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Research

Plasma bicarbonate and risk of type 2 diabetes mellitus

Ernest I. Mandel, Gary C. Curhan, Frank B. Hu and Eric N. Taylor
CMAJ September 18, 2012 184 (13) E719-E725; DOI: https://doi.org/10.1503/cmaj.120438
Ernest I. Mandel
From the Renal Division (Mandel, Curhan) and the Channing Division of Network Medicine (Mandel, Curhan, Hu, Taylor), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; the Departments of Epidemiology (Mandel, Curhan, Hu) and Nutrition (Hu), Harvard School of Public Health, Boston, Mass.; and the Division of Nephrology and Transplantation (Taylor), Maine Medical Center, Portland, Me.
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  • For correspondence: emandel@partners.org
Gary C. Curhan
From the Renal Division (Mandel, Curhan) and the Channing Division of Network Medicine (Mandel, Curhan, Hu, Taylor), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; the Departments of Epidemiology (Mandel, Curhan, Hu) and Nutrition (Hu), Harvard School of Public Health, Boston, Mass.; and the Division of Nephrology and Transplantation (Taylor), Maine Medical Center, Portland, Me.
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Frank B. Hu
From the Renal Division (Mandel, Curhan) and the Channing Division of Network Medicine (Mandel, Curhan, Hu, Taylor), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; the Departments of Epidemiology (Mandel, Curhan, Hu) and Nutrition (Hu), Harvard School of Public Health, Boston, Mass.; and the Division of Nephrology and Transplantation (Taylor), Maine Medical Center, Portland, Me.
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Eric N. Taylor
From the Renal Division (Mandel, Curhan) and the Channing Division of Network Medicine (Mandel, Curhan, Hu, Taylor), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; the Departments of Epidemiology (Mandel, Curhan, Hu) and Nutrition (Hu), Harvard School of Public Health, Boston, Mass.; and the Division of Nephrology and Transplantation (Taylor), Maine Medical Center, Portland, Me.
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Abstract

Background: Several biomarkers of metabolic acidosis, including lower plasma bicarbonate and higher anion gap, have been associated with greater insulin resistance in cross-sectional studies. We sought to examine whether lower plasma bicarbonate is associated with the development of type 2 diabetes mellitus in a prospective study.

Methods: We conducted a prospective, nested case–control study within the Nurses’ Health Study. Plasma bicarbonate was measured in 630 women who did not have type 2 diabetes mellitus at the time of blood draw in 1989–1990 but developed type 2 diabetes mellitus during 10 years of follow-up. Controls were matched according to age, ethnic background, fasting status and date of blood draw. We used logistic regression to calculate odds ratios (ORs) for diabetes by category of baseline plasma bicarbonate.

Results: After adjustment for matching factors, body mass index, plasma creatinine level and history of hypertension, women with plasma bicarbonate above the median level had lower odds of diabetes (OR 0.76, 95% confidence interval [CI] 0.60–0.96) compared with women below the median level. Those in the second (OR 0.92, 95% CI 0.67–1.25), third (OR 0.70, 95% CI 0.51–0.97) and fourth (OR 0.75, 95% CI 0.54–1.05) quartiles of plasma bicarbonate had lower odds of diabetes compared with those in the lowest quartile (p for trend = 0.04). Further adjustment for C-reactive protein did not alter these findings.

Interpretation: Higher plasma bicarbonate levels were associated with lower odds of incident type 2 diabetes mellitus among women in the Nurses’ Health Study. Further studies are needed to confirm this finding in different populations and to elucidate the mechanism for this relation.

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Canadian Medical Association Journal: 184 (13)
CMAJ
Vol. 184, Issue 13
18 Sep 2012
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Plasma bicarbonate and risk of type 2 diabetes mellitus
Ernest I. Mandel, Gary C. Curhan, Frank B. Hu, Eric N. Taylor
CMAJ Sep 2012, 184 (13) E719-E725; DOI: 10.1503/cmaj.120438

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Plasma bicarbonate and risk of type 2 diabetes mellitus
Ernest I. Mandel, Gary C. Curhan, Frank B. Hu, Eric N. Taylor
CMAJ Sep 2012, 184 (13) E719-E725; DOI: 10.1503/cmaj.120438
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