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Jiang L, Hu X, Jin J, Wang W, Yu B, Chen G, Dong H, Zhou Y. Inflammatory Risk Status Shapes the Association Between Uric Acid and Cognitive Function in Non-Hyperuricemia Middle Aged and Elderly. J Alzheimers Dis 2024; 97:249-257. [PMID: 38043014 DOI: 10.3233/jad-230841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
BACKGROUND The association between uric acid (UA) and cognitive function still remains controversial. Moreover, the role of inflammation in the above association is also unclear. OBJECTIVE We aimed to determine the association between UA and cognitive function among non-hyperuricemia adults, and in particular, whether the association was shaped by different inflammation levels. METHODS From the China Health and Retirement Longitudinal Study (CHARLS), 7,272 participants aged 45 and above were enrolled in 2011. Cognitive function measurement included orientation and attention, episodic memory, and visuospatial ability. Fasting blood samples were collected to measure levels of UA and high-sensitivity C-reactive protein (hs-CRP). Generalized estimating equation models were used to evaluate the effect of UA on cognitive function in all participants and those at different levels of hs-CRP (hs-CRP <3 mg/L or ≥3 mg/L). RESULTS Among non-hyperuricemia adults (mean age: 58.08, 49.59% males) for a median of 7 years follow-up, participants with higher levels of UA had better cognitive function score compared to those with lower UA levels (β: 0.09, 95% confidence interval [CI]: 0.01-0.17, p = 0.023). And this association was significant under low-grade inflammation levels condition (β:0.10, 95% CI: 0.10-0.19, p = 0.024), but not in high-grade inflammation levels condition. Further, the cognitive function benefit of elevated UA existed only in people with persistent low-grade inflammation levels at a longitudinal perspective (β: 0.14, 95% CI: 0.01-0.27, p = 0.039). CONCLUSIONS Elevated UA levels were associated with better cognitive function in non-hyperuricemia population, especially for those at low inflammation levels.
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Affiliation(s)
- Lujing Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Xiangming Hu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Junguo Jin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Weimian Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Bingyan Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Guo Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Nyingchi People's Hospital, Nyingchi, Tibet, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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Wang C, Zhao Z, Deng X, Cai Z, Gu T, Li L, Guo C, Wang D, Yang L, Zhao L, Yuan G. Association of triglyceride-glucose with cardiac hemodynamics in type 2 diabetes. Diab Vasc Dis Res 2022; 19:14791641221083396. [PMID: 35345912 PMCID: PMC8972936 DOI: 10.1177/14791641221083396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Triglyceride-glucose (TyG) index is a reliable and inexpensive alternative indicator of insulin resistance. Previous studies have shown that elevated TyG index increases the risk of diabetes, coronary heart disease, and other diseases, but the relationship between TyG index and cardiac hemodynamics in patients with type 2 diabetes mellitus (T2DM) is not clear. This study was conducted in patients with T2DM to assess the relationship between TyG and cardiac hemodynamics and its predictive ability for T2DM. METHODS A total of 647 individuals (348 males and 299 females) were enrolled in this study, including 446 T2DM patients and 201 healthy controls. The clinical data and related laboratory variables were assessed and recorded, and TyG index was calculated. Cardiac hemodynamics was measured by echocardiography. Pearson or Spearman correlation analysis and linear regression analysis were conducted to explore the association between TyG and cardiac hemodynamics. The receiver operating characteristics (ROC) curve was used to evaluate the efficacy of TyG index in the diagnosis of T2DM. RESULTS Compared with healthy controls, the systolic blood pressure (SBP), body weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), HOMA-IR, and TyG levels were higher in patients with T2DM. With the increase of TyG, the levels of left ventricular mass index (LVMI), left ventricular mass (LVM), left ventricular end diastolic diameter (LVDd), posterior wall thickness (PWT), and interventricular septum thickness (IVST) were also increased in T2DM individuals. Multivariate linear regression analysis showed that TyG was an independent determinant of LVEF, PWT, IVST, and ejection time (ET) after adjusting for confounding factors. In addition, individuals with visceral obesity had higher TyG and TyG can be used as a predictor of T2DM with an AUC of 0.903 (95% CI:0.879-0.927). CONCLUSIONS The increase of TyG index is closely related to cardiac hemodynamics of T2DM patients, which is expected to be a simple and practical biological index to predict the changes of cardiac function in patients with T2DM.
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Affiliation(s)
- Chenxi Wang
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Zhicong Zhao
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Xia Deng
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Zhensheng Cai
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Tian Gu
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Lian Li
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Chang Guo
- Department of Nephrology, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Dong Wang
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Ling Yang
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Li Zhao
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
| | - Guoyue Yuan
- Department of Endocrinology and
Metabolism, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
- Guoyue Yuan, Department of Endocrinology
and Metabolism, Affiliated Hospital of Jiangsu University, 438 Jiefang Road,
Zhenjiang 212001, China.
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The assessment of the relationship between the severity of gingivitis and the glycosylated hemoglobin levels in adolescent and adult patients with type 1 diabetes. POSTEP HIG MED DOSW 2021. [DOI: 10.2478/ahem-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstrakt
Background
Diabetes and periodontitis belong to the group of civilizational diseases, which are not associated with any specific bacterial or viral infection but with the rapid development of civilization and technological advances that affect comfort and quality of life. Civilizational diseases occur in highly developed and developing societies. Glycosylated hemoglobin A1c (HbA1c) is one of the standard indicators for the assessment of metabolic compensation in diabetes that reflects the risk of disease complications. One of the significant complications of diabetes that manifests in the oral cavity is gingival and periodontal inflammation, which is directly related to increased insulin resistance and worsened diabetes compensation. Factors influencing inflammation are the patient’s age, directly linked with fine motor skills when it comes to cleaning teeth, and patients’ awareness related to cause-and-effect relationship between dental hygiene, gingival and periodontal inflammation, and HbA1c testing during routine check-ups.
Objectives
To compare the relationship between gingival inflammation and metabolic compensation (HbA1c levels), depending on the patient’s age.
Materials and methods
The study involved 100 patients (50 adolescents and 50 adults, 42 M; 58 F) with type 1 diabetes. The study group was divided according to sex and age into 19 male adolescent patients (10–18 years old; mean age 15.5) and 23 male adult patients (19–45 years old; mean age 27.1). The mean duration of diabetes was 7 years in the group of adolescents and 11 years in the group of adults. The HbA1c levels and gingival index (GI) were measured in all patients. The obtained results were statistically analyzed.
Results
By comparing the study groups, higher HbA1c values were reported in the group of adolescents. HbA1c has been shown to correlate with the GI in adolescents and adults. Despite poorer compensation for diabetes (higher HbA1c), GI values were similar in adolescents and adults.
