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Rony M, Quintero-Arias C, Osorio M, Ararso Y, Norman EM, Ravenell JE, Wall SP, Lee DC. Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes. J Racial Ethn Health Disparities 2023; 10:3150-3158. [PMID: 36520369 PMCID: PMC10267290 DOI: 10.1007/s40615-022-01488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Given the significant disparities in diabetes burden and access to care, this study uses qualitative interviews of Black men having HbA1c levels consistent with previously undiagnosed diabetes or prediabetes to understand their perceptions of the healthcare system. RESEARCH DESIGN AND METHODS We recruited Black men from Black-owned barbershops in Brooklyn, NY, who were screened using point-of-care HbA1c tests. Among those with HbA1c levels within prediabetes or diabetes thresholds, qualitative interviews were conducted to uncover prevalent themes related to their overall health status, health behaviors, utilization of healthcare services, and experiences with the healthcare system. We used a theoretical framework from the William and Mohammed medical mistrust model to guide our qualitative analysis. RESULTS Fifty-two Black men without a prior history of diabetes and an HbA1c reading at or above 5.7% were interviewed. Many participants stated that their health was in good condition. Some participants expressed being surprised by their abnormal HbA1c reading because it was not previously mentioned by their healthcare providers. Furthermore, many of our participants shared recent examples of negative interactions with physicians when describing their experiences with the healthcare system. Finally, several participants cited a preference for incorporating non-pharmaceutical options in their diabetes management plans. CONCLUSION To help alleviate the disparity in diabetes burden among Black men, healthcare providers should take a more active role in recognizing and addressing their own implicit biases, engage in understanding the specific healthcare needs and expectations of each patient, and consider emphasizing non-medication approaches to improve glycemic control.
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Affiliation(s)
- Melissa Rony
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | | | - Marcela Osorio
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Yonathan Ararso
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Elizabeth M Norman
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, 10003, USA
| | - Joseph E Ravenell
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Stephen P Wall
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - David C Lee
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA.
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA.
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2
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Li S, Chen D, Xiu M, Li J, Zhang XY. Prevalence and clinical correlates of impaired glucose tolerance in first-episode versus chronic patients with schizophrenia. Early Interv Psychiatry 2022; 16:985-993. [PMID: 34743408 DOI: 10.1111/eip.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/26/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
AIM Studies using oral glucose tolerance tests (OGTT) have shown that impaired glucose metabolism presents in the early stages of schizophrenia (SCZ). However, there is a lack of studies on changes in glucose metabolism with the stage of the disease. We first explored the features of glucose metabolic pattern at different phases of male SCZ. METHODS We recruited 83 male first episode drug-naïve patients with SCZ (FEDN-SCZ) and 64 male chronic patients with SCZ (CH-SCZ), as well as 14 male healthy controls. The Positive and Negative Syndrome Scale (PANSS) was used to assess the psychopathology of patients. OGTT, fasting plasma glucose and lipid profiles of all participants were examined. RESULTS While the impaired glucose tolerance (IGT) rate of male SCZ patients was higher than that of HC (P < .05), there was no difference in IGT prevalence between FEDN-SCZ and CH-SCZ. In male FEDN-SCZ, LDL (OR = 2.64, 95% CI = 1.11-6.29, P = .028) and PANSS total score (OR = 1.03, 95% CI = 1.00-1.06, P = .046) were positively correlated with IGT; in male CH-SCZ, BMI (OR = 1.7, 95% CI = 1.08-2.67, P = .023), PANSS total score (OR = 0.82, 95% CI = 0.70-0.96, P = .015) and positive symptoms (OR = 0.45, 95% CI = 0.20-0.99, P = .046) were significantly correlated with IGT. CONCLUSIONS Our findings reflect different glucose metabolism patterns in different stages of SCZ.
