A targeted metabolomics approach was used to identify candidate biomarkers of pre-diabetes. The relevance of the identified metabolites is further corroborated with a protein-metabolite interaction network and gene expression data.

About 40% of the population aged 55 to 74 years in the Augsburg region have disturbed glucose tolerance or diabetes. Half of the total cases with diabetes are undiagnosed. Cardiovascular risk factors worsen among glucose tolerance categories, indicating the need for screening and prevention. Screening for undiagnosed diabetes could be most efficient in individuals with abdominal adiposity (men), hypertriglyceridaemia (women), hypertension, and parental diabetes history.

Aims/hypothesis. A population-based sample was studied to define immune abnormalities in individuals at risk of Type II (non-insulin-dependent) diabetes mellitus because of impaired glucose tolerance. Methods. A total of 1653 individuals aged 55 to 74 years participated in a population based survey in Southern Germany (KORA Survey 2000). Those without a history of diabetes were subjected to an OGTT. Randomly selected subjects with IGT (n=80) were compared with non-diabetic control subjects (n=77) and patients with Type II diabetes (n=152) of the same population-based sample after matching for age and sex. Immune parameters were analysed in serum with rigidly evaluated ELISA. Results. Serum pro-inflammatory cytokine interleukin 6 (IL-6) concentrations were higher in subjects with IGT and Type II diabetes than in the control subjects (median 1.8 and 2.5 vs 0.8 pg/ml, p<0.0001). Soluble IL-6 receptors potentiate IL-6 bioactivity and their concentrations were mildly increased in Type II diabetes (p<0.05). These immune changes seem relevant because IL-6 dependent acute-phase proteins C-reactive protein, serum amyloid A protein and fibrinogen were also increased in IGT and Type II diabetes. Circulating concentrations of TNF-α and its two receptors sTNF-R60 and sTNF-R80 were not increased in IGT subjects compared with the control subjects. Conclusion/interpretation. Our study shows systemic up-regulation of selected inflammatory mediators in patients with Type II diabetes and IGT. The pattern observed is non-random and fits with an IL-6 associated rather than TNF-α associated response. [Diabetologia (2002) 45:805-812]

Associations between the characteristics of general practitioners and their patients with type 2 diabetes O besity is an important cardiovascular risk factor in type 2 diabetes (1). Physician characteristics such as age and sex are related to counseling for overweight (2). Other physician characteristics may also be related. Patients indicated greater confidence in nonobese versus obese physicians. Whether this translates into increased success in obesity management is unknown (3). We aimed to study associations between the weight of general practitioners and their type 2 diabetic patients.A postal survey was performed among 36 general practitioners participating in a shared-care diabetes project in 2000. It contained questions about the general practitioners' age, sex, weight, height, smoking behavior, work experience, practice population size, and opinion regarding how much influence they have on a patient's weight and smoking cessation. The project's target population consisted of type 2 diabetic patients who were exclusively treated in primary care. Patients who were cotreated in secondary care or who were terminally ill or had dementia were excluded. Participating patients (n ϭ 1,441) represented 87% of the target population. Data on patient age, sex, diabetes duration, BMI, and smoking were collected by nurses. We performed a regression analysis with the mean BMI of patients as the dependent variable and the above variables as predictors.The survey response rate was 100%. Most general practitioners were nonsmoking (94%) men (83%) with a mean (ϮSD) age of 51.1 Ϯ 7.0 years and work experience of 18.1 Ϯ 8.9 years. The general practitioners' mean BMI was 24.4 Ϯ 3.5 kg/m 2 (BMI Ͻ25 in 72%). For patients (per general practitioner), mean age was 68.2 Ϯ 2.9 years, diabetes duration 7.2 Ϯ 1.3 years, and BMI 29.3 Ϯ 0.85 kg/m 2 ; 44 Ϯ 9% were men. The mean BMI of patients showed the strongest correlation with the BMI of general practitioners: Ϫ0.40 (partial correlation) and unstandardized coefficient B of Ϫ1.05 (95% CI Ϫ0.197 to Ϫ0.013). The optimal model (P ϭ 0.07) had a multiple correlation (R) of 0.56, and explained variance (R 2 ) was 31% (adjusted 17%). We found a negative correlation between the BMI of type 2 diabetic patients and their general practitioners. Obese doctors had lean patients. Our study is limited by the cross-sectional design; associations were found, not causal relations.Hash et al. (3) showed that patients indicated greater confidence in nonobese physicians. However, we found no translation into increased success in obesity management. On the contrary, patients of nonobese general practitioners had a higher BMI compared with patients of obese general practitioners. A discernable negative impact of patient weight on physician behavior was shown earlier (4). Could it be that nonobese general practitioners lack motivation to treat overweight patients? Is it time for general practitioners to search our own hearts? • LIELITH J. UBINK-VELTMAAT, MD Sudden sensorineural hearing loss (SSNHL) is define...

