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Diabetes Care 29:2123-2126, 2006
DOI: 10.2337/dc06-0964
© 2006 by the American Diabetes Association
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Pathophysiology/Complications
Brief Report

Atherosclerotic Risk Factors in Japanese Subjects With Isolated Impaired Fasting Glucose and Those With Isolated Impaired Glucose Tolerance According to 1997 and 2003 American Diabetes Association Criteria

Shinya Morita, MD1, Soji Kasayama, MD, PHD1, Michio Otsuki, MD, PHD1, Nobuyuki Asanuma, MD, PHD1, Hiroshi Saito, MD, PHD2, Mikio Mukai, MD, PHD2 and Masafumi Koga, MD, PHD2

1 Department of Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
2 Department of Internal Medicine, Kinki Central Hospital, Itami, Japan

Address correspondence and reprint requests to Soji Kasayama, MD, PhD, Department of Medicine, Osaka University Graduate School of Medicine (C-4), 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. E-mail: kasayama{at}imed3.med.osaka-u.ac.jp

Abbreviations: ADA, American Diabetes Association • baPWV, brachial-ankle PWV • CRP, C-reactive protein • FPG, fasting plasma glucose • HOMA, homeostasis model assessment • HOMA-%ß, HOMA of ß-cell function • HOMA-%S, HOMA of insulin sensitivity • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • NGT, normal glucose tolerance • PWV, pulse-wave velocity


   INTRODUCTION
TOP
 INTRODUCTION
RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
 References
 
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are different clinical categories of abnormal glucose metabolism (1–3). Both IGT and IFG are similarly associated with increased risk of diabetes, but IGT may be more strongly associated with cardiovascular diseases (4–7). Although insulin secretion and insulin resistance have been shown to differ between these two clinical categories (8,9), mechanisms underlying the differences in the association with cardiovascular diseases are not well determined. There are only a few studies that have tried to identify differences in cardiovascular risk factors among subjects with abnormal glucose metabolism (10–13). The definition of normal glucose tolerance (NGT), IFG, and IGT and the study populations differ among these studies, such that their results do not appear to be uniform.

The aim of this study was to evaluate cardiovascular risk factors in Japanese subjects with IFG and IGT. Two diagnostic criteria defined in 1997 and in 2003 by the American Diabetes Association (ADA) (2,3) were used for the comparison. The measures included pulse-wave velocity (PWV), a noninvasive technique for assessing an aspect of atherosclerosis related to arterial stiffness (14,15).


   RESEARCH DESIGN AND METHODS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
RESULTS
 CONCLUSIONS
 References
 
Of 1,934 Japanese subjects who visited the Kinki Central Hospital between April and October 2003 for periodic health examinations, we evaluated 1,541 subjects (955 men and 586 women, aged 30–77 years) after exclusion of subjects with diabetes, malignant diseases, chronic or acute inflammatory diseases, elevated serum creatinine levels (≥106 µmol/l), or autoimmune disorders.

Brachial-ankle PWV (baPWV) was measured with the use of a Waveform analyzer (VaSera VS-1000; Fukuda Denshi, Tokyo, Japan) (16,17) after at least 5 min of rest. In this study, PWV was defined as the mean of right and left baPWV readings.

Laboratory data included single measurements of fasting plasma glucose (FPG), 2-h plasma glucose in a 75-g oral glucose tolerance test (2-h glucose), serum insulin, and lipids. Plasma high-sensitivity C-reactive protein (CRP) was determined by nephelometry. Homeostasis model assessment (HOMA) indexes of insulin sensitivity (HOMA-%S) and ß-cell function (HOMA-%ß) were estimated by the correct HOMA evaluation (18).

Unadjusted comparisons for continuous variables were performed among groups using ANOVA, and the Bonferroni method was used to estimate the level of significance of differences between means. Comparisons for categorized variables were made using Fisher’s exact test. A P value <0.05 defined statistical significance.


   RESULTS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
CONCLUSIONS
 References
 
The demographic characteristics of subjects in each group according to 1997 ADA criteria are shown in Table 1 and 2003 ADA criteria in Table 2. In both analyses, there were significant differences between the four groups with respect to variables except for LDL cholesterol.


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  		Table 1— Clinical characteristics of 1,541 nondiabetic Japanese subjects categorized into NGT, isolated IFG, isolated IGT, and combined IGT/IFG: 1997 ADA criteria

 

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  		Table 2— Clinical characteristics of 1,541 nondiabetic Japanese subjects categorized into NGT, isolated IFG, isolated IGT, and combined IGT/IFG: 2003 ADA criteria

 
By both the 1997 and 2003 ADA criteria, subjects with IFG and IGT had higher BMI, FPG, 2-h glucose, logCRP, and systolic and diastolic blood pressure and lower HOMA-%S than subjects with NGT. HOMA-%ß were lower in subjects with IFG than in subjects with NGT and IGT.

