All subjects underwent anthropometric evaluation including measurements of BMI and waist circumference body composition was determined by using bioelectrical impedance. Exclusion criteria included previous diagnosis of type 1 or type 2 diabetes previous cardiovascular disease (determined from the medical history and an electrocardiogram recorded at rest) uncontrolled hypertension history of malignant or autoimmune diseases heart or renal failure chronic liver disease acute infection gastrointestinal disease associated with malabsorption history of alcohol or drug abuse and treatment with antidiabetes drugs, medicaments known to affect glucose and lipid metabolism (including corticosteroids, estroprogestins, and statins), or medicaments affecting heart function (including ACE inhibitors, angiotensin-receptor blockers, angiotensin receptor–neprilysin inhibitors, β-blockers, and diuretics). All subjects were consecutively recruited according to two inclusion criteria: age between 30 and 60 years, and the presence of one or more cardiometabolic risk factors (family history of diabetes, dysglycemia, hypertension, dyslipidemia, and overweight/obesity). Recruitment mechanisms included word of mouth, fliers, and newspaper advertisements. We examined 30 subjects participating in the Catanzaro Metabolic Risk Factors (CATAMERI) study, an observational study comprising adult Caucasian outpatients participating in a campaign to assess cardiometabolic risk factors and recruited at a referral university hospital of the University “Magna Graecia” of Catanzaro ( 9, 18). To address this issue, insulin-stimulated myocardial glucose metabolism was measured through the use of cardiac dynamic PET combined with a euglycemic-hyperinsulinemic clamp in individuals with IGT and those with NGT 1-h high none had coronary artery disease. Thus, in individuals with IGT or NGT 1-h high characterized by systemic insulin resistance the presence of cardiac insulin resistance remains uncertain. ( 25) found that myocardial 18F-FDG uptake assessed under fasting state was not decreased in individuals with IFG. ( 24) reported that uptake of 18F-FDG after glucose loading was not impaired in individuals with IGT and coronary artery disease. Few studies have assessed myocardial MRGlu in individuals with prediabetes ( 24, 25). Myocardial positron emission tomography (PET) with 18F-fluorodeoxyglucose ( 18F-FDG), a widely used glucose analog, in combination with a euglycemic-hyperinsulinemic clamp is considered to be the gold standard for measuring the myocardial metabolic rate of glucose (MRGlu) under standardized experimental conditions ( 21– 23). Because impaired insulin-stimulated myocardial glucose uptake has been found in patients with type 2 diabetes with or without coronary artery disease ( 21), it is conceivable that both individuals with IGT and those with NGT 1-h high may exhibit myocardial insulin resistance. From a pathophysiological standpoint, both IGT ( 19) and NGT with high plasma glucose (≥155 mg/dL) at 1 h (NGT 1-h high) are characterized by impaired peripheral insulin sensitivity, a well-known metabolic defect preceding the development of type 2 diabetes ( 10, 20). Notably, 1-h postload hyperglycemia has been associated with cardiovascular organ damage, cardiovascular disease, and all-cause mortality ( 11– 18). Several studies showed that a plasma glucose concentration ≥155 mg/dL at hour 1 during an oral glucose tolerance test (OGTT) can identify individuals with normal glucose tolerance (NGT) who are at increased risk for type 2 diabetes ( 5– 11). Prediabetes not only is associated with an increased risk of progression to type 2 diabetes it also confers an increased risk for cardiovascular morbidity and mortality ( 3, 4). This number is projected to increase to 587 million by 2045 ( 2). The International Diabetes Federation estimates that, worldwide, 374 million individuals aged 18–99 years have IGT. This condition occurs in individuals with impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and high-risk glycated hemoglobin A 1c (HbA 1c) ( 1). Prediabetes is considered to be an intermediate metabolic condition between normal homeostasis and type 2 diabetes.
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