The GOAL lifestyle implementation trial helped individuals at risk for Type 2 diabetes to maintain a reduction in weight, body mass index (BMI), and serum total cholesterol for 36 months, say researchers.

“The GOAL Lifestyle Implementation Trial was designed to replicate results from efficacy trials such as the Diabetes Prevention Study (DPS), under more ‘real world’ conditions with a more modest program delivered by existing health care personnel,” say Pilvikki Absetz (National Institute for Health and Welfare, Helsinki, Finland) and co-investigators.

The team report in the journal Diabetes Care that the statistically significant mean reductions in weight, BMI, and total cholesterol of 1.0 kg, 0.5 kg/m², and 0.40 mmol/l (15.47 mg/dl), respectively, achieved by the participants at 12 months were maintained at 36 months.

Overall, 12% of individuals who had impaired glucose tolerance (IGT) at baseline developed Type 2 diabetes at 3 years. This is in line with the DPS, in which 9% of those with IGT in the intervention group converted to Type 2 diabetes at study completion compared with 20% of the control group.

The cohort consisted of 352 men and women aged 50??”65 years with a Type 2 diabetes risk score (FINDRISC) of 16.2 and an average BMI of 32.6 kg/m² at baseline. Of the original 352 participants, 312 attended the measurement session at 1 year and 271 the session at 3 years.

The intervention had the same lifestyle change objectives as the DPS and consisted of six sessions of task oriented sociobehavioral group counseling carried out by nurses over a period of 8 months. There was no other contact with participants apart from follow-up measurements which were taken at 1 and 3 years.

The authors conclude: “Wit

A study of Hispanic African Americans shows that insulin resistance and beta-cell dysfunction independently predict diabetes.

Central obesity, however, was not significantly associated with diabetes independently of insulin sensitivity or secretion, suggesting “a portion of the association of visceral adipose tissue with diabetes mellitus operates through these disorders,” report the authors.

Anthony Hanley (University of Toronto, Canada) and colleagues investigated the association of directly measured visceral and subcutaneous adiposity, insulin sensitivity, and beta-cell dysfunction with the 5-year incidence of Type 2 diabetes in 1230 Hispanic??” and African??”American participants who were free of diabetes at baseline.

The study cohort was from the Insulin Resistance Atherosclerosis (IRAS) Family Study, which is assessing three generations of family members to determine how many of the precursors to adult-onset Type 2 diabetes and obesity are inherited.

Fat mass in the abdominal region was measured by computed tomography. Insulin sensitivity and the acute insulin response (AIR), a measure of insulin secretion, were determined from frequently sampled intravenous glucose tolerance tests.

Incident Type 2 diabetes was diagnosed in 90 participants over 5 years. These individuals had significantly lower baseline insulin sensitivity and AIR, as well as higher glucose and insulin concentrations, and were more likely to have had impaired fasting glucose at baseline than those who did not develop the condition.

In individual models, both insulin sensitivity and AIR were inversely associated with Type 2 diabetes incidence after adjustment for baseline variables including age, gender, ethnicity, center, and impaired fasting glucose, with odds ratios of 0.53 and 0.22, respectively. Visceral and subcutaneous adipose tissue were both positively associated with Type 2 diabetes, with odds ratios of 1.68 and 1.49, respectively.

The association of visceral adipose tissue with diabetes was notably stronger in women than men.

In models including both visceral and subcutaneous adipose tissue, only visceral adiposity was a significant risk factor for diabetes.

Finally, in a model examining the joint effects of visceral and subcutaneous adipose tissue and insulin sensitivity/secretion, insulin sensitivity and AIR were significant predictors of Type 2 diabetes, but associations with visceral and subcutaneous adiposity were no longer significant.

“The detrimental effect of reduced insulin sensitivity and secretion is independent of directly quantified visceral and subcutaneous adipose tissue, and is present in multiple high-risk populations, including African and Hispanic Americans,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Levels of low-density lipoprotein (LDL) cholesterol are positively correlated with serum concentration of advanced glycation end products (AGEs), show study results.

AGEs occur naturally in the body, but under certain pathologic conditions, such as hyperglycemia in people with diabetes, their formation can increase beyond normal levels.

“There is accumulating evidence that AGEs elicit oxidative stress generation, vascular inflammation, and thrombosis, thus being involved in the development and progression of atherosclerosis,” explain Sho-ichi Yamagishi and co-workers from Kurume University School of Medicine in Japan.

In this study, the team investigated whether LDL cholesterol levels influenced levels of glyceraldehyde-derived AGEs in a group of 170 men and women, aged 65.4 years on average, from a fishing community in southwestern Japan.

Individuals with diabetes are known to have high AGE levels and were therefore excluded from the study to improve the accuracy of any observed associations.

The mean AGE level was 4.07 U/ml, and fasting plasma glucose and glycated hemoglobin levels were 93.7 mg/dl and 5.2%, respectively.

Both univariate and multivariate analysis showed that LDL cholesterol and fasting plasma glucose levels were significantly and positively associated with serum concentration of AGEs.

“Intake of cholesterol-rich, probably more AGE-containing foods could increase both LDL cholesterol- and glyceraldehyde-derived AGEs levels in nondiabetic subjects, thus providing a positive and independent correlationship between the two markers,” suggest the authors.

They conclude in the journal Clinical Cardiology: “The present study is the first demonstration that LDL cholesterol levels are one of the independent determinants of serum levels of AGEs in a nondiabetic general population.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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