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Magliano DJ, Chen L, Islam RM, Carstensen B, Gregg EW, Pavkov ME, Andes LJ, Balicer R, Baviera M, Boersma-van Dam E, Booth GL, Chan JCN, Chua YX, Fosse-Edorh S, Fuentes S, Gulseth HL, Gurevicius R, Ha KH, Hird TR, Jermendy G, Khalangot MD, Kim DJ, Kiss Z, Kravchenko VI, Leventer-Roberts M, Lin CY, Luk AOY, Mata-Cases M, Mauricio D, Nichols GA, Nielen MM, Pang D, Paul SK, Pelletier C, Pildava S, Porath A, Read SH, Roncaglioni MC, Lopez-Doriga Ruiz P, Shestakova M, Vikulova O, Wang KL, Wild SH, Yekutiel N, Shaw JE. Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings. Lancet Diabetes Endocrinol 2021; 9:203-211. [PMID: 33636102 PMCID: PMC10984526 DOI: 10.1016/s2213-8587(20)30402-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. METHODS In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. FINDINGS Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. INTERPRETATION The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. FUNDING US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
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Affiliation(s)
- Dianna J Magliano
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lei Chen
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi Xian Chua
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hanne L Gulseth
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Thomas R Hird
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - György Jermendy
- 3rd Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Mykola D Khalangot
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine; Endocrinology Department, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Victor I Kravchenko
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics and Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Gregory A Nichols
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mark M Nielen
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Deanette Pang
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Pelletier
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Olga Vikulova
- Diabetes Institute, Endocrinology Research Center, Moscow, Russia
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, Latrobe University, Bundoora, VIC, Australia
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Qiu Y, Deng X, Sha Y, Wu X, Zhang P, Chen K, Zhao Z, Wei W, Yang L, Yuan G, Zhao L, Wang D. Visceral Fat Area, Not Subcutaneous Fat Area, is Associated with Cardiac Hemodynamics in Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:4413-4422. [PMID: 33235479 PMCID: PMC7680090 DOI: 10.2147/dmso.s284420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/30/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This study was conducted in patients with type 2 diabetes mellitus (T2DM) to assess the association between visceral fat area (VFA) and cardiac hemodynamics. METHODS A total of 568 patients with type 2 diabetes (mean age 54±12 years; 40.8% of women) were enrolled. Visceral fat area (VFA, m2) and subcutaneous fat area (SFA, m2) were evaluated by a bioelectrical impedance analyzer. Cardiac hemodynamics were measured by echocardiography, and other clinical and laboratory variables were also assessed and recorded. Patients were divided into those with VFA ≤ 100 (n=369) and those with VFA > 100 (n=199). RESULTS VFA, SFA, LVMI (left ventricular mass index), left atrial diameter, left ventricular diastolic diameter (LvDd), interventricular septal thickness (IVST), left ventricular systolic diameter (LvSd), and posterior wall thickness (PWT) levels in high-V groups were significantly higher than those in low-V groups. Correlation analysis showed that VFA was positively correlated with LVMI (r=0.120, p=0.004), LVM (r=0.249, p<0.0001), left atrial diameter (r=0.375, p<0.0001), aortic root diameter (r=0.243, p<0.0001), left ventricular systolic diameter (LvSd) (r=0.211, p<0.0001) and negatively correlated with LVEF (r=-0.107, p=0.011). In multivariate linear regression analysis, VFA was the strongest independent determinant of LVMI (β=0.04, p=0.016), LVEF (β=-0.01, p=0.023), and left atrial diameter (β=0.035, p<0.0001), Internal diameter of the aortic root (β=0.014, p<0.0001) and LvSd (β=0.017, p<0.0001). In addition, the VFA also better predicted cardiovascular disease risk with AUC of 0.609 (95% CI:0.563-0.656), compared with SFA, waist-hip ratio (WHR), in a statistically significant manner. CONCLUSION We found a significant correlation between VFA (but not SFA) and cardiac hemodynamic parameters. The VFA has advantages as a predictor of visceral obesity and is significantly associated with the development of cardiovascular risk factors (CVD) in T2DM patients.
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Affiliation(s)
- Yue Qiu
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Xia Deng
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Yujing Sha
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Xunan Wu
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Panpan Zhang
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Ke Chen
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Zhicong Zhao
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Weiping Wei
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Ling Yang
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Guoyue Yuan
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Li Zhao
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
| | - Dong Wang
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu212001, People’s Republic of China
- Correspondence: Dong Wang; Li Zhao Department of Endocrinology, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, Jiangsu212001, People’s Republic of ChinaTel +86-13605282460; +86-15800578209 Email ;
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Magliano DJ, Islam RM, Barr ELM, Gregg EW, Pavkov ME, Harding JL, Tabesh M, Koye DN, Shaw JE. Trends in incidence of total or type 2 diabetes: systematic review. BMJ 2019; 366:l5003. [PMID: 31511236 PMCID: PMC6737490 DOI: 10.1136/bmj.l5003] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes. DESIGN Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines. DATA SOURCES Medline, Embase, CINAHL, and reference lists of relevant publications. ELIGIBILITY CRITERIA Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year. RESULTS Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively. CONCLUSIONS The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42018092287.
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Affiliation(s)
- Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Rakibul M Islam
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | | | - Edward W Gregg
- Centres for Diseases Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
- School of Public Health, Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Meda E Pavkov
- Centres for Diseases Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
| | - Jessica L Harding
- Centres for Diseases Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
| | - Maryam Tabesh
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Digsu N Koye
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Fu Q, Sun M, Wang Z, He W, Duan Y, Yang T. Impaired β-cell function and decreased insulin sensitivity in subjects with normal oral glucose tolerance but isolated high glycosylated hemoglobin. Endocr J 2018; 65:13-22. [PMID: 28904260 DOI: 10.1507/endocrj.ej17-0325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The pathophysiology is distinct in various state of glucose metabolism abnormalities. As the defect of individuals with normal oral glucose tolerance (NGT) but isolated high glycosylated hemoglobin (HbA1c), i.e. iHH, was ambiguous, we aimed to investigate the insulin sensitivity and β-cell function of iHH. According to the ADA criteria of HbA1c cut-off point (5.7%), 3,517 subjects with NGT screened from a total of 7,855 middle-aged and elderly Chinese without known diabetes were divided into two groups, 1,877 subjects with HbA1c < 5.7% and 1,640 with HbA1c ≥ 5.7% (i.e. iHH). A variety of indexes from blood glucose and insulin levels of oral glucose tolerance were calculated to evaluate insulin sensitivity and β-cell function. Compared with subjects with HbA1c < 5.7%, individuals with iHH had increased homeostasis model assessment of insulin resistance (HOMA-IR), early-phase and total insulin release indexes (insulin release index 30 min and 120 min, i.e. INRS30 and INSR120), and decreased Matsuda insulin sensitivity index (Matsuda ISI) and early-phase disposition index (DI30). After adjustment for confounding factors, the significant difference of HOMA-IR and INSR30 between the two groups vanished, however, Matsuda ISI and DI30 remained significantly lower and INSR120 was still higher in iHH group compared with HbA1c < 5.7%. In conculsion, subjects with NGT may not be perfectly healthy in glycometabolism, those with iHH have impaired early-phase β-cell function and decreased insulin sensitivity.
