Screening for diabetes mellitus in adults. The utility of random capillary blood glucose measurements

Screening for diabetes and impaired glucose metabolism in Qatar: Models' development and validation

AIM

To establish two scoring models for identifying individuals at risk of developing Impaired Glucose Metabolism (IGM) or Type two Diabetes Mellitus (T2DM) in Qatari.

MATERIALS AND METHODS

A sample of 2000 individuals, from Qatar BioBank, was evaluated to determine features predictive of T2DM and IGM. Another sample of 1000 participants was obtained for external validation of the models. Several scoring models screening for T2DM were evaluated and compared to the model proposed by this study.

RESULTS

Age, gender, waist-to-hip-ratio, history of hypertension and hyperlipidemia, and levels of educational were statistically associated with the risk of T2DM and constituted the Qatar diabetes mellitus risk score (QDMRISK). Along with, the 6 aforementioned variables, the IGM model showed that BMI was statistically significant. The QDMRISK performed well with area under the curve (AUC) 0.870 and .815 in the development and external validation cohorts, respectively. The QDMRISK showed overall better accuracy and calibration compared to other evaluated scores. The IGM model showed good accuracy and calibration, with AUCs .796 and .774 in the development and external validation cohorts, respectively.

CONCLUSIONS

This study developed Qatari-specific diabetes and IGM risk scores to identify high risk individuals and can guide the development of a nationwide primary prevention program.

Comparison of Point-of-Care Testing and Hospital-Based Methods in Screening for Potential Type 2 Diabetes Mellitus and Abnormal Glucose Regulation in a Dental Setting

This study aimed to compare the screening methods between point-of-care (POC) testing and hospital-based methods for potential type 2 DM and abnormal glucose regulation (AGR) in a dental setting. A total of 274 consecutive subjects who attended the Faculty of Dentistry, Mahidol University, Bangkok, Thailand, were selected. Demographic data were collected. HbA_1c was assessed using a finger prick blood sample and analyzed with a point-of-care (POC) testing machine (DCA Vantage^®). Hyperglycemia was defined as POC HbA_1c ≥ 5.7%. Random blood glucose (RBG) was also evaluated using a glucometer (OneTouch^® SelectSimple™) and hyperglycemia was defined as RBG ≥ 110 mg/dl or ≥140 mg/dl. The subjects were then sent for laboratory measurements for fasting plasma glucose (FPG) and HbA_1c. The prevalence of AGR (defined as FPG ≥ 100 mg/dl or laboratory HbA_1c ≥ 5.7%) and potential type 2 DM (defined as FPG ≥ 126 mg/dl or laboratory HbA_1c ≥ 6.5%) among subjects was calculated and receiver operating characteristic (ROC) analysis was performed using FPG and HbA_1c for the diagnosis of AGR and potential type 2 DM. The prevalence of hyperglycemia defined as POC HbA_1c ≥ 5.7%, RBG ≥ 110 mg/dl, and RBG ≥ 140 mg/dl was 49%, 63%, and 32%, respectively. After the evaluation using laboratory measurements, the prevalence of AGR was 25% and 17% using laboratory FPG and HbA_1c criteria, respectively. Based on the ROC curves, the performances of POC HbA_1c and RBG in predicting FPG-defined potential type 2 DM were high (AUC = 0.99; 95% CI 0.98–0.99 and AUC = 0.94; 95% CI 0.86–1.0, respectively) but lower in predicting AGR (AUC = 0.72; 95% CI 0.67–0.78 and AUC = 0.65; 95% CI 0.59–0.70, respectively). This study suggested that POC testing might be a potential tool for screening of subjects with potential type 2 DM in a dental setting.

Characteristics of undiagnosed diabetes in men and women under the age of 50 years in the Indian subcontinent: the National Family Health Survey (NFHS-4)/Demographic Health Survey 2015-2016

OBJECTIVE

Prior studies examining diabetes prevalence in India have found that nearly 50% of the diabetes population remains undiagnosed; however, the specific populations at risk are unclear.

RESEARCH DESIGN AND METHODS

First, we estimated the prevalence of undiagnosed diabetes in India for 750 924 persons between the ages of 15 years and 50 years who participated in the National Family Health Survey (NFHS-4)/Demographic Health Survey (2015-2016), a cross-sectional survey of all 29 states and 7 union territories of India. We defined 'undiagnosed diabetes' as individuals who did not know about their diabetes status but had high random (≥200 mg/dL) or fasting (≥126 mg/dL) blood glucose levels. Second, using Poisson regression, we associated 10 different factors, including the role of healthcare access, and undiagnosed diabetes. Third, we examined the association of undiagnosed diabetes with other potential comorbid conditions.

RESULTS

The crude prevalence of diabetes for women and men aged 15-50 years was 2.9%, 95% CI 2.9% to 3.1%, with self-reported diabetes prevalence at 1.7%, 95% CI 1.6 to 1.8. The overall prevalence of undiagnosed diabetes for 15-50 year olds was at 1.2%, 95% CI 1.2% to 1.3%. Forty-two per cent, 95% CI 40.7% to 43.4% of the individuals with high glucose levels were unaware of their diabetes status. Approximately 45%, 95% CI 42.9% to 46.4% of undiagnosed diabetes population had access to healthcare. Men, younger individuals, and those with lower levels of education were most at risk of being undiagnosed. Geographically, the Southern states in India had a significantly higher prevalence of undiagnosed diabetes despite having nearly universal access to healthcare. Risk factors combined with random glucose could predict undiagnosed diabetes (area under the curve of 97.8%, 95% CI 97.7% to 97.8%), Nagelkerke R2 of 66%).

CONCLUSION

Close to half (42%) of the people with diabetes in India are not aware of their disease status, and a large subset of these people are at risk of poor detection, despite having health insurance and/or having access to healthcare. Younger age groups and men are the most vulnerable.

Random plasma glucose predicts the diagnosis of diabetes

Aims/Hypothesis

Early recognition of those at high risk for diabetes as well as diabetes itself can permit preventive management, but many Americans with diabetes are undiagnosed. We sought to determine whether routinely available outpatient random plasma glucose (RPG) would be useful to facilitate the diagnosis of diabetes.

Methods

Retrospective cohort study of 942,446 U.S. Veterans without diagnosed diabetes, ≥3 RPG in a baseline year, and ≥1 primary care visit/year during 5-year follow-up. The primary outcome was incident diabetes (defined by diagnostic codes and outpatient prescription of a diabetes drug).

Results

Over 5 years, 94,599 were diagnosed with diabetes [DIAB] while 847,847 were not [NONDIAB]. Baseline demographics of DIAB and NONDIAB were clinically similar, except DIAB had higher BMI (32 vs. 28 kg/m²) and RPG (150 vs. 107 mg/dl), and were more likely to have Black race (18% vs. 15%), all p<0.001. ROC area for prediction of DIAB diagnosis within 1 year by demographic factors was 0.701, and 0.708 with addition of SBP, non-HDL cholesterol, and smoking. These were significantly less than that for prediction by baseline RPG alone (≥2 RPGs at/above a given level, ROC 0.878, p<0.001), which improved slightly when other factors were added (ROC 0.900, p<0.001). Having ≥2 RPGs ≥115 mg/dl had specificity 77% and sensitivity 87%, and ≥2 RPGs ≥130 mg/dl had specificity 93% and sensitivity 59%. For predicting diagnosis within 3 and 5 years by RPG alone, ROC was reduced but remained substantial (ROC 0.839 and 0.803, respectively).

Conclusions

RPG levels below the diabetes “diagnostic” range (≥200 mg/dl) provide good discrimination for follow-up diagnosis. Use of such levels–obtained opportunistically, during outpatient visits–could signal the need for further testing, allow preventive intervention in high risk individuals before onset of disease, and lead to earlier identification of diabetes.

