MINISTRY OF EDUCATION & TRAINING MINISTRY OF NATIONAL DEFENSE
108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES
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NGUYEN THI HONG VAN
RESEARCHING CLINICAL FEATURES, SOME TARGET ORGAN
LESIONS AND TARGET INSULIN RESISTANCE IN NEW
HYPERTENSIVE PATIENTS WITH IMPAIRED FASTING
GLUCOSE
Major : Cardiology
Code : 62720141
SUMMARY OF DOCTORAL DISSERTATION
HA NOI - 2019
THE THESIS WAS DONE AT 108 INSTITUTE OF CLINICAL
MEDICAL AND PHARMACEUTICAL SCIENCES
Full name of supervisor:
1. Dr. VIEN VAN DOAN
2. Associate Prof. Dr. NGUYEN VAN QUYNH
Reviewer 1: Associate Prof. Dr. Nguyen Oanh Oanh
Reviewer 2: Associate Prof. Dr. Vu Bich Nga
Reviewer 3: Associate Prof. Dr. Vu Dien Bien
This thesis will be presented at Institute Council at 108 Institute of
Clinical Medical and Pharmaceutical Sciences
At Day Month Year
The thesis can be found at:
1. National Library of Vietnam
2. Library of 108 Institute of Clinical Medical and
Pharmaceutical Sciences
1
BACKGROUND
Impaired fasting glucose is a new concept developed by the
American Diabetes Association in 1997 and approved by the World
Health Organization in 1998 to address "pre-diabetes" as a risk factor
of type 2 diabetes mellitus. In 2003, the American Diabetes
Association proposed lowering the threshold to 5.6 mmol/l and
impaired fasting glucose was defined when fasting glucose levels
ranged from 5.6 to 6.9 mmol/l for early detection of potential risks of
type 2 diabetes mellitus.
The rate of prediabetes is increasing rapidly, especially in
people with high cardiovascular risk factors.
Although in the pre-diabetic stage, blood glucose levels
increase slightly, it begins to cause damage to the target organs,
especially when combined with other cardiovascular risk factors such
as obesity, hypertension, etc., then the lesions appear early and more.
The glucose tolerance test has not been routinely used in cases
of impaired fasting glucose, therefore, many cases of diabetes are
missed. On the other hand, screening for target lesions in high-risk
individuals for aggressive intervention for the purpose of delaying or
minimizing complications is not concerned. Therefore, this topic is
researched for two goals:
1. Study clinical characteristics, target organ lesions, glucose
tolerance test results and insulin resistance in patients with new
hypertension associated with impaired fasting glucose.
2. Evaluate the relationship between insulin resistance and
target organ lesions in patients with new hypertension associated
with impaired fasting glucose.
2
CHAPTER 1: OVERVIEW
1.1. CONCEPTS OF INSULIN AND INSULIN RESISTANCE
1.1.1. The concept of insulin
Insulin is a hormone secreted by the pancreas β cells to maintain
blood glucose levels. Insulin regulates carbohydrate metabolism, lipid
and protein metabolism, promotes cell division and growth.
1.1.2. The concept of insulin resistance
"Insulin resistance is a decrease in the biological response of
cells, organs, and organizations to the actions of insulin." The
concept of insulin resistance refers to the decline in the biological
response of insulin on the target cells, which is usually expressed by
an increase in insulin levels in the blood.
1.1.3. Methods to determine insulin resistance
Endogenous methods
- Basic fasting insulin measurement: (I0).
- Oral glucose tolerance test: quantifies concentration of
glucose and fasting plasma insulin (G0, I0), after 75 g of glucose
intake for 5-10 minutes. After 120 minutes, blood is taken again to
measure the concentration of glucose and insulin (G120, I120).
Exogenous methods
- The glucose “clamp”: This method is considered to be the
most accurate or "gold standard". Glucose level is "clamped" or fixed
at a certain level while evaluating the secretion of insulin.
If the patient needs a large amount of glucose to maintain
normal blood glucose levels, then it is not insulin resistant.
Some indicators of insulin resistance
- Index HOMA-IR (Homeostasis Model Assessment Insulin
Resistance):
3
HOMA- IR =
- QUICKI index: Quantitative Insulin Sensitivity Check Index.
QUICKI = 1 / log (I 0 + G 0 )
- ß cell function Homeostasis Model Assessment based on
Matthew D.
+ HOMA -% ß =
1.1.4. The pathology and clinical syndrome associated with
insulin resistance
1.4.1.1 The role of insulin resistance in type 2 diabetes
Insulin resistance is a prerequisite in glucose metabolism
disorder. Forms of insulin resistance are also abundant including:
decreased ability to inhibit glucose production in the liver, reduced
ability of glucose uptake in peripheral tissues and reduced ability to
use glucose in organs. The early phase of insulin secretion is reduced
in both impaired fasting glucose and glucose tolerance disorders. In
the late phase of insulin secretion, people with impaired fasting
glucose are normal while glucose tolerance disorder are reduced.
Impaired fasting glucose
In 2003, the American Diabetes Association proposed
lowering the threshold to 5.6 mmol/l (100/mg/dl) and impaired
fasting glucose is determined when fasting plasma glucose level
from 5.6 to 6.9 mmol/l. This standard is widely applied today.
Glucose tolerance disorder
Glucose tolerance disorder is a concept adopted by the World
Health Organization in 1980 for use in pre-diabetes and the
regulation of oral glucose tolerance testing for diagnosing and
quantifying fasting plasma glucose level, followed by 75 g of
glucose dissolved in 250 - 300 ml of drinking water within 5 - 15