The incidence of Type 2 Diabetes Mellitus (T2DM) is increasing rapidly, therefore there is a need to detect this disease earlier and more efficiently, and also to identify novel risk factors that may aid both its detection and prevention. Aims: 1) To discuss the benefits and disadvantages of using HbA1c for diagnosis of T2DM and impaired glucose regulation (IGR). 2) To explore the impact on prevalence of using HbA1c to detect T2DM and IGR in global and local populations. 3) To determine if diagnostic cut-points are equivalent in different ethnic groups 4) To determine the use of the triglyceride-to-HDL ratio and its association with insulin resistance and whether statins and liver enzymes predict T2DM. 5) To investigate if Vitamin D deficiency has a role in the prevention of T2DM by designing a 6 month randomised controlled trial on vitamin D replacement. Key findings: 1) Using HbA1c for diagnosis has some logistical advantages over glucose testing, but may not detect the same people as having T2DM or IGR. 2) In Leicestershire, using HbA1c will increase numbers of people with T2DM and IGR. On global level, there will be regional variation on the effect on prevalence. 3) HbA1c, fasting and two hour plasma glucose are independently higher in South Asians (SA). Complications of T2DM may begin earlier in SA. 4) The triglyceride-to-HDL ratio associates with insulin resistance in Europeans and SA men but not women. Statin therapy reduces the risk of incident T2DM. Liver enzymes predict T2DM in Europeans but not SA. 5) Vitamin D deficiency may form a target for reducing insulin resistance in SA – the final results of the VITALITY study in 2015 will contribute to evidence base in this area. Conclusions: In this thesis I have explored new ways of detecting T2DM and IGR by using HbA1c and what impact this may have; also novel risk factors for T2DM have been investigated that may help improve methods of both earlier detection and prevention of T2DM.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:634402 |
| Date | January 2015 |
| Creators | Mostafa, Samiul Adim |
| Contributors | Davies, Melanie; Khunti, Kamlesh |
| Publisher | University of Leicester |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/2381/31395 |
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