Prevalence of periodontitis in patients with pulmonary disease: A cross-sectional survey in the industrial district of India

Background

Evidence state that periodontitis may have a contributory role in the onset and progression of pulmonary diseases. However, very limited data are available till date, studying the coexistence of both the conditions.

Aim and Objective

The aim and objective of this study are to determine the prevalence of periodontitis among patients affected with various pulmonary diseases in Moradabad District, Uttar Pradesh, India.

Materials and Methods

A total of 700 patients suffering from pulmonary diseases including tuberculosis (TB), chronic obstructive pulmonary disease, or pneumonia within the age group of 12-70 years were selected for the study. A detailed case-history for both pulmonary and periodontal status was taken. Periodontal Disease Index and Periodontal Index for Risk of Infectiousness were recorded for all patients. The scores were calculated and subjected to statistical analysis.

Results

Individuals with pulmonary diseases showed a statistically significant prevalence of periodontal disease with higher values of periodontal disease index (31%) and periodontal index for risk of infectiousness (55%) at P < 0.05. Patients suffering from TB within the age group of 51-60 (42%) showed the highest prevalence of periodontitis with a more number of males (43%) being affected as compared to females at P < 0.01.

Conclusion

Most of the study population was diagnosed with periodontitis with a higher proportion categorized under high-risk category as per PIRI scores.

Mannose Metabolism Is Essential for Th1 Cell Differentiation and IFN-γ Production

Glucose-derived mannose is a common component of glycoproteins, and its deficiency leads to a severe defect in protein glycosylation and failure in basic cell functions. In this work, we show that mannose metabolism is essential for IFN-γ production by mouse Th1 cells. In addition, we demonstrate that the susceptibility of Th1 cells to glycolysis restriction depends on the activation conditions and that under diminished glycolytic flux, mannose availability becomes the limiting factor for IFN-γ expression. This study unravels a new role for glucose metabolism in the differentiation process of Th1 cells, providing a mechanistic explanation for the importance of glycolysis in immune cell functions.

Mortality in persons with undetected and diagnosed hypertension, type 2 diabetes, and hypothyroidism, compared with persons without corresponding disease - a prospective cohort study; The HUNT Study, Norway

Background

Suggested strategies in reducing the impact of non-communicable diseases (NCD) are early diagnosing and screening. We have limited proof of benefit of population screening for NCD. Increased mortality in persons with diagnosed NCD has been shown for decades. However, mortality in undetected NCD has barely been studied. This paper explores whether all-cause mortality differed between persons with diagnosed hypothyroidism, type 2 diabetes (T2DM), and hypertension, compared with persons with undetected-, and with persons without the corresponding disease.

Methods

A prospective cohort study of the general population in Nord-Trøndelag, Norway. Persons ≥20 years at baseline 1995–97 were followed until death or June 15, 2016. Cox proportional hazards models were used to compute age and multiple adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between disease status and all-cause mortality. The number of participants in the hypothyroidism study was 31,960, in the T2DM study 37,957, and in the hypertension study 63,371.

Results

Mortality was increased in persons with diagnosed type 2 diabetes and hypertension, compared to persons without corresponding disease; HR 1.69 (95% CI 1.55–1.84) and HR 1.23 (95% CI 1.09–1.39), respectively. Among persons with undetected T2DM, the HR was 1.21 (95% CI 1.08–1.37), whilst among undetected hypothyroidism and hypertension, mortality was not increased compared with persons without the diseases. Further, the association with mortality was stronger in persons with long duration of T2DM (HR 1.96 (95% CI 1.57–2.44)) and hypertension (HR 1.32 (95% CI 1.17–1.49)), compared with persons with short duration (HR 1.29 (1.09–1.53) and HR 1.16 (1.03-1-30) respectively).