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Affiliation(s)
- Shen Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China.,Department of Psychiatry, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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3
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Lim WY, Ma S, Heng D, Tai ES, Khoo CM, Loh TP. Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore. Sci Rep 2018; 8:12419. [PMID: 30127499 PMCID: PMC6102285 DOI: 10.1038/s41598-018-29998-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022] Open
Abstract
The prevalence of diabetes in Singapore is high. Screening to facilitate early detection and intervention has been shown to be cost-effective. Current clinical practice guidelines in Singapore recommend screening with fasting plasma glucose (FPG), followed by an oral glucose tolerance test (OGTT) in those with FPG 6.1-6.9 mmol/L. Glycated haemoglobin A1c (HbA1c) has robust stability at ambient temperature, and can be performed on non-fasted capillary blood samples, making it an attractive potential alternative for screening. However, limitations of HbA1c include differential performance in different races, and its performance as a screening test has not been well characterized in Asian populations. This study compares HbA1c and FPG as diabetes screening modalities in 3540 community-dwelling Singapore residents of Chinese, Malay and Indian race to detect diabetes mellitus diagnosed based on blood glucose (FPG ≥ 7.0 mmol/L, 2 hr OGTT ≥ 11.1 mmol/L). The area under the receiver-operating-characteristic curve (AUC) was higher for FPG compared to HbA1c in the overall population and age, race and age-race strata, but these differences were not statistically significant. HbA1c > = 7.0% identified 95% of individuals with diabetes mellitus, and the remainder had impaired glucose tolerance (IGT). HbA1c cut-off at 6.1% had better sensitivity (0.825) to FPG at 6.1 mmol/L. The positive predictive value of HbA1c at 6.1% was 40-50% in different age-race combinations with a negative predictive value of about 98%. If follow-up screening with FPG is used, a lower cut-off at 5.6 mmol/L is appropriate in identifying people with pre-diabetes, as about 85% of people with HbA1c 6.1-6.9% and FPG 5.6-6.9 mmol/L had IFG/IGT or diabetes in the study sample. HbA1c is an appropriate alternative to FPG as a first-step screening test, and the combination of Hba1c > = 6.1% and FPG > = 5.6 mmol/L would improve the identification of individuals with diabetes mellitus and prediabetes.
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Affiliation(s)
- Wei-Yen Lim
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore, Singapore
| | - Derrick Heng
- Public Health Group, Ministry of Health, Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Chin Meng Khoo
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Tze Ping Loh
- Department Laboratory Medicine, National University Hospital, Singapore, Singapore.
- Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore, Singapore.
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4
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Salgado-Bustamante M, Rocha-Viggiano AK, Rivas-Santiago C, Magaña-Aquino M, López JA, López-Hernández Y. Metabolomics applied to the discovery of tuberculosis and diabetes mellitus biomarkers. Biomark Med 2018; 12:1001-1013. [PMID: 30043640 DOI: 10.2217/bmm-2018-0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tuberculosis (TB) and diabetes mellitus Type 2 (DM2) are two diseases as ancient as they are harmful to human health. The outcome for both diseases in part depends on immune and metabolic individual responses. DM2 is increasing yearly, mainly due to environmental, genetic and lifestyle habits. There are multiple evidence that DM2 is one of the most important risk factor of becoming infected with TB or reactivating latent TB. Mass spectrometry-based metabolomics is an important tool for elucidating the metabolites and metabolic pathways that influence the immune responses to M. tuberculosis infection during diabetes. We provide an up-to-date review highlighting the importance and benefit of metabolomics for identifying biomarkers as candidate molecules for diagnosis, disease activity or prognosis.
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Affiliation(s)
- Mariana Salgado-Bustamante
- Biochemistry Department, Medicine Faculty, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Ana K Rocha-Viggiano
- Biochemistry Department, Medicine Faculty, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - César Rivas-Santiago
- CONACyT, Unidad Academica de Ciencias Biologicas, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Martín Magaña-Aquino
- Infectology Department, Hospital Central Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Jesús A López
- MicroRNAs Laboratory, Unidad Academica de Ciencias Biologicas, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Yamilé López-Hernández
- CONACyT, Unidad Academica de Ciencias Biologicas, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
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Zhai D, Lang Y, Feng Y, Liu Y, Dong G, Wang X, Cao Y, Cui T, Ni C, Ji Y, Zhang X, Zhao Y, Zhang R. Early onset of cardiometabolic risk factor profiles in drug naïve adolescents and young adults with first-episode schizophrenia. Schizophr Res 2017; 190:60-62. [PMID: 28318836 DOI: 10.1016/j.schres.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE AND METHOD We performed a case-control study, which included antipsychotic-naïve first-episode schizophrenia (FES) of adolescents and young adults and general population controls, to investigate the early-onset cardiometabolic risk factors in FES. RESULTS FES had more frequent lower HDL-C when compared to controls. However, the distribution of BMI and the frequency of hypercholesterolemia, elevated LDL-C, hypertriglyceridemia in FES were not significantly different to controls. CONCLUSIONS The results indicated that abnormal HDL-C might be an early-onset event in drug-naïve FES of adolescents and young adults who are unlikely to have other cardiometabolic risks.