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Affiliation(s)
- Qi Fu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Sun
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhixiao Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei He
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Duan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Yang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Teeuw WJ, Kosho MXF, Poland DCW, Gerdes VEA, Loos BG. Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Res Care 2017; 5:e000326. [PMID: 28316794 PMCID: PMC5337701 DOI: 10.1136/bmjdrc-2016-000326] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/17/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The early diagnosis of (pre)diabetes mellitus is essential for the prevention of diabetes complications. It has been suggested that gum disease (periodontitis) might be an early complication of diabetes and may be a useful risk indicator for diabetes screening. Therefore, a dental office could be a good location for screening for (pre)diabetes in patients with periodontitis using a validated glycated hemoglobin (HbA1c) dry spot analysis. RESEARCH DESIGN AND METHODS A total of 313 individuals from a university dental clinic participated. From 126 patients with mild/moderate periodontitis, 78 patients with severe periodontitis and 109 subjects without periodontitis, HbA1c values were obtained by the analysis of dry blood spots. Differences in mean HbA1c values and the prevalence of (pre)diabetes between the groups were analyzed. RESULTS The mild/moderate and severe periodontitis groups showed significantly higher HbA1c values (6.1%±1.4% (43 mmol/mol±15 mmol/mol) and 6.3%±1.3% (45 mmol/mol±15 mmol/mol), respectively) compared with the control group (5.7%±0.7% (39 mmol/mol±8 mmol/mol), p=0.003). In addition, according to the American Diabetes Association (ADA) guidelines for diagnosis, there was a significant over-representation of subjects with suspected diabetes (23% and 14%) and pre-diabetes (47% and 46%) in the severe periodontitis group and mild/moderate periodontitis groups, respectively, compared with the control group (10% and 37%, p=0.010). Notably, 18.1% of patients with suspected new diabetes were found among subjects with severe periodontitis compared with 9.9% and 8.5% among subjects with mild/moderate periodontitis and controls, respectively (p=0.024). CONCLUSIONS The dental office, with particular focus on patients with severe periodontitis, proved to be a suitable location for screening for (pre)diabetes; a considerable number of suspected new diabetes cases were identified. The early diagnosis and treatment of (pre)diabetes help to prevent more severe complications and benefit the treatment of periodontitis.
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Affiliation(s)
- Wijnand J Teeuw
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Madeline X F Kosho
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Dennis C W Poland
- Department of Clinical Chemistry, MC Slotervaart, Amsterdam, The Netherlands
| | - Victor E A Gerdes
- Department of Vascular Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, MC Slotervaart, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
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Kumar R, Nandhini LP, Kamalanathan S, Sahoo J, Vivekanadan M. Evidence for current diagnostic criteria of diabetes mellitus. World J Diabetes 2016; 7:396-405. [PMID: 27660696 PMCID: PMC5027003 DOI: 10.4239/wjd.v7.i17.396] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/24/2016] [Accepted: 07/18/2016] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus is a non-communicable metabolic derangement afflicting several millions of individuals globally. It is associated with several micro and macrovascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Association (ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of evidence.This review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose (FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications.
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10
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Zhao Z, Basilio J, Hanson S, Little RR, Sumner AE, Sacks DB. Evaluation of hemoglobin A1c measurement by Capillarys 2 electrophoresis for detection of abnormal glucose tolerance in African immigrants to the United States. Clin Chim Acta 2015; 446:54-60. [PMID: 25861848 DOI: 10.1016/j.cca.2015.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/11/2015] [Accepted: 03/17/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hemoglobin A1c (HbA1c) is used to monitor long-term glycemic control in individuals with diabetes, guide therapy, predict the risk of microvascular complications, and more recently to diagnose diabetes. An automated liquid-flow capillary electrophoresis method was recently developed to measure HbA1c using the Capillarys 2 Flex Piercing instrument. METHODS Analytical evaluation was performed at 2 clinical centers. A clinical analysis was conducted in 109 African-born individuals, 24% of whom have variant hemoglobin (HbAS or HbAC). Abnormal glucose tolerance (which includes both diabetes and prediabetes) was defined as 2h glucose of ≥ 140 mg/dl (7.8 mmol/l) during an oral glucose tolerance test. RESULTS Interlaboratory CVs were ≤ 2.1%. The method showed satisfactory correlation with 2 other analyzers that measure HbA1c by high-performance liquid chromatography. Neither labile HbA1c, carbamylated hemoglobin, uremia, bilirubin nor common hemoglobin variants (HbC/HbS/HbE) interfered. Forty-five individuals (41%) had abnormal glucose tolerance. The sensitivity of HbA1c for diagnosing abnormal glucose tolerance was 38%, 36% and 42% for total, normal and variant hemoglobin groups, respectively. CONCLUSIONS The analytical performance of HbA1c on the Capillarys 2 is suitable for clinical application. Variant hemoglobin in Africans did not interfere with the detection of abnormal glucose tolerance by HbA1c measured on the Capillarys 2.
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Affiliation(s)
- Zhen Zhao
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Jeffrey Basilio
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Steven Hanson
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, United States
| | - Randie R Little
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, United States
| | - Anne E Sumner
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States.
| | - David B Sacks
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
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Qie LY, Sun JP, Ning F, Pang ZC, Gao WG, Ren J, Nan HR, Zhang L, Qiao Q. Cardiovascular risk profiles in relation to newly diagnosed type 2 diabetes diagnosed by either glucose or HbA1c criteria in Chinese adults in Qingdao, China. Diabet Med 2014; 31:920-6. [PMID: 24824545 DOI: 10.1111/dme.12498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/04/2014] [Accepted: 05/09/2014] [Indexed: 12/18/2022]
Abstract
AIMS To study the cardiovascular disease risk profiles in newly diagnosed diabetes diagnosed by either glucose or/and HbA(1c) criteria in Chinese adults. METHODS Two population-based cross-sectional studies were conducted in 2006 and 2009, respectively. Data from 1987 men and 2815 women aged 35-74 years were analysed. Newly diagnosed diabetes was defined according to either glucose (fasting and/or 2-h glucose), HbA(1c) or both criteria. RESULTS Ageing, positive family history of diabetes, elevated levels of waist circumference, systolic blood pressure, total cholesterol, triglycerides and γ-glutamyl transferase were independently associated with newly diagnosed diabetes defined by glucose criterion alone, but not for diabetes defined by HbA(1c) criterion alone. Only waist circumference, total cholesterol and smoking were significantly associated with the presence of diabetes defined by HbA(1c) criterion alone. CONCLUSIONS Cardiovascular disease risk profiles were different in patients with newly diagnosed diabetes defined by the two diagnostic criteria for diabetes. This may have certain clinical implications on diabetes management and research.
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Affiliation(s)
- L Y Qie
- Department of Geriatrics, Qilu Hospital of Shandong University, Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, China
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Fernández-Yunquera A, Ripoll C, Bañares R, Puerto M, Rincón D, Yepes I, Catalina V, Salcedo M. Everolimus immunosuppression reduces the serum expression of fibrosis markers in liver transplant recipients. World J Transplant 2014; 4:133-140. [PMID: 25032102 PMCID: PMC4094948 DOI: 10.5500/wjt.v4.i2.133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/29/2014] [Accepted: 02/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the expression of serum fibrosis markers in liver transplantation (LT) recipients on everolimus monotherapy compared to patients on an anti-calcineurin regimen.
METHODS: This cross-sectional case-control study included LT patients on everolimus monotherapy (cases) (E) (n = 30) and matched controls on an anti-calcineurin regimen (calcineurin inhibitors, CNI), paired by etiology of liver disease and time since LT (n = 30). Clinical characteristics, blood tests and elastography were collected. Serum levels of transforming growth factor-β (TGF-β), angiopoietin-1, tumor necrosis factor (TNF), platelet derived growth factor, amino-terminal propeptide of type III procollagen (PIIINP), hyaluronic acid (HA), VCM-1 (ng/mL), interleukin (IL)-10, interferon-inducible protein 10 (IP-10), vascular endothelial growth factor and hepatocyte growth factor (HGF) (pg/mL) were determined by enzyme-linked immunosorbent assay. Expression of these markers between E and CNI was compared. Stratified analysis was done according to factors that may influence liver fibrosis. Variables are described with medians (interquartillic range) or percentages.
