American Diabetes Association 2017

Introduction and objectivesTraditionally, the oral glucose tolerance test has been useful to diagnose unknown diabetes. Recently, the American Diabetes Association committee has accepted glycated hemoglobin ≥6.5% as a criterion for unknown diabetes. The aim was to determine the benefit of glycated hemoglobin for diagnosing unknown diabetes and also create a predictive model that adjusts the indication for oral glucose tolerance

Настоящее практическое руководство содержит информацию о влиянии как фактора риска на возникновение и развитие терапевтических социально-значимых заболеваний. Руководство состоит из 6 разделов, с различных патофизиологических сторон освещающих вопросы влияния фактора избыточной массы тела на физиологические процессы организма. В руководстве подробно описан метод лечения терапевтических социально-значимых заболеваний на основе снижения индивидуальной избыточной массы тела с помощью внедрения технологии клинического менеджмента способом аналиментарной детоксикации. В руководстве даны принципы первичной и вторичной профилактики терапевтических социально-значимых заболеваний на основе внедрения принципов рационального питания и модификации пищевого поведения. Практическое руководство предназначено для врачей общей практики, терапевтов, кардиологов, эндокринологов, медицинских работников первичной медико-санитарной помощи, специалистов службы формирования здорового образа жизни, а также ...

OBJECTIVE In view of the previously described anti-inflammatory effects of insulin, we investigated the potential suppressive effect of insulin on plasma concentrations and expression of the chemokines, monocyte chemoattractant protein-1 (MCP-1) and regulated on activation normal T-cell expressed and secreted (RANTES) and their receptors, chemokine receptor (CCR)-2 and CCR-5, in mononuclear cells (MNCs). We also investigated the effect of insulin on other chemokines. RESEARCH DESIGN AND METHODS Ten obese type 2 diabetic patients were infused with insulin (2 units/h with 100 ml of 5% dextrose/h) for 4 h. Another 8 and 6 type 2 diabetic patients were infused with 100 ml of 5% dextrose/h or saline for 4 h, respectively, and served as control subjects. Blood samples were obtained at 0, 2, 4, and 6 h. RESULTS Insulin infusion significantly suppressed the plasma concentrations of MCP-1, eotaxin, and RANTES and the expression of RANTES, macrophage inflammatory protein (MIP)-1β, CCR-2, and ...

OBJECTIVE: The major aims of this study were to determine in normal subjects whether the effects of erythromycin on gastric emptying, postprandial hunger, and fullness are modified by the blood glucose concentration. RESEARCH DESIGN AND METHODS: A total of 10 normal subjects (aged 20-39 years) underwent concurrent measurements of gastric emptying, blood glucose, hunger, and fullness on four separate occasions: twice during euglycemia (approximately 4 mmol/l) and twice during hyperglycemia (approximately 15 mmol/l). Either erythromycin (3 mg/kg) or saline (0.9%) was administered intravenously immediately before ingestion of a radioisotopically labeled solid meal. RESULTS: Gastric emptying was slower (P < 0.0001) during hyperglycemia when compared with euglycemia after both erythromycin and saline administration. During hyperglycemia, erythromycin reduced the lag phase (77.8 +/- 12.6 vs. 20.3 +/- 7.3 min; P < 0.05) but had no effect on the postlag emptying rate (0.32 +/- 0.077% ...

Objectives: Alzheimer's disease (AD) is increasingly recognized as an important comorbidity of diabetes mellitus and is often accompanied by parahippocampal gyrus atrophy (PGA). But the associations between diabetes-related parameters and PGA are not well known. Voxel-based morphometry (VBM) recently became a popular tool for the early diagnosis of AD. One of the clinically useful tools using magnetic resonance imaging (MRI) is the Voxel-based Specific Regional Analysis system for AD (VSRAD) that evaluates the degree of volume loss of parahippocampal gyrus by comparing grey matter with the original normal database template. We examined the risk factors for PGA by using VSRAD in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 137 patients aged ≥ 50 years with T2DM (mean age 67.8 ± 9.8 years) underwent brain MRI scans and comprehensive health examinations. Volume of interest (VOI) was measured using VSRAD for each patient. We examined associations between the se...