Age, triglycerides, total cholesterol, and PWV were higher and HDL cholesterol lower in subjects with IGT, unlike in IFG, than in subjects with NGT according to the 1997 ADA criteria. According to the 2003 ADA criteria, age, triglycerides, and PWV were higher and HDL cholesterol lower in subjects with IFG and those with IGT than in subjects with NGT. Total cholesterol was lower in subjects with IGT but not in subjects with IFG.


   CONCLUSIONS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
References
 
The present study has shown that according to the 1997 ADA criteria, subjects with IGT, but not IFG, had abnormal serum lipid profiles and higher PWV compared with subjects with NGT. PWV is shown to be influenced by age, blood pressure, diabetes, insulin resistance, smoking, serum creatinine, and triglycerides (15,17,19,20) and to predict future cardiovascular mortality (21). Therefore, differences of this parameter in IFG and IGT may support the association of IGT but not IFG with cardiovascular diseases (4–7).

In contrast, subjects with IFG and IGT similarly had abnormal lipid profiles and higher PWV according to the 2003 ADA criteria. It indicates that IFG and IGT, based on the 2003 ADA criteria, carries strong risks for atherosclerosis. Many subjects classified as NGT and IGT by the 1997 ADA criteria were shifted into IFG and IFG/IGT groups by the 2003 ADA criteria. These were predominantly male subjects, and they could have caused the change in cardiovascular risk. Differences in numbers of IFG subjects (47 vs. 410) according to the two criteria may also influence the statistical analyses.

HOMA-%S was lower in both IFG and IGT compared with subjects with NGT, while HOMA-%ß was lower in IFG and rather higher in subjects with IGT. This indicates that there is defective insulin secretion in IFG but not in IGT. These results appear consistent with a study involving Pima Indians (22) but not with other studies (8,9).

CRP, a known marker associated with cardiovascular risk factors (23), was elevated in subjects with IFG and those with IGT according to the 1997 and 2003 ADA criteria. CRP is shown to be related to BMI and insulin resistance (24,25). In our analyses, BMI was higher and HOMA-%S lower in subjects with IFG and IGT. Thus, CRP may more strongly reflect high BMI and increased insulin resistance rather than atherosclerosis per se.

In conclusion, according to the 1997 ADA criteria (also adopted by the Japan Diabetes Society), subjects with IGT, but not IFG, had higher levels of atherosclerotic risk factors than NGT subjects, whereas according to the 2003 ADA criteria, subjects with IFG and those with IGT were fraught with cardiovascular risk. Criteria for the metabolic syndrome include abnormal glucose metabolism, but its definitions differ depending on the organization developing the criteria (26–28). Our results, studying Japanese nondiabetic subjects, suggest that a FPG cutoff level of 100 mg/dl, rather than 110 mg/dl, is suitable for differentiating between individuals with and those without high atherosclerotic risks.


   Acknowledgments
 
This study was supported by the grants from the Ministry, Education, Science and Sports of Japan.


   Footnotes
 
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

Received for publication May 10, 2006. Accepted for publication June 8, 2006.