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Affiliation(s)
- Desheng Zhai
- Xinxiang Medical University, The Second Affiliated Hospital, Xinxiang 453002, China; Xinxiang Medical University, School of Public Health, Xinxiang 453003, China
| | - Yan Lang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Yihang Feng
- Xinxiang Medical University, School of Pharmacy, Xinxiang 453003, China
| | - Yijun Liu
- Xinxiang Medical University, School of Public Health, Xinxiang 453003, China
| | - Gaopan Dong
- Xinxiang Medical University, School of Pharmacy, Xinxiang 453003, China
| | - Xin Wang
- McLean Hospital & Harvard Medical School, USA
| | - Ying Cao
- McLean Hospital & Harvard Medical School, USA
| | - Taizhen Cui
- Xinxiang Medical University, School of Pharmacy, Xinxiang 453003, China
| | - Chenyang Ni
- Xinxiang Medical University, School of Pharmacy, Xinxiang 453003, China
| | - Yonggan Ji
- Xinxiang Medical University, School of Pharmacy, Xinxiang 453003, China
| | - Xiaodan Zhang
- Xinxiang Medical University, School of Pharmacy, Xinxiang 453003, China
| | - Ying Zhao
- Xinxiang Medical University, School of Pharmacy, Xinxiang 453003, China; McLean Hospital & Harvard Medical School, USA.
| | - Ruiling Zhang
- Xinxiang Medical University, The Second Affiliated Hospital, Xinxiang 453002, China.
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Pillinger T, Beck K, Gobjila C, Donocik J, Jauhar S, Howes O. Impaired Glucose Homeostasis in First-Episode Schizophrenia: A Systematic Review and Meta-analysis. JAMA Psychiatry 2017; 74:261-269. [PMID: 28097367 PMCID: PMC6352957 DOI: 10.1001/jamapsychiatry.2016.3803] [Citation(s) in RCA: 298] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Schizophrenia is associated with an increased risk of type 2 diabetes. However, it is not clear whether schizophrenia confers an inherent risk for glucose dysregulation in the absence of the effects of chronic illness and long-term treatment. OBJECTIVE To conduct a meta-analysis examining whether individuals with first-episode schizophrenia already exhibit alterations in glucose homeostasis compared with controls. DATA SOURCES The EMBASE, MEDLINE, and PsycINFO databases were systematically searched for studies examining measures of glucose homeostasis in antipsychotic-naive individuals with first-episode schizophrenia compared with individuals serving as controls. STUDY SELECTION Case-control studies reporting on fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and hemoglobin A1c (HbA1c) levels in first-episode antipsychotic-naive individuals with first-episode schizophrenia compared with healthy individuals serving as controls. Two independent investigators selected the studies. DATA EXTRACTION Two independent investigators extracted study-level data for a random-effects meta-analysis. Standardized mean differences in fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and HbA1c levels were calculated. Sensitivity analyses examining the effect of body mass index, diet and exercise, race/ethnicity, and minimal (≤2 weeks) antipsychotic exposure were performed. DATA SYNTHESIS Of 3660 citations retrieved, 16 case-control studies comprising 15 samples met inclusion criteria. The overall sample included 731 patients and 614 controls. Fasting plasma glucose levels (Hedges g = 0.20; 95% CI, 0.02 to 0.38; P = .03), plasma glucose levels after an oral glucose tolerance test (Hedges g = 0.61; 95% CI, 0.16 to 1.05; P = .007), fasting plasma insulin levels (Hedges g = 0.41; 95% CI, 0.09 to 0.72; P = .01), and insulin resistance (homeostatic model assessment of insulin resistance) (Hedges g = 0.35; 95% CI, 0.14 to 0.55; P = .001) were all significantly elevated in patients compared with controls. However, HbA1c levels (Hedges g = -0.08; CI, -0.34 to 0.18; P = .55) were not altered in patients compared with controls. CONCLUSIONS AND RELEVANCE These findings show that glucose homeostasis is altered from illness onset in schizophrenia, indicating that patients are at increased risk of diabetes as a result. This finding has implications for the monitoring and treatment choice for patients with schizophrenia.
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Affiliation(s)
- Toby Pillinger
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Katherine Beck
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Cristian Gobjila
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Jacek Donocik
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sameer Jauhar
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Oliver Howes
- IoPPN, King’s College London, De Crespigny Park, London, SE5 8AF, UK,MRC Clinical Sciences Centre (CSC), Du Cane Road, London W12 0NN,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN
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7
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Chen DC, Du XD, Yin GZ, Yang KB, Nie Y, Wang N, Li YL, Xiu MH, He SC, Yang FD, Cho RY, Kosten TR, Soares JC, Zhao JP, Zhang XY. Impaired glucose tolerance in first-episode drug-naïve patients with schizophrenia: relationships with clinical phenotypes and cognitive deficits. Psychol Med 2016; 46:3219-3230. [PMID: 27604840 DOI: 10.1017/s0033291716001902] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Schizophrenia patients have a higher prevalence of type 2 diabetes mellitus with impaired glucose tolerance (IGT) than normals. We examined the relationship between IGT and clinical phenotypes or cognitive deficits in first-episode, drug-naïve (FEDN) Han Chinese patients with schizophrenia. METHOD A total of 175 in-patients were compared with 31 healthy controls on anthropometric measures and fasting plasma levels of glucose, insulin and lipids. They were also compared using a 75 g oral glucose tolerance test and the homeostasis model assessment of insulin resistance (HOMA-IR). Neurocognitive functioning was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS Of the patients, 24.5% had IGT compared with none of the controls, and they also had significantly higher levels of fasting blood glucose and 2-h glucose after an oral glucose load, and were more insulin resistant. Compared with those patients with normal glucose tolerance, the IGT patients were older, had a later age of onset, higher waist or hip circumference and body mass index, higher levels of low-density lipoprotein and triglycerides and higher insulin resistance. Furthermore, IGT patients had higher PANSS total and negative symptom subscale scores, but no greater cognitive impairment except on the emotional intelligence index of the MCCB. CONCLUSIONS IGT occurs with greater frequency in FEDN schizophrenia, and shows association with demographic and anthropometric parameters, as well as with clinical symptoms but minimally with cognitive impairment during the early course of the disorder.
