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>Magister Scientiae - MSc / Diabetes, a worldwide disease, is classified into two types, type 1 or insulin-dependent and type 2 or noninsulin-dependent. Based on reports published by the International Diabetes Federation, the total number of those suffering from diabetes is growing every year. Statistics predict that type 2 diabetes, currently affecting about 8% of the adult population, would spread at such a pace that by 2030, more than 40 million cases of diabetes would be found throughout the world. On the other hand, studies revealed that patients with type 2 diabetes mellitus (T2DM) have a lower incidence of tumour development than healthy controls and that patients diagnosed with cancer have a lower risk of mortality when treated with metformin. However, the frequent use of metformin with low oral bioavailability ranging between 40-60% in the intestinal environment leads to large accumulation on the enterocytes. / 2024-02-24

Diss. (sammanfattning) Stockholm : Karol inst., 2003. / Härtill 5 uppsatser.

Ensaio clinico randomizado, constituído por 82 adultos com Diabetes Mellitus tipo 2, desenvolvido em Pachuca, Hidalgo no México, cujo objetivo foi avaliar os efeitos da utilização do protocolo Staged Diabetes Management no controle metabólico (pressão arterial sistólica e diastólica, índice de massa corporal, glicemia de jejum e capilar, hemoglobina glicada, colesterol total, HDL, LDL, triglicérides), conhecimento da doença e cuidados. A população constituiu-se pelas pessoas atendidas no período de junho a dezembro de 2007. Formaram-se dois grupos, aleatoriamente, um intervenção e outro controle. O grupo intervençao recebeu atenção de uma equipe multiprofissional, de acordo com as diretrizes do protocolo MDE e intervenções educativas grupais durante oito semanas, com carga horária de 16 horas e dois seguimentos trimestrais. O grupo controle manteve-se conforme rotina do serviço. As avaliações foram realizadas no início do estudo e nos terceiro e sexto meses seguintes. Para o processamento dos dados, utilizou-se o programa estatístico SPSS-15 e para as análises estatísticas, o teste t Student para as variáveis contínuas, qui-quadrado para as variáveis categóricas e o teste Wilks\' lambada para análise de associações inter grupos. A população do estudo ficou constituída por 41 pessoas adultas com DM2, respectivamente nos grupos intervenção e controle. No grupo intervenção houve predominância do sexo feminino (70,7%) enquanto que, no controle, do sexo masculino (51,2%). Em ambos, a faixa etária predominante foi de 50 |- 60 anos; as maiores freqüências foram para escolaridade \"primária\", ocupação \"empregado\" e estado civil \"casado\". Entre os parâmetros do controle metabólico alterados, destacam-se para os grupos, a pressão arterial sistólica perfil glicêmico, colesterol e triglicérides. Antes das intervenções os grupos apresentavam-se semelhanças, exceto para o sexo. Na análise de associações intra grupos, observaram-se mudanças significantes (p<0,005), na seguintes variáveis: entre a primeira e segunda medidas, houve diferenças nos valores da pressão arterial sistólica (t=2, 31, p=0,026); índice de massa corporal (t=5, 21, p=0,001); glicemia capilar (t=7, 06, p=0,001; glicemia plasmática (t=2, 09, p=0,043); hemoglobina glicada (t=4, 26, p=0,001); colesterol (t=3, 78, p=0,001); triglicérides (p=3, 38, p=0,002). Na terceira medida observaram-se diferenças significantes para as variáveis da pressão arterial sistólica (t=3, 61, p=.0001); pressão arterial diastólica (t=2, 42, p=0,002); Índice de Massa Corporal (t=4, 56, p=0,001); glicemia capilar (t=7, 98, p=0,001; glicemia plasmática (t=2, 89, p=0,006); hemoglobina glicada (t=9, 53, p=0,001); colesterol (t=6, 18, p=0,001); triglicérides (t=5, 52, p=0,001). O grupo controle mostrou diferenças significativas após a intervenção, na glicemia capilar e plasmática, porém, as médias são superiores às do grupo intervenção e fora dos parâmetros normais. Observaram-se diferenças significantes nos índices de conhecimentos (t=11.42, p<. 