Objective: The use of self-reported data to assess diabetes risk in the general population is a key component of the National Diabetes Prevention Program. The American Diabetes Association Diabetes Risk Test (ADADRT) is a popular tool used for this purpose, yet there is paucity of data on its validity in real-world clinical settings. We assessed the performance of ADADRT in identifying undiagnosed prediabetes or diabetes at a Federally Qualified Health Center serving predominantly African Americans. Methods: The ADADRT was administered to participants without pre-existing diagnosis of prediabetes or diabetes and standard validation measures were calculated using HbA1c as the gold standard. Findings are reported for participants who self-identified as being Black or African American (n = 151). Results: HbA1c identified 25.8% of the sample as having prediabetes or diabetes. At the recommended cutoff for ADADRT (i.e., score ≥5) the following measures were observed: proportion of high-r...

The recent American Diabetes Association/American Heart Association statement recommends the use of low doses of aspirin as a strategy for primary prevention of cardiovascular diseases in all individuals with diabetes aged >40 years or who have additional risk factors (1). Like in previous recommendations (2), only selected pieces of evidence are mentioned to support this statement. The data used to sustain the efficacy of aspirin come from the Early Treatment Diabetic Retinopathy Study, the only study specifically conducted in diabetic patients with and without previous cardiovascular disease (3). In this trial, treatment with 650 mg aspirin for 5 years was associated with a nonsignificant 9% reduction in the primary end …

Introduction and objectivesTraditionally, the oral glucose tolerance test has been useful to diagnose unknown diabetes. Recently, the American Diabetes Association committee has accepted glycated hemoglobin ≥6.5% as a criterion for unknown diabetes. The aim was to determine the benefit of glycated hemoglobin for diagnosing unknown diabetes and also create a predictive model that adjusts the indication for oral glucose tolerance

The coronavirus disease 2019 (COVID-19) global pandemic continues to spread worldwide with approximately 216 million confirmed cases and 4.49 million deaths to date. Intensive efforts are ongoing to combat this disease by suppressing viral transmission, understanding its pathogenesis, developing vaccination strategies, and identifying effective therapeutic targets. Individuals with preexisting diabetes also show higher incidence of COVID-19 illness and poorer prognosis upon infection. Likewise, an increased frequency of diabetes onset and diabetes complications has been reported in patients following COVID-19 diagnosis. COVID-19 may elevate the risk of hyperglycemia and other complications in patients with and without prior diabetes history. It is unclear whether the virus induces type 1 or type 2 diabetes or instead causes a novel atypical form of diabetes. Moreover, it remains unknown if recovering COVID-19 patients exhibit a higher risk of developing new-onset diabetes or its com...

OBJECTIVE—To establish the impact of different amounts of increased energy expenditure on type 2 diabetes care. RESEARCH DESIGN AND METHODS—Post hoc analysis of long-term effects of different amounts of increased energy expenditure (metabolic equivalents [METS] per hour per week) through voluntary aerobic physical activity was performed in 179 type 2 diabetic subjects (age 62 ± 1 years [mean ± SE]) randomized to a physical activity counseling intervention. Subjects were followed for 2 years and divided into six groups based on their increments in METs per hour per week: group 0 (no activity, n = 28), group 1–10 (6.8 ± 0.3, n = 27), group 11–20 (17.1 ± 0.4, n = 31), group 21–30 (27.0 ± 0.5, n = 27), group 31–40 (37.5 ± 0.5, n = 32), and group >40 (58.3 ± 1.8, n = 34). RESULTS—At baseline, the six groups did not differ for energy expenditure, age, sex, diabetes duration, and all parameters measured. After 2 years, in group 0 and in group 1–10, no parameter changed; in groups 11–20,...

Although loss of functional β-cell mass is a hallmark of diabetes, no treatment approaches that halt this process are currently available. We recently identified thioredoxin-interacting protein (TXNIP) as an attractive target in this regard. Glucose and diabetes upregulate β-cell TXNIP expression, and TXNIP overexpression induces β-cell apoptosis. In contrast, genetic ablation of TXNIP promotes endogenous β-cell survival and prevents streptozotocin (STZ)- and obesity-induced diabetes. Finding an oral medication that could inhibit β-cell TXNIP expression would therefore represent a major breakthrough. We were surprised to discover that calcium channel blockers inhibited TXNIP expression in INS-1 cells and human islets and that orally administered verapamil reduced TXNIP expression and β-cell apoptosis, enhanced endogenous insulin levels, and rescued mice from STZ-induced diabetes. Verapamil also promoted β-cell survival and improved glucose homeostasis and insulin sensitivity in BTBR...