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Affiliation(s)
- D C Chen
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - X D Du
- Suzhou Psychiatric Hospital,Suzhou,Jiangsu Province,People's Republic of China
| | - G Z Yin
- Suzhou Psychiatric Hospital,Suzhou,Jiangsu Province,People's Republic of China
| | - K B Yang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - Y Nie
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - N Wang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - Y L Li
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - M H Xiu
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - S C He
- Department of Psychology,Peking University,Beijing,People's Republic of China
| | - F D Yang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
| | - R Y Cho
- Department of Psychiatry and Behavioral Sciences,The University of Texas Health Science Center at Houston,Houston, TX,USA
| | - T R Kosten
- Department of Psychiatry and Behavioral Sciences,Baylor College of Medicine,Houston, TX,USA
| | - J C Soares
- Department of Psychiatry and Behavioral Sciences,The University of Texas Health Science Center at Houston,Houston, TX,USA
| | - J P Zhao
- Mental Health Institute of the Second Xiangya Hospital, Central South University,Changsha,People's Republic of China
| | - X Y Zhang
- Beijing HuiLongGuan Hospital,Peking University,Beijing,People's Republic of China
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8
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Okosun IS, Seale JP, Lyn R, Davis-Smith YM. Improving Detection of Prediabetes in Children and Adults: Using Combinations of Blood Glucose Tests. Front Public Health 2015; 3:260. [PMID: 26636060 PMCID: PMC4654065 DOI: 10.3389/fpubh.2015.00260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022] Open
Abstract
Highlights Aim To determine combinations of blood glucose tests: oral glucose tolerance (OGT), fasting plasma glucose (FPG), and hemoglobin A1C (HbA1C) that are associated with highest diagnostic rates of prediabetes in non-diabetic American children and adults. Methods The 2007–2008 U.S. National Health and Nutrition Examination Surveys data were used for this study. Overall and specific prevalence of prediabetes (defined using OGT + FPG, OGT + HbA1C, HbA1C + FPG, and OGT + FPG + HbA1C tests) were determined across age, race/ethnicity, sex, and BMI categories. Results FPG + HbA1C test was associated with significantly higher diagnostic rates of prediabetes across age, race/ethnicity, and BMI. Estimates of overall prevalence of prediabetes using OGT + FPG, OGT + HbA1C, HbA1C + FPG, and OGT + FPG + HbA1C tests were 20.3, 24.2, 33, and 34.3%, respectively. Compared to OGT + FPG, the use of HbA1C + FPG test in screening was associated with 44.8, 135, 38.6, and 35.9% increased prevalence of prediabetes in non-Hispanic White, non-Hispanic Black, Mexican-American, and other racial/ethnic men, respectively. The corresponding values in women were 67.8, 140, 37.2, and 42.6%, respectively. Combined use of all blood glucose tests did not improve the overall and gender-specific prediabetes prevalence beyond what was observed using HbA1C + FPG test. Conclusion HbA1C criteria were associated with higher diagnosis rates of prediabetes than FPG and OGT tests in non-diabetic American children and adults. Using a combination of HbA1C and FPG test in screening for prediabetes reduces intrinsic systematic bias in using just HbA1C testing and offers the benefits of each test. A well-defined HbA1C that takes into consideration race/ethnicity, gender, age, and body mass index may improve detection of prediabetes in population and clinical settings.