RESULTS: A total of 60 patients [age: 59 (49-64), hepatitis C virus (HCV): n = 21 (35%), time from LT: 73 mo (16-105)] were included. Patients had been on everolimus for a median of 15 mo. No differences in inflammatory activity, APRI test or liver elastography were found between the groups. No significant differences were observed between the groups in serum levels of PIIINP, metalloproteinase type = 1, angiopoietin, HGF, IP-10, TNF-α, IL-10 and vascular cell adhesion molecule. Patients on E had a lower expression of TGF-β [E: 12.7 (3.7-133.6), CNI: 152.5 (14.4-333.2), P = 0.009] and HA [E: 702.89 (329.4-838.2), CNI: 1513.6 (691.9-1951.4), P = 0.001] than those on CNI. This difference was maintained in the stratified analysis when recipient age is more than 50 years (TFG-β1: P = 0.06; HA: P = 0.005), in patients without active neoplasia (TFG-β1, P = 0.009; HA: P = 0.01), according to time since LT (> than 5 years, TFG-β1: P = 0.001; HA: P = 0.002), related to previous history of biliary complications (HA: P = 0.01) and HCV recurrence (HA: P = 0.004). Liver transplant recipients with everolimus monotherapy had less serum expression of TGF-β y HA than matched patients with anti-calcineurins. This difference remains when classifying patients according to donor age and time since LT. Due to the small sample size, when examining patients with a prior history of biliary complications or recurrent HCV, the difference was non-significant but trends towards the lower expression of TFG-β1 in the everolimus group. Mammalian target of rapamycin (mTOR) plays a role in the transformation of quiescent hepatocellular stellate cell to their active profibrotic state, and experimental models have demonstrated the potential activity of mTOR inhibition in attenuating fibrogenesis.
CONCLUSION: This study supports a possible role of everolimus in liver fibrosis modulation after LT in a clinical setting and suggests that tailoring immunosuppression could avoid fibrosis progression in the allograft.
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Davidson MB, Duran P, Lee ML. Community screening for pre-diabetes and diabetes using HbA1c levels in high-risk African Americans and Latinos. Ethn Dis 2014; 24:195-199. [PMID: 24804366 PMCID: PMC4287403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To evaluate community screening using HbA1c levels in high risk African Americans and Latinos in those not known to have diabetes. DESIGN HbA1c levels were measured in 1542 African Americans and Latinos aged > or = 40 years with one or more of the following risk factors: family history in first degree relatives, waist circumference > or = 40 inches in males or > or = 35 inches in females, and hypertension, either treatment for or a measured BP of > or = 140/ 90 mm Hg. Oral glucose tolerance tests (OGTT) were offered to those meeting the HbA1c criterion for pre-diabetes. SETTING Churches, community health fares, senior citizen sites. PARTICIPANTS People without known diabetes. MAIN OUTCOME MEASURES Proportion of people meeting the HbA1c criteria for prediabetes (5.8-6.4%) and diabetes (> or = 6.5%). RESULTS 32% had one, 50% had two and 18% had three risk factors. By HbA1c criteria, 40% had pre-diabetes and 25% had diabetes. Increased waist circumference was the most common risk factor followed by a positive family history, and lastly, hypertension. Each individual risk factor was significantly (P < .001) and progressively more common as glycemia increased. Each additional risk factor increased the odds of pre-diabetes or diabetes by 2- to 4-fold. In individuals with pre-diabetes who underwent an OGTT, 59% were normal, 35% had pre-diabetes and only 6% had diabetes. CONCLUSIONS Community screening of high risk African Americans and Latinos with HbA1c levels identifies a large proportion of people with pre-diabetes and diabetes. Those identified with pre-diabetes are unlikely to meet the OGTT criteria for diabetes.
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Kim TH, Choi SH. Diagnosing diabetes with hemoglobin a1c: current debates and considerations for anemic patients. Diabetes Metab J 2013; 37:340-2. [PMID: 24199162 PMCID: PMC3816134 DOI: 10.4093/dmj.2013.37.5.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tae Hyuk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Deedwania P, Patel K, Fonarow GC, Desai RV, Zhang Y, Feller MA, Ovalle F, Love TE, Aban IB, Mujib M, Ahmed MI, Anker SD, Ahmed A. Prediabetes is not an independent risk factor for incident heart failure, other cardiovascular events or mortality in older adults: findings from a population-based cohort study. Int J Cardiol 2013; 168:3616-22. [PMID: 23731526 DOI: 10.1016/j.ijcard.2013.05.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 04/24/2013] [Accepted: 05/04/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whether prediabetes is an independent risk factor for incident heart failure (HF) in non-diabetic older adults remains unclear. METHODS Of the 4602 Cardiovascular Health Study participants, age≥65 years, without baseline HF and diabetes, 2157 had prediabetes, defined as fasting plasma glucose (FPG) 100-125 mg/dL. Propensity scores for prediabetes, estimated for each of the 4602 participants, were used to assemble a cohort of 1421 pairs of individuals with and without prediabetes, balanced on 44 baseline characteristics. RESULTS Participants had a mean age of 73 years, 57% were women, and 13% African American. Incident HF occurred in 18% and 20% of matched participants with and without prediabetes, respectively (hazard ratio {HR} associated with prediabetes, 0.90; 95% confidence interval {CI}, 0.76-1.07; p=0.239). Unadjusted and multivariable-adjusted HRs (95% CIs) for incident HF associated with prediabetes among 4602 pre-match participants were 1.22 (95% CI, 1.07-1.40; p=0.003) and 0.98 (95% CI, 0.85-1.14; p=0.826), respectively. Among matched individuals, prediabetes had no independent association with incident acute myocardial infarction (HR, 1.02; 95% CI, 0.81-1.28; p=0.875), angina pectoris (HR, 0.93; 95% CI, 0.77-1.12; p=0.451), stroke (HR, 0.86; 95% CI, 0.70-1.06; p=0.151) or all-cause mortality (HR, 0.99; 95% CI, 0.88-1.11; p=0.840). CONCLUSIONS We found no evidence that prediabetes is an independent risk factor for incident HF, other cardiovascular events or mortality in community-dwelling older adults. These findings question the wisdom of routine screening for prediabetes in older adults and targeted interventions to prevent adverse outcomes in older adults with prediabetes.