Guidelines for the management of type 2 diabetes mellitus from the UK National Institute for Health and Clinical Excellence and the joint American Diabetes Association/European Association for the Study of Diabetes identify a role for glucagon-like peptide 1 (GLP-1) agonists as second- or third-line treatments. In the LEAD-2 trial the GLP-1 agonist liraglutide was similar to glimepiride for glycaemic control

The Naturopathic Patient Database is a data management tool developed by the Canadian College of Naturopathic Medicine to collect patient data from its teaching clinic, the Robert Schad Naturopathic Clinic. This study investigated how type 2 diabetes mellitus was managed at the Robert Schad Naturopathic Clinic from May 2009 to February 2011. Cases of type 2 diabetes mellitus from the Robert Schad Naturopathic Clinic reported in the Naturopathic Patient Database were extracted based on an International Classification of Diseases, 10th revision code assessment of E11 (non-insulin-dependent diabetes mellitus) and files were audited. The American Diabetes Association 2010 standards of medical care in diabetes were used as guidelines for the audit. Multiple categories in diagnosis, physical exam, laboratory tests, and management were graded on a 0 to 2 scale. The average audit score was 55.5/90. The most common interventions being used are diet and aerobic exercise, followed by supplemen...

To determine the incidence rates of type 2 diabetes and associated factors among professional and office workers in Bangkok. Data on fasting glucose measurements and physical examination were obtained from a cohort of 6,924 workers in 43 establishments in Bangkok during 1999-2003. Impaired fasting glucose and diabetes were defined according to the American Diabetes Association criteria. The type 2 diabetes incidence rates were calculated based on the person-time of follow-up period. A total of 136 individuals developed type 2 diabetes during 11,581 person-years (py) of follow-up. The incidence rates of type 2 diabetes in individuals aged 35-60 years was 11.4 per 1000 py Men had a higher incidence rate than women (17.8 vs 9.2 per 1,000 py). The incidence rates increased with age. Factors associated with development of diabetes included baseline fasting plasma glucose (FPG) level, overweight and obesity status. Adjusted incidence rate ratios (IRR, 95%CI) for FPG of 93-99 mg/dl and 100...