001), destacando-se que, aos três meses, no grupo intervenção houve aumento destes índices. Na análise de associação entre os grupos, observou-se que a variável pressão arterial sistólica, índice de massa corporal, glicemia capilar, hemoglobina glicada, colesterol, LDL e triglicérides, dos grupos intervenção e controle, entre as três medidas estão interagindo, indicando que o comportamento dos grupos não são os mesmos através das medidas. Os resultados do estudo apontaram para efeitos positivos das intervenções propostas no controle metabólico, no entanto, sugerem-se estudos para investigar a relação custo e benefício quando comparados a outros estudos de intervenções junto às pessoas com diabetes mellitus. / This randomized clinical essay was performed with 82 adults with Type II Diabetes Mellitus, in Pachuca, Hidalgo, Mexico. The purpose was to assess the effects that using the Staged Diabetes Management protocol had over metabolic control (systolic and diastolic blood pressure, body mass index, fasting and capillary glucose, glycosylated hemoglobin, total cholesterol, HDL, LDL, triglycerides), knowledge about the disease, and care. The population consisted of people seen from June to December 2007. Two groups, intervention and control, were composed at random. The intervention group was seen by a multiprofessional team, as recommended in the Staged Diabetes Management protocol, and received a total of 16 hours of group interventions during eight weeks, with two quarterly follow-up appointments. The control group was provided with the regular service. Assessments were performed at the beginning of the study and in the third and sixth following months. Data processing was done using the SPSS-15 statistical software, Student t test for statistical analyses, for continuous variable, chi-square, for categorical variables, and the Wilks\' lambada test to analyze intergroup association. Each group was composed of 41 adults with Type 2 Diabetes Mellitus. In the intervention group, most participants were women (70.7%) whereas in the control group, men prevailed (51.2%). In both, the predominant age group was 50 |- 60 years; the highest frequencies were in \"primary education\", \"employed\", and \"married\". Among the parameters for altered metabolic control, special emphasis is given to systolic blood pressure, glucose profile, cholesterol and triglycerides. Prior to the interventions, the groups were similar except in terms of gender. The intragroup association analysis showed there were significant changes (p<0.005) in the following variables, between the firts and second measurements: systolic blood pressure (t=2.31, p=0.026); body mass index (t=5.21, p=0.001); capillary glucose (t=7.06, p=0.001; plasma glucose (t=2.09, p=0.043); glycosylated hemoglobin (t=4.26, p=0.001); cholesterol (t=3.78, p=0.001); triglycerides (p=3.38, p=0.002). In the third measurement it was observed there were significant changes for the variables regarding systolic blood pressure (t=3.61, p=0. 0001); diastolic blood pressure (t=2.42, p=0.002); Body Mass Index (t=4.56, p=0.001); capillary glucose (t=7.98, p=0.001; plasma glucose (t=2.89, p=0.006); glycosylated hemoglobin (t=9.53, p=0.001); cholesterol (t=6.18, p=0.001); triglycerides (t=5.52, p=0.001). The control group showed significant differences after intervention on capillary and plasma glucose; however, the means are above those of the intervention group and not within the normal standards. Significant differences were observed in the knowledge rates (t=11.42, p<<. 001), and it is worth emphasizing that, at three months, in the intervention group, those rates increased. The analysis of the association between the groups showed that there is an interaction among the variables systolic blood pressure, body mass index, capillary glucose, glycosylated hemoglobin, cholesterol, LDL and triglycerides in the intervention. This shows that the groups\' behaviors are not the same. The results revealed that the proposed interventions have positive effects over the metabolic control, however, further studies are needed in order to analyze cost effectiveness in comparison with other studies of intervention among people with diabetes mellitus.