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Valdes S.,Hospital Universitario Central Of Asturias | Valdes S.,Hospital Universitario Carlos Haya Fundacion | Valdes S.,CIBER ISCIII | Botas P.,Hospital San Agustin | And 3 more authors.
Diabetes and Metabolism | Year: 2011

Aim: Fasting plasma glucose (FPG) and the 2-h post-challenge plasma glucose (2hPG) are commonly used to identify those at risk of type 2 diabetes. However, the role of HbA1c in this prediction has still not been ascertained. Methods: The Asturias study is a prospective population-based survey of diabetes and cardiovascular risk factors. Baseline examination, carried out during 1998-1999, involved 1034 individuals, aged 30-75 years, randomly selected to determine the prevalence of type 2 diabetes and prediabetes in the principality of Asturias (northern Spain). In 2004-2005, these same subjects were invited to a follow-up examination, and 700 participated. The present study includes only those who did not have diabetes at baseline. All participants with no known diabetes underwent an OGTT. Baseline HbA1c levels were measured by HPLC. Results: Diabetes had developed in 44 participants at the time of follow-up. Quartiles of baseline HbA1c values were 3.4-4.8 (Q1), 4.9-5.1 (Q2), 5.2-5.4 (Q3) and 5.5-6.9 (Q4), and the incidence rates of diabetes by quartiles were 1.0 (0.1-7.1), 4.0 (1.5-10.7), 7.9 (4.0-15.9) and 32.6 (22.9-46.4) cases/1000 person-years, respectively. ROC curve analysis comparing HbA1c, FPG and 2hPG in the prediction of diabetes showed areas under the curve (ROC-AUC) of 0.80 (0.74-0.86), 0.83 (0.77-0.90) and 0.79 (0.72-0.87), respectively. The combination of FPG and HbA1c had the best predictive performance with an ROC-AUC of 0.88 (0.82-0.93). Conclusion: Our study indicates that HbA1c is strongly predictive of new-onset diabetes in this northern Spanish population, and was similar to FPG and 2hPG in predictive capability. Also, the combined measurement of FPG and HbA1c improved their individual predictive performance. © 2010 Elsevier Masson SAS.

Garcia-Escobar E.,Hospital Universitario Carlos Haya Fundacion | Garcia-Escobar E.,CIBER ISCIII | Garcia-Escobar E.,Institute Salud Carlos III | Rodriguez-Pacheco F.,CIBER ISCIII | And 18 more authors.
European Journal of Clinical Investigation | Year: 2011

Background Insulin has several biological functions besides glycaemic control. We investigated and compared the effects of six different commercial insulins on adipocyte cell differentiation, the lipolytic activity of differentiated cells, and the expression levels of genes involved in adipogenesis and associated with insulin activity. Materials and methods 3T3-L1 cells were induced to differentiate with six commercial insulins: glargine, lispro, aspart, detemir, NPH and regular recombinant human insulin (used as control). Cell differentiation, lipolysis and gene expression were measured at day 7 (D7) and day 10 (D10) after induction of differentiation in these cells. Results The highest values of cell differentiation and lipolysis were found at D10 for all the insulins used. Preadipocyte differentiation differed at both times depending on the insulin used, with detemir insulin being the least adipogenic. The PPARγ mRNA level varied according to the insulin and was a good genetic marker of adipogenesis at D7. Cells treated with glargine insulin showed the highest lipolysis and HSL expression on both days. Gene expression levels of InsR, SREBP-1c and SCD-1 differed depending on the insulin studied. Conclusions Detemir insulin was the least adipogenic of the insulins tested, whereas treatment with glargine insulin tended to produce the highest lipolysis levels. Under these experimental conditions, the modifications made in commercial insulins to improve glycaemic control also affect adipocyte differentiation, the lipolysis level of differentiated cells, and the expression of different genes that can modify metabolic pathways independently of glucose metabolism. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.

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