Sirs: Protease inhibitors (PI) are currently used to treat HIV infection. They inhibit HIV protease which is necessary for the processing of viral proteins in the last stage of the viral cycle, and can achieve an undetectable viral load when used in combination with nucleoside analogues in triple therapy. However, PI are not free of adverse effects (Flexner, 1998). Hyperlipidaemia and abnormal fat distribution were soon related to the use of these drugs (Massip et al., 1997). The latter occurred between two and 12 months after beginning treatment and was not preceded by weight loss (Viraben & Aquilina, 1998). The lipoatrophy was noted mainly in the legs, arms and face, sparing the central portion of the body (Carr et al., 1998a). Hyperglycaemia was also noted with the use of PI (FDA, 1997) and new onset diabetes mellitus, easily controlled with the use of hypoglycaemic agents or insulin (Eastone & Decker, 1997), or even severe diabetes (Visnegarwala et al., 1997) have been reported. However, treatment with PI could not to be discontinued in the majority of patients (Ault, 1997). In 1998, an association between the syndrome of lipodystrophy, hyperlipidaemia and insulin resistance, with the appearance of overt diabetes mellitus in less than 2% of the cases was demonstrated (Carret al., 1998a). A recent publication indicated a prevalence of 83% for lipodystrophy which can be severe in 11% of cases, and abnormalities in glucose homeostasis in 23% of patients, with less than 1% of cases with diabetes mellitus and less than 3% with glucose intolerance, after 21 months of treatment with PI (Carret al., 1999). There is no information on the long-term natural history or complications of the diabetes associated to the use of PI nor about its reversibility after cessation of therapy. We report a patient with complete resolution of PI induced diabetes mellitus. In all of these communications, nothing was said about the natural history of the diabetes associated to the use of protease inhibitors. Nevertheless, it was proposed that cessation of therapy might be considered for patients with difficult control of severe diabetes mellitus. A 47-year-old man presented with polyuria, polydipsia, polyphagia, blurred vision and weight loss of four kilograms for one month. He had HIV infection in A2 stage and had received treatment with indinavir and two nucleoside analogues (stavudine and lamivudine) for 10 months. He had no personal nor familial history of diabetes mellitus or hyperglycaemia. He had not suffered acute nor chronic pancreatitis and never received treatment with anabolic steroids, pentamidine or other hyperglycaemia associated drugs apart from protease inhibitors. Physical examination revealed fat wasting of face, legs and arms, sparing the abdomen and central part of the body. Height was 1·79 m, weight 79 kg and BMI 24·6. No acanthosis nigricans was noted. He had a CD4 level of 515 per mm and a viral load of less than 1·7 logs (less than 50 virions per mm), showing a good response to treatment. He presented with a fasting glucose level of 43·6 mmol/l, venous pH 7·37, ketonuria almost undetectable, triglycerides 6·54 mmol/l, cholesterol 7·68 mmol/l, HDL 0·80 mmol/l, LDL 5·22 mmol/l, HbA1c 12·9%. Levels of CH-50 and C3 were 0·89 mmol/l and 1·19 mmol/l, respectively. Islet cell autoantibody were absent. Treatment with the PI was stopped and insulin was started (Fig. 1). C-peptide rose after injection of glucagon was from 0·72 nmol/l (0) to 1·39 nmol/l (6) with glucose levels of 8·27 mmol/l and 9·27 mmol/l, respectively. Basal insulin was 153 pmol/l for a fasting glucose level of 8·27 mmol/l. Insulin resistance calculated by HOMA was 7·86. The patient was discharged with insulin therapy, lipid lowering treatment with atorvastatin and treatment for HIV infection with nevirapine (a non-nucleoside antiretroviral), lamivudine and stavudine (both nucleoside analogues). One month later, insulin was withdrawn, and basal and postprandial glucose levels were normal (Fig. 1). The patient was admitted into our Metabolic Unit in order to perform a glucagon test and basal measurements of insulin. C-peptide levels were of 1·25 nmol/l (0 ) to 2·44 nmol/l (6), and glucose levels of 4·7 mmol/l and 5·38 mmol/l, respectively. Basal insulin determination was of 406 pmol/l for a glucose level of 4·7 mmol/l. Insulin resistance was 11·83 determined by HOMA model. Triglycerides were 2·23 mmol/l and cholesterol 6·1 mmol/l on atorvastatin treatment, and lipodystrophy was still clinically evident. The present case shows that PI induced diabetes mellitus can be a rapidly reversible phenomenon after cessation of the drug. The inhibition of proteins involved in regulation of blood lipid levels and in adipocyte proliferation, has been proposed as a cause of lipodystrophy and insulin resistance (Carr et al., 1998b). However, decreased insulin secretion may also play a role in the pathogenesis of associated diabetes mellitus (Visnegarwala et al.,…

OBJECTIVE—β-Cell response to glucose is characterized by mitochondrial membrane potential (ΔΨ) hyperpolarization and the production of metabolites that serve as insulin secretory signals. We have previously shown that glucose-induced mitochondrial hyperpolarization accompanies the concentration-dependent increase in insulin secretion within a wide range of glucose concentrations. This observation represents the integrated response of a large number of mitochondria within each individual cell. However, it is currently unclear whether all mitochondria within a single β-cell represent a metabolically homogenous population and whether fuel or other stimuli can recruit or silence sizable subpopulations of mitochondria. This study offers insight into the different metabolic states of β-cell mitochondria. RESULTS—We show that mitochondria display a wide heterogeneity in ΔΨ and a millivolt range that is considerably larger than the change in millivolts induced by fuel challenge. Increasing ...

The physiological signaling mechanisms that link glucose sensing to the electrical activity in metabolism-regulating hypothalamus are still controversial. Although ATP production was considered the main metabolic signal, recent studies show that the glucose-stimulated signaling in neurons is not totally dependent on this production. Here, we examined whether mitochondrial reactive oxygen species (mROS), which are physiologically generated depending on glucose metabolism, may act as physiological sensors to monitor the glucose-sensing response. Transient increase from 5 to 20 mmol/l glucose stimulates reactive oxygen species (ROS) generation on hypothalamic slices ex vivo, which is reversed by adding antioxidants, suggesting that hypothalamic cells generate ROS to rapidly increase glucose level. Furthermore, in vivo, data demonstrate that both the glucose-induced increased neuronal activity in arcuate nucleus and the subsequent nervous-mediated insulin release might be mimicked by th...