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Affiliation(s)
- Ike S Okosun
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University , Atlanta, GA , USA
| | - J Paul Seale
- Department of Family Medicine, Mercer University School of Medicine , Macon, GA , USA
| | - Rodney Lyn
- Division of Health Management and Policy, School of Public Health, Georgia State University , Atlanta, GA , USA
| | - Y Monique Davis-Smith
- Department of Family Medicine, Mercer University School of Medicine , Macon, GA , USA
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9
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Ye Z, Cong L, Ding G, Yu M, Zhang X, Hu R, Wu J, Fang L, Wang H, Zhang J, He Q, Su D, Zhao M, Wang L, Gong W, Xiao Y, Liang M, Pan J. Optimal cut-off points for two-step strategy in screening of undiagnosed diabetes: a population-based study in China. PLoS One 2014; 9:e87690. [PMID: 24609110 PMCID: PMC3946449 DOI: 10.1371/journal.pone.0087690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 01/02/2014] [Indexed: 12/03/2022] Open
Abstract
To identify optimal cut-off points of fasting plasma glucose for two-step strategy in screening of undiagnosed diabetes in Chinese people, data were selected from two cross-sectional studies of Metabolic Syndrome in Zhejiang Province of China, Zhejiang Statistical Yearbook (2010), and published literatures. Two-step strategy was used among 17437 subjects sampled from population to screen undiagnosed diabetes. Effectiveness (proportion of cases identified), costs (including medical and non-medical costs), and efficiency (cost per case identified) of these different two-step screening strategies were evaluated. This study found the sensitivities of all the two-step screening strategies with further Oral Glucose Tolerance Test (OGTT) at different Fasting Plasma Glucose (FPG) cut-off points from 5.0 to 7.0 (mmol/L) ranged from 0.66 to 0.91. For the FPG point of 5.0 mmol/L, 91 percent of undiagnosed cases were identified. The total cost of detecting one undiagnosed diabetes case ranged from 547.1 to 1294.5 CNY/case, and the strategy with FPG at cut-off point of 6.1 (mmol/L) resulted in the least cost. Considering both sensitivity and cost of screening diabetes, FPG cut-off point at 5.4 mmol/L was optimized for the two-step strategy. In conclusion, different optimal cut-off points of FPG for two-step strategy in screening of undiagnosed diabetes should be used for different screening purposes.
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Affiliation(s)
- Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Liming Cong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Gangqiang Ding
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Min Yu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (MY); (LF)
| | - Xinwei Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jianjun Wu
- Zhejiang University, Hangzhou, Zhejiang, China
| | - Le Fang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (MY); (LF)
| | - Hao Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jie Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qingfang He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Danting Su
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ming Zhao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Lixin Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Weiwei Gong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yuanyuan Xiao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Mingbin Liang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jin Pan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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10
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Spadea L, Paroli MP. Laser refractive surgery in diabetic patients: a review of the literature. Clin Ophthalmol 2012; 6:1775-83. [PMID: 23152656 PMCID: PMC3497454 DOI: 10.2147/opth.s37384] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the current recommendations regarding laser refractive surgery in patients with diabetes mellitus and to assess whether these patients make appropriate candidates for laser vision correction. METHODS A literature search was conducted to identify current research on the ocular complications of diabetes and original publications on laser refractive surgery in diabetic patients. RESULTS Diabetes was associated with several ocular complications. Initially the US Food and Drug Administration listed these complications as justification to advise against refractive surgery in patients with diabetes. However, recent studies on laser in situ keratomileusis in diabetic patients indicate that this procedure may be safe in diabetic patients with very well controlled systemic disease and no ocular manifestations. CONCLUSION Laser refractive surgery may be performed safely in a very selected group of patients with diabetes.
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Affiliation(s)
- Leopoldo Spadea
- University of L'Aquila, Department of Biotechnological and Applied Clinical Sciences, Eye Clinic, L'Aquila
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11
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Kim HJ, Lee SG, Chae IG, Kim MJ, Im NK, Yu MH, Lee EJ, Lee IS. Antioxidant effects of fermented red ginseng extracts in streptozotocin- induced diabetic rats. J Ginseng Res 2011; 35:129-37. [PMID: 23717054 PMCID: PMC3659529 DOI: 10.5142/jgr.2011.35.2.129] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/26/2010] [Accepted: 11/15/2010] [Indexed: 01/01/2023] Open
Abstract
The antioxidant activities of fermented red ginseng (FRG) were investigated in vitro and in vivo. The contents of total polyphenol and total flavonoid in FRG extracts were 17.01±2.00 μg/mg and 18.42±3.97 μg/mg, respectively. These extracts were capable of directly scavenging α, α-diphenyl-picrylhydrazyl free radicals. The antioxidative effects of the FRG extracts in streptozotocin (STZ)-induced diabetic rats were also investigated. The activities of plasma alanine transaminase, aspartate transaminase, and γ-glutamyltransferase were significantly decreased by extract administration as compared to an STZ control group. Hepatic glutathione content depleted by STZ treatment was significantly increased by treatment of the FRG extracts, but the elevation of lipid peroxide content induced by STZ was significantly decreased by the extracts. Activities of superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase decreased after STZ-treatment were recovered by the treatment of the FRG extracts. These results indicate that FRG extracts have antioxidative effets in STZ-induced diabetic rats.
