Baseline osteocalcin levels and incident diabetes in a 3-year prospective study of high-risk individuals.

AIM: Experimental evidence suggests that osteocalcin is a key messenger that affects both adipocytes and insulin-producing ß cells. Epidemiological cross-sectional studies have shown a negative association between plasma levels of osteocalcin and glucose. For this reason, the hypothesis that lower baseline osteocalcin plasma levels are associated with diabetes was prospectively tested. METHODS: The study population consisted of individuals at high risk for type 2 diabetes who were screened for participation in the Greek arm of a European type 2 diabetes prevention study (the DE-PLAN study). All participants were free of diabetes at baseline and underwent a second evaluation 3 years later. Diabetes status was defined according to an oral glucose tolerance test. RESULTS: A total of 307 subjects were included in the present analysis. The population, including 154 men (50.3%), was middle-aged (54.4 ± 10.2 years) and overweight (BMI: 29.5 ± 4.9 kg/m(2)). At baseline, mean total plasma osteocalcin was lower in those with impaired fasting glucose and/or impaired glucose tolerance compared with those with normal glucose tolerance (6.0 ± 3.1 ng/mL vs. 7.3 ± 4.0 ng/mL, respectively; P = 0.01). After 3 years, 36 subjects had developed diabetes. In the prospective evaluation, there was no association between baseline osteocalcin levels and diabetes (OR: 1.04 per 1 ng/mL, 95% CI: 0.93-1.15; P = 0.49) on multivariable logistic regression analysis, nor was there any correlation with changes in plasma glucose after 3 years (r = 0.09, P = 0.38). CONCLUSION: Our prospective results show that lower levels of circulating osteocalcin do not predict future diabetes development and, in contrast to most cross-sectional published data so far, suggest that this molecule may not be playing a major role in glucose homoeostasis in humans.

Validation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in Greece.

AIM: The present study aimed to validate the Finnish Type 2 Diabetes Risk Score (FINDRISC) questionnaire for its ability to predict the presence of any glucose homoeostasis abnormalities and the metabolic syndrome (MetS) in the Greek population. METHODS: Validation was performed on a sample of individuals who had agreed to participate in a screening program for type 2 diabetes (T2D) prevention (the Greek part of the DE-PLAN study), using both FINDRISC and oral glucose tolerance tests (OGTT). Impaired fasting glucose (IFG) was defined as a fasting plasma glucose level of 6.1-6.9 mmol/L, and impaired glucose tolerance (IGT) as a 2-h plasma glucose of 7.8-11.0 mmol/L. The predictive value of the FINDRISC was cross-sectionally evaluated using the area under the receiver operating characteristic (AUROC) curve method. RESULTS: A total of 869 individuals (379 men, aged 56.2 ± 10.8 years) were screened from the general population living in the city and suburbs of Athens. OGTT revealed the presence of unknown diabetes in 94 cases (10.8%), IFG in 85 (9.8%) and IGT in 109 (12.6%). The sensitivity of a FINDRISC score greater or equal to 15 (45% of the population) to predict unknown diabetes was 81.9% and its specificity was 59.7%. The AUROC curve for detecting unknown diabetes was 0.724 (95% CI: 0.677-0.770). For any dysglycaemia, the AUROC curve was 0.716 (0.680-0.752) while, for detection of the MetS, it was 0.733 (0.699-0.767). CONCLUSION: The FINDRISC questionnaire performed well as a screening tool for the cross-sectional detection of unknown diabetes, IFG, IGT and the MetS in the Greek population.

Acute respiratory distress syndrome due to miliary tuberculosis in a patient with rheumatoid arthritis under corticosteroid therapy.

We report the case of a 65-year-old woman with rheumatoid arthritis (RA) under corticosteroid therapy who presented with high fever and dyspnea and who, within 48 h, developed acute respiratory distress syndrome (ARDS) due to Mycobacterium tuberculosis (MTB). Miliary tuberculosis is a rare cause of ARDS; however, because of its ominous outcome, it should be included in the differential diagnosis of immunocompromised patients with rapidly worsening respiratory discomfort. A brief review of miliary tuberculosis as a cause of ARDS is presented.