OBJECTIVE To define cellular mechanisms by which B cells promote type 1 diabetes. RESEARCH DESIGN AND METHODS The study measured islet-specific CD4 T cell regulation in T-cell receptor transgenic mice with elevated frequencies of CD4 T cells recognizing hen egg lysozyme (HEL) autoantigen expressed in islet β-cells and thymic epithelium under control of the insulin-gene promoter. The effects of a mutation in Roquin that dysregulates T follicular helper (Tfh) cells to promote B-cell activation and anti-islet autoantibodies were studied, as were the effects of HEL antigen–presenting B cells and passively transferred or maternally transmitted anti-islet HEL antibodies. RESULTS Mouse anti-islet IgG antibodies—either formed as a consequence of excessive Tfh activity, maternally transmitted, or passively transferred—caused a breakdown of tolerance in islet-reactive CD4+ cells and fast progression to diabetes. Progression to diabetes was ameliorated in the absence of B cells or when the B c...

Weight loss in response to energy restriction is highly variable, and identification of genetic contributors can provide insights into underlying biology. Leveraging 1000 Genomes imputed genotypes, we carried out genome-wide association study (GWAS) analysis in 551 unrelated obese subjects of European ancestry who participated in an intensively supervised weight loss program with replication of promising signals in an independent sample of 1,331 obese subjects who completed the program at a later date. By single nucleotide polymorphism–based and sib-pair analysis, we show that that weight loss is a heritable trait, with estimated heritability (h2 = 0.49) within the range reported for obesity. We find rs679482, intronic to SGCG (sarcoglycan γ), highly expressed in skeletal muscle, to concordantly associate with weight loss in discovery and replication samples reaching GWAS significance in the combined meta-analysis (β = −0.35, P = 1.7 × 10−12). Located in a region of open chromatin, ...

OBJECTIVE—The purpose of this study was to determine whether the continuous glucose monitoring system (CGMS) (MiniMed, Sylmar, CA) 1) is sufficiently representative of the overall metabolic control as assessed by HbA1c, 2) could be used to identify a particular blood glucose threshold value affecting hemoglobin glycation; and 3) is able to show any relationship between particular glycemic profiles and HbA1c levels. RESEARCH DESIGN AND METHODS—Of 44 pediatric patients with type 1 diabetes who wore CGMS devices, 28 subjects were selected for the study. Criteria for inclusion were high levels of HbA1c (≥8%) for more than 1 year or a history of frequent hypoglycemic episodes and a complete CGMS registration for 72 h. Age of the subjects ranged from 5.7 to 24.8 years, the mean duration of disease was 7.63 ± 4.75 years, and the mean HbA1c value was 8.7 ± 1.3%. CGMS data were downloaded and glucose profiles were analyzed. The area under each glucose profile was calculated by means of a pro...

Emerging data suggest that type 1 diabetes is a more aggressive disease in children than in adults, with important differences in pathophysiology and clinical course. Therefore, the efficacy of disease-modifying therapies may be different in the two populations. Understanding the developmental and regulatory pathways for type 1 diabetes-modifying therapies in children will enable industry, academia, funders, advocacy groups, and regulators to translate new science to clinical care. This consensus report characterizes the fundamental differences in type 1 diabetes between children and adults and proposes a thoughtful approach to better understand the development and regulatory pathways for type 1 diabetes therapies.

OBJECTIVE Regulatory T-cells (Tregs) recognizing islet autoantigens are proposed as a key mechanism in the maintenance of self-tolerance and protection from type 1 diabetes. To date, however, detailed information on such cells in humans, and insight into their mechanisms of action, has been lacking. We previously reported that a subset of CD4 T-cells secreting high levels of the immunosuppressive cytokine interleukin-10 (IL-10) is significantly associated with late onset of type 1 diabetes and is constitutively present in a majority of nondiabetic individuals. Here, we test the hypothesis that these T-cells represent a naturally generated population of Tregs capable of suppressing proinflammatory T-cell responses. RESEARCH DESIGN AND METHODS We isolated and cloned islet-specific IL-10–secreting CD4+ T-cells from nondiabetic individuals after brief ex vivo exposure to islet autoantigens using cytokine capture technology and examined their phenotype and regulatory potential. RESULTS I...