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Affiliation(s)
- Hyun-Jeong Kim
- The Center for Traditional Microorganism Resources, Keimyung University, Daegu 704-701, Korea
| | - Sung-Gyu Lee
- Department of Food and Technology, Keimyung University, Daegu 704-701, Korea
- Bio Research Institute, NUC Electronics Co. Ltd., Daegu 702-053, Korea
| | - In-Gyeong Chae
- Department of Food and Technology, Keimyung University, Daegu 704-701, Korea
| | - Mi-Jin Kim
- Department of Food and Technology, Keimyung University, Daegu 704-701, Korea
| | - Nam-Kyung Im
- Department of Food and Technology, Keimyung University, Daegu 704-701, Korea
| | - Mi-Hee Yu
- Department of Food and Technology, Keimyung University, Daegu 704-701, Korea
| | - Eun-Ju Lee
- Bio Research Institute, NUC Electronics Co. Ltd., Daegu 702-053, Korea
| | - In-Seon Lee
- The Center for Traditional Microorganism Resources, Keimyung University, Daegu 704-701, Korea
- Department of Food and Technology, Keimyung University, Daegu 704-701, Korea
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Dasgupta A, Singh OP, Rout JK, Saha T, Mandal S. Insulin resistance and metabolic profile in antipsychotic naïve schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1202-7. [PMID: 20600470 DOI: 10.1016/j.pnpbp.2010.06.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 05/27/2010] [Accepted: 06/11/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Several studies have suggested insulin resistance related to dyslipidemia and body weight in drug treated schizophrenia patients. Although, insulin resistance or impaired glucose tolerance is also reported in antipsychotic naïve schizophrenia patients, their relationship with dyslipidemic changes and body weight is not well established. The present study was undertaken to examine insulin resistance in antipsychotic naïve schizophrenia patients of this region and to evaluate any association between lipid parameters and body weight with their insulin resistance, if any. METHOD Plasma glucose, total serum cholesterol and its LDL, HDL fractions, and serum insulin levels were measured from fasting blood samples of newly diagnosed, antipsychotic naïve schizophrenia patients (n=30) and matched control group (n=25) in a hospital based case control study. Homoeostatic model assessment (HOMA) was done to evaluate insulin resistance. RESULTS Means of plasma glucose, total serum cholesterol and its LDL, HDL fractions did not vary significantly (p>0.05) between cases and control. Insulin resistance was significantly increased (p<0.05) in drug naïve cases. Multiple linear regression analyses did not show any association (p>0.05) between insulin resistance and lipid parameters. CONCLUSIONS Newly diagnosed schizophrenia patients were more prone to insulin resistance in our study population. This was not associated with any dyslipidemic changes as the lipid parameters were not elevated in them compared to the healthy controls. It was not dyslipidemia, but some other common genetic or risk factors that might be responsible for the increased insulin resistance in antipsychotic naïve schizophrenia patients in our study population.
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Affiliation(s)
- Anindya Dasgupta
- Department of Biochemistry, Burdwan Medical College & Hospital, Burdwan-713104, West Bengal, India.
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13
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Fernandez-Egea E, Bernardo M, Donner T, Conget I, Parellada E, Justicia A, Esmatjes E, Garcia-Rizo C, Kirkpatrick B. Metabolic profile of antipsychotic-naive individuals with non-affective psychosis. Br J Psychiatry 2009; 194:434-8. [PMID: 19407273 PMCID: PMC2703813 DOI: 10.1192/bjp.bp.108.052605] [Citation(s) in RCA: 205] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Some studies suggest individuals with schizophrenia have an increased risk of diabetes prior to antipsychotic use. Small sample sizes and the potential for confounding by hypercortisolaemia have decreased confidence in those results. AIMS To examine diabetes-related factors in newly diagnosed, antipsychotic-naive people with non-affective psychosis. METHOD Participants with psychosis (the psychosis group; n = 50) and matched controls (the control group; n = 50) were given a 2 h oral glucose tolerance test. Fasting concentrations were also determined for adiponectin, interleukin-6 and C-reactive protein. RESULTS Compared with the control group, the psychosis group had significant increases in 2 h glucose and interleukin-6 concentrations, and in the prevalence of abnormal glucose tolerance (16% of psychosis group v. 0% of control group). Adiponectin and C-reactive protein concentrations did not differ significantly between the two groups. These findings could not be attributed to differences in cortisol concentrations, smoking, gender, neighbourhood of residence, body mass index, aerobic conditioning, ethnicity, socioeconomic status or age. CONCLUSIONS Individuals with non-affective psychosis appear to have an increased prevalence of abnormal glucose tolerance prior to antipsychotic treatment, as well as abnormalities in a related inflammatory molecule. These underlying problems may contribute to the metabolic side-effects of antipsychotic medications.
