ArticleBMJ open2016
Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland.
Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- Prevalence, Management, and Associated Factors of Obesity, Hypertension, and Diabetes in Tibetan Population Compared with China Overall.International journal of environmental research and public health · 2022Pooled it
- Blood glucose concentration is unchanged during exposure to acute normobaric hypoxia in healthy humans.Physiological reports · 2021Trial
- Differences in prevalence arising from reference values for physiological and laboratory measurements used in studies of Tibetan highlanders and differences in study populations between the two studies.Journal of physiological anthropology · 2026Article
- Effects and interactive effects of high-altitude environment on metabolism in normal and diabetic populations: a comparative metabolomics study.Frontiers in endocrinology · 2026Article
- The impact of high altitude (hypobaric hypoxia) on insulin resistance in humans.Journal of physiology and biochemistry · 2025Review
- Sex differences in genotype frequency and the risk of polycythemia associated with rs13419896 and rs2790859 among Tibetan highlanders living in Tsarang, Mustang, Nepal.Journal of physiological anthropology · 2024Article
- Integrated biomarker profiling of the metabolome associated with type 2 diabetes mellitus among Tibetan in China.Diabetology & metabolic syndrome · 2023Article
- Polysomnographic predictors of incident diabetes and pre-diabetes: an analysis of the DREAM study.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2023Observational
- Distinctive biochemistry profiles associated with hyperuricemia between Tibetans and Hans in China.Frontiers in endocrinology · 2023Article
- Identification of key pathways, genes and immune cell infiltration in hypoxia of high-altitude acclimatizationFrontiers in genetics · 2023Article
- The joint effects of physical activity and air pollution on type 2 diabetes in older adults.BMC geriatrics · 2022Article
- High prevalence of rheumatoid arthritis and its risk factors among Tibetan highlanders living in Tsarang, Mustang district of Nepal.Journal of physiological anthropology · 2022Article
- Prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019.PLOS global public health · 2022Article
- Unique hemoglobin dynamics in female Tibetan highlanders.Tropical medicine and health · 2021Article
- Impact of High Altitude on Cardiovascular Health: Current Perspectives.Vascular health and risk management · 2021Review
- Better understanding the neurobiology of primary lateral sclerosis.Amyotrophic lateral sclerosis & frontotemporal degeneration · 2020Review
- Chromatin accessibility landscape and regulatory network of high-altitude hypoxia adaptation.Nature communications · 2020Article
- Nutrition Transition and Health Outcomes Among Indigenous Populations of Chile.Current developments in nutrition · 2020Article
- Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis.PloS one · 2020Article
- Early-onset diabetes: an epidemic in China.Frontiers of medicine · 2018Review
Corrections and comments
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Authors and funding
31 authors at 11 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo clarify the association between glucose intolerance and high altitudes (2900-4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing.
designCross-sectional epidemiological study on Tibetan highlanders.
participantsWe enrolled 1258 participants aged 40-87 years. The rural population comprised farmers in Domkhar (altitude 2900-3800 m) and nomads in Haiyan (3000-3100 m), Ryuho (4400 m) and Changthang (4300-4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m).
main outcome measureParticipants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression.
resultsThe prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500-4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance.
conclusionsSocioeconomic factors, hypoxaemia and the effects of altitudes >3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and ageing.
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