   References
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
 References
 

  1. World Health Organization: Diabetes Mellitus: Report of a WHO Study Group. Geneva, World Health Org., 1985
  2. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 20:1183–1197, 1997[Medline]
  3. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160–3167, 2003[Free Full Text]
  4. The DECODE Study Group: Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 354:617–621, 1999[Medline]
  5. Tominaga M, Eguchi H, Manaka H, Igarashi K, Kato T, Sekikawa A: Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose: the Funagata Diabetes Study. Diabetes Care 22:920–924, 1999[Abstract]
  6. Hanefeld M, Temelkova-Kurktschiev T, Schaper F, Henkel E, Siegert G, Koehler C: Impaired fasting glucose is not a risk factor for atherosclerosis. Diabet Med 16:212–218, 1999[Medline]
  7. Unwin N, Shaw J, Zimmet P, Alberti KG: Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 19:708–723, 2002[Medline]
  8. Carnevale Schianca GP, Rossi A, Sainaghi PP, Maduli E, Bartoli E: The significance of impaired fasting glucose versus impaired glucose tolerance: importance of insulin secretion and resistance. Diabetes Care 26:1333–1337, 2003[Abstract/Free Full Text]
  9. Hanefeld M, Koehler C, Fuecker K, Henkel E, Schaper F, Temelkova-Kurktschiev T: Insulin secretion and insulin sensitivity pattern is different in isolated impaired glucose tolerance and impaired fasting glucose: the risk factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes study. Diabetes Care 26:868–874, 2003[Abstract/Free Full Text]
  10. Festa A, D’Agostino R Jr, Hanley AJ, Karter AJ, Saad MF, Haffner SM: Differences in insulin resistance in nondiabetic subjects with isolated impaired glucose tolerance or isolated impaired fasting glucose. Diabetes 53:1549–1555, 2004[Abstract/Free Full Text]
  11. Blake DR, Meigs JB, Muller DC, Najjar SS, Andres R, Nathan DM: Impaired glucose tolerance, but not impaired fasting glucose, is associated with increased levels of coronary heart disease risk factors: results from the Baltimore Longitudinal Study on Aging. Diabetes 53:2095–2100, 2004[Abstract/Free Full Text]
  12. Nóvoa FJ, Boronat M, Saavedra P, Diaz-Cremades JM, Varillas VF, La Roche F, Alberiche MP, Carrillo A: Differences in cardiovascular risk factors, insulin resistance, and insulin secretion in individuals with normal glucose tolerance and in subjects with impaired glucose regulation: the Telde Study. Diabetes Care 28:2388–2393, 2005[Abstract/Free Full Text]
  13. Nishi Y, Fukushima M, Suzuki H, Mitsui R, Ueda N, Taniguchi A, Nakai Y, Kawakita T, Kurose T, Seino Y, Yamada Y: Insulin secretion and insulin sensitivity in Japanese subjects with impaired fasting glucose and isolated fasting hyperglycemia. Diabetes Res Clin Pract 70:46–52, 2005[Medline]
  14. Wilkinson IB, Webb DJ, Cockcroft JR: Aortic pulse-wave velocity (Letter). Lancet 354:1996–1997, 1999[Medline]
  15. Taniwaki H, Kawagishi T, Emoto M, Shoji T, Kanda H, Maekawa K, Nishizawa Y, Morii H: Correlation between the intima-media thickness of the carotid artery and aortic pulse-wave velocity in patients with type 2 diabetes: vessel wall properties in type 2 diabetes. Diabetes Care 22:1851–1857, 1999[Abstract/Free Full Text]
  16. Bortolotto LA, Blacher J, Kondo T, Takazawa K, Safar ME: Assessment of vascular aging and atherosclerosis in hypertensive subjects: second derivative of photoplethysmogram versus pulse wave velocity. Am J Hypertens 13:165–171, 2000[Medline]
  17. Kubo T, Miyata M, Minagoe S, Setoyama S, Maruyama I, Tei C: A simple oscillometric technique for determining new indices of arterial distensibility. Hypertens Res 25:351–358, 2002[Medline]
  18. Levy JC, Matthews DR, Hermans MP: Correct homeostasis model assessment (HOMA) evaluation uses the computer program (Letter). Diabetes Care 21:2191–2192, 1998[Medline]
  19. Tomiyama H, Yamashina A, Arai T, Hirose K, Koji Y, Chikamori T, Hori S, Yamamoto Y, Doba N, Hinohara S: Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement: a survey of 12517 subjects. Atherosclerosis 166:303–309, 2003[Medline]
  20. Kasayama S, Saito H, Mukai M, Koga M: Insulin sensitivity independently influences brachial-ankle pulse-wave velocity in non-diabetic subjects. Diabet Med 22:1701–1706, 2005[Medline]
  21. Shokawa T, Imazu M, Yamamoto H, Toyofuku M, Tasaki N, Okimoto T, Yamane K, Kohno N: Pulse wave velocity predicts cardiovascular mortality: findings from the Hawaii-Los Angeles-Hiroshima study. Circ J 69:259–264, 2005[Medline]
  22. Weyer C, Bogardus C, Pratley RE: Metabolic characteristics of individuals with impaired fasting glucose and/or impaired glucose tolerance. Diabetes 48:2197–2203, 1999[Abstract]
  23. Mendall MA, Patel P, Ballam L, Strachan D, Northfield TC: C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. BMJ 312:1061–1065, 1996[Abstract/Free Full Text]
  24. Hashimoto K, Kasayama S, Yamamoto H, Kurebayashi S, Kawase I, Koga M: Strong association of C-reactive protein with body mass index and 2-h post-challenge glucose in non-diabetic, non-smoker subjects without hypertension. Diabet Med 21:581–585, 2004[Medline]
  25. Temelkova-Kurktschiev T, Siegert G, Bergmann S, Henkel E, Koehler C, Jaross W, Hanefeld M: Subclinical inflammation is strongly related to insulin resistance but not impaired insulin secretion in a high risk population for diabetes. Metabolism 51:743–749, 2002[Medline]
  26. World Health Organization: Definition, Diagnosis, and Classification of Diabetes Mellitus and Its Complications: Report of a WHO Consultation. Geneva, World Health Org., 1999
  27. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106:3143–3421, 2002[Medline]
  28. International Diabetes Federation: The IDF Consensus: Worldwide Definition of the Metabolic Syndrome. Vol. 2005. Brussels, International Diabetes Federation, 2005

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