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The Pre-Diabetic, Insulin-Resistant State

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The Epidemiology of Aging

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Abstract

Adult-onset type 2 diabetes is a late outcome of metabolic and inflammatory processes that predate glucose level elevation by many years. The negative effects of these processes on the health of older adults are enhanced by the inter-relationship of these processes with those associated with “aging”. Insulin resistance occurs prior to the elevated serum glucose levels that define diabetes. Obesity is the primary factor that leads to insulin resistance. The pre-diabetic insulin-resistant condition can have serious cardiovascular consequences, including subclinical or clinical cardiovascular disease and cardiovascular autonomic dysfunction. It can also have serious non-cardiovascular consequences, such as renal disease, cognitive decline, impaired mobility, frailty, interference with circadian rhythms, sleep apnea, bone disease and liver disease. Methods for attenuating the rise in glucose levels in those who have insulin resistance include pharmacological interventions and lifestyle change. Lifestyle changes include weight reduction and increased physical activity, which can be effective even in those with a genetic predisposition to diabetes and can ameliorate the decreased insulin sensitivity that is associated with aging.

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Abbreviations

ACEi:

Angiotensin Converting Enzyme Inhibitor

AGE:

Advanced Glycation Endproduct

ARB:

Angiotensin Receptor Blockers

ARIC:

Atherosclerosis Risk in Communities

ATPIII:

Adult Treatment Panel III

BP:

Blood Pressure

CHD:

Coronary Heart Disease

CHF:

Congestive Heart Failure

CHS:

Cardiovascular Health Study

CI:

Confidence Interval

CRP:

C-Reactive Protein

CVD:

Cardiovascular Disease

DPP:

Diabetes Prevention Program

DREAM:

Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication

ECG:

Electrocardiogram

FFA:

Free Fatty Acid

GDM:

Gestational Diabetes Mellitus

HOPE:

Heart Outcomes Prevention Evaluation

HR:

Hazard Ratio

HRV:

Heart Rate Variation

ICAM:

Intercellular Adhesion Molecule

IFG:

Impaired Fasting Glucose

IGT:

Impaired Glucose Tolerance

IL-6:

Interleukin-6

JAK-STAT:

Janus Kinase-Signal Transducer and Activator of Transcription

MetS:

Metabolic Syndrome

MMP:

Matrix Metalloproteinases

NADPH:

Nicotinamide Adenine Dinucleotide Phosphate

NAFLD:

Non-Alcoholic Fatty Liver Disease

NASH:

Non-Alcoholic Steato-Hepatitis

NAVIGATOR:

Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research

NEFA:

Non-Esterified Fatty Acids

NHANES:

National Health and Nutrition Examination Surveys

NNT:

Number Needed to Treat

ONTARGET:

Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

OR:

Odds Ratio

OSA:

Obstructive Sleep Apnea

p38-MAPK:

p38-Mitogen-Activated Protein Kinases

PAI-1:

Plasminogen Activator Inhibitor type-1

RAS:

Renin Angiotensin System

RR:

Risk Ratio

TNFα:

Tumor Necrosis Factor Alpha

TRANSCEND:

Telmisartan Randomized Assessment Study in Ace Intolerant Subjects with Cardiovascular Disease

US:

United States

VCAM:

Vascular Cell Adhesion Molecules

VEGF:

Vascular Endothelial Growth Factor

VSMC:

Vascular Smooth Muscle Cell

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Authors and Affiliations

  1. Division of Endocrinology, Kaiser Permanente of Georgia, 200 Crescent Center Parkway, Tucker, Atlanta, GA, 30084, USA

    Joshua Barzilay M.D.

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Correspondence to Joshua Barzilay M.D. .

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  1. , Graduate School of Public Health, University of Pittsburgh, A527 Crabtree Hall, DeSoto Street 130, Pittsburgh, 15261, Pennsylvania, USA

    Anne B. Newman

  2. Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, DeSoto Street, A510 Crabtree 130, Pittsburgh, 15261, Pennsylvania, USA

    Jane A. Cauley

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Barzilay, J. (2012). The Pre-Diabetic, Insulin-Resistant State. In: Newman, A., Cauley, J. (eds) The Epidemiology of Aging. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5061-6_25

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