title: Diabetes and pre-diabetes are associated with cardiovascular risk factors and carotid/femoral intima-media thickness independently of markers of insulin resistance and adiposity.
abstract: BACKGROUND
  Impaired glucose regulation (IGR) is associated with detrimental cardiovascular outcomes such as cardiovascular disease risk factors (CVD risk factors) or intima-media thickness (IMT). Our aim was to examine whether these associations are mediated by body mass index (BMI), waist circumference (waist) or fasting serum insulin (insulin) in a population in the African region.
  
  
  METHODS
  Major CVD risk factors (systolic blood pressure, smoking, LDL-cholesterol, HDL-cholesterol,) were measured in a random sample of adults aged 25-64 in the Seychelles (n = 1255, participation rate: 80.2%). According to the criteria of the American Diabetes Association, IGR was divided in four ordered categories: 1) normal fasting glucose (NFG), 2) impaired fasting glucose (IFG) and normal glucose tolerance (IFG/NGT), 3) IFG and impaired glucose tolerance (IFG/IGT), and 4) diabetes mellitus (DM). Carotid and femoral IMT was assessed by ultrasound (n = 496).
  
  
  RESULTS
  Age-adjusted levels of the major CVD risk factors worsened gradually across IGR categories (NFG < IFG/NGT < IFG/IGT < DM), particularly HDL-cholesterol and blood pressure (p for trend < 0.001). These relationships were marginally attenuated upon further adjustment for waist, BMI or insulin (whether considered alone or combined) and most of these relationships remained significant. With regards to IMT, the association was null with IFG/NGT, weak with IFG/IGT and stronger with DM (all more markedly at femoral than carotid levels). The associations between IMT and IFG/IGT or DM (adjusted by age and major CVD risk factors) decreased only marginally upon further adjustment for BMI, waist or insulin. Further adjustment for family history of diabetes did not alter the results.
  
  
  CONCLUSIONS
  We found graded relationships between IGR categories and both major CVD risk factors and carotid/femoral IMT. These relationships were only partly accounted for by BMI, waist and insulin. This suggests that increased CVD-risk associated with IGR is also mediated by factors other than the considered markers of adiposity and insulin resistance. The results also imply that IGR and associated major CVD risk factors should be systematically screened and appropriately managed.
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and University of Lausanne, Bugnon 17, 1005 Lausanne, Switzerland. david.faeh@ifspm.uzh.ch
authors.forename: David
authors.initials: D
authors.lastname: Faeh
authors.forename: Julita
authors.initials: J
authors.lastname: William
authors.forename: Patrick
authors.initials: P
authors.lastname: Yerly
authors.forename: Fred
authors.initials: F
authors.lastname: Paccaud
authors.forename: Pascal
authors.initials: P
authors.lastname: Bovet
mesh_terms: D050154:Adiposity; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D008076:Cholesterol, HDL / Q000097:blood; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL