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Yang C, Li S, Wu L, Ding Z, Zhou H, Pan Y, Yang C, Lin J, Li Q, You Y, Zhong X, Chen Y, Zhao Y. Prevalence of prediabetes by the fasting plasma glucose and HbA1c screening criteria among the children and adolescents of Shenzhen, China. Front Endocrinol (Lausanne) 2024; 15:1301921. [PMID: 38313368 PMCID: PMC10836591 DOI: 10.3389/fendo.2024.1301921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Background Prediabetes is associated with an increased risk of cardiovascular diseases and all-cause mortality. Rare research in China has evaluated the prevalence of prediabetes among children and adolescents using the HbA1c criterion or the combined FPG-or-HbA1c diagnostic criterion, and researchers paid no attention to the distributions of blood glucose in Shenzhen, especially for juveniles. Methods We conducted a school-based cross-sectional study based on the first-year students from 17 primary, middle, and high schools. Prediabetes was defined as FPG of 5.6-6.9 mmol/L or HbA1c of 5.7%-6.4%. The crude and standardized prevalence of prediabetes with 95% confidence interval (95% CI) was estimated. Results A total of 7519 participants, aged 6 to 17 years, were included. For all subjects, the crude prevalence (95% CI) of prediabetes was 1.49% (1.21-1.77), 8.72% (8.08-9.36), and 9.80% (9.13-10.47) by the FPG-only, HbA1c-only, and FPG-or-HbA1c criteria, respectively. Based on the 2010 Shenzhen census population, the standardized prevalence was 1.56% (males 1.85%, females 1.19%), 11.05% (males 11.47%, females 10.53%), and 12.19% (males 13.01%, females 11.15%) by the corresponding criteria. The proportion of prediabetes was higher for males than females, and the prevalence decreased with grade for males but increased for females. The association of BMI and prediabetes was U-shaped curve, indicating higher rates of prediabetes for underweight and obesity people. Conclusion The blood glucose status of children and adolescents in Shenzhen is worrisome, and the early detection and management of prediabetes are imperative.
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Affiliation(s)
- Chen Yang
- Department of Endocrinology, Baoan Central Hospital of Shenzhen, The 5th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
- Department of Endocrinology and Metabolism, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
| | - Shaohua Li
- Wards of Cadres, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
| | - Liangyan Wu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zan Ding
- Department of Science and Education, Baoan Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Hua Zhou
- Department of Administrative, Baoan Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Ying Pan
- Department of Endocrinology, Baoan Central Hospital of Shenzhen, The 5th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Chufu Yang
- Department of Huangtian Outpatient, Baoan Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Jinjun Lin
- Department of Endocrinology, Baoan Central Hospital of Shenzhen, The 5th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Qiang Li
- Department of Endocrinology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Yingbin You
- Department of Administrative, Baoan Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Xu Zhong
- Department of Endocrinology, Baoan Central Hospital of Shenzhen, The 5th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Yuyuan Chen
- Department of Endocrinology, Baoan Central Hospital of Shenzhen, The 5th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Yu Zhao
- Department of Endocrinology, Baoan Central Hospital of Shenzhen, The 5th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
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Huang L, Pan Y, Zhou K, Liu H, Zhong S. Correlation Between Glycemic Variability and Diabetic Complications: A Narrative Review. Int J Gen Med 2023; 16:3083-3094. [PMID: 37496596 PMCID: PMC10368016 DOI: 10.2147/ijgm.s418520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
Diabetes mellitus is a metabolic disorder with a complex etiology in which glycemic dynamics are disturbed and the body is unable to maintain the process of glucose homeostasis through the pancreas. Persistent symptoms of high blood glucose or low blood glucose may lead to diabetic complications, such as neuropathy, nephropathy, retinopathy, and cardiovascular diseases. Glycemic variability which can represent the presence of excessive glycemic excursions is an indicator for evaluating glucose homoeostasis. Limiting glycemic variability has gradually become an emerging therapeutic target in improve diabetes metabolism and prevent associated complications. This article reviews the progress of research on the various quantifiable parameters of glycemic variability and their relationships with vascular lesions and mechanisms.
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Affiliation(s)
- Lining Huang
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Ying Pan
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Kaixin Zhou
- Guangzhou Laboratory, Guangzhou, 510005, People’s Republic of China
| | - Hongying Liu
- Hangzhou Kang Ming Information Technology Co., Ltd, Hangzhou, 310000, People’s Republic of China
| | - Shao Zhong
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
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Di Bonito P, Licenziati MR, Corica D, Wasniewska MG, Di Sessa A, Del Giudice EM, Morandi A, Maffeis C, Faienza MF, Mozzillo E, Calcaterra V, Franco F, Maltoni G, Valerio G. Phenotypes of prediabetes and metabolic risk in Caucasian youths with overweight or obesity. J Endocrinol Invest 2022; 45:1719-1727. [PMID: 35579861 PMCID: PMC9360115 DOI: 10.1007/s40618-022-01809-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the prevalence of pre-diabetes phenotypes, i.e., impaired fasting glucose (IFG), impaired glucose tolerance (IGT), increased HbA1c (IA1c), and their association with metabolic profile and atherogenic lipid profile in youths with overweight/obesity (OW/OB). METHODS This cross-sectional study analyzed data of 1549 youths (5-18 years) with OW/OB followed in nine Italian centers between 2016 and 2020. Fasting and post-load measurements of glucose, insulin, and HbA1c were available. Insulin resistance (IR) was estimated by HOMA-IR and insulin sensitivity (IS) by reciprocal of fasting insulin. The atherogenic lipid profile was assessed by triglycerides-to-HDL ratio or cholesterol-to-HDL ratio. Insulinogenic index was available in 939 youths, in whom the disposition index was calculated. RESULTS The prevalence of overall pre-diabetes, IFG, IGT and IA1c was 27.6%, 10.2%, 8% and 16.3%, respectively. Analyzing each isolated phenotype, IGT exhibited two- to three-fold higher odds ratio of family history of diabetes, and worse metabolic and atherogenic lipid profile vs normoglycemic youths; IFG was associated only with IR, while IA1c showed a metabolic and atherogenic lipid profile intermediate between IGT and IFG. CONCLUSION Prevalence of pre-diabetes was high and IA1c was the most prevalent phenotype in Italian youths with OW/OB. The IGT phenotype showed the worst metabolic and atherogenic lipid profile, followed by IA1c. More studies are needed to assess whether HbA1c may help improving the prediction of diabetes.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, "S. Maria Delle Grazie" Hospital, Pozzuoli, Italy
| | - M R Licenziati
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - D Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - M G Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - A Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - C Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - M F Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - E Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, University of Naples "Federico II", Naples, Italy
| | - V Calcaterra
- Pediatric Department, "V. Buzzi" Children's Hospital, Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - F Franco
- Pediatric Department, Azienda Sanitaria Universitaria del Friuli Centrale, Hospital of Udine, Udine, Italy
| | - G Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - G Valerio
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", via Medina 40, 80133, Naples, Italy.
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Evaluation and Treatment of Prediabetes in Youth. J Pediatr 2020; 219:11-22. [PMID: 32143933 PMCID: PMC7585934 DOI: 10.1016/j.jpeds.2019.12.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/11/2019] [Accepted: 12/26/2019] [Indexed: 12/29/2022]
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Martos-Moreno GÁ, Martínez-Villanueva J, González-Leal R, Chowen JA, Argente J. Sex, puberty, and ethnicity have a strong influence on growth and metabolic comorbidities in children and adolescents with obesity: Report on 1300 patients (the Madrid Cohort). Pediatr Obes 2019; 14:e12565. [PMID: 31373441 DOI: 10.1111/ijpo.12565] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The capacity to correctly assess insulin resistance and its role in further obesity-associated metabolic derangement in children is under debate, and its determinants remain largely unknown. OBJECTIVE We investigated the association of the insulin secretion profile with other metabolic derangements and anthropometric features in children and adolescents with obesity, exploring the role of ethnicity. PATIENTS AND METHODS Growth and metabolic features, including fasting insulin levels and insulin secretory profile in an oral glucose tolerance test (OGTT), were analyzed according to ethnicity in 1300 patients with obesity (75.8% Caucasians/19.0% Latinos). RESULTS Height and bone age were influenced by sex, ethnicity, and insulinemia. Latino patients had higher insulin (P < .001), but similar glycemia both prepubertally and postpubertally, compared with Caucasians. Type 2 diabetes was uncommon (0.1%). Impaired glucose tolerance was associated to higher age, BMI, uric acid, and triglyceride levels (all P < .05), as was fasting hyperinsulinism. Impaired fasting glucose or HbA1c 5.7% to 6.4% showed no association with further metabolic derangement. A delayed insulin peak in the OGTT was associated to more severe metabolic disturbances. CONCLUSIONS Obesity-associated hyperglycemia is unusual in our environment whereas fasting and late postprandial hyperinsulinemia are highly prevalent, with this being influenced by race and closely related with lipid metabolism impairment.
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Affiliation(s)
- Gabriel Á Martos-Moreno
- Department of Endocrinology, Research Institute "La Princesa", Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65E-28009, Madrid, Spain.,Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Julián Martínez-Villanueva
- Department of Endocrinology, Research Institute "La Princesa", Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65E-28009, Madrid, Spain
| | - Rocío González-Leal
- Department of Endocrinology, Research Institute "La Princesa", Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65E-28009, Madrid, Spain
| | - Julie A Chowen
- Department of Endocrinology, Research Institute "La Princesa", Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65E-28009, Madrid, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Argente
- Department of Endocrinology, Research Institute "La Princesa", Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65E-28009, Madrid, Spain.,Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,CEI UAM + CSIC, IMDEA Food Institute, Madrid, Spain
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Iskandar S, Migahid A, Kamal D, Megahed O, DeFronzo RA, Zirie M, Jayyousi A, Al Jaidah M, Abdul-Ghani M. Glycated hemoglobin versus oral glucose tolerance test in the identification of subjects with prediabetes in Qatari population. BMC Endocr Disord 2019; 19:87. [PMID: 31438915 PMCID: PMC6704621 DOI: 10.1186/s12902-019-0412-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 07/19/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Subjects with prediabetes are at increased risk of future T2DM and cardiovascular disease (CVD) compared to NGT individuals. The OGTT (FPG = 100-125 and 2 h-PG = 140-199 mg/dl) and HbA1c 5.7-6.4% have been used to diagnose subjects with prediabetes. In the present study, we compared the ability of the OGTT and HbA1c to identify Qatari subjects with prediabetes. METHODS Four hundred forty six subjects without a history of T2DM received 75-g OGTT and measurement of HbA1c. The incidence of prediabetes in this cohort according to OGTT criteria was compared to that of HbA1c criteria. RESULTS The agreement between the OGTT and HbA1c in identifying subjects with prediabetes in Qatari subjects was poor, though significant (k = 015, p < 0.0001). Only 56% of participants had prediabetes or NGT according to OGTT and HbA1c. The disagreement between OGTT and HbA1c in diagnosing prediabetes was primarily due to low sensitivity of HbA1c. Moreover, subjects with prediabetes diagnosed with the OGTT have more severe metabolic profile than prediabetic subjects diagnosed with HbA1c. Lastly, more subjects with the metabolic syndrome were identified with OGTT (60%) criteria than with the HbA1c (49%), p < 0.0001. CONCLUSION These results demonstrate subjects with prediabetes diagnosed with OGTT have more severe metabolic risk than those diagnosed with HbA1c, and more likely to have greater risk of progression to T2DM.