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For the first time, we have estimated the incidence of Type 2 diabetes in an elderly German cohort and demonstrated that it is among the highest in Europe. The OGTT appears to be useful in identifying individuals with high Type 2 diabetes risk. Our results support a role of smoking in the progression to diabetes.

ContextHepatic steatosis, defined as increased hepatocellular lipid content (HCL), associates with visceral obesity and glucose intolerance. As exact HCL quantification by 1H-magnetic resonance spectroscopy (1H-MRS) is not generally available, various clinical indices are increasingly used to predict steatosis.ObjectiveThe purpose of this study was to test the accuracy of NAFLD liver fat score (NAFLD-LFS), hepatic steatosis index (HSI) and fatty liver index (FLI) against 1H-MRS and their relationships with insulin sensitivity and secretion.Design, Setting and ParticipantsNinety-two non-diabetic, predominantly non-obese humans underwent clinical examination, 1H-MRS and an oral glucose tolerance test (OGTT) to calculate insulin sensitivity and β-cell function. Accuracy of indices was assessed from the area under the receiver operating characteristic curve (AROC).ResultsMedian HCL was 2.49% (0.62;4.23) and correlated with parameters of glycemia across all subjects. NAFLD-LFS, FLI and HSI yielded AROCs of 0.70, 0.72, and 0.79, respectively, and related positively to HCL, insulin resistance, fasting and post-load β-cell function normalized for insulin resistance. Upon adjustment for age, sex and HCL, regression analysis revealed that NAFLD-LFS, FLI and HSI still independently associated with both insulin sensitivity and β-cell function.ConclusionThe tested indices offer modest efficacy to detect steatosis and cannot substitute for fat quantification by 1H-MRS. However, all indices might serve as surrogate parameters for liver fat content and also as rough clinical estimates of abnormal insulin sensitivity and secretion. Further validation in larger collectives such as epidemiological studies is needed.

OBJECTIVE -A reduction of diabetes-related amputations by at least one-half within 5 years was declared a primary objective for Europe (St. Vincent Declaration, 1989). We collected data about incidence rates of amputations in one German city (Leverkusen, with a population of ϳ160,000 inhabitants) between 1990 and 1998 to ascertain a potential change in rates of incidence. RESEARCH DESIGN AND METHODS-From all three hospitals in Leverkusen, we obtained complete lists of lower-limb amputations. From each patient record, diabetic status was determined. Only the first observed amputation was counted for the analysis. We estimated incidence rates of amputations in the entire population, the diabetic population, and the nondiabetic population. To test for time trend, we fitted Poisson regression models, adjusting for age and sex.RESULTS -During the defined period (the years 1990, 1991, and 1994 -1998), 339 patients (all residents of Leverkusen) without previous amputations had nontraumatic lower-limb amputations. Of all subjects, 46% were female. Moreover, 76% of the subjects were known to have diabetes. Mean age was 71.3 years. Incidence rates in the diabetic population (standardized to the estimated German diabetic population, per 100,000 person-years) were as follows : 1990, 549; 1991, 356; 1994, 544; 1995, 386; 1996, 426; 1997, 433; and 1998, 463. The Poisson models showed no significant change of incident amputations over time in the diabetic population or in the nondiabetic population.CONCLUSIONS -Beyond random variation, no change of incidence rates could be observed over the past 9 years. More specific interventions are needed to achieve a substantial reduction of diabetes-related amputations. Diabetes Care 24:855-859, 2001