PubMed Health⌕ Search

Biomedical subjects

Paul Z Zimmet

Publications and source records attributed to Paul Z Zimmet.

At least 19 recordsLinked to original sources
PubMed2006

The effects of repeated exposure to sub-toxic doses of plecomacrolide antibiotics on the endocrine pancreas.

The plecomacrolide vacuolar ATPase inhibitors bafilomycin and concanamycin contaminate tuberous vegetables and damage pancreatic islets in mice. The consequences of repeated exposure of adult mice to sub-toxic doses of bafilomycin A1 or concanamycin A was examined by injection of the plecomacrolides on each of five consecutive days. There was a significant reduction in islet size in female C57BL/6j mice (p<0.004 and p<0.0001 respectively). There were no significant differences in fasted insulin levels and beta cell mass between treated and control groups but oral glucose tolerance worsened with increasing age in BALB/c female mice injected with concanamycin A. Streptozotocin reduced glucose tolerance and islet number but not islet size in all strains and sexes. Chronic exposure of C57BL/6j mice to concanamycin A for 16 weeks caused a significant reduction in islet size in both sexes and a significant increase in the spleen weight of female mice (p<0.001). We conclude that repeated exposure to small quantities of vacuolar proton-translocating ATPase inhibitory plecomacrolides reduces islet size and can lead to glucose intolerance, possibly due to impaired maintenance of pancreatic islets. This may lead to earlier progression to beta cell failure and insulin deficiency in those at risk of diabetes.

Animals↗
PubMed2006

Association between impaired glucose metabolism and quality of life: results from the Australian diabetes obesity and lifestyle study.

AIMS: We examined the association of quality of life with glucose tolerance status in an Australian population to determine the stage in the development of diabetes that quality of life is impaired. METHODS: The Australian Diabetes, Obesity and Lifestyle study (AusDiab) was a population-based study of 11,247 people from randomly selected areas of Australia. As part of the study, participants underwent an oral glucose tolerance test and completed the SF-36 quality of life questionnaire. RESULTS: Previously diagnosed diabetes was associated with a significantly greater risk of being in the lowest quartile of each dimension of the SF-36 scale (except for mental health) and this association was only partially attenuated by adjustment for age, sex, body mass index (BMI), physical activity and treatment for hypertension and lipid abnormalities (adjusted odds ratios [95% CI]: bodily pain, 1.51 [1.18-1.94]; general health, 2.20 [1.64-2.95]; physical functioning, 1.50 [1.10-2.05]; role limitation (emotional), 1.43 [1.07-1.91]; role limitation (physical), 1.57 [1.13-2.18]; social functioning, 1.93 [1.46-2.54] and vitality, 2.24 [1.56-3.22]. Among those with newly diagnosed diabetes (NDM) and impaired glucose tolerance (IGT), there was also evidence of reduced quality of life on some dimensions of the SF-36 scale (NDM, general health, physical functioning and role limitation (physical); IGT, physical functioning and social functioning) after adjustment for confounders. CONCLUSION: These findings show that diabetes is associated with a reduced quality of life and that this is evident in the early stage of the disease, particularly in relation to the ability to perform physical activities.

Australia↗
PubMed2006

Six year incidence and progression of diabetic retinopathy: results from the Mauritius diabetes complication study.

AIMS: To determine the incidence, progression and risk factors for diabetic retinopathy in the multiethnic population of Mauritius. METHOD: A longitudinal, population-based study was conducted in Mauritius, during 1987, 1992 and 1998. Participants identified through the study as having diabetes (both known and newly diagnosed, by self-report and oral glucose tolerance test) and one in four participants with impaired glucose tolerance (IGT) underwent complications screening in 1992 and 1998. Retinal photographs were taken using a TRC-50VT retinal camera in three fields of the right eye (centred on the optic disc; macula (temporal to the optic disc); and nasal to disc). Photographs were graded according to a simplified version of the Wisconsin grading system. RESULTS: The 6-year incidence of diabetic retinopathy was 23.8% (sight-threatening in 0.4%). Among those with known diabetes mellitus (KDM) and free of retinopathy at baseline the incidence of non-proliferative diabetic retinopathy (NPDR) was 29.2% and proliferative diabetic retinopathy (PDR) was 1.0%. Among those with newly diagnosed diabetes mellitus (NDM) at baseline the incidence of NPDR was 19.1% (no incident cases of PDR were found). Independent risk factors for retinopathy using the baseline population characteristics were duration of diabetes and fasting plasma glucose. CONCLUSIONS: This is one of the few recent population-based studies of diabetic retinopathy undertaken in a developing nation. The incidence of retinopathy in Mauritius was high among those with NDM at baseline, with one in five developing retinopathy over 6 years. These results support the concept that screening for diabetes is important.

