Women, Men Differ in Prediabetes Development

Women who progress from normoglycemia to prediabetes have greater endothelial dysfunction than do men who similarly progress, a study has found.

It has previously been shown that women with impaired glucose tolerance have a more atherogenic risk profile than men, and that this is evident years before clinical diabetes develops—an observation that led to the “ticking clock” hypothesis that attributes diabetic patients' risk for coronary heart disease to a long-standing atherogenic state.

New data from patients enrolled in the Western New York Study, an epidemiologic case-control investigation that originally looked at alcohol intake and cardiovascular disease risk, now have demonstrated that emerging risk factors such as markers of endothelial dysfunction, inflammation, and fibrinolysis/thrombosis also are elevated early in women who develop prediabetes.

Among the study's 1,455 participants, 52 women and 39 men whose fasting serum glucose levels were below 100 mg/dL at baseline had levels between 100 and 125 mg/dL at a 6-year follow-up visit, according to Richard P. Donahue, Ph.D., of the department of social and preventive medicine, State University of New York at Buffalo, and colleagues (Diabetes Care 2007;30:354–9).

The women who progressed from normoglycemia to prediabetes were older than matched controls and had higher mean waist circumference, higher levels of triglycerides and fasting glucose, higher values on the homeostasis model assessment of insulin resistance (HOMA-IR), and a greater frequency of hypertension.

Aside from these conventional atherogenic risk factors, the women also had higher age-adjusted levels of biomarkers including human soluble intercellular adhesion molecule-1, E-selectin, and plasminogen activator inhibitor-1 (PAI-1).

In contrast, men who progressed from normoglycemia to prediabetes had higher levels of C-reactive protein and higher values on the HOMA-IR, compared with controls, without showing increased levels of the markers of endothelial dysfunction.

Dr. Donahue and his colleagues from Buffalo and from the University of North Carolina at Charlotte noted that previous studies have shown that elevations of E-selectin and PAI-1 are independent predictors of both type 2 diabetes and coronary heart disease. Elevated PAI-1, reflecting impaired fibrinolysis, is one of the most predictive of biomarkers, possibly working through a different pathway than do the cellular adhesion molecules, they said.

The markers of endothelial dysfunction that were elevated in women in this study and that predicted progression to prediabetes were independent of the effects of age or body mass index and HOMA-IR, according to the investigators.

Women who progress from normoglycemia to prediabetes have greater endothelial dysfunction than do men who similarly progress, a study has found.

It has previously been shown that women with impaired glucose tolerance have a more atherogenic risk profile than men, and that this is evident years before clinical diabetes develops—an observation that led to the “ticking clock” hypothesis that attributes diabetic patients' risk for coronary heart disease to a long-standing atherogenic state.

New data from patients enrolled in the Western New York Study, an epidemiologic case-control investigation that originally looked at alcohol intake and cardiovascular disease risk, now have demonstrated that emerging risk factors such as markers of endothelial dysfunction, inflammation, and fibrinolysis/thrombosis also are elevated early in women who develop prediabetes.

Among the study's 1,455 participants, 52 women and 39 men whose fasting serum glucose levels were below 100 mg/dL at baseline had levels between 100 and 125 mg/dL at a 6-year follow-up visit, according to Richard P. Donahue, Ph.D., of the department of social and preventive medicine, State University of New York at Buffalo, and colleagues (Diabetes Care 2007;30:354–9).

The women who progressed from normoglycemia to prediabetes were older than matched controls and had higher mean waist circumference, higher levels of triglycerides and fasting glucose, higher values on the homeostasis model assessment of insulin resistance (HOMA-IR), and a greater frequency of hypertension.

Aside from these conventional atherogenic risk factors, the women also had higher age-adjusted levels of biomarkers including human soluble intercellular adhesion molecule-1, E-selectin, and plasminogen activator inhibitor-1 (PAI-1).

In contrast, men who progressed from normoglycemia to prediabetes had higher levels of C-reactive protein and higher values on the HOMA-IR, compared with controls, without showing increased levels of the markers of endothelial dysfunction.

Dr. Donahue and his colleagues from Buffalo and from the University of North Carolina at Charlotte noted that previous studies have shown that elevations of E-selectin and PAI-1 are independent predictors of both type 2 diabetes and coronary heart disease. Elevated PAI-1, reflecting impaired fibrinolysis, is one of the most predictive of biomarkers, possibly working through a different pathway than do the cellular adhesion molecules, they said.

The markers of endothelial dysfunction that were elevated in women in this study and that predicted progression to prediabetes were independent of the effects of age or body mass index and HOMA-IR, according to the investigators.

Women who progress from normoglycemia to prediabetes have greater endothelial dysfunction than do men who similarly progress, a study has found.

It has previously been shown that women with impaired glucose tolerance have a more atherogenic risk profile than men, and that this is evident years before clinical diabetes develops—an observation that led to the “ticking clock” hypothesis that attributes diabetic patients' risk for coronary heart disease to a long-standing atherogenic state.

New data from patients enrolled in the Western New York Study, an epidemiologic case-control investigation that originally looked at alcohol intake and cardiovascular disease risk, now have demonstrated that emerging risk factors such as markers of endothelial dysfunction, inflammation, and fibrinolysis/thrombosis also are elevated early in women who develop prediabetes.

Among the study's 1,455 participants, 52 women and 39 men whose fasting serum glucose levels were below 100 mg/dL at baseline had levels between 100 and 125 mg/dL at a 6-year follow-up visit, according to Richard P. Donahue, Ph.D., of the department of social and preventive medicine, State University of New York at Buffalo, and colleagues (Diabetes Care 2007;30:354–9).

The women who progressed from normoglycemia to prediabetes were older than matched controls and had higher mean waist circumference, higher levels of triglycerides and fasting glucose, higher values on the homeostasis model assessment of insulin resistance (HOMA-IR), and a greater frequency of hypertension.

Aside from these conventional atherogenic risk factors, the women also had higher age-adjusted levels of biomarkers including human soluble intercellular adhesion molecule-1, E-selectin, and plasminogen activator inhibitor-1 (PAI-1).

In contrast, men who progressed from normoglycemia to prediabetes had higher levels of C-reactive protein and higher values on the HOMA-IR, compared with controls, without showing increased levels of the markers of endothelial dysfunction.

Dr. Donahue and his colleagues from Buffalo and from the University of North Carolina at Charlotte noted that previous studies have shown that elevations of E-selectin and PAI-1 are independent predictors of both type 2 diabetes and coronary heart disease. Elevated PAI-1, reflecting impaired fibrinolysis, is one of the most predictive of biomarkers, possibly working through a different pathway than do the cellular adhesion molecules, they said.

The markers of endothelial dysfunction that were elevated in women in this study and that predicted progression to prediabetes were independent of the effects of age or body mass index and HOMA-IR, according to the investigators.