Conclusions

Mortality was increased in persons with diagnosed T2DM and hypertension, and in undetected T2DM, compared with persons without the diseases. The strength of the association with mortality in undetected T2DM was however lower compared with persons with diagnosed T2DM, and mortality was not increased in persons with undetected hypothyroidism and hypertension, compared with persons without the diseases. Thus, future research needs to test more thoroughly if early diagnosing of these diseases, such as general population screening, is beneficial for health.

Prevalence of dysglycaemia in rural Andhra Pradesh: 2005, 2010, and 2014

BACKGROUND

Communities in rural Andhra Pradesh may be at increasing risk of diabetes. In the present study we analyzed three cross-sectional studies over 9 years to estimate the changing prevalence of dysglycemia (diabetes and prediabetes).

METHODS

The 2005 study sampled 4535 individuals from 20 villages, the 2010 study sampled 4024 individuals from 14 villages, and the 2014 project of 62 254 individuals sought to include all adults aged 40-85 years from 54 villages. Blood glucose levels were estimated using a hand-held device in 2005 and 2014 and using HbA1c dried blood spots in 2010.

RESULTS

In primary analyses restricted to assays based on fasting samples (2005, n = 3243; 2014, n = 749), the prevalence estimates for dysglycemia were 53.7% (95% confidence interval [CI] 51.8%-55.7%) in 2005 and 62.0% (95% CI 58.5%-65.4%) in 2014 (P < 0.001). Over the same period, mean body mass index (BMI) increased from 22.2 to 24.3 kg/m² (mean difference 2.1 kg/m² ; 95% CI 2.0-2.2 kg/m² ; P < 0.001). In secondary analyses using data from all participants (2005, n = 4535; 2010, n = 4024; 2014, n = 62 254), regardless of measurement technique, the estimated prevalence of dysglycemia was 53.9% (95% CI 52.0%-55.9%) in 2005, 50.5% (95% CI 46.1%-54.9%) in 2010, and 41.3% (95% CI 40.9%-41.7%) in 2014 (P < 0.001).

CONCLUSIONS

The prevalence of dysglycemia was high at every assessment using every measurement method. Dysglycemia in this population is most likely to have risen with the rise in BMI. The decline in prevalence suggested by the secondary analyses was likely due to confounding from the different assessment methods.

Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients

BACKGROUND

In 2015, the United States Preventive Services Task Force (USPSTF) recommended targeted screening for prediabetes and diabetes (dysglycemia) in adults who are aged 40 to 70 y old and overweight or obese. Given increasing prevalence of dysglycemia at younger ages and lower body weight, particularly among racial/ethnic minorities, we sought to determine whether the current screening criteria may fail to identify some high-risk population subgroups.

METHODS AND FINDINGS

We investigated the performance of the 2015 USPSTF screening recommendation in detecting dysglycemia among US community health center patients. A retrospective analysis of electronic health record (EHR) data from 50,515 adult primary care patients was conducted. Longitudinal EHR data were collected in six health centers in the Midwest and Southwest. Patients with a first office visit between 2008 and 2010 were identified and followed for up to 3 y through 2013. We excluded patients who had dysglycemia at baseline and those with fewer than two office visits during the follow-up period. The exposure of interest was eligibility for screening according to the 2015 USPSTF criteria. The primary outcome was development of dysglycemia during follow-up, determined by: (1) laboratory results (fasting/2-h postload/random glucose ≥ 100/140/200 mg/dL [5.55/7.77/11.10 mmol/L] or hemoglobin A1C ≥ 5.7% [39 mmol/mol]); (2) diagnosis codes for prediabetes or type 2 diabetes; or (3) antidiabetic medication order. At baseline, 18,846 (37.3%) participants were aged ≥40 y, 33,537 (66.4%) were overweight or obese, and 39,061 (77.3%) were racial/ethnic minorities (34.6% Black, 33.9% Hispanic/Latino, and 8.7% Other). Overall, 29,946 (59.3%) patients had a glycemic test within 3 y of follow-up, and 8,478 of them developed dysglycemia. Only 12,679 (25.1%) patients were eligible for screening according to the 2015 USPSTF criteria, which demonstrated the following sensitivity and specificity (95% CI): 45.0% (43.9%-46.1%) and 71.9% (71.3%-72.5%), respectively. Racial/ethnic minorities were significantly less likely to be eligible for screening yet had higher odds of developing dysglycemia than whites (odds ratio [95% CI]: Blacks 1.24 [1.09-1.40]; Hispanics 1.46 [1.30-1.64]; and Other 1.33 [1.16-1.54]). In addition, the screening criteria had lower sensitivity in all racial/ethnic minority groups compared to whites. Limitations of this study include the ascertainment of dysglycemia only among patients with available test results and findings that may not be generalizable at the population level.

