Alanine-aminotransferase (ALT) is an independent predictor for impaired glucose tolerance (IGT), a precursor to Type 2 diabetes, show results from a German worksite population.

The BASF (Baden Aniline and Soda Factory) Occupational Medicine and Health Protection Department offered a diabetes screening program to its 33,000 employees in 2006, of whom 1594 had their diabetes risk tested.

Michael Morcos and fellow researchers from the University of Heidelberg found that of all the employees tested, 374 had the metabolic syndrome according to the International Diabetes Federation criteria.

They also found that 285 had a medium-to-high risk for IGT and Type 2 diabetes according to the Finrisk scoring system, of whom 157, aged 49 years on average, underwent the oral glucose tolerance test.

Of the 157 individuals tested, 18% had either IGT (n=22) or Type 2 diabetes (n=5).

Following adjustment for various confounding factors including age and gender, fasting glucose and ALT were the only independent predictors of IGT.

More specifically, mean fasting glucose was 97 mg/dl in individuals with normoglycemia and 103 mg/dl in those with IGT. In addition, ALT levels were 28 U/l in normoglycemic participants and 36 U/l in those with IGT.

Participants in the upper quartile for ALT and fasting glucose had a significant 4.8 and 5.5-fold increased risk for Type 2 diabetes compared with the lower quartile, respectively.

“These data point to an important role of the liver in insulin resistance and the development of IGT in the relatively young and small population studied,” conclude the authors in the journal Acta Diabetologia.

They add: “Our data support the intention to study ALT as a potential predictive marker of IGT and diabetes Type 2 in more detail in a larger population in a prospective, randomized study.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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Results from a meta-analysis published in the journal Diabetes Care show that moderate alcohol intake has a protective effect against Type 2 diabetes.

Heavier consumption of over 60 g/day in men and 50 g/day in women, however, was found to increase the risk for the condition.

Researchers lead by Dolly Baliunas (University of Toronto, Ontario, Canada) carried out a meta-analysis of 20 cohort studies comprising 477,200 individuals, 12,556 of whom developed incident Type 2 diabetes.

Inclusion criteria were having incident Type 2 diabetes as an endpoint diagnosed using World Health Organization criteria, having a longitudinal design, and a quantitative measure of alcohol consumption. Study duration ranged from 3 to 20 years.

The team found that compared with lifetime abstainers, men who consumed 22 g/day alcohol and women who consumed 24 g/day had a respective 13% and 40% reduction in relative risk for incident Type 2 diabetes.

Overall, the results showed a U-shaped curve, as higher levels of consumption (over 60 g/day in men and 50 g/day in women) increased the risk for Type 2 diabetes.

“Our findings confirm previous research, both individual studies and summary estimates, of the U-shaped relationship between average alcohol consumption and risk of diabetes in both men and women,” conclude Baliunas et al.

“Although the biological mechanism responsible for this relationship is still a matter of research, several possibilities exist including increased insulin sensitivity with low levels of alcohol consumption,” they add.

Other possibilities include the increased levels of high-density lipoprotein cholesterol and the anti-inflammatory effect associated with alcohol consumption.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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The rate of insulin initiation in elderly Type 2 diabetes patients taking oral anti-diabetes drugs is low, whether this is due to failure of first-line drug therapy or better management of the condition is not clear, say researchers.

“Unfortunately, oral antidiabetes drugs have limited efficacy for long-term glucose lowering and, therefore, many patients may require insulin to achieve better metabolic control,” explain Jean-Pierre Gregoire (University of Quebec, Canada) and colleagues.

They conducted a population-based cohort study among people aged 66 years or older, including 69,674 new users of oral antidiabetes drugs, .

The researchers found that 1955 (2.8%) patients who were initially taking oral antidiabetes medication alone started insulin therapy over a median follow-up period of 2.9 years. The rate of initiation of insulin therapy was 9.7 cases per 1000 patient??”years.

Factors predicting initiation of insulin therapy included initially receiving an insulin secretagogue rather than metformin, receiving oral corticosteroids, using glucometer strips, prescription of initial oral antidiabetes medication by an endocrinologist or an internist, receipt of a higher initial dose of oral antidiabetes medication, a hospital stay in the year before initiation of oral antidiabetes therapy, and receipt of 16 or more medications overall.

However, those who initially received thiazides rather than other oral antidiabetes treatment, or who used up to 12 medications compared with none were less likely to have insulin therapy started.

“There is a need for better understanding of the role of insulin in elderly patients who start oral antidiabetes therapy,” conclude Gregoire et al.

They add: “Further investigation is needed to explore the relation among glycemic control, insulin initiation, and health outcomes, notably in elderly patients with Type 2 diabetes.”

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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