Adult↗
PubMed2006

Population prevalence of albuminuria in the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study: immunonephelometry compared with high-performance liquid chromatography.

BACKGROUND: Microalbuminuria is an independent risk factor for cardiovascular morbidity and mortality in the general population. Standard immunochemical urinary albumin assays detect immunoreactive albumin, whereas high-performance liquid chromatography (HPLC) detects both immunoreactive and immunounreactive albumin. METHODS: Using data from the Australian Diabetes, Obesity, and Lifestyle cohort study of randomly selected community-based Australian adults, spot urine samples were tested for albuminuria (spot urine albumin-creatinine ratio [ACR]: normal, < 30 mg/g; microalbuminuria, 30 to 300 mg/g; and macroalbuminuria, > 300 mg/g) by using both immunonephelometry (IN) and HPLC (n = 10,010). RESULTS: Bland-Altman analysis showed significant bias, with a greater ACR by means of HPLC, particularly at lower levels of ACR. Mean ACR was 15.8 mg/g (95% confidence interval [CI], 12.3 to 19.2) by means of IN compared with 30.0 mg/g (95% CI, 27.0 to 35.0) by means of HPLC. The prevalence of microalbuminuria was 4 times greater by means of HPLC compared with IN (20% versus 5.5%). In all demographic and comorbid subgroups associated with microalbuminuria, the prevalence of microalbuminuria increased by 2 to 4 times. A total of 1,743 subjects (17.4%) classified as normoalbuminuric by means of IN were reclassified as microalbuminuric by means of HPLC. Using multivariate logistic regression, women, patients with untreated and treated hypertension, and those with impaired glucose tolerance or diabetes were associated significantly with a change in category from normoalbuminuric to microalbuminuria by means of HPLC. CONCLUSION: HPLC measures significantly more urinary albumin within the normoalbuminuria and microalbuminuria range, resulting in a significant increase in prevalence of microalbuminuria. Longitudinal studies are needed to determine whether the extra individuals identified by means of HPLC are at increased risk for developing hard clinical outcomes (renal and cardiovascular).

Albuminuria↗
PubMed2006

How to best define the metabolic syndrome.

The constellation of metabolic abnormalities including centrally distributed obesity, decreased high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, elevated blood pressure (BP), and hyperglycaemia is known as the metabolic syndrome. Associated with increased risk of both type 2 diabetes and cardiovascular disease (CVD), the metabolic syndrome is thought to be a driver of the modern day epidemics of diabetes and CVD and has become a major public health challenge around the world 1. Since its initial description, several definitions of the syndrome have emerged. Each of these definitions used differing sets of criteria, the combination of which either reflected contrasting views on pathogenic mechanisms or clinical usefulness. The use of these definitions to conduct research into the metabolic syndrome in diverse populations resulted in wide ranging prevalence rates, inconsistencies and confusion, and spurred on the vigorous debate regarding how the metabolic syndrome should be defined. In response to this controversy, the International Diabetes Federation (IDF) has recently proposed a new definition, which is applicable to populations around the world 12. It is envisaged that the development of the new definition for the metabolic syndrome will help resolve the confusion caused by the number of earlier attempts to define this important entity.

Cardiovascular Diseases↗
PubMed2006

Beneficial associations of physical activity with 2-h but not fasting blood glucose in Australian adults: the AusDiab study.