CONCLUSIONS

Targeted diabetes screening based on new USPSTF criteria may detect approximately half of adult community health center patients with undiagnosed dysglycemia and proportionately fewer racial/ethnic minorities than whites. Future research is needed to estimate the performance of these screening criteria in population-based samples.

Diagnostic labelling influences self-rated health. A prospective cohort study: the HUNT Study, Norway

BACKGROUND

Studies have shown an independent association between poor self-rated health (SRH) and increased mortality. Few studies, however, have investigated any possible impact on SRH of diagnostic labelling.

OBJECTIVE

To test whether SRH differed in persons with known and unknown hypothyroidism, diabetes mellitus (DM) or hypertension, opposed to persons without these conditions, after 11-year follow-up.

METHODS

Prospective population-based cohort study in North-Trøndelag County, Norway, HUNT2 (1995-97) to HUNT3 (2006-08). All inhabitants aged 20 years and older were invited. The response rate was 69.5% in HUNT2 and 54.1% in HUNT3. In total, 34144 persons aged 20-70 years were included in the study population. The outcome was poor SRH.

RESULTS

Persons with known disease had an increased odds ratio (OR) to report poor SRH at follow-up; figures ranging from 1.11 (0.68-1.79) to 2.52 (1.46-4.34) (men with hypothyroidism kept out owing to too few numbers). However, in persons not reporting, but having laboratory results indicating these diseases (unknown disease), no corresponding associations with SRH were found. Contrary, the OR for poor SRH in women with unknown hypothyroidism and unknown hypertension was 0.64 (0.38-1.06) and 0.89 (0.79-1.01), respectively.

CONCLUSIONS

Awareness opposed to ignorance of hypothyroidism, DM and hypertension seemed to be associated with poor perceived health, suggesting that diagnostic labelling could have a negative effect on SRH. This relationship needs to be tested more thoroughly in future research but should be kept in mind regarding the benefits of early diagnosing of diseases.

The Intra- or Extracellular Redox State Was Not Affected by a High vs. Low Glycemic Response Diet in Mice

A low glycemic response (LGR) vs. high glycemic response (HGR) diet helps curtail the development of obesity and diabetes, though the mechanisms are unknown. We hypothesized that consumption of a HGR vs. a LGR diet would lead to a more oxidized circulating redox state and predicted that a HGR diet would increase fat accumulation, reduce insulin sensitivity, and impair metabolic acclimation to a high fat diet in a mouse model. Hence, male C57BL/6 mice consumed a HGR or LGR diet for 16 weeks and a subset of the mice subsequently consumed a high fat diet for 4 weeks. We found that body mass increased at a faster rate for those consuming the HGR diet. Percent body fat was greater and percent lean mass was lesser in the HGR group starting at 12 weeks. However, the groups did not differ in terms of glucose tolerance at week 14 and metabolic parameters (respiratory exchange ratio, heat production, activity) at weeks 4 or 15. Moreover, mice on either diet did not show differences in metabolic acclimation to the high fat leg of the study. At the termination of the study, the groups did not differ in terms of redox pairs (lactate/pyruvate and β-hydroxybutyrate/acetoacetate) or thioredoxin reductase activity in blood. Also, total and oxidized glutathione levels and lipid peroxidation were similar in blood and liver. Correlations between baseline measures, longitudinal parameters, environmental conditions, and terminal metrics revealed that individual mice have innate propensities to metabolic regulation that may be difficult to perturb with diet alone; for example, starting mass correlated negatively with energy expenditure 4 weeks into the study and total hepatic glutathione at the end of the study. In conclusion, these data suggest that the mechanism by which HGR carbohydrates contributes to obesity is not via prolonged oxidation of the circulating redox state.