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Vlaar EMA, Admiraal WM, Busschers WB, Holleman F, Nierkens V, Middelkoop BJC, Stronks K, van Valkengoed IGM. Screening South Asians for type 2 diabetes and prediabetes: (1) comparing oral glucose tolerance and haemoglobin A1c test results and (2) comparing the two sets of metabolic profiles of individuals diagnosed with these two tests. BMC Endocr Disord 2013; 13:8. [PMID: 23442875 PMCID: PMC3700889 DOI: 10.1186/1472-6823-13-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The glycated haemoglobin A1c (HbA1c) level may be used for screening for type 2 diabetes and prediabetes instead of a more burdensome oral glucose tolerance test (OGTT). However, among the high-risk South Asian population, little is known about the overlap of the methods or about the metabolic profiles of those disconcordantly diagnosed. METHODS We included 944 South Asians (18-60 years old), whom we screened with the HbA1c level and the OGTT in The Hague, the Netherlands. We calculated the area under the receiver-operator characteristic curve (AUROC) with a 95% confidence interval of HbA1c using the American Diabetes Association classifications, and determined the sensitivity and specificity with 95% confidence intervals at different thresholds. Moreover, we studied differences in metabolic characteristics between those identified by HbA1c and by the OGTT alone. RESULTS The overlap between HbA1c and OGTT classifications was partial, both for diabetes and prediabetes. The AUROC of HbA1c for OGTT defined diabetes was 0.86 (0.79-0.93). The sensitivity was 0.46 (0.29-0.63); the specificity 0.98 (0.98-0.99). For prediabetes, the AUROC was 0.73 (0.69-0.77). Each of the 31 individuals with diabetes and 353 with prediabetes identified with the HbA1c level had a high body mass index, large waist circumference, high blood pressure, and low insulin sensitivity, all of which were similar to the values shown by those among the 19 with diabetes or 62 with prediabetes who only met the OGTT criteria, but not the HbA1c criteria. CONCLUSIONS The HbA1c level identified a partially different group than the OGTT did. However, both those identified with the HbA1c level and those identified with the OGTT alone were at increased metabolic risk. TRIAL REGISTRATION Dutch Trial Register: NTR1499.
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Affiliation(s)
- Everlina MA Vlaar
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands
| | - Wanda M Admiraal
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands
| | - Wim B Busschers
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands
| | - Frits Holleman
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands
| | - Vera Nierkens
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands
| | - Barend JC Middelkoop
- Department of Public Health, Leiden University Medical Centre, Leiden, The Netherlands
- Public Health Service, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands
| | - Irene GM van Valkengoed
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands
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Dankner R, Bergman M, Danoff A, Qureshi S, Whitford I, Kaviani N, Dynkevich Y, Roth J. The metabolic deterioration that antedates diabetes: personal trajectories of HbA(1c) and fasting glucose as early indicators and possible triggers for intervention. Diabetes Metab Res Rev 2013; 29:1-7. [PMID: 23175191 DOI: 10.1002/dmrr.2373] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 11/11/2012] [Indexed: 12/16/2022]
Abstract
HbA(1c) testing has become an accepted means of diagnosing diabetes as an alternative to blood glucose levels. However, population-based norms of glucose and of HbA(1c) levels do not enable the detection of diabetes at an early enough stage to thwart complications. Personal trajectories of glucose levels show steep increases a number of years prior to diabetes diagnosis. Here, we hypothesize that a comparable time-dependent deviation in an individual's HbA(1c) level may be an early manifestation of disease that should prompt lifestyle modifications. We predict that analysis of personal trajectories of glucose and of HbA(1c) will promote earlier intervention and a greater reduction in disease complications than current standards, which are based on population-based norms.
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Affiliation(s)
- Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Hutchinson MS, Joakimsen RM, Njølstad I, Schirmer H, Figenschau Y, Svartberg J, Jorde R. Effects of Age and Sex on Estimated Diabetes Prevalence Using Different Diagnostic Criteria: The Tromsø OGTT Study. Int J Endocrinol 2013; 2013:613475. [PMID: 23365572 PMCID: PMC3556443 DOI: 10.1155/2013/613475] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/04/2012] [Accepted: 12/05/2012] [Indexed: 12/30/2022] Open
Abstract
HbA(1c) 6.5% has recently been recommended as an alternative diagnostic criterion for diabetes. The aims of the study were to evaluate the effects of age, sex, and other factors on prevalence of diabetes and to compare risk profiles of subjects with diabetes when defined by HbA(1c) and glucose criteria. Subjects were recruited among participants in the longitudinal population-based Tromsø Study. HbA(1c), fasting plasma glucose, and 2-hour plasma glucose were measured in 3,476 subjects. In total, 294 subjects met one or more of the diagnostic criteria for diabetes; 95 met the HbA(1c) criterion only, 130 met the glucose criteria only, and 69 met both. Among subjects with diabetes detected by glucose criteria (regardless of HbA(1c)), isolated raised 2-hour plasma glucose was more common in subjects aged ≥ 60 years as compared to younger subjects and in elderly women as compared to elderly men. Subjects with diabetes detected by glucose criteria only had worse cardiometabolic risk profiles than those detected by HbA(1c) only. In conclusion, the current HbA(1c) and glucose criteria defined different subjects with diabetes with only modest overlap. Among a substantial proportion of elderly subjects, and especially elderly women, the 2-hour plasma glucose was the only abnormal value.
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Affiliation(s)
- Moira Strand Hutchinson
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
- *Moira Strand Hutchinson:
| | - Ragnar Martin Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, University of Tromsø, 9037 Tromsø, Norway
| | - Henrik Schirmer
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Yngve Figenschau
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
- Department of Medical Biology, University of Tromsø, 9037 Tromsø, Norway
- Division of Laboratory Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Johan Svartberg
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
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Bianchi C, Miccoli R, Bonadonna RC, Giorgino F, Frontoni S, Faloia E, Marchesini G, Dolci MA, Cavalot F, Cavallo GM, Leonetti F, Del Prato S. Pathogenetic mechanisms and cardiovascular risk: differences between HbA(1c) and oral glucose tolerance test for the diagnosis of glucose tolerance. Diabetes Care 2012; 35:2607-12. [PMID: 22912427 PMCID: PMC3507559 DOI: 10.2337/dc11-2504] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/31/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To ascertain to which extent the use of HbA(1c) and oral glucose tolerance test (OGTT) for diagnosis of glucose tolerance could identify individuals with different pathogenetic mechanisms and cardiovascular risk profile. RESEARCH DESIGN AND METHODS A total of 844 subjects (44% men; age 49.5 ± 11 years; BMI 29 ± 5 kg/m(2)) participated in this study. Parameters of β-cell function were derived from deconvolution of the plasma C-peptide concentration after a 75-g OGTT and insulin sensitivity assessed by homeostasis model assessment of insulin resistance (IR). Cardiovascular risk profile was based on determination of plasma lipids and measurements of body weight, waist circumference, and blood pressure. Glucose regulation categories by OGTT and HbA(1c) were compared with respect to insulin action, insulin secretion, and cardiovascular risk profile. RESULTS OGTT results showed 42% of the subjects had prediabetes and 15% had type 2 diabetes mellitus (T2DM), whereas the corresponding figures based on HbA(1c) were 38 and 11%, with a respective concordance rate of 54 and 44%. Subjects meeting both diagnostic criteria for prediabetes presented greater IR and impairment of insulin secretion and had a worse cardiovascular risk profile than those with normal glucose tolerance at both diagnostic methods. In a logistic regression analyses adjusted for age, sex, and BMI, prediabetic subjects, and even more T2DM subjects by OGTT, had greater chance to have IR and impaired insulin secretion. CONCLUSIONS HbA(1c) identifies a smaller proportion of prediabetic individuals and even a smaller proportion of T2DM individuals than OGTT, with no difference in IR, insulin secretion, and cardiovascular risk profile. Subjects fulfilling both diagnostic methods for prediabetes or T2DM are characterized by a worse metabolic profile.