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Bando Y, Kanehara H, Aoki K, Katoh KI, Toya D, Tanaka N. Characteristics of undiagnosed diabetes mellitus in a population undergoing health screening in Japan: target populations for efficient screening. Diabetes Res Clin Pract 2009; 83:341-6. [PMID: 19118911 DOI: 10.1016/j.diabres.2008.11.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 08/05/2008] [Accepted: 11/11/2008] [Indexed: 11/17/2022]
Abstract
AIMS To estimate the prevalence of undiagnosed diabetes mellitus and its relationship with various risk factors in a population undergoing health screening in Japan. METHODS Oral glucose tolerance tests were carried out in a total sample of 14,674 Japanese subjects undergoing health screening, aged 20-83 years and without known diabetes. The prevalence of glucose tolerance categories (1999 WHO criteria) was adjusted for sample probabilities. The optimal FPG cut-off point for screening diabetes was estimated using ROC curve analysis for the continuous value of FPG corresponding to a 2-h PG of 200 mg/dl. The number needed to screen (NNTS) to identify one person with undiagnosed diabetes with various risk factors was estimated using the following equation: the number of undiagnosed diabetic plus nondiabetic subjects/the number of undiagnosed diabetic subjects. RESULTS The prevalence of undiagnosed diabetes among men and women was 6.4% (NNTS 15.7) and 3.2% (NNTS 31.7), respectively. The optimal FPG cut-off point for screening diabetes among men and women was 105 and 106 mg/dl, respectively. NNTS was lower in individuals with more risk factors, e.g. aging (> or =50), BMI (> or =25), hypertension (SBP> or =140 mmHg and/or DBP> or =90 mmHg) and dyslipidemia (TC> or =220 and/or HDL-C<40 and/or TG> or =150 mg/dl), resulting in the lowest NNTS in individuals having all four risk factors among men (6.1) and women (6.7), respectively. CONCLUSIONS In Japan, screening for diabetes may be more efficient among individuals having an FPG of more than 105-106 mg/dl and with more risk factors, especially in men.
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Affiliation(s)
- Yukihiro Bando
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Wadanaka-machi, Fukui, Japan.
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Kim KR, Choi JH, Woo MH, Kim YH, Choi SW. Effects of Enzymatic Hydrolysates from Hamcho (Salicornia herbacea L.) on Blood Glucose and Serum Lipid Composition in Streptozotocin-Induced Diabetic Rats. ACTA ACUST UNITED AC 2008. [DOI: 10.3746/jkfn.2008.37.2.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Spelman LM, Walsh PI, Sharifi N, Collins P, Thakore JH. Impaired glucose tolerance in first-episode drug-naïve patients with schizophrenia. Diabet Med 2007; 24:481-5. [PMID: 17381506 DOI: 10.1111/j.1464-5491.2007.02092.x] [Citation(s) in RCA: 263] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS To determine whether there is an association between Type 2 diabetes mellitus and schizophrenia, independent of medication. METHODS In this cross-sectional study we performed an oral glucose tolerance test on 38 non-obese white Caucasians who fulfilled the criteria for first-episode drug-naïve schizophrenia, 38 control subjects (matched for age, gender, smoking status, alcohol intake and ethnicity) and 44 first-degree relatives of the patients. RESULTS The frequency of impaired glucose tolerance (IGT), defined by World Health Organization criteria, was 10.5% (n = 4) in patients with schizophrenia, 18.2% (n = 8) in unaffected relatives and 0.0% in healthy control subjects (chi(2) = 4.22, d.f. = 2, P < 0.05). CONCLUSIONS The high point prevalence of IGT in never-treated patients and relatives supports either shared environmental or genetic predisposition to IGT. Both patients and their relatives present an ideal cost-effective opportunity to screen for Type 2 diabetes mellitus, as they are both easily identifiable.
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Affiliation(s)
- L M Spelman
- Neuroscience Centre, St Vincent's Hospital, Dublin, Ireland
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González-Clemente JM. [Screening for type 2 diabetes mellitus: more than looking for undiagnosed diabetes]. Med Clin (Barc) 2004; 123:177-80. [PMID: 15274796 DOI: 10.1016/s0025-7753(04)74451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Costa A, Yuri A, Solà J, Conget I. [Screening ability of a questionnaire designed for the detection of diabetes mellitus in hospital outpatients clinic]. Med Clin (Barc) 2003; 120:287-91. [PMID: 12636897 DOI: 10.1016/s0025-7753(03)73679-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The socio-economical burden of type 2 diabetes mellitus (DM2) recommends its screening when the disease is suspected. In the present study we aimed to evaluate: the results of the oral glucose tolerance test (OGTT) normally indicated in hospital outpatient clinics when diabetes is suspected, and the efficacy of the American Diabetes Association (ADA) diabetes risk questionnaire to detect glucose tolerance abnormalities. PATIENTS AND METHOD All subjects with an indication of OGTT were included consecutively. Individuals filled up a questionnaire including the ADA items. The sensitivity and specificity of the questionnaire were calculated. RESULTS Two hundred and twenty nine subjects were studied (62.9% women): 44.1% had normal glucose tolerance (NGT) with normal fasting glucose. Moreover, 6.5%, 25.8% and 23.6% showed an impaired fasting glucose, impaired glucose tolerance and diabetes, respectively. According to the questionnaire, 45.8% of subjects undergoing the OGTT had a positive risk of diabetes. The questionnaire revealed a sensitivity = 72.2%, specificity = 60.6% and a positive predictive value = 37.1%. Age was the only variable that increased the risk of DM (odds ratio = 3.48, p = 0.0001). CONCLUSIONS The important proportion of patients with NGT found in our study suggests the need to improve the indication of a diagnosis test when diabetes is suspected. One possibility would be to validate a questionnaire to detect the risk of diabetes in our own area.