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-18T19:07:46Z No. of bitstreams: 1 LucianaNevesCosensoMatin_tese.pdf: 9100904 bytes, checksum: 8377e4f9c53810a2aa89b71e454e7aea (MD5) / Made available in DSpace on 2018-10-18T19:07:47Z (GMT). No. of bitstreams: 1 LucianaNevesCosensoMatin_tese.pdf: 9100904 bytes, checksum: 8377e4f9c53810a2aa89b71e454e7aea (MD5) Previous issue date: 2017-02-02 / Several trials have shown that dipeptidyl peptidase-4 (DPP-4) inhibitors, used to treat patients with diabetes mellitus type 2 (T2DM), improve endothelial function. Objectives: The current study investigated the effects of vildagliptin, a DPP-4 inhibitor, compared to glibenclamide on endothelial function and arterial stiffness (AS) in patients with T2DM and hypertension (HT). Casuistics and Methods: This trial was a prospective randomized, open label, controlled by drug. Fifty patients aged over 35 years with T2DM and hypertension, without cardiovascular disease, were randomly allocated to treatment with vildagliptin (n=25) or glibenclamide (n=25). Both groups used metformin. A 24-h non-invasive ambulatory blood pressure monitoring and assessment of endothelial function were performed before and after 12 weeks of treatment. Endothelial function was evaluated by peripheral artery tonometry (Endo- PAT 2000), measuring the reactive hyperemia index (RHI) and arterial stiffness. AS was also evaluated by augmentation index (Aix@75), pulse wave velocity (PWV) and central systolic blood pressure (cSBP) parameters with a portable compact digital BP recorder Mobil-O-Graph® 24-hour PWA monitor. The primary study outcome was change in the RHI after vildagliptin vs. glibenclamide treatment. Results: There were no changes in RHI in the vildalgliptin group (before 2.348 ± 0.5868; after 2.2408 ± 0.6019, P = 0.742) or in the glibenclamide group (before 2.3636 ± 0.5163; after 2.3375 ± 0.4996, P = 0.950) and no difference between groups (P = 0.5479). There was no difference between vildagliptin and glibenclamide treatment in AIx@75 PAT (P = 0.696), in 24-hs: cSBP (P = 0.274) and in PWV (P = 0.324). Conclusions: Vildagliptin in patients with T2DM and HT did not change endothelial function and AS during 12 weeks. Thus, this drug has a neutral effect on vascular function, providing its effectiveness for the treatment of patients with cardiovascular disease. / Vários estudos demonstraram que os inibidores da dipeptidyl peptidase-4 (DPP-4), usados no tratamento de pacientes portadores de diabetes mellitus do tipo 2 (DM 2), melhoraram a função endotelial. Objetivos: O presente estudo avaliou os efeitos da vildagliptina, um inibidor de DPP-4, comparado à glibenclamida (sulfonilureia), na função endotelial, na rigidez arterial e na pressão arterial de 24 horas de pacientes com DM 2 e hipertensão arterial (HA). Casuística e Métodos: Este foi um estudo prospectivo, randomizado, aberto, controlado por fármaco, que incluiu cinquenta pacientes com idade superior a 35 anos, com DM 2 e HA, livres de doença cardiovascular, randomizados para tratamento com vildagliptina ou glibenclamida. Metformina foi adicionada a todos os pacientes. A monitorização ambulatorial de pressão arterial de 24 horas e avaliação da função endotelial foram realizadas antes e após 12 semanas de tratamento. A função endotelial foi avaliada pela tonometria arterial periférica (Endo-PAT 2000), que calcula o índice de hiperemia reativa (IHR) e a rigidez arterial por meio do augmentation index (Aix@75). A rigidez arterial também foi avaliada por parâmetros do Aix@75, velocidade da onda de pulso (VOP) e pressão arterial sistólica central (PSc) por meio de monitorização ambulatorial de 24 horas usando Mobil-O-Graph® PWA. O desfecho primário foi variação do IHR após tratamento com vildalgiptina comparado ao tratamento com glibenclamida. Resultados: Não houve diferença no IHR no grupo da vildagliptina (antes 2,348 ± 0,5868; depois 2,2408 ± 0,6019, P = 0,742) ou no grupo da glibenclamida (antes 2,3636 ± 0,5163; depois 2,3375 ± 0,4996, P = 0,950) e entre os grupos (P = 0,5479). Similarmente, o tratamento com vildagliptina e glibenclamida não produziu efeitos no AIx@75 PAT (P = 0,696), na 24-hs: PSc (P = 0,274) e na VOP (P = 0,324). Conclusões: O tratamento durante 12 semanas com vildagliptina em pacientes portadores de DM 2 e HA não alterou a função endotelial e nem a rigidez arterial. Assim, este fármaco apresenta uma ação neutra na função vascular, confirmando sua segurança no tratamento de pacientes com doença cardiovascular.

