Novel Noninvasive Breath Test Method for Screening Individuals at Risk for Diabetes

OBJECTIVE—Diagnosis of pre-diabetes and early-stage diabetes occurs primarily by means of an oral glucose tolerance test (OGTT), which requires invasive blood sampling. The aim of this study was to determine whether differences exist in breath 13CO2 excretion during a 13C-labeled OGTT between individuals with normal glucose tolerance (NGT) and individuals with pre-diabetes and early-stage diabetes (PDED) and whether these differences correlated with blood glucose kinetics

Metabolic Changes Following a 1-Year Diet and Exercise Intervention in Patients With Type 2 Diabetes

Objective—To characterize the relationships among longterm improvements in peripheral insulin sensitivity (glucose disposal rate [GDR]), fasting glucose, and free fatty acids (FFAs) and concomitant changes in weight and adipose tissue mass and distribution induced by lifestyle intervention in obese individuals with type 2 diabetes. Research Design And Methods—We measured GDR, fasting glucose, and FFAs during a euglycemic clamp and adipose tissue mass and distribution, organ fat, and adipocyte size by dual-energy X-ray absorptiometry, CT scan, and adipose tissue biopsy in 26 men and 32 women in the Look-AHEAD trial before and after 1 year of diet and exercise aimed at weight loss. Results—Weight and fasting glucose decreased significantly (P _ 0.0001) and significantly more in men than in women (_12 vs. _8% and _16 vs. _7%, respectively; P _ 0.05), while FFAs during hyperinsulinemia decreased and GDR increased significantly (P _ 0.00001) and similarly in both sexes (_53 vs. _41% and 63 vs. 43%; P _ NS). Men achieved a more favorable fat distribution by losing more from upper compared with lower and from deeper compared with superficial adipose tissue depots (P _ 0.01). Decreases in weight and adipose tissue mass predicted improvements in GDR but not in fasting glucose or fasting FFAs; however, decreases in FFAs during hyperinsulinemia significantly determined GDR improvements. Hepatic fat was the only regional fat measure whose change contributed independently to changes in metabolic variables. Conclusions—Patients with type 2 diabetes undergoing a 1-year lifestyle intervention had significant improvements in GDR, fasting glucose, FFAs and adipose tissue distribution. However, changes in overall weight (adipose tissue mass) and hepatic fat were the most important determinants of metabolic improvements.Jeanine B. Albu, Leonie K. Heilbronn, David E. Kelley, Steven R. Smith, Koichiro Azuma, Evan S. Berk, F. Xavier Pi-Sunyer, Eric Ravussin, and the Look AHEAD Adipose Research Grou

State legitimacy and famines in Sub-Saharan Africa

Political Economy of famines mainly focuses on political regimes to understand the role of institutions. In this paper, we investigate a broader concept, state legitimacy, and its role on one specific development outcome, famine management. State legitimacy refers to the political history of a country, meaning the embedding of state and society. Using a database of Sub-Saharan countries observed from 1980 to 2005, we use three empirical strategies: logit on famine occurrence, negative binomial regression and Arellano-Bond dynamic model on the number of years of famines. They all lead to the same results: there is room for a political economy of famine based on an analysis of state. State legitimacy prevents famines, controlling for shocks countries might go through, and controlling for the quality of government. The main contributions of this paper are first to consider the role of state legitimacy in the political economy of famines and second to apply the concept in an empirical analysis, using for the first time a state legitimacy variable

Metabolic flexibility in response to glucose is not impaired in type 2 diabetes after controlling for glucose disposal rate

OBJECTIVE—Compared with nondiabetic subjects, type 2 diabetic subjects are metabolically inflexible with impaired fasting fat oxidation and impaired carbohydrate oxidation during a hyperinsulinemic clamp. We hypothesized that impaired insulin-stimulated glucose oxidation is a consequence of the lower cellular glucose uptake rate in type 2 diabetes. Therefore, we compared metabolic flexibility to glucose adjusted for glucose disposal rate in nondiabetic versus type 2 diabetic subjects and in the latter group after 1 year of lifestyle intervention (the Look AHEAD [Action For Health in Diabetes] trial). RESEARCH DESIGN AND METHODS—Macronutrient oxidation rates under fasting and hyperinsulinemic conditions (clamp at 80 mU/m2 per min), body composition (dual-energy X-ray absorptiometry), and relevant hormonal/metabolic blood variables were assessed in 59 type 2 diabetic and 42 nondiabetic individuals matched for obesity, sex, and race. Measures were repeated in diabetic participants after weight loss. RESULTS—Metabolic flexibility to glucose (change in respiratory quotient [RQ]) was mainly related to insulin-stimulated glucose disposal rate (R2 = 0.46, P < 0.0001) with an additional 3% of variance accounted for by plasma free fatty acid concentration at the end of the clamp (P = 0.03). The impaired metabolic flexibility to glucose observed in type 2 diabetic versus nondiabetic subjects (ΔRQ 0.06 ± 0.01 vs. 0.10 ± 0.01, respectively, P < 0.0001) was no longer observed after adjusting for glucose disposal rate (P = 0.19). Additionally, the increase in metabolic flexibility to glucose after weight loss was accounted for by the concomitant increase in insulin-stimulated glucose disposal rate. CONCLUSIONS—This study suggests that metabolic inflexibility to glucose in type 2 diabetic subjects is mostly related to defective glucose transport.Jose E. Galgani, Leonie K. Heilbronn, Koichiro Azuma, David E. Kelley, Jeanine B. Albu, Xavier Pi-Sunyer, Steven R. Smith, Eric Ravussin and the Look AHEAD Adipose Research Grou