OBJECTIVE: We examined the associations of physical activity with fasting plasma glucose (FPG) and with 2-h postload plasma glucose (2-h PG) in men and women with low, moderate, and high waist circumference. RESEARCH DESIGN AND METHODS: The Australian Diabetes, Obesity and Lifestyle (AusDiab) study provided data on a population-based cross-sectional sample of 4,108 men and 5,106 women aged >or=25 years without known diabetes or health conditions that could affect physical activity. FPG and 2-h PG were obtained from an oral glucose tolerance test. Self-reported physical activity level was defined according to the current public health guidelines as active (>or=150 min/week across five or more sessions) or inactive (<150 min/week and/or less than five sessions). Sex-specific quintiles of physical activity time were used to ascertain dose response. RESULTS: Being physically active and total physical activity time were independently and negatively associated with 2-h PG. When physical activity level was considered within each waist circumference category, 2-h PG was significantly lower in active high-waist circumference women (beta -0.30 [95% CI -0.59 to -0.01], P = 0.044) and active low-waist circumference men (beta -0.25 [-0.49 to -0.02], P = 0.036) compared with their inactive counterparts. Considered across physical activity and waist circumference categories, 2-h PG levels were not significantly different between active moderate-waist circumference participants and active low-waist circumference participants. Associations between physical activity and FPG were nonsignificant. CONCLUSIONS: There are important differences between 2-h PG and FPG related to physical activity. It appears that 2-h PG is more sensitive to the beneficial effects of physical activity, and these benefits occur across the waist circumference spectrum.

Adult↗
PubMed2006

A single factor underlies the metabolic syndrome: a confirmatory factor analysis.

OBJECTIVE: Confirmatory factor analysis (CFA) was used to test the hypothesis that the components of the metabolic syndrome are manifestations of a single common factor. RESEARCH DESIGN AND METHODS: Three different datasets were used to test and validate the model. The Spanish and Mauritian studies included 207 men and 203 women and 1,411 men and 1,650 women, respectively. A third analytical dataset including 847 men was obtained from a previously published CFA of a U.S. population. The one-factor model included the metabolic syndrome core components (central obesity, insulin resistance, blood pressure, and lipid measurements). We also tested an expanded one-factor model that included uric acid and leptin levels. Finally, we used CFA to compare the goodness of fit of one-factor models with the fit of two previously published four-factor models. RESULTS: The simplest one-factor model showed the best goodness-of-fit indexes (comparative fit index 1, root mean-square error of approximation 0.00). Comparisons of one-factor with four-factor models in the three datasets favored the one-factor model structure. The selection of variables to represent the different metabolic syndrome components and model specification explained why previous exploratory and confirmatory factor analysis, respectively, failed to identify a single factor for the metabolic syndrome. CONCLUSIONS: These analyses support the current clinical definition of the metabolic syndrome, as well as the existence of a single factor that links all of the core components.

Blood Pressure↗
PubMed2005

Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes?

The aim was to investigate whether the addition of supervised high intensity progressive resistance training to a moderate weight loss program (RT+WLoss) could maintain bone mineral density (BMD) and lean mass compared to moderate weight loss (WLoss) alone in older overweight adults with type 2 diabetes. We also investigated whether any benefits derived from a supervised RT program could be sustained through an additional home-based program. This was a 12-month trial in which 36 sedentary, overweight adults aged 60 to 80 years with type 2 diabetes were randomized to either a supervised gymnasium-based RT+WLoss or WLoss program for 6 months (phase 1). Thereafter, all participants completed an additional 6-month home-based training without further dietary modification (phase 2). Total body and regional BMD and bone mineral content (BMC), fat mass (FM) and lean mass (LM) were assessed by DXA every 6 months. Diet, muscle strength (1-RM) and serum total testosterone, estradiol, SHBG, insulin and IGF-1 were measured every 3 months. No between group differences were detected for changes in any of the hormonal parameters at any measurement point. In phase 1, after 6 months of gymnasium-based training, weight and FM decreased similarly in both groups (P<0.01), but LM tended to increase in the RT+WLoss (n=16) relative to the WLoss (n=13) group [net difference (95% CI), 1.8% (0.2, 3.5), P<0.05]. Total body BMD and BMC remained unchanged in the RT+WLoss group, but decreased by 0.9 and 1.5%, respectively, in the WLoss group (interaction, P<0.05). Similar, though non-significant, changes were detected at the femoral neck and lumbar spine (L2-L4). In phase 2, after a further 6 months of home-based training, weight and FM increased significantly in both the RT+WLoss (n=14) and WLoss (n=12) group, but there were no significant changes in LM or total body or regional BMD or BMC in either group from 6 to 12 months. These results indicate that in older, overweight adults with type 2 diabetes, dietary modification should be combined with progressive resistance training to optimize the effects on body composition without having a negative effect on bone health.

Aged↗
PubMed2005

Retinopathy in persons with impaired glucose metabolism: the Australian Diabetes Obesity and Lifestyle (AusDiab) study.