Ensaio clinico randomizado, constituído por 82 adultos com Diabetes Mellitus tipo 2, desenvolvido em Pachuca, Hidalgo no México, cujo objetivo foi avaliar os efeitos da utilização do protocolo Staged Diabetes Management no controle metabólico (pressão arterial sistólica e diastólica, índice de massa corporal, glicemia de jejum e capilar, hemoglobina glicada, colesterol total, HDL, LDL, triglicérides), conhecimento da doença e cuidados. A população constituiu-se pelas pessoas atendidas no período de junho a dezembro de 2007. Formaram-se dois grupos, aleatoriamente, um intervenção e outro controle. O grupo intervençao recebeu atenção de uma equipe multiprofissional, de acordo com as diretrizes do protocolo MDE e intervenções educativas grupais durante oito semanas, com carga horária de 16 horas e dois seguimentos trimestrais. O grupo controle manteve-se conforme rotina do serviço. As avaliações foram realizadas no início do estudo e nos terceiro e sexto meses seguintes. Para o processamento dos dados, utilizou-se o programa estatístico SPSS-15 e para as análises estatísticas, o teste t Student para as variáveis contínuas, qui-quadrado para as variáveis categóricas e o teste Wilks\' lambada para análise de associações inter grupos. A população do estudo ficou constituída por 41 pessoas adultas com DM2, respectivamente nos grupos intervenção e controle. No grupo intervenção houve predominância do sexo feminino (70,7%) enquanto que, no controle, do sexo masculino (51,2%). Em ambos, a faixa etária predominante foi de 50 |- 60 anos; as maiores freqüências foram para escolaridade \"primária\", ocupação \"empregado\" e estado civil \"casado\". Entre os parâmetros do controle metabólico alterados, destacam-se para os grupos, a pressão arterial sistólica perfil glicêmico, colesterol e triglicérides. Antes das intervenções os grupos apresentavam-se semelhanças, exceto para o sexo. Na análise de associações intra grupos, observaram-se mudanças significantes (p<0,005), na seguintes variáveis: entre a primeira e segunda medidas, houve diferenças nos valores da pressão arterial sistólica (t=2, 31, p=0,026); índice de massa corporal (t=5, 21, p=0,001); glicemia capilar (t=7, 06, p=0,001; glicemia plasmática (t=2, 09, p=0,043); hemoglobina glicada (t=4, 26, p=0,001); colesterol (t=3, 78, p=0,001); triglicérides (p=3, 38, p=0,002). Na terceira medida observaram-se diferenças significantes para as variáveis da pressão arterial sistólica (t=3, 61, p=.0001); pressão arterial diastólica (t=2, 42, p=0,002); Índice de Massa Corporal (t=4, 56, p=0,001); glicemia capilar (t=7, 98, p=0,001; glicemia plasmática (t=2, 89, p=0,006); hemoglobina glicada (t=9, 53, p=0,001); colesterol (t=6, 18, p=0,001); triglicérides (t=5, 52, p=0,001). O grupo controle mostrou diferenças significativas após a intervenção, na glicemia capilar e plasmática, porém, as médias são superiores às do grupo intervenção e fora dos parâmetros normais. Observaram-se diferenças significantes nos índices de conhecimentos (t=11.42, p<. 001), destacando-se que, aos três meses, no grupo intervenção houve aumento destes índices. Na análise de associação entre os grupos, observou-se que a variável pressão arterial sistólica, índice de massa corporal, glicemia capilar, hemoglobina glicada, colesterol, LDL e triglicérides, dos grupos intervenção e controle, entre as três medidas estão interagindo, indicando que o comportamento dos grupos não são os mesmos através das medidas. Os resultados do estudo apontaram para efeitos positivos das intervenções propostas no controle metabólico, no entanto, sugerem-se estudos para investigar a relação custo e benefício quando comparados a outros estudos de intervenções junto às pessoas com diabetes mellitus. / This randomized clinical essay was performed with 82 adults with Type II Diabetes Mellitus, in Pachuca, Hidalgo, Mexico. The purpose was to assess the effects that using the Staged Diabetes Management protocol had over metabolic control (systolic and diastolic blood pressure, body mass index, fasting and capillary glucose, glycosylated hemoglobin, total cholesterol, HDL, LDL, triglycerides), knowledge about the disease, and care. The population consisted of people seen from June to December 2007. Two groups, intervention and control, were composed at random. The intervention group was seen by a multiprofessional team, as recommended in the Staged Diabetes Management protocol, and received a total of 16 hours of group interventions during eight weeks, with two quarterly follow-up appointments. The control group was provided with the regular service. Assessments were performed at the beginning of the study and in the third and sixth following