The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed Type 2 diabetes mellitus in primary hyperparathyroidism

Procopio, Massimo; Magro, G; Cesario, Flora; Piovesan, Alessandro; Pia, Anna; Molineri, Nadia; Borretta, Giorgio

doi:10.1046/j.1464-5491.2002.00809.x

Cited by 106 publications

(78 citation statements)

References 17 publications

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“…Therefore, it was impossible to determine which individuals were at high risk of primary hyperparathyroidism or secondary hyperparathyroidism due to vitamin D deficiency. Both of these conditions, which are relatively frequent in elderly people, have been related to an increased risk of abnormal glucose metabolism and diabetes (39,40). Because primary hyperparathyroidism is the first cause of hypercalcemia, the association between serum calcium and risk of diabetes observed in our study could be explained by the presence of individuals with established or incipient primary hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 49%

Increased Serum Calcium Levels and Risk of Type 2 Diabetes in Individuals at High Cardiovascular Risk

et al. 2014

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OBJECTIVEInsulin resistance and secretion depend on calcium homeostasis. Cross-sectional studies have associated elevated serum calcium levels with markers of impaired glucose metabolism. However, only one prospective cohort study has demonstrated an increased risk of diabetes in individuals with increased serum calcium concentrations. The aim of the current study was to prospectively investigate the association between albumin-adjusted serum calcium concentrations and type 2 diabetes in subjects at high cardiovascular risk. RESEARCH DESIGN AND METHODSProspective assessment of participants from two Spanish PREDIMED study centers where serum calcium levels were measured at baseline and yearly during follow-up. Multivariate-adjusted Cox regression models were fitted to assess associations between baseline and changes during follow-up in serum calcium levels and relative risk of diabetes incidence. RESULTSAfter a median follow-up of 4.78 years, 77 new cases of type 2 diabetes occurred. An increase in serum calcium levels during follow-up was related to an increased risk of diabetes. In comparison with individuals in the lowest tertile (20.78 6 0.29 mg/dL), the hazard ratio (HR) and 95% CI for diabetes incidence in individuals in the higher tertile of change (0.52 6 0.13 mg/dL) during follow-up was 3.48 (95% CI 1.48-8.17; P for trend = 0.01). When albumin-adjusted serum calcium was analyzed as a continuous variable, per 1 mg/dL increase, the HR of diabetes incidence was 2.87 (95% CI 1.18-6.96; P value = 0.02). These associations remained significant after individuals taking calcium supplements or having calcium levels out of normal range had been excluded. CONCLUSIONSAn increase in serum calcium concentrations is associated with an increased risk of type 2 diabetes in individuals at high cardiovascular risk.Type 2 diabetes is an important health problem worldwide. In the last three decades, the number of individuals with type 2 diabetes has doubled (1). Diabetes is associated with such complications as blindness, renal failure, and lower-limb amputation (2) and increases the risk of premature cardiovascular disease (3).

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Section: Discussionmentioning

confidence: 49%

Increased Serum Calcium Levels and Risk of Type 2 Diabetes in Individuals at High Cardiovascular Risk

et al. 2014

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“…Previous reports have also shown that patients with diabetes have elevated serum levels of calcium compared with nondiabetic individuals [3][4][5], and that the serum levels of calcium increase even further with decreasing metabolic control [3,4]. Moreover, in diseases with supranormal levels of serum calcium, such as primary hyperparathyroidism, there is a two-to fourfold higher prevalence of NIDDM and prediabetic states than in the general population [4,6,7]. Less is known about the relationship between serum calcium concentration and the two underlying causes of diabetes: insulin sensitivity and defective insulin secretion.…”

Section: Introductionmentioning

confidence: 98%

Serum calcium is independently associated with insulin sensitivity measured with euglycaemic–hyperinsulinaemic clamp in a community-based cohort

et al. 2006

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Aims/hypothesis Diabetes mellitus type 2 is associated with altered calcium metabolism. Moreover, in diseases with supranormal serum calcium levels, such as primary hyperparathyroidism, the prevalence of diabetes is increased. Relatively little is known about the relationship between serum calcium concentration and the underlying causes of diabetes-insulin resistance and defective insulin secretionin the normocalcaemic general population. Materials and methods We investigated associations between serum calcium concentration and insulin sensitivity and secretion in a population-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men, n=961). Insulin sensitivity index (M/I; glucose disposal rate [M] divided by mean insulin concentration [I]) was assessed using euglycaemic-hyperinsulinaemic clamp, and insulin secretion was estimated from the early insulin response (EIR) during an OGTT.Results In a multivariable linear regression model adjusting for BMI, physical activity, smoking, consumption of tea, alcohol, coffee and dietary calcium, serum phosphate and serum creatinine, 1 SD increase in serum calcium was associated with 0.17 mg kg −1 min −1 (mU/l) −1 × 100 (0.024 mg kg −1 min −1 [pmol/l] −1 ×100) decrease in M/I (p=0.01). The results remained robust in individuals with normal fasting glucose, normal glucose tolerance and serum calcium within the normal range (n=413, regression coefficient for 1 SD increase −0.45, p=0.001). Serum calcium was not associated with EIR. Dietary intake of calcium was not independently associated with insulin sensitivity or EIR. Conclusion/interpretation Our data support the notion that endogenous calcium may be involved early in the development of diabetes and that this effect is mediated mainly through effects on insulin sensitivity rather than defective insulin secretion. Dietary intake of calcium does not seem to influence insulin sensitivity.

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“…Calcium is an established regulator of GLUT4 expression, a passive transporter essential for peripheral glucose uptake (4). As a consequence, abnormalities in calcium homeostasis could potentially affect glucose metabolism and contribute to the development of T2DM (5).…”

Section: Introductionmentioning

confidence: 99%

Association between direct measurement of active serum calcium and risk of type 2 diabetes mellitus: A prospective study

Zaccardi

Webb

Carter

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

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The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed Type 2 diabetes mellitus in primary hyperparathyroidism

Abstract: Our data in a large and modern day pHPT series, with a preponderance of asymptomatic patients, confirm increased insulin resistance and pre-valence of IGT and undiagnosed diabetes.

Cited by 106 publications

References 17 publications

Increased Serum Calcium Levels and Risk of Type 2 Diabetes in Individuals at High Cardiovascular Risk

Increased Serum Calcium Levels and Risk of Type 2 Diabetes in Individuals at High Cardiovascular Risk

Serum calcium is independently associated with insulin sensitivity measured with euglycaemic–hyperinsulinaemic clamp in a community-based cohort

Association between direct measurement of active serum calcium and risk of type 2 diabetes mellitus: A prospective study

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