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Affiliation(s)
- Angels Costa
- Servei d'Endocrinologia i Diabetis. Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS). Hospital Clínic i Universitari de Barcelona. Barcelona. Spain
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Cardiovascular risk profile assessment in glucose-intolerant Asian individuals--an evaluation of the World Health Organization two-step strategy: the DECODA Study (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Asia). Diabet Med 2002; 19:549-57. [PMID: 12099957 DOI: 10.1046/j.1464-5491.2002.00735.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS To assess the cardiovascular (CVD) risk factor profile in individuals with diabetes and impaired glucose tolerance (IGT) identified by a one-step (fasting plasma glucose (FPG)) or a two-step strategy (including an oral glucose tolerance test (OGTT) in subjects with impaired fasting glucose (IFG)) as recommended by the World Health Organization (WHO). METHODS Twelve population-based studies in six countries (17 512 subjects, age 30-89 years, without known diabetes, with OGTT (fasting and 2-h plasma glucose (2-h PG))). Age, gender, and centre-adjusted means of CVD risk factors were compared according to the level of glucose intolerance. RESULTS Diabetes was found in 1270 individuals and IFG or IGT in 3158. In the diabetic group 55.1% had a FPG > or = 7.0 mmol/l (range between countries 36.2-67.0%), 20.5% were identified through the stepwise strategy (range 0-32%), while 24.4% would remain undiagnosed (FPG < 6.1 mmol/l) (range 9.0-40.0%). The two-step strategy identified 60-91% of all newly diagnosed diabetic subjects with 5-12% of the population requiring an OGTT. Mean body mass index (BMI), blood pressure, and total cholesterol did not differ between diabetic individuals diagnosed by FPG or OGTT. The step-wise strategy identified < 50% of the subjects with impaired glucose regulation, and the cardiovascular risk profile (BMI, blood pressure, and cholesterol) did not differ between those identified and those not identified in the screening process. CONCLUSIONS Applying an OGTT in subjects with IFG will fail to detect every fourth diabetic individual and every second individual with impaired glucose regulation. Individuals not diagnosed had a cardiovascular risk profile identical to those identified in the diagnostic process. Lower thresholds for an OGTT may be necessary in Asian populations.
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Abstract
PURPOSE To report the incidence of complications and the refractive results in patients with diabetes mellitus treated with laser-assisted in situ keratomileusis (LASIK). METHODS A retrospective review of the charts, focusing on 6-month postoperative data, was performed on 30 eyes from patients with diabetes and 150 age- and gender-matched control eyes operated on during the same period. The incidence of complications and postoperative refractive results were compared. The data analyzed include UCVA, spherical equivalent, astigmatism power, astigmatism axis, and vector astigmatism change. RESULTS Diabetic eyes treated with LASIK had an overall complication rate of 47% compared with the control population complication incidence of 6.9% (p< 0.01). The most frequent complications occurring in the diabetic population are punctate epithelial erosions and persistent epithelial defects. Spherical correction change was -4.64 diopters (D) for diabetic eyes and -4.98 D for control eyes (p= 0.49). Mean spherical equivalent change was -4.69 D for diabetic eyes and -4.75 D for control eyes (p= 0.9). Mean change in uncorrected visual acuity (LogMAR) was 1.5 for diabetic eyes and 1.65 for control eyes (p= 0.18). Mean astigmatism magnitude change was 0.31 in diabetic eyes and 0.57 in control eyes (p= 0.12). Mean vector corrected astigmatism change was 0.97 for diabetic eyes and 1.12 for control eyes (p= 0.31). Mean vector-corrected astigmatism axis for patients with diabetes was 18.17 for diabetic eyes and 6.20 for control eyes (p= 0.30). CONCLUSION Patients with diabetes who undergo LASIK are at a significantly higher risk of developing postoperative epithelial complications. In addition, this study revealed poorer refractive results in the eyes of patients with diabetes treated with LASIK.
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