months. Data processing was done using the SPSS-15 statistical software, Student t test for statistical analyses, for continuous variable, chi-square, for categorical variables, and the Wilks\' lambada test to analyze intergroup association. Each group was composed of 41 adults with Type 2 Diabetes Mellitus. In the intervention group, most participants were women (70.7%) whereas in the control group, men prevailed (51.2%). In both, the predominant age group was 50 |- 60 years; the highest frequencies were in \"primary education\", \"employed\", and \"married\". Among the parameters for altered metabolic control, special emphasis is given to systolic blood pressure, glucose profile, cholesterol and triglycerides. Prior to the interventions, the groups were similar except in terms of gender. The intragroup association analysis showed there were significant changes (p<0.005) in the following variables, between the firts and second measurements: systolic blood pressure (t=2.31, p=0.026); body mass index (t=5.21, p=0.001); capillary glucose (t=7.06, p=0.001; plasma glucose (t=2.09, p=0.043); glycosylated hemoglobin (t=4.26, p=0.001); cholesterol (t=3.78, p=0.001); triglycerides (p=3.38, p=0.002). In the third measurement it was observed there were significant changes for the variables regarding systolic blood pressure (t=3.61, p=0. 0001); diastolic blood pressure (t=2.42, p=0.002); Body Mass Index (t=4.56, p=0.001); capillary glucose (t=7.98, p=0.001; plasma glucose (t=2.89, p=0.006); glycosylated hemoglobin (t=9.53, p=0.001); cholesterol (t=6.18, p=0.001); triglycerides (t=5.52, p=0.001). The control group showed significant differences after intervention on capillary and plasma glucose; however, the means are above those of the intervention group and not within the normal standards. Significant differences were observed in the knowledge rates (t=11.42, p<<. 001), and it is worth emphasizing that, at three months, in the intervention group, those rates increased. The analysis of the association between the groups showed that there is an interaction among the variables systolic blood pressure, body mass index, capillary glucose, glycosylated hemoglobin, cholesterol, LDL and triglycerides in the intervention. This shows that the groups\' behaviors are not the same. The results revealed that the proposed interventions have positive effects over the metabolic control, however, further studies are needed in order to analyze cost effectiveness in comparison with other studies of intervention among people with diabetes mellitus.

Peroxisome proliferator-activated receptors (PPARs) are nuclear receptors that function as ligand activated transcription factors. There are three identified isotypes: PPAR alpha, PPAR gamma and PPAR delta, together controlling the expression of genes involved in inflammation, cell differentiation, proliferation, lipid and carbohydrate metabolism and energy homeostasis. The PPARs are potential targets for the treatment of dyslipidaemia, type II diabetes mellitus and the metabolic syndrome. This thesis uses a multi-platform metabolomics approach, 13C-isotope substrate flux analysis, respirometry and transcriptomics to determine the role PPAR delta and PPAR gamma play in metabolic control both in adipose tissue and systemically. To achieve this, the metabolic phenotype of the 3T3-L1 adipocyte cell line was defined to generate a metabolically phenotyped in vitro model of adipose tissue. The importance of fatty acid alpha-oxidation in the differentiation of adipocytes was emphasised The effects of PPAR delta and PPAR gamma activation in white adipose tissue from the ob/ob mouse model of insulin resistance, and in the phenotyped 3T3-L1 adipocyte model, were investigated. PPAR delta activation was distinguished by oxidative catabolism of fatty acids and citric acid cycle intermediates. Conversely, PPAR gamma activation was identified by the sequestration of lipids into adipose tissue. Moreover, to address the systemic influence of PPAR activation, with a focus on the Cori cycle and the interactions of the liver and skeletal muscle, the metabolic changes that occur in these tissues following PPAR delta and PPAR gamma activation in the ob/ob mouse were examined. PPAR delta activation was characterised by the mobilisation and release of triacylglycerols (TAGs) into circulation as an energy source for peripheral tissues whereas PPAR gamma activation was defined by a reduction and sequestration of circulating TAGs. This thesis has better characterised the role of the PPARs as master regulators of metabolism and emphasised their potential as therapeutic targets for metabolic diseases of global importance.