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Affiliation(s)
| | - Ayman Migahid
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Dalia Kamal
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Osama Megahed
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Ralph A. DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX USA
| | - Mahmoud Zirie
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Amin Jayyousi
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | | | - Muhammad Abdul-Ghani
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX USA
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Brar PC. Update on the current modalities used to screen high risk youth for prediabetes and/or type 2 diabetes mellitus. Ann Pediatr Endocrinol Metab 2019; 24:71-77. [PMID: 31261470 PMCID: PMC6603607 DOI: 10.6065/apem.2019.24.2.71] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023] Open
Abstract
The modalities currently employed to screen for type 2 diabetes mellitus (T2DM)/prediabetes are HbA1c, fasting plasma glucose (FPG), and 2-hour plasma glucose (PG) during an oral glucose tolerance test (OGTT). The purpose of this review is to highlight the positive qualities and pitfalls of these diagnostic modalities and reflect on the most reasonable and effective approach to screen high risk youth. Given its inherent preanalytical advantages, glycated hemoglobin (HbA1c) continues to be the preferred diagnostic modality used by pediatricians to screen high risk youth. However, when the three aforementioned tests are performed in youths of different races/ethnicities, discrepant results for T2DM/prediabetes are observed. The prevalence rates for T2DM vary from 0.53% in Chinese youth (including youth of all body mass indexes) to 18.3% in high-risk, overweight, obese Korean youth. Moreover, the FPG is abnormal (>100 less than <126 mg/dL) in 15% of Korean youth versus 8.7% of Chinese youth. The prevalence rates for prediabetes are 1.49% in Chinese youth versus 21% in Emirati youth (HbA1c, 5.7%-6.4%). The coefficient of agreement, k, between these screening tests for T2DM are fair, 0.45-0.5 across all youth. However, using HbA1c as a comparator, the agreement is weak with FPG (k=0.18 in German youth versus k=0.396 in Korean youth). The American Diabetes Association (ADA) Standards of Medical Care Guidelines define "high risk youth" who need to be tested for T2DM and/or prediabetes. OGTT and HbA1c do not always detect T2DM in similar individuals. HbA1c may not be an ideal test for screening Hispanic and African American youth. FPG and OGTT are suitable screening tests for youth of ethnic minorities and those with cystic fibrosis or hemoglobinopathies. Performing all three tests either together or sequentially may be the only way to encompass all youth who have aberrations in different aspects of glucose homeostasis.
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Affiliation(s)
- Preneet Cheema Brar
- Division of Pediatric Endocrinology and Diabetes, New York University School of Medicine, New York, NY, USA
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Nam HK, Cho WK, Kim JH, Rhie YJ, Chung S, Lee KH, Suh BK. HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents. J Korean Med Sci 2018; 33:e93. [PMID: 29542302 PMCID: PMC5852422 DOI: 10.3346/jkms.2018.33.e93] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Oral glucose tolerance test (OGTT) is a traditional diagnostic tool for diabetes. Hemoglobin A1c (HbA1c) is an alternative method used in adults; however, its application in youths has been controversial. We evaluated the diagnostic performance of HbA1c and determined optimal cutoff points for detecting prediabetes and diabetes in youth. METHODS This retrospective study included 389 obese children (217 boys, 55.8%) who had undergone simultaneous OGTT and HbA1c testing at six hospitals, Korea, between 2010 and 2016. Subjects were diagnosed with diabetes (fasting glucose ≥ 7.0 mmol/L; 2-hour glucose ≥ 11.1 mmol/L) or prediabetes (fasting glucose 5.6-6.9 mmol/L; 2-hour glucose 7.8-11.0 mmol/L). The diagnostic performance of HbA1c for prediabetes and diabetes was determined using the area under the receiver operating characteristic curve (AUC). RESULTS At diagnosis, 197 (50.6%) subjects had normoglycemia, 121 (31.1%) had prediabetes, and 71 (18.3%) had diabetes. The kappa coefficient for agreement between OGTT and HbA1c was 0.464. The optimal HbA1c cutoff points were 5.8% (AUC, 0.795; a sensitivity of 64.1% and a specificity of 83.8%) for prediabetes and 6.2% (AUC, 0.972; a sensitivity of 91.5% and a specificity of 93.7%) for diabetes. When HbA1c (≥ 6.2%) and 2-hour glucose level were used to diagnose diabetes, 100% were detected. CONCLUSION Pediatric criteria for HbA1c remain unclear, therefore, we recommend the combination of fasting and 2-hour glucose levels, in addition to HbA1c, in the diagnosis of childhood prediabetes and diabetes.