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Affiliation(s)
- Cristina Bianchi
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
| | - Roberto Miccoli
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
| | - Riccardo C. Bonadonna
- Department of Biomedical and Surgical Sciences, Section of Endocrinology and Metabolic Diseases, University of Verona, Verona, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy
| | - Simona Frontoni
- Diabetes Center, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Faloia
- Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Marchesini
- Unit of Clinical Dietetics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maria A. Dolci
- Section of Diabetes and Metabolic Diseases, SS. Giacomo e Cristoforo Hospital, Massa, Italy
| | - Franco Cavalot
- Diabetes Unit, Department of Clinical Biological Sciences, University of Turin, Turin, Italy
| | - Gisella M. Cavallo
- Department of Clinic and Medical Therapy, University of Rome “La Sapienza,” Rome, Italy
| | - Frida Leonetti
- Department of Clinical Sciences, University of Rome “La Sapienza,” Rome, Italy
| | - Stefano Del Prato
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
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Echouffo-Tcheugui JB, Mayige M, Ogbera AO, Sobngwi E, Kengne AP. Screening for hyperglycemia in the developing world: rationale, challenges and opportunities. Diabetes Res Clin Pract 2012; 98:199-208. [PMID: 22975016 DOI: 10.1016/j.diabres.2012.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/17/2012] [Accepted: 08/09/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND The prevalence of diabetes and prediabetes are increasingly high in developing countries, where detection rates remain very low. This manuscript discusses the rationale, challenges and opportunities for early detection of diabetes and prediabetes in developing countries. METHODS PubMed was searched up to March 2012 for studies addressing screening for hyperglycemia in developing countries. Relevant studies were summarized through key questions derived from the Wilson and Junger criteria. RESULTS In developing countries, diabetes predominantly affects working-age persons, has high rates of complications and devastating economic impacts. These countries are ill-equipped to handle advanced stages of the disease. There are acceptable and relatively simple tools that can aid screening in these countries. Interventions shown to be cost-effective in preventing diabetes and its complications in developed countries can be used in screen-detected people of developing countries. However, effective implementation of these interventions remains a challenge, and the costs and benefits of diabetes screening in these settings are less well-known. Implementing screening policies in developing countries will require health systems strengthening, through creative funding and staff training. CONCLUSIONS For many compelling reasons, screening for hyperglycemia preferably targeted, should be a policy priority in developing countries. This will help reorient health systems toward cost-saving prevention.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Marini MA, Succurro E, Arturi F, Ruffo MF, Andreozzi F, Sciacqua A, Lauro R, Hribal ML, Perticone F, Sesti G. Comparison of A1C, fasting and 2-h post-load plasma glucose criteria to diagnose diabetes in Italian Caucasians. Nutr Metab Cardiovasc Dis 2012; 22:561-566. [PMID: 21944738 DOI: 10.1016/j.numecd.2011.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 04/04/2011] [Accepted: 04/06/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The American Diabetes Association (ADA) has revised criteria for diagnosis of type 2 diabetes recommending an A1C cut point of ≥6.5% in addition to criteria based on glucose levels. We compared A1C, fasting plasma glucose (FPG) or 2-h post-challenge glucose (2-hPG) criteria for the diagnosis of diabetes in a cohort of Italian Caucasians. METHODS AND RESULTS A total of 1019 individuals without known diabetes completed an oral glucose tolerance test (OGTT) and had A1C measured. Moderate agreement existed for A1C and FPG criteria for diagnosis of type 2 diabetes (κ coefficient = 0.522), with 85.5% of individuals classified as not having diabetes by both A1C and FPG criteria, and 5.8% classified as having diabetes by both A1C and FPG criteria. Discordant classifications occurred for 5.5% of individuals who had an A1C ≥ 6.5% and FPG <126 mg dl(-1), and for 3.2% who had an A1C <6.5% and FPG ≥126 mg dl(-1). Modest agreement existed for A1C and 2-hPG criteria for diagnosis of type 2 diabetes (κ coefficient = 0.427), with 81.8% of individuals classified as not having diabetes by both A1C and 2-hPG criteria, and 6.0% classified as having diabetes by both A1C and 2-hPG criteria. The area under the receiver operating characteristic curve of A1C for identifying subjects with diabetes according to FPG or 2-hPG criteria was 0.856 and 0.794, respectively. Modest agreement existed for A1C and FPG and/or 2-hPG criteria for diagnosis of type 2 diabetes (κ coefficient = 0.446). CONCLUSIONS A1C ≥ 6.5% demonstrates a moderate agreement with fasting glucose and 2-hPG for diagnosing diabetes among adult Italian Caucasians subjects.
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Affiliation(s)
- M A Marini
- Department of Internal Medicine, University of Rome-Tor Vergata, Rome, Italy
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22
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Cosson E, Chiheb S, Hamo-Tchatchouang E, Nguyen MT, Aout M, Banu I, Pillegand C, Vicaut E, Valensi P. Use of clinical scores to detect dysglycaemia in overweight or obese women. DIABETES & METABOLISM 2012; 38:217-24. [DOI: 10.1016/j.diabet.2011.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 12/16/2022]
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Abstract
PURPOSE OF REVIEW To evaluate the controversial aspects of diabetes diagnosis. RECENT FINDINGS Within the past 2 years, revised guidelines for the diagnosis of diabetes have been issued which endorse the use of the hemoglobin A1C as a diagnostic test, in addition to the previously recommended tests. Updated diagnostic criteria for gestational diabetes were also published in the same period. Recent publications on the current role of oral glucose tolerance tests and diagnosis of diabetes in the acutely ill are sparse. There are new recommendations regarding the use of genetic testing and antibody testing in establishing the cause of diabetes. SUMMARY The inclusion of A1C as a diagnostic test has many advantages including reproducibility of the test and convenience, but there are situations where the test is unreliable and it misses many individuals who would have been diagnosed by plasma glucose testing. The diagnostic threshold of 6.5% for the A1C remains controversial. There is still no consensus on the best approach to diagnose gestational diabetes. The role of the oral glucose tolerance test seems to be diminishing. Diagnosis of diabetes in acute illness is aided by A1C testing. Genetic and autoantibody testing in specific situations offer diagnostic and therapeutic utility.
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Affiliation(s)
- Samir Malkani
- University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Rathmann W, Kowall B, Tamayo T, Giani G, Holle R, Thorand B, Heier M, Huth C, Meisinger C. Hemoglobin A1c and glucose criteria identify different subjects as having type 2 diabetes in middle-aged and older populations: the KORA S4/F4 Study. Ann Med 2012; 44:170-7. [PMID: 21091229 DOI: 10.3109/07853890.2010.531759] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The American Diabetes Association (ADA) has recently recommended HbA1c for diagnosing diabetes as an alternative to glucose-based criteria. We compared the new HbA1c-based criteria for diagnosis of diabetes and prediabetes with the glucose-based criteria. RESEARCH DESIGN AND METHODS In the population-based German KORA surveys (S4/F4) 1,764 non-diabetic participants aged 31-60 years and 896 participants aged 61-75 years underwent measurements of HbA1c, fasting plasma glucose (FPG), and 2-h glucose. RESULTS Only 20% of all subjects diagnosed with diabetes by glucose or HbA1c criteria had diabetes by both criteria; for prediabetes, the corresponding figure was 23%. Using HbA1c ≥ 6.5%, the prevalence of diabetes was strongly reduced compared to the glucose criteria (0.7% instead of 2.3% in the middle-aged, 2.9% instead of 7.9% in the older subjects). Only 32.0% (middle-aged) and 43.2% (older group) of isolated impaired glucose tolerance (i-IGT) cases were detected by the HbA1c criterion (5.7% ≤ HbA1c < 6.5%). CONCLUSION By glucose and the new HbA1c diabetes criteria, different subjects are diagnosed with type 2 diabetes in middle-aged as well as older subjects. The new HbA1c criterion lacks sensitivity for impaired glucose tolerance.