Osteoarthritis (OA) is a common and incapacitating joint disease beginning with breakdown of articular cartilage and extending into subchondral bone. At present, the processes through which the disease occurs are poorly understood, and interventions are limited to pain relief and eventual joint replacement. OA is commonly associated with obesity and corresponding pathologies, and as OA is demonstrably not a product of passive erosion of cartilage over time or under increased loads there must needs be some other mechanistic link between the two conditions. We hypothesize that the production of ceramides, a hallmark of the insulin resistance syndrome underlying many obesity-related conditions, acts to induce OA through its pro-inflammatory and pro-apoptotic activities, as well as directly inhibiting intracellular mediators of cartilage production and homeostasis. We demonstrate in Wistar rats that a high-fat, high-sugar (HFHS) diet successfully induces OA and that downregulation of ceramide synthesis through intraperitoneal myriocin administration does not prevent this degradation, and that myriocin in conjunction with a standard chow diet actually induces OA. Alteration in OA biomarkers in this study are discussed. We then tested the efficacy of a topical regimen of wogonin, an anti-inflammatory, anti-oxidative, and potentially analgesic compound in a surgical destabilization model (DMM) of OA in mice and demonstrate its disease modifying anti-OA properties. We further test the efficacy of this compound on the HFHS model previously established and find it successfully ameliorated the morphology and biomarker changes associated with OA; based on this data we hypothesize that inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) is the most relevant physiological target of wogonin in a HFHS-induced OA model. Lastly and separately, we seek to clarify conflicting data regarding secondhand smoke (SHS), which observational studies suggest having either deleterious or beneficial effects to preexisting OA. In the first controlled study on the subject we model we demonstrate in a murine DMM model that SHS accelerates cartilage degradation and patterns of biomarker expression characteristic of OA, eliminating the question of any potential benefits of SHS to articular cartilage.

INTRODUCTION/OBJECTIVES: Current screening guidelines for pre-diabetes and type 2 diabetes mellitus note that there are discrepancies in diagnosing the disease using the fasting plasma glucose test, oral glucose tolerance test, and HbA1c in high-risk populations. The objective of this study is to compare the effectiveness of screening methods for type 2 diabetes mellitus (T2DM) and pre-diabetes by race/ethnicity and gender. METHODS: Secondary analyses of the National Health and Nutrition Examination Survey (NHANES, 2005-2008) were performed using SPSS 19.0. Screening outcomes were assessed and compared for a sample of n=10,566, NHW, NHB, MA, and Multiracial/other men and women. Analyses included cross tabulations, ANOVA and partial correlations to establish disease prevalence, effectiveness of screenings, and statistical significance. RESULTS: It was found that the HbA1c test is comparable in precision, and is correlated with the FPG for racial and ethnic minorities. The specificities for detecting pre-diabetes using the HbA1c were higher (64-66%) for these groups than by using the standard, FPG screening method (42-49%). There were no strong, significant differences for screening effectiveness for men versus women. DISCUSSION: This study revealed that the HbA1c test might be an effective method for screening for pre-diabetes in racial and ethnic minorities instead of the FPG test alone. Screening in high-risk populations will help delay the onset of T2DM, with increased prevention during the pre-clinical phase.

Abstract Type 2 diabetes can be prevented if the impaired glucose tolerance is found. Oral glucose tolerance test is needed in clinical practise for that but it is expensive and inconvenient. Obesity, hypertension, dyslipidemia and hypertension in pregnancy are factors often found in persons with type 2 diabetes. When there are more than one factor in same person the risk of type 2 diabetes multiplies. The purpose of this study was to investigate the prevalence of abnormal glucose metabolism and risk factors of type 2 diabetes in middle aged Finnish population in Savitaipale municipality and develop a method to screen abnormal glucose metabolism in primary health care. It was also studied the correlation of blood pressure and body mass index during pregnancy and abnormal glucose metabolism in later life. The study population was 1561 people born 1933–1956. 