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Affiliation(s)
- Hyo Kyoung Nam
- Department of Pediatrics, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Won Kyoung Cho
- Department of Pediatrics, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea.
| | - Young Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kee Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Byung Kyu Suh
- Department of Pediatrics, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Valderhaug TG, Sharma A, Kravdal G, Rønningen R, Nermoen I. The usage of fasting glucose and glycated hemoglobin for the identification of unknown type 2 diabetes in high risk patients with morbid obesity. Scand J Clin Lab Invest 2017; 77:505-512. [PMID: 28715238 DOI: 10.1080/00365513.2017.1347958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In spite of increased vigilance of undiagnosed type 2 diabetes (DM2), the prevalence of unknown DM2 in subjects with morbid obesity is not known. AIM To assess the prevalence of undiagnosed DM2 and compare the performance of glycated A1c (HbA1c) and fasting glucose (FG) for the diagnosis of DM2 and prediabetes (preDM) in patients with morbid obesity. PATIENTS AND METHODS We measured fasting glucose and HbA1c in 537 consecutive patients with morbid obesity without previously known DM2. RESULTS A total of 49 (9%) patients with morbid obesity had unknown DM2 out of which 16 (33%) fulfilled both the criteria for HbA1c and FG. Out of 284 (53%) subjects with preDM, 133 (47%) fulfilled both the criteria for HbA1c and FG. Measurements of agreement for FG and HbA1c were moderate for DM2 (κ = 0.461, p < .001) and fair for preDM (κ = 0.317, p < .001). Areas under the curve for FG and HbA1c in predicting unknown DM2 were 0.970 (95% CI 0.942, 0.998) and 0.894 (95% CI 0.837, 0.951) respectively. The optimal thresholds to identify unknown DM2 were FG ≥6.6 mmol/L and HbA1c ≥ 6.1% (43 mmol/mol). CONCLUSIONS The prevalence of DM2 remains high and both FG and HbA1c identify patients with unknown DM2. FG was slightly superior to HbA1c in predicting and separating patients with unknown DM2 from patients without DM2. We suggest that an FG ≥6.6 mmol/L or an HbA1c ≥6.1% (43 mmol/mol) may be used as primary cut points for the identification of unknown DM2 among patients with morbid obesity.
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Affiliation(s)
- Tone G Valderhaug
- a Department of Endocrinology , Akershus University Hospital HF , Lørenskog , Norway.,b Division of Medicine and Laboratory Sciences , Institute of Clinical Medicine, University of Oslo , Norway
| | - Archana Sharma
- a Department of Endocrinology , Akershus University Hospital HF , Lørenskog , Norway
| | - Gunnhild Kravdal
- c Multidisciplinary Laboratory Medicine and Medical Biochemistry , Akershus University Hospital HF , Lørenskog , Norway
| | - Reidun Rønningen
- a Department of Endocrinology , Akershus University Hospital HF , Lørenskog , Norway
| | - Ingrid Nermoen
- a Department of Endocrinology , Akershus University Hospital HF , Lørenskog , Norway.,b Division of Medicine and Laboratory Sciences , Institute of Clinical Medicine, University of Oslo , Norway
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