Screening for prediabetes and type 2 diabetes in dental offices

Objectives

Most Americans see dentists at least once a year. Chair‐side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c ≥5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices.

Methods

We recruited 1,033 adults ≥30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population ≥30 years of age.

Results

Individuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self‐reported body mass index ≥35 kg/m² (severe obesity) or random capillary glucose ≥110 mg/dl. We estimate that 30 percent of patients ≥30 years of age seen in these general dental practices had dysglycemia.

Conclusions

There is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair‐side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high‐risk patients.

Practical implications

Further studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost‐effectiveness of chair‐side screening.

Screening for HbA1c-defined prediabetes and diabetes in an at-risk greek population: performance comparison of random capillary glucose, the ADA diabetes risk test and skin fluorescence spectroscopy

BACKGROUND

We examined the accuracy of random capillary glucose (RCG) and two noninvasive screening methods, the ADA diabetes risk test (DRT) and skin fluorescence spectroscopy (SFS) as measured by Scout DS for detecting HbA1c-defined dysglycemia or type 2 diabetes in an at-risk cohort.

METHODS

Subjects were recruited at two clinical sites for a single non-fasting visit. Each subject had measurements of height, weight and waist circumference. A diabetes score was calculated from skin fluorescence measured on the left forearm. A finger prick was done to measure RCG and HbA1c (A1C). Health questionnaires were completed for the DRT. Increasing dysglycemia was defined as A1C ≥ 5.7% (39 mmol/mol) or ≥ 6.0% (42 mmol/mol). Type 2 diabetes was defined as A1C ≥ 6.5% (47.5 mmol/mol).

RESULTS

398 of 409 subjects had complete data for analysis with means for age, body mass index, and waist of 52 years, 27 kg/m(2) and 90 cm. 51% were male. Prevalence of A1C ≥ 5.7%, ≥ 6.0% and ≥ 6.5% were 54%, 34% and 12%, respectively. Areas under the curve (AUC) for detection of increasing levels dysglycemia or diabetes for RCG were 63%, 66% and 72%, for the ADA DRT the AUCs were 75%, 76% and 81% and for SFS the AUCs were 82%, 84% and 90%, respectively. For each level of dysglycemia or diabetes, the SFS AUC was significantly higher than RCG or the ADA DRT.

CONCLUSIONS

The noninvasive skin fluorescence spectroscopy measurement outperformed both RCG and the ADA DRT for detection of A1C-defined dysglycemia or diabetes in an at-risk cohort.

Food for Life / Comida para la Vida: creating a food festival to raise diabetes awareness

African and Latino Americans have higher rates of diabetes and its complications than White Americans. Identifying people with undiagnosed diabetes and helping them obtain care can help to prevent complications and mortality. To kick off a screening initiative, our community-academic partnership created the "Food for Life Festival," or "Festival Comida para la Vida." This article will describe the community's perspective on the Festival, which was designed to screen residents, and demonstrate that eating healthy can be fun, tasty, and affordable in a community-centered, culturally consonant setting. More than 1,000 residents attended the event; 382 adults were screened for diabetes, and 181 scored as high risk. Fifteen restaurants distributed free samples of healthy versions of their popular dishes. Community residents, restaurateurs, and clinicians commented that the event transformed many of their preconceived ideas about healthy foods and patient care.

Random capillary blood glucose cut points for diabetes and pre-diabetes derived from community-based opportunistic screening in India

OBJECTIVE

To determine random capillary blood glucose (RCBG) cut points that discriminate diabetic and pre-diabetic subjects from normal individuals.