We explored the association of grade of Diabetic Retinopathy (DR) with amputations in 2500, T2DM patients (males 1295, females 1205) who were screened for DR in year 2010, underwent Mini Mental State Examination (MMSE) for cognitive decline, and followed-up for 7 years, till 2017. Cohort was stratified into tertiles based on demographics, grade of DR and type of amputation. DR was observed in 56% patients [Non Proliferative DR (NPDR) n=962, 38%; Proliferative DR (PDR) n=438, 18%] demonstrating a strong association with all types of amputations (p<0.00001), with highest association for amputation of both limbs (n=640) (p<0.00001). Significant association was observed with comorbidities of hypertension, dyslipidemia and hyperhomocysteinemia (p<0.00001). The age tertile of 40-60 years with amputations reported highest number of NPDR and PDR, n=561 and n=263 respectively; highest tertile of HbA1c (>15%) and duration of diabetes (>15 years) corroborated with the high incid...

We analyzed Sardinian registry data to assess time trends in incidence rates (IRs) of type 1 diabetes during the period 1989–2009 (2,371 case subjects 0–14 years of age). Poisson regression models were used to estimate the effects of sex, age, period of diagnosis, and birth cohorts. IR was 44.8 cases/100,000 person-years (95% CI 43.1–46.7). The annual increase was 2.12% (1.45–2.80; test for linear trend, P < 0.001). For boys, the increasing trend was evident up to 5 years of age and for girls up to 8 years of age. Compared with the 1989–1994 birth cohort, the relative risk increased from 0.78 (0.61–1.10) in 1974–1979 to 1.62 (1.18–2.23) in 2004–2009. The increase over period was less striking, with a tendency to regress in more recent years. The best-fitting model for boys included age and a linear time trend, and for girls age and nonlinear effects of calendar period and birth cohort. In conclusion, incidence increased over time, and the increase tended to level off in more rece...

OBJECTIVE—To characterize insulin action in Africans with ketosis-prone diabetes (KPD) during remission. RESEARCH DESIGN AND METHODS—At Saint-Louis Hospital, Paris, France, 15 African patients with KPD with an average 10.5-month insulin-free near-normoglycemic remission period (mean A1C 6.2%) were compared with 17 control subjects matched for age, sex, BMI, and geographical origin. Insulin stimulation of glucose disposal, and insulin suppression of endogenous glucose production (EGP) and nonesterified fatty acids (NEFAs), was studied using a 200-min two-step (10 mU · m−2 body surface · min−1 and 80 mU · m−2 · min −1 insulin infusion rates) euglycemic clamp with [6,6-2H2]glucose as the tracer. Early-phase insulin secretion was determined during an oral glucose tolerance test. RESULTS—The total glucose disposal was reduced in patients compared with control subjects (7.5 ± 0.8 [mean ± SE] vs. 10.5 ± 0.9 mg · kg−1 · min−1; P = 0.018). EGP rate was higher in patients than control subject...

Patients with type 2 diabetes have a three-fold increased risk of developing vascular disease with death in 75% due to a vascular complication. Large prospective studies have demonstrated the benefits of treating patients with type 2 diabetes to strict targets regarding blood pressure (BP), lipids and glucose. Using both American Diabetes Association and Joint British Societies/Guidelines we assessed the effectiveness of this `treat-to-target' policy in diabetic patients attending secondary care. Of 321 patient notes analysed 54—87% were within target for total cholesterol, 80—84% for LDL cholesterol, 77% for HDL cholesterol, 51% for triglycerides, 44—61% for systolic BP, 62% for diastolic BP and 30—44% for HbA1C. In the secondary care setting we are performing well for lipids, less well for BP and poorly for HbA1C.

We assessed (i) the risk of cardiovascular disease in an industrial population in Chennai, southern India and (ii) whether the status of treatment and control of diabetes and hypertension would be different in an industrial population, which is provided free healthcare, compared with the general population of Chennai. Subjects residing in the residential areas of 2 industries (Indian Airlines and Integral Coach Factory) in Chennai in southern India were recruited. The subjects were employees (n = 440) selected by an age- and sex-stratified random sampling method, and their family members (n = 727) in the age group of 20-69 years; a total of 1167 subjects. Fasting plasma glucose, lipid estimations and anthropometric measurements were done in all the subjects. Information on demographic and lifestyle determinants was obtained using a questionnaire. Diabetes was diagnosed using the American Diabetes Association criteria and metabolic syndrome was defined by the Adult Treatment Panel II...