45.7%)

  29. Why Waiting Two Hours, When We Can Gain More Information at 1Hour ?

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