In this representative national sample of adults, mortality rates were higher for diabetic men than for diabetic women and for diabetic blacks than for diabetic whites. The study confirms the substantially higher risk of death, lower survival, and lower life expectancy of diabetic adults compared with nondiabetic adults.

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Highlights d Simultaneous imaging of interacting mice reveals interbrain synchrony of activity d Interbrain synchrony arises from ongoing social interaction between animals d Synchrony emerges from neurons encoding behavior of oneself and the social partner d Interbrain synchrony predicts future social decisions and dominance relationships

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OBJECTIVE -To determine the effect of lowering the fasting plasma glucose (FPG) criterion for impaired fasting glucose (IFG) on the prevalence of IFG, the risks of diabetes, and cardiovascular disease (CVD) associated with IFG. RESEARCH DESIGN AND METHODS-Three studies were used: 1) the 1998 National Health Survey (NHS98), a randomly selected cross-sectional sample of 4,723 subjects; 2) the Singapore Impaired Glucose Tolerance (IGT) Follow-up Study, a cohort study comprising 295 IGT and 292 normal glucose tolerance subjects (frequency matched for age, sex, and ethnic group) followed up from 1992 to 2000; and 3) the Singapore CVD Cohort Study, comprising 5,920 subjects from three cross-sectional studies in whom the first ischemic heart disease (IHD) event was identified through linkage to registry databases. Risk of diabetes (Singapore IGT Follow-up study) was estimated using logistic regression adjusted for age, sex, and ethnicity. Risk of IHD (Singapore CVD cohort) was estimated using stratified (by study, from which data were derived) Cox's proportional hazards models adjusted for age, sex, and ethnicity.RESULTS -Lowering the criterion for diagnosing IFG to 5.6 mmol/l increased the prevalence of IFG from 9.5 to 32.3% in the NHS98. The lower cutoff identified more subjects at risk of diabetes and IHD, but the relative risk was lower than that for IGT.CONCLUSIONS -Greater efforts to identify those with IGT, or a group at similar risk of diabetes and CVD, may be a more efficient public health measure than lowering the FPG criterion for diagnosing IFG. Diabetes Care 27:1728 -1734, 2004T he American Diabetes Association had previously recommended (1) the recognition of impaired fasting glucose (IFG) as a category of glucose tolerance analogous to impaired glucose tolerance (IGT). It was recommended that IFG be diagnosed in those with fasting plasma glucose (FPG) between 6.1 and 6.9 mmol/l. Since then, many analyses have examined the equivalence of FPG and 2-h postchallenge glucose (2-h PG) in predicting both diabetes and cardiovascular disease (CVD). Several key findings have emerged from these studies. First, the association between IGT and CVD events and mortality is stronger than that for IFG (2,3). Second, although IFG and IGT identify some of the same individuals, the degree of overlap is variable (4,5). As a consequence of the recommendations to use FPG rather than 2-h PG for the diagnosis of diabetes, many subjects with IGT, who are at risk of future CVD events, would not be identified.On the basis of the aforementioned findings, the American Diabetes Association has recently recommended (6) that the lower limit for the diagnosis of IFG be changed from 6.1 to 5.6 mmol/l. However, the need for this change has been questioned by others (7,8). Singapore is a small country in Asia with a high prevalence of diabetes and IGT. As in Europe and the U.S., we have found that IFG and IGT often identify different individuals. Only 26% of subjects with IGT had IFG (as defined by the older criteria of FPG 6.1-6.9 mmol/l),...

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We found wide variations in fasting insulin and fasting C-peptide levels by race and ethnicity in US adults that were not explained by confounding factors, primarily measures of obesity. Most notably, the higher fasting insulin and lower fasting C-peptide levels in blacks implies that there is a derangement in insulin clearance and an impairment in beta-cell function in blacks compared with whites and Mexican Americans.

E. SHYONG TAI, MD 5OBJECTIVE -To 1) document the change in glucose tolerance for subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) over time, 2) identify baseline factors associated with worsening of glucose tolerance, and 3) determine whether cardiovascular disease (CVD) risk factors associated with IGT improved in tandem with glucose tolerance.RESEARCH DESIGN -Subjects with IGT and NGT (matched for age, sex, and ethnic group) were identified from a cross-sectional survey conducted in 1992. Subjects with IGT (297) and NGT (298) (65.0%) were reexamined in 2000. Glucose tolerance (assessed by 75-g oral glucose tolerance test), anthropometric data, serum lipids, blood pressure, and insulin resistance were determined at baseline and at the follow-up examination.RESULTS -For NGT subjects, 14.0% progressed to IGT and 4.3% to diabetes over 8 years. For IGT subjects, 41.4% reverted to NGT, 23.0% remained impaired glucose tolerant, and 35.1% developed diabetes. Obesity, hypertriglyceridemia, higher blood pressure, increased insulin resistance, and lower HDL cholesterol at baseline were associated with worsening of glucose tolerance in both IGT and NGT subjects. Those with IGT who reverted to NGT remained more obese and had higher blood pressure than those with NGT in both 1992 and 2000. However, serum triglyceride, HDL cholesterol, and insulin resistance values in 2000 became indistinguishable from those of subjects who maintained NGT throughout the study period.CONCLUSIONS -Some, but not all, CVD risk factors associated with IGT and with the risk of future diabetes normalize when glucose tolerance normalizes. Continued surveillance and treatment in subjects with IGT, even after they revert to NGT, may be important in the prevention of CVD. Diabetes Care 26:3024 -3030, 2003D iabetes is associated with increased risk of microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (1). The latter manifests primarily as cardiovascular disease (CVD) (2). Diabetes is now recognized as a CVD risk equivalent in the National Cholesterol Education Program Adult Treatment Panel III (3). Although microvascular complications have been shown to be associated with the duration of diabetes (4 -6), the same cannot be said of CVD (7).It has been suggested that the lack of association between the duration of diabetes and CVD might be related to the presence of diabetes-associated CVD risk factors (dyslipidemia, hypertension, and obesity-all features of the metabolic syndrome) before the onset of glucose intolerance. As such, the atherosclerotic process is already underway by the time glucose intolerance sets in. In support of this hypothesis, in 1990, Haffner et al. (8) reported the 8-year follow-up of 614 nondiabetic Mexican Americans and compared the baseline characteristics of those who did and did not develop diabetes. Subjects who developed diabetes exhibited an atherogenic pattern of risk factors, including dyslipidemia, obesity, and hypertension, even in the nondiabetic s...