title: Hypertriglyceridemia: A simple approach to identify insulin resistance and enhanced cardio-metabolic risk in patients with prediabetes.
abstract: OBJECTIVE
  Prediabetes (PreDM) is a metabolically heterogeneous condition, differing in degree of insulin resistance and risk of type 2 diabetes mellitus and coronary heart disease (CHD). This study was initiated to evaluate the hypothesis that a fasting plasma triglyceride (TG) concentration ⩾1.7mmol/L can aid in identifying the subset of individuals with PreDM who are most insulin resistant and at greatest risk to develop CHD as well as type 2 diabetes mellitus.
  
  
  METHODS
  In this cross-sectional study, measurements were made of: (1) steady-state plasma glucose (SSPG) concentration during the insulin suppression test to ascertain degree of insulin resistance and (2) conventional CHD risk factors in 587 apparently healthy individuals with normal fasting plasma glucose (NFG, n=370) or PreDM (n=217).
  
  
  RESULTS
  Subjects with PreDM were significantly (P<0.001) more insulin resistant (higher SSPG concentrations) and had a more adverse CHD risk profile than those with NFG. A TG concentration ⩾1.7mmol/L identified a subset of individuals with PreDM (38%) who had a higher mean SSPG concentration (11.3±3.5mmol/L vs. 9.3±3.9mmol/L, P<0.001), were more likely to be insulin resistant (66% vs. 39%, P<0.001), and had a more adverse CHD risk factor profile.
  
  
  CONCLUSIONS
  Measurement of fasting TG concentration in individuals with PreDM may provide a simple clinical approach to identify those who are insulin resistant, at enhanced risk of CHD, and more likely to develop type 2 diabetes mellitus.
authors: Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Falk CVRC, 300 Pasteur Drive, Stanford, CA 94305-5406, USA. Electronic address: fahim@stanford.edu.
authors: Fahim
authors: F
authors: Abbasi
authors: Kaiser Permanente, 2045 Franklin Street, Denver, CO 80205, USA. Electronic address: payal.kohli.md@gmail.com.
authors: Payal
authors: P
authors: Kohli
authors: Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Falk CVRC, 300 Pasteur Drive, Stanford, CA 94305-5406, USA. Electronic address: greaven@stanford.edu.
authors: Gerald M
authors: GM
authors: Reaven
authors: Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Falk CVRC, 300 Pasteur Drive, Stanford, CA 94305-5406, USA. Electronic address: knowlej@stanford.edu.
authors: Joshua W
authors: JW
authors: Knowles
mesh_terms: D000328:Adult; D001786:Blood Glucose; D003324:Coronary Artery Disease / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000175:diagnosis*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood* / Q000175:diagnosis; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides
keywords: Coronary heart disease; Hypertriglyceridemia; Insulin resistance; Prediabetes; Type 2 diabetes mellitus