PURPOSE: To describe risk factors and vascular disease associations of retinopathy in people with impaired glucose metabolism. DESIGN: Population-based cross-sectional study. METHODS: Retinal photographs taken of participants with impaired glucose tolerance and impaired fasting glucose were graded for retinopathy. Risk factors and cardiovascular outcomes were ascertained. RESULTS: Retinopathy was present in 69 (6.7%) of 1027 participants with impaired glucose tolerance or impaired fasting glucose. After multivariate adjustment, retinopathy was associated with prevalent stroke (odds ratio 4.2, 95% confidence interval, 1.8 to 9.7). CONCLUSIONS: Retinopathy is common in persons with impaired glucose metabolism and may be associated with prevalent stroke.

Adult↗
PubMed2005

Prevalence and treatment of cardiovascular disease and traditional risk factors in Australian adults with renal insufficiency.

AIM: To evaluate the prevalence and treatment of cardiovascular disease and traditional cardiovascular disease risk factors in Australian adults with renal insufficiency. METHODS: The Australian Diabetes, Obesity and Lifestyle Study was a cross-sectional survey of Australian adults undertaken in 1999-2000. Participants were categorized based on the Cockcroft-Gault estimated glomerular filtration rate in terms of normal renal function (<60 mL/min per 1.73 m(2)) and renal insufficiency (<60 mL/min per 1.73 m(2)). Outcome measures were the prevalence of cardiovascular disease, estimated risk of cardiovascular disease (20% over 10 years) and traditional cardiovascular risk factors, and frequency of pharmacological treatment of traditional cardiovascular risk factors. RESULTS: Among adults with renal insufficiency, cardiovascular disease was present in 29.4 (95% CI: 25.1-33.6) per 100, with an additional 47.9 (95% CI: 44.9-50.9) per 100 having an estimated risk of cardiovascular disease (20% over 10 years). At least one cardiovascular risk factor was present in 90.1%. Hypertension and type 2 diabetes mellitus were three times more frequent, while hyperlipidaemia was nearly twice as frequent in those participants with renal insufficiency. Of those with renal insufficiency, 58.2% with hypertension were treated, with only 14.5% of this group being treated to current recommended target levels of blood pressure, while only 32.5% with hyperlipidaemia were treated, with 7.4% of this group being treated to target lipid levels. CONCLUSION: The present study demonstrates significant scope to reduce the high burden of cardiovascular risk factors in Australian adults with renal insufficiency in the general community, through treatment of traditional risk factors for cardiovascular disease.

Adult↗
PubMed2004

Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects.

INTRODUCTION: No published study has reported the prevalence of the metabolic syndrome in Asians using Adults Treatment Panel III (ATP III) criteria, comparing results with that using the obesity criteria of the Asia-Pacific region. METHODS: We evaluated the components of the metabolic syndrome among 40,698 participants aged 20-82 years (26,528 men; 14,170 women) who underwent a medical checkup at a University hospital in Seoul during 2001. RESULTS: Using ATP III criteria, the age-adjusted prevalence of the metabolic syndrome for Koreans was 6.8% in total (5.2% male, 9.0% female). Using the Asia-Pacific criteria for abdominal obesity based on waist circumference (APC-WC: >/=90 cm in men, >/=80 cm in women), prevalence rates were 10.9% (9.8% male, 12.4% female), and by the Asia-Pacific criteria for obesity based on body mass index (BMI) (APC-BMI: >/=25 kg/m2 in both sexes), rates were 13.1% (13.2% male, 13.1% female). Using BMI-adjusted logistic regression analysis, the odds ratio for the presence of the metabolic syndrome in those aged over 70 years against those aged 20-29 years was 13.8 (95% CI 8.2-23.2). Using age and BMI-adjusted logistic regression analysis, the odds ratio for the presence of the metabolic syndrome in women versus men was 1.4 (95% CI 1.2-1.5). The age-specific prevalence of the metabolic syndrome increased in both male and female participants, and females had higher prevalence rates than males in age groups older than 50 years. The highest prevalence rates were observed by applying APC-BMI criteria. CONCLUSION: Use of ATP III criteria to define the metabolic syndrome is not appropriate to Asian populations. The CVD risk attached to the use of the Asia-Pacific criteria needs to be determined in different Asian populations.

Adult↗