77,5% participated and 1097 people of them not having known abnormal glucose metabolism were taken to the cross-sectional study to develop the screening method. All 325 women who have had childbirth and files of that were taken to the prospective pregnancy cohort study. Information was collected with interview, measurements, laboratory research and from childbirth files. According the World Health Organisation criteria 1999 the prevalence of diabetes was 8,7% in men and 7,4% in women, previously undiagnosed 3,9% and 3,1%. Every fourth had abnormal glucose metabolism (men 23,2%, women 23,5%). The prevalence of obesity, hypertension, use of long-term antihypertensive medication and dyslipidemia (only in women) was higher among those, who had abnormal glucose metabolism. Logistic models were made for the classified risk factors. The model (AUC 0.718 for men, 0.761 for women) containing age, gender, waist circumference, systolic blood pressure and use of long-term antihypertensive medication was as good as model containing in addition family history of diabetes, smoking habits, serum lipids and long-term use of lipid lowering medication. Risk score tables were made from classified risk factors to evaluate the probability of the abnormal glucose metabolism. The blood pressure level and body mass index in pregnancy correlated independently with abnormal glucose metabolism in later life, blood pressure also adjusted with body mass index. Hypertension in pregnancy or after delivery correlated with abnormal glucose metabolism adjusted with body mass index. Hypertension in pregnancy doubled the risk of abnormal glucose metabolism in later life adjusted for body mass index in pregnancy and hypertension in later life. This information is important in prevention of type 2 diabetes. / Tiivistelmä Tyypin 2 diabetesta voidaan estää, mikäli heikentynyt glukoosinsieto tunnistetaan. Siihen tarvitaan glukoosirasituskoetta, jota on pidetty kalliina ja hankalana toteuttaa. Lihavuus, kohonnut verenpaine, dyslipidemia ja raskausdiabetes ovat tyypin 2 diabeteksen riskitekijöitä ja niiden ryvästyminen samaan henkilöön lisää diabetekseen sairastumisen todennäköisyyttä. Tyypin 2 diabeteksen riskitekijöiden ja poikkeavan glukoosiaineenvaihdunnan määrää ja raskauden aikaisen verenpaineen yhteyttä myöhemmin ilmaantuvaan poikkeavaan glukoosiaineenvaihduntaan tutkittiin 1933–1956 syntyneessä savitaipalelaisessa väestössä. Tavoitteena oli kehittää perusterveydenhuoltoon soveltuva poikkeavan glukoosiaineenvaihdunnan seulontamenetelmä. Kohdejoukosta (n = 1561) osallistui 77,5 %, joista 1097:llä henkilöllä ei tiedetty olevan diabetesta. Heistä kerättiin tietoa haastattelulla, mittauksilla ja laboratoriotutkimuksilla sekä äitiysneuvolakorteista. Raskausaineistoon ja takenevaan kohorttitutkimukseen otettiin kaikki ne 325 naista, myös diabeetikot, joista raskaudesta oli tiedot käytettävissä. Diabetesta sairasti 8,7 % miehistä ja 7,4 % naisista, aiemmin diagnosoimattomia oli 3,9 % ja 3,1 %. Poikkeava glukoosiaineenvaihdunta oli joka neljännellä. Lihavuutta, kohonnutta verenpainetta, verenpainelääkkeen käyttöä ja naisilla dyslipidemiaa oli enemmän niillä, joilla oli poikkeava glukoosiaineenvaihdunta. Tutkimuksessa luotiin luokitelluista muuttujista logistisia malleja. Malli, johon muuttujiksi valittiin ikä, sukupuoli, vyötärön ympärys, systolinen verenpaine ja verenpainelääkkeen käyttö, todettiin yhtä hyväksi (miesten ROC -käyrän AUC 0.718, naisten 0.761) ennustamaan heikentynyt glukoosinsieto ja diabetes kuin malli, johon lisäksi valittiin suvun diabetes, tupakointi, rasva-arvoja ja lipidilääkityksen käyttö. Muuttujista tehtiin taulut, joista voi nähdä poikkeavan glukoosiaineenvaihdunnan todennäköisyyden. Raskauden aikainen verenpaine ja painoindeksi olivat yhteydessä myöhemmin ilmaantuvaan poikkeavaan glukoosiaineenvaihduntaan, samoin loppuraskauden verenpaine painoindeksillä vakioituna. Raskaudessa todettu kohonnut verenpaine oli, mutta raskauden aiheuttama kohonnut verenpaine ei ollut, yhteydessä myöhemmin ilmaantuvaan poikkeavaan glukoosiaineenvaihduntaan painoindeksistä riippumatta, samoin loppuraskauden diastolinen verenpaine seulonnan diastolisesta verenpaineesta riippumatta. Raskaudessa tai sen jälkeen todettu kohonnut verenpaine kaksinkertaisti poikkeavan glukoosiaineenvaihdunnan riskin loppuraskauden painoindeksistä tai seulonnassa todetusta kohonneesta verenpaineesta riippumatta. Kahdella helposti mitattavalla muuttujalla voidaan päätellä glukoosirasituskokeen tarve. Diabetesta ehkäistäessä on tärkeä tietää, että raskauden kohonnut verenpaine ja ylipaino lisäävät myöhempää poikkeavaa glukoosiaineenvaihduntaa.