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New clinical tool to identify those at highest risk for having undetected hyperglycemia

April 22, 2016

A University of Missouri researcher has created a clinical tool to identify those at highest risk for having undetected hyperglycemia, impaired fasting glucose (IFG) and undiagnosed diabetes. If these conditions are identified early, patients may benefit from preventative strategies that can minimize progression to diabetes, other diseases and mortality.

"Diabetic risk factors are not equal and assessing a combination of risk factors can be confusing," said Richelle J. Koopman, assistant professor of family and community medicine in the MU School of Medicine. "A tool that weighs the relative contributions of multiple risk factors and creates an overall risk score will help clinicians decide which patients to screen for diabetes. The tool we have developed is easy to use and the screening can be done with pencil and paper. Patients can do it at a health fair or a physician's office."

The Tool to Assess Likelihood of Fasting Glucose Impairment (TAG-IT) is designed to use factors that are self-reported or easily measured. The six factors include: age, sex, BMI, family history resting heart rate and measured high blood pressure.

The average age of diagnosis for diabetes in the United States is 46 years old. However, patients are likely to develop prediabetic conditions at a younger age. In the United States, 57 million people have IFG. As type 2 diabetes becomes an increasing burden in younger populations, it's important to have a screening tool that can assess undiagnosed diabetes and IFG in people as young as 20, Koopman said.

"There has been increasing evidence that prediabetic states are associated with diseases and other complications, and strategies that prevent diabetes in those with prediabetes are effective," Koopman said. "The TAG-IT tool will help physicians assess patients' risk levels. Hopefully, knowing their TAG-IT scores will encourage high-risk patients to use preventative strategies and make positive changes in their behaviors. The tool has potential as a Web-based screening tool that could improve awareness and encourage compliance with lifestyle changes recommended by physicians."

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"It's hard to say functionally what those cytokine changes might mean," Huey said. "IL-1beta is primarily a pro-inflammatory cytokine, so that could be a good thing - especially in terms of cardiac function."

However, she said, "IL-6 can have both pro- or anti-inflammatory actions." She said that the literature has yielded some evidence pointing to the detrimental effects of chronic increases in IL-6. But the effects of acute increases in IL-6 in skeletal muscles - which occur during exercise - may be another story.

"Whether there's a difference between exercise-induced increases versus inflammation-induced increases in IL-6 is still highly debatable," she said.

Nonetheless, Huey said, the larger take-home message of the study, published in the December issue of the journal Experimental Physiology , is that Vitamin E "may be beneficial in individuals with chronic inflammation, such as the elderly or patients with type II diabetes or chronic heart failure."

While the Illinois research team's work provides a foundation for future investigations that could ultimately have positive outcomes for people afflicted with chronic skeletal or cardiac muscle inflammation, Huey cautioned that it is still far too soon to speculate on results in humans.

"This is clearly an animal model so whether it would translate to humans still requires a lot more research," she said. "Vitamin E is a supplement that is already approved, and these results may suggest an additional benefit of taking Vitamin E beyond what's already been shown."

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