Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Prediabetes: Fatty Liver, Visceral Obesity, impaired Production and Action of Insulin modulate Risk

19.05.2016

Prediabetes is associated with increased risk of diabetes, cardiovascular disease, dementia and cancer. However, the disease risk considerably varies among subjects. In The Lancet Diabetes & Endocrinology* DZD scientists have now summarized information from the literature and have provided novel data indicating that in the future the determination of the 4 major phenotypes fatty liver, visceral obesity and impaired production and action of insulin may help to improve prediction and prevention of cardiometabolic risk in prediabetes.

In many countries the prevalence of diabetes and prediabetes has reached epidemic numbers. In the USA and in China more than half of the adult population already has elevated blood glucose levels. Worrisome is that already in the state of prediabetes hyperglycemia is associated with increased risk of type 2 diabetes, cardiovascular disease, dementia and cancer.


Source: Stefan et al. Phenotypes of prediabetes and stratification of cardiometabolic risk. Lancet Diabetes & Endocrinology 2016.

© The Lancet Diabetes & Endocrinology

However, the disease risk considerably varies even in the state of prediabetes. This lead scientists at the Department of Internal Medicine IV of the University Hospital of Tübingen and of the Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, partners of the German Center for Diabetes Research (DZD), to study what parameters may explain this variability in disease risk in prediabetes.

Type 2 diabetes is a very heterogeneous disease

Among scientists it is well established that several pathophysiological mechanisms are involved in the development of type 2 diabetes. However, in a clinical setting it is very difficult to disentangle these mechanisms which may be very useful to implement a personalized prevention and treatment of diabetes.

The relevance to account for the major pathophysiological mechanisms of diabetes can be observed that in diabetes diagnosed by elevated fasting or 2 hr glucose levels during a standard oral glucose tolerance test (OGTT) the prevalence and the sequence of appearance of impaired insulin production and impaired insulin secretion differ. This variability in the prevalence of these risk phenotypes can already be observed in the prediabetic states isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) or IFG+IGT combined.

At-Risk Phenotypes predict prediabetes and cardiovascular risk

In an analysis of data from 1003 subjects of the Tübingen Diabetes Family Study of whom 405 had prediabetes, the 4 at risk phenotypes insulin secretion failure, insulin resistance, fatty liver, and magnetic-resonance imaging (MRI)-determined visceral obesity, but not BMI category (normal weight, overweight, and obese) or visceral obesity based on waist circumference, were independent determinants of prediabetes.

Except for visceral obesity, the other 3 at risk-phenotypes also predicted the regression from prediabetes to normal glucose regulation (NGR) during a lifestyle intervention. Among the individuals with prediabetes, fatty liver was the strongest determinant of increased carotid intima–media thickness, an early marker of atherosclerosis, followed by MRI-determined visceral obesity.

Phenotypes of prediabetes

Based on the emerging evidence for the existence of the very interesting extreme metabolic phenotypes metabolically healthy obesity and metabolically unhealthy normal weight the scientist then studied the prevalence of the 4 at-risk phenotypes among the different BMI categories (normal weight, overweight, and obese) in subjects with NGR and prediabetes.

They could show that there are distinct signatures of these phenotypes among these BMI categories (figure). For example, while insulin secretion failure is by far the most prevalent at-risk phenotype in normal weight subjects with prediabetes, fatty liver and visceral obesity become more prevalent in overweight and obese subjects.

Conclusion: Phenotypes of prediabetes should be consideration in prevention and treatment of cardiometabolic diseases

Norbert Stefan, the first author of the article, proposes that ‘after initial classification of the glucose categories NGR and prediabetes, fatty liver, visceral obesity and impaired production and action of insulin should be included in assessment of cardiometabolic risk. If proven to be effective, this strategy could be included in medical guidelines about the prevention and treatment of diabetes and associated diseases’. Hans Häring, the last author of the study adds ‘the application of precise phenotyping strategies in clinical trials will also help to improve understanding of the pathophysiology of cardiometabolic diseases.’

Source

Norbert Stefan, Andreas Fritsche, Fritz Schick, Hans-Ulrich Häring. Phenotypes of prediabetes and stratification of cardiometabolic risk. Lancet Diabetes & Endocrinology 2016 [epub ahead of print] DOI: http://dx.doi.org/10.1016/S2213-8587(16)00082-6

The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Zentrum München – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of the Helmholtz Zentrum München at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Zentrum München at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. More information: www.dzd-ev.de/en

The Helmholtz Zentrum München, the German Research Center for Environmental Health, pursues the goal of developing personalized medical approaches to the prevention and therapy of major common diseases such as diabetes and lung disease. To achieve this, it investigates the interaction of genetics, environmental factors and lifestyle. The Helmholtz Zentrum München has about 2,300 staff members and is headquartered in Neuherberg in the north of Munich. It is a member of the Helmholtz Association, a community of 18 scientific-technical and medical-biological research centers with a total of about 37,000 staff members. The Helmholtz Zentrum München is a partner in the German Center for Diabetes Research.

Media contact

Dr. Astrid Glaser
German Center for Diabetes Research (DZD)
Ingolstädter Landstr. 1
85764 Neuherberg
Germany
Phone: 089-3187-1619
Email: contact@dzd-ev.de
www.dzd-ev.de

Contact for inquiries about the current publication

Prof. Dr. med. Norbert Stefan
Tübingen University Hospital
Department of Internal Medicine IV
Otfried-Müller-Straße 10, 72076 Tübingen
Germany
Phone: +49 (0)7071 29-80390
Email: norbert.stefan@med.uni-tuebingen.de

Weitere Informationen:

https://www.dzd-ev.de/en/index.html
https://twitter.com/DiabResearch

Dr. Silvia Grote | idw - Informationsdienst Wissenschaft

Further reports about: Fatty Insulin Visceral fatty liver normal weight phenotypes prediabetes

More articles from Health and Medicine:

nachricht Nanoparticles as a Solution against Antibiotic Resistance?
15.12.2017 | Friedrich-Schiller-Universität Jena

nachricht Plasmonic biosensors enable development of new easy-to-use health tests
14.12.2017 | Aalto University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: First-of-its-kind chemical oscillator offers new level of molecular control

DNA molecules that follow specific instructions could offer more precise molecular control of synthetic chemical systems, a discovery that opens the door for engineers to create molecular machines with new and complex behaviors.

Researchers have created chemical amplifiers and a chemical oscillator using a systematic method that has the potential to embed sophisticated circuit...

Im Focus: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

Engineers program tiny robots to move, think like insects

15.12.2017 | Power and Electrical Engineering

One in 5 materials chemistry papers may be wrong, study suggests

15.12.2017 | Materials Sciences

New antbird species discovered in Peru by LSU ornithologists

15.12.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>