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Affiliation(s)
- Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Germany
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Heianza Y, Hara S, Arase Y, Saito K, Tsuji H, Kodama S, Hsieh SD, Mori Y, Okubo M, Yamada N, Kosaka K, Sone H. Impact of introducing HbA1c into the diagnostic criteria on prevalence and cardiovascular risk profiles of individuals with newly diagnosed diabetes in Japan: the Toranomon Hospital Health Management Center Study 2 (TOPICS 2). Diabetes Res Clin Pract 2012; 95:283-90. [PMID: 22104263 DOI: 10.1016/j.diabres.2011.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 10/07/2011] [Accepted: 10/17/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate the impact of HbA1c for diagnosis of diabetes and investigate whether cardiovascular risks profiles differ among individuals with diabetes diagnosed by HbA1c or fasting plasma glucose (FPG). METHODS This cross-sectional study involved 26,884 participants (30.6% women; aged 20-91 years) without known diabetes. Subjects were categorized into 4 groups according to the presence or absence of FPG ≥7.0 mmol/L and/or HbA1c ≥6.5%, which were American Diabetes Association criteria. Oral glucose tolerance test data were not available. RESULTS Prevalence of undiagnosed diabetes was 3.6%. Of those individuals, 47.5% fulfilled both two criteria and 26.0% fulfilled only HbA1c criterion. Individuals with diabetes according to FPG ≥7.0 mmol/L alone were characterized as having poorly controlled hypertension while those with HbA1c ≥6.5% alone were characterized as older, female, and having lower blood pressure and γ-glutamyltransferase values. Persons with newly diagnosed diabetes by HbA1c had low HDL cholesterol and high LDL or non-HDL cholesterol levels. CONCLUSIONS Introducing HbA1c into the diagnosis allowed detection of many previously undiagnosed cases of diabetes in Japanese individuals. Those diagnosed by FPG were characterized by hypertension and those diagnosed by HbA1c had unfavorable lipid profiles, reflecting an atherosclerotic trait.
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Affiliation(s)
- Yoriko Heianza
- Department of Endocrinology and Metabolism, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan
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Hayes L, Hawthorne G, Unwin N. Undiagnosed diabetes in the over-60s: performance of the Association of Public Health Observatories (APHO) Diabetes Prevalence Model in a general practice. Diabet Med 2012; 29:115-20. [PMID: 21781154 DOI: 10.1111/j.1464-5491.2011.03389.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The Association of Public Health Observatories (APHO) Diabetes Prevalence Model has been interpreted to suggest that a substantial number of people with diabetes are 'missed'. An affluent suburb of Newcastle upon Tyne has a low known diabetes prevalence. We aimed to determine the true prevalence of diabetes in the practice population aged over 60 years and compare our prevalence estimate with that of the Association of Public Health Observatories Diabetes Prevalence Model (18.0%; uncertainty limit 10.7-27.7%). At baseline, the known prevalence of diabetes in this group was 7.4%. METHODS All individuals aged 60 years and over registered with one general practice in Newcastle-upon-Tyne, not known to have diabetes (n = 1375), were invited for a standard oral glucose tolerance test and measurement of HbA(1c). Standard World Health Organization cut points for fasting and post-challenge glucose on oral glucose tolerance test or HbA(1c) ≥ 48 mmol/mol (6.5%) were used to identify diabetes. RESULTS Five hundred and eighty-four individuals (42.5%) attended for screening. Using oral glucose tolerance test criteria, 4.5% were identified with undiagnosed diabetes. Using HbA(1c), 3.1% had undiagnosed diabetes. The estimated prevalence of total diabetes for the practice population aged 60 years and older is 11.8 (10.5-13.2%) and 10.3 (9.3-11.6) for oral glucose tolerance test and HbA(1c) criteria, respectively. CONCLUSIONS The prevalence of diabetes in those aged 60 years and older registered with this practice is lower than the point estimate of the Association of Public Health Observatories Diabetes Prevalence Model, but within its uncertainty limits. Application of the Association of Public Health Observatories model must take into account its uncertainty limits.
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Affiliation(s)
- L Hayes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Kim HJ, Choi EY, Park EW, Cheong YS, Lee HY, Kim JH. The Utility of HbA1c as a Diagnostic Criterion of Diabetes. Korean J Fam Med 2011; 32:383-9. [PMID: 22745876 PMCID: PMC3383149 DOI: 10.4082/kjfm.2011.32.7.383] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 10/13/2011] [Indexed: 12/16/2022] Open
Abstract
Background Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves. Methods This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria. Results The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05). Conclusion For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
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Affiliation(s)
- Hee-Jung Kim
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
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Kowall B, Rathmann W, Landgraf R. Is HbA1c a valid and feasible tool for the diagnosis of diabetes? Diabetes Res Clin Pract 2011; 93:314-6. [PMID: 21852014 DOI: 10.1016/j.diabres.2011.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 11/19/2022]
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Echouffo-Tcheugui JB, Ali MK, Griffin SJ, Narayan KMV. Screening for type 2 diabetes and dysglycemia. Epidemiol Rev 2011; 33:63-87. [PMID: 21624961 DOI: 10.1093/epirev/mxq020] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Implications of using hemoglobin A1C for diagnosing diabetes mellitus. Am J Med 2011; 124:395-401. [PMID: 21531226 PMCID: PMC3086708 DOI: 10.1016/j.amjmed.2010.11.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 10/23/2010] [Accepted: 11/01/2010] [Indexed: 12/11/2022]
Abstract
Until 2010, the diagnosis of diabetes mellitus was based solely on glucose concentration, but the American Diabetes Association (ADA) recommendations now include a new criterion: hemoglobin A1C ≥6.5%. Because this change may have significant implications for diabetes diagnosis, we conducted a comprehensive literature review including peer-reviewed articles not referenced in the ADA report. We conclude that A1C and plasma glucose tests are frequently discordant for diagnosing diabetes. A1C ≥6.5% identifies fewer individuals as having diabetes than glucose-based criteria. Convenience of A1C test might increase the number of patients diagnosed, but this is unproven. Diagnostic cut-points for both glucose and A1C are based on consensus judgments regarding optimal sensitivity and specificity for the complications of hyperglycemia. A1C may not accurately reflect levels of glycemia in some situations, but in comparison with glucose measurements, it has greater analytic stability and less temporal variability. When choosing a diagnostic test for diabetes, the limitations of each choice must be understood. Clinical judgment and consideration of patient preference are required to appropriately select among the diagnostic alternatives.
