stronger in older versus younger subjects of a given age and gender.
glucose measurements along with other data would be dismissed as being normal. It was our belief that as a rst approximation examining correlations might obviate this dilemma. The ability to show that fasting glucose levels prior to the development of outright diabetes correlate adversely with many risk factors or unhealthy parameters present in the metabolic syndrome would lead to better understanding of certain aspects behind the syndrome. Also, it would allow means for earlier comprehension of unfavorable but treatable health status and provide incentives to overcome these undesired events at the most appropriate time. For example, reduce sugar and rened carbohydrate intake to enhance insulin sensitivity. The similarity to lowering cholesterol levels by restricting saturated fat intake to favorably affect cardiovascular disorders is obvious.
To begin with, we reexamined data from a recently reported investigation concentrating on the pathogenesis of hypertension in females of different ages.37
that study, fasting glucose concentrations correlated signicantly in a positive manner with HbA1C, and insulin measurements. Concerning differences between the earlier and the present examination, we now focused on effects of circulating fasting glucose rather than age as the independent variable and only data from subjects with non-diabetic glucose levels were considered (Table 1). We found signicant positive correlations when assessing various diagnostic components of the metabolic syndrome: body weight and fat mass (obesity) systolic and diastolic blood pressure (hypertension) and circulating insulin (insulin resistance) with serum glucose concentrations. The signicant positive correlation with blood pressure corroborates earlier published ndings.30 Further, the elevation of ALT and the trend toward a rise in AST and alkaline phosphatase could signal the onset of fatty liver that is often associated with the syndrome.55,84,85 Finally, inammation is an important occurrence in the syndrome. The positive correlations between fasting glucose levels and WBC and neutrophils cell counts suggest its presence. 86,87
To support the interpretation of the ndings in Table 1, information from more subjects was examined (Table 2). Data from the last 200 individuals enrolled in a number of different protocols carried out by the IHT group were gathered and once more, only those with glucose levels in the non-diabetic range were considered. The second grouping added the following in addition to more subjects: the presence of males (21%), the examination of circulating lipid concentrations, and nally, evaluation of highly sensitive C-reactive protein (hsCRP) measurements.
to those subjects possessing a circulating glucose in the non-diabetic range, 192 subjects remained with average serum glucose of 94 mg/dl and a mean age of 60 years.
82 After limiting used material In
Because data was derived from subjects whose glucose levels were in the non-diabetic range, we chose to use Pearson’s Correlations Coefcient analysis. We expected that values examined under our criteria would fall mostly in the clinically accepted normal range.
Accordingly,
rise in WBC and neutrophil counts found in the rst and also in the second set, the positive correlation of highly sensitive C reactive protein (hsCRP) with serum glucose strengthens the association of inammation with rising glucose concentrations.88
the signicant positive correlation of globulins with glucose strengthens that possibility, since raised globulin concentrations are commonly linked to liver disturbances.89 Because the number of subjects contributing to statistics for body composition and cardiac dynamics in the second grouping were fewer than those for the laboratory values, it was decided to combine these data with the rst grouping’s (Table 3).
values strengthen the observation that body weight via fat accumulation and blood pressure correlate positively with raised non-diabetic glucose concentrations.
To reinforce the conclusions derived from the correlation ndings, we compared data from the two groups of non- diabetic subjects with the lowest circulating glucose (lowest quartile) to that from the highest circulating glucose (highest quartile). These values depicted in Table 4 support the concept suggested from the correlation data in the rst three tables, i.e., in the highest quartile of circulating glucose levels compared to the lowest: body weight and fat accumulation systolic and diastolic blood pressure insulin concentrations and triglycerides are statistically signicantly higher, while HDL-cholesterol is signicantly lower. Because of the consistent ndings that hsCRP, WBC and neutrophil count and the level of HbA1C were signicantly elevated, the implications of more inammation and increased glycation at the higher, non-diabetic glucose readings were supported.
Based on the above ndings, we believe fasting circulating glucose levels are a more important biomarker for health than realized. Obviously, measurements of circulating glucose can cause some confusion because levels vary so much during the day with food consumption. Measuring glucose after an overnight fast is the most consistent means to obtain measurements for comparison. Although HbA1C and insulin levels might provide even better information, these are not routine ofce measurements and in any case, glucose measurements correlate signicantly with HbA1C and insulin levels (Table 1). The bottom line is that fasting glucose, at least in this study, allows for a good, easily-obtained approximation of health status.
In the realm of laboratory values, we consistently found correlations of fasting glucose with ALT and not so much with the other hepatic enzymes such as AST and alkaline phosphatase (Tables 1 and 2). The reason for this may relate to earlier ndings concerning the AST/ ALT ratio.85
THE ORIGINAL INTERNIST JUNE 2016 The additional conrming
seems to be no link between glucose and total or LDL- cholesterol concentrations. ALT again correlated with glucose, however, AST and alkaline phosphatase did not.85
Important to point out, there Nevertheless, concerning early hepatic maladies,
Comparing glucose concentrations in the non-diabetic range, the new ndings related to circulating lipids were interesting. The positive correlation of triglycerides and the negative correlation of HDL-cholesterol with glucose levels were consistent with the initial phases of the metabolic syndrome.42-45
To go along with the signicant
The ratio characteristically rises in alcoholic (Continued on next page)
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