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Mostafa SA, Khunti K, Srinivasan BT, Webb D, Davies MJ. Detecting Type 2 diabetes and impaired glucose regulation using glycated hemoglobin in different populations. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/dmt.10.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Boronat M, Saavedra P, López-Ríos L, Riaño M, Wägner AM, Nóvoa FJ. Differences in cardiovascular risk profile of diabetic subjects discordantly classified by diagnostic criteria based on glycated hemoglobin and oral glucose tolerance test. Diabetes Care 2010; 33:2671-3. [PMID: 20807875 PMCID: PMC2992210 DOI: 10.2337/dc10-0529] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize the cardiovascular risk profile of subjects categorized differently by A1C- and oral glucose tolerance test (OGTT)-based diagnostic criteria for diabetes according to the recommendations of the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS An OGTT, A1C, and several cardiovascular risk factors were assessed in 964 individuals without known diabetes participating in a cross-sectional epidemiological survey in Gran Canaria, Spain. RESULTS Taking the OGTT as the gold standard, the sensitivity and specificity of an A1C value ≥ 6.5% were 38.7 and 99.6%, respectively. Subjects who fulfilled A1C-based criterion presented greater measures of BMI and waist circumference, lower values for HDL cholesterol, and higher values for fasting plasma glucose, homeostasis model assessment of insulin resistance, and fibrinogen than subjects with diabetic OGTT but A1C <6.5%. CONCLUSIONS Newly diagnosed diabetic individuals who fulfill A1C-based diagnostic criterion for the disease display a more unfavorable cardiovascular risk profile than individuals who only meet the glucose-based criteria.
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Affiliation(s)
- Mauro Boronat
- Section of Endocrinology and Nutrition, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain.
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Olson DE, Rhee MK, Herrick K, Ziemer DC, Twombly JG, Phillips LS. Screening for diabetes and pre-diabetes with proposed A1C-based diagnostic criteria. Diabetes Care 2010; 33:2184-9. [PMID: 20639452 PMCID: PMC2945158 DOI: 10.2337/dc10-0433] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE An International Expert Committee (IEC) and the American Diabetes Association (ADA) proposed diagnostic criteria for diabetes and pre-diabetes based on A1C levels. We hypothesized that screening for diabetes and pre-diabetes with A1C measurements would differ from using oral glucose tolerance tests (OGTT). RESEARCH DESIGN AND METHODS We compared pre-diabetes, dysglycemia (diabetes or pre-diabetes), and diabetes identified by the proposed criteria (A1C ≥ 6.5% for diabetes and 6.0-6.4% [IEC] or 5.7-6.4% [ADA] for high risk/pre-diabetes) with standard OGTT diagnoses in three datasets. Non-Hispanic white or black adults without known diabetes who had A1C and 75-g OGTT measurements were included from the prospective Screening for Impaired Glucose Tolerance study (n = 1,581), and from the National Health and Nutrition Examination Survey (NHANES) III (n = 2014), and NHANES 2005-2006 (n = 1,111). RESULTS OGTTs revealed pre-diabetes in 35.8% and diabetes in 5.2% of combined study subjects. A1C provided receiver operating characteristic (ROC) curve areas for diabetes of 0.79-0.83, but ROC curve areas were ≤ 0.70 for dysglycemia or pre-diabetes. The proposed criteria missed 70% of individuals with diabetes, 71-84% with dysglycemia, and 82-94% with pre-diabetes. Compared with the IEC criteria, the ADA criteria for pre-diabetes resulted in fewer false-negative and more false-positive result. There were also racial differences, with false-positive results being more common in black subjects and false-negative results being more common in white subjects. With use of NHANES 2005-2006 data, ∼5.9 million non-Hispanic U.S. adults with unrecognized diabetes and 43-52 million with pre-diabetes would be missed by screening with A1C. CONCLUSIONS The proposed A1C diagnostic criteria are insensitive and racially discrepant for screening, missing most Americans with undiagnosed diabetes and pre-diabetes.
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Lorenzo C, Wagenknecht LE, Hanley AJG, Rewers MJ, Karter AJ, Haffner SM. A1C between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study (IRAS). Diabetes Care 2010; 33:2104-9. [PMID: 20573754 PMCID: PMC2928372 DOI: 10.2337/dc10-0679] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A1C is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose for detecting at-risk individuals is not well known. RESEARCH DESIGN AND METHODS A 2-h glucose tolerance test, frequently sampled intravenous glucose tolerance test, and A1C were obtained at the follow-up examination in 855 participants in the Insulin Resistance Atherosclerosis Study (IRAS). For this report, 385 individuals were at increased risk of diabetes as defined by A1C between 5.7 and 6.4%, impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG). RESULTS IFG and IGT identified 69.1 and 59.5% of all individuals at increased risk of diabetes, respectively. A1C 5.7-6.4% detected 23.6% of all at-risk individuals, although more African Americans (31.4%) and Hispanics (35.2%) than non-Hispanic whites (9.9%). Relative to A1C, FPG was more strongly related to fasting insulin (r = 0.38 vs. 0.26; P < 0.01), acute insulin response (r = - 0.20 vs. - 0.09; P < 0.01), and waist circumference (r = 0.43 vs. 0.25; P < 0.001) by the Spearman correlation test. Similarly, 2-h plasma glucose was more strongly related to Si (r = - 0.40 vs. - 0.27; P < 0.01) and triglycerides (r = 0.30 vs. 0.08; P < 0.001). CONCLUSIONS A1C 5.7-6.4% is less sensitive for detecting at-risk individuals than IFG and IGT, particularly among non-Hispanic whites. Single determinations of FPG and 2-h plasma glucose seem to be more precise correlates of insulin resistance and secretion than A1C and, in general, better for other metabolic disorders.
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Affiliation(s)
- Carlos Lorenzo
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA.
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Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95:2038-49. [PMID: 20375205 DOI: 10.1210/jc.2009-2724] [Citation(s) in RCA: 623] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Women with polycystic ovary syndrome (PCOS) often have cardiovascular disease (CVD) risk factors. The Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society created a panel to provide evidence-based reviews of studies assessing PCOS-CVD risk relationships and to develop guidelines for preventing CVD. PARTICIPANTS An expert panel in PCOS and CVD reviewed literature and presented recommendations. EVIDENCE Only studies comparing PCOS with control patients were included. All electronic databases were searched; reviews included individual studies/databases, systematic reviews, abstracts, and expert data. Articles were excluded if other hyperandrogenic disorders were not excluded, PCOS diagnosis was unclear, controls were not described, or methodology precluded evaluation. Inclusion/exclusion criteria were confirmed by at least two reviewers and arbitrated by a third. CONSENSUS PROCESS Systematic reviews of CVD risk factors were compiled and submitted for approval to the AE-PCOS Society Board. CONCLUSIONS Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance, and subclinical vascular disease are at risk, whereas those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Body mass index, waist circumference, serum lipid/glucose, and blood pressure determinations are recommended for all women with PCOS, as is oral glucose tolerance testing in those with obesity, advanced age, personal history of gestational diabetes, or family history of type 2 diabetes mellitus. Mood disorder assessment is suggested in all PCOS patients. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist.
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Affiliation(s)
- Robert A Wild
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
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