RESEARCH DESIGN AND METHODS

RCBG was performed in 1,333 individuals randomly chosen from 63,305 individuals who had participated in an opportunistic screening program. An oral glucose tolerance test was also performed by venous plasma glucose on an autoanalyzer. RCBG cut points that discriminate diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were determined using receiver operating characteristic curves.

RESULTS

Using 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) criterion, the RCBG cut point of 140 mg/dl (7.7 mmol/l) gave the highest sensitivity and specificity. For 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) and fasting plasma glucose (FPG) >or=126 mg/dl (7.0 mmol/l) criteria, either 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) or FPG >or=126 mg/dl (7.0 mmol/l) criterion, and the FPG >or=126 mg/dl (7.0 mmol/l) criterion, RCBG cut point was 143 mg/dl (7.9 mmol/l). RCBG cut points for IGT, IFG according to World Health Organization criterion, and IFG according to American Diabetes Association criterion were 119 mg/dl (6.6 mmol/l), 118 mg/dl (6.6 mmol/l), and 113 mg/dl (6.3 mmol/l), respectively.

CONCLUSIONS

Asian Indians with RCBG >110 mg/dl at screening can be recommended to undergo definitive testing.

Random plasma glucose in serendipitous screening for glucose intolerance: screening for impaired glucose tolerance study 2

BACKGROUND

With positive results from diabetes prevention studies, there is interest in convenient ways to incorporate screening for glucose intolerance into routine care and to limit the need for fasting diagnostic tests.

OBJECTIVE

The aim of this study is to determine whether random plasma glucose (RPG) could be used to screen for glucose intolerance.

DESIGN

This is a cross-sectional study.

PARTICIPANTS

The participants of this study include a voluntary sample of 990 adults not known to have diabetes.

MEASUREMENTS

RPG was measured, and each subject had a 75-g oral glucose tolerance test several weeks later. Glucose intolerance targets included diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose(110) (IFG(110); fasting glucose, 110-125 mg/dl, and 2 h glucose < 140 mg/dl). Screening performance was measured by area under receiver operating characteristic curves (AROC).

RESULTS

Mean age was 48 years, and body mass index (BMI) was 30.4 kg/m(2); 66% were women, and 52% were black; 5.1% had previously unrecognized diabetes, and 24.0% had any "high-risk" glucose intolerance (diabetes or IGT or IFG(110)). The AROC was 0.80 (95% CI 0.74-0.86) for RPG to identify diabetes and 0.72 (0.68-0.75) to identify any glucose intolerance, both highly significant (p < 0.001). Screening performance was generally consistent at different times of the day, regardless of meal status, and across a range of risk factors such as age, BMI, high density lipoprotein cholesterol, triglycerides, and blood pressure.

CONCLUSIONS

RPG values should be considered by health care providers to be an opportunistic initial screening test and used to prompt further evaluation of patients at risk of glucose intolerance. Such "serendipitous screening" could help to identify unrecognized diabetes and prediabetes.

The relationship between post-prandial plasma glucose and post-challenge plasma glucose in Japanese population

The relationship between post-prandial plasma glucose (PPG) and post-challenge plasma glucose (PCG) within individuals was investigated in Japanese population. The oral glucose tolerance test (OGTT) and measurements of PPG 2h after ingestion of a standardized rice-based meal (PPG2h), were performed in 4471 middle-aged Japanese subjects (2774 men and 1697 women, 50.7+/-8.5 years). There was a loose correlation between PPG2h and PCG2h (r=0.327, p<0.001). The diabetes group (n=170) showed the highest PPG2h, followed by the IGT group (n=786) and the NGT group (n=3414) (p<0.05). At the cutoff point of 140 mg/dl (7.8 mmol/l) for PPG2h, specificities were 94.9% for IGT plus diabetes and 92.9% for diabetes, but sensitivities were as low as 23.2% for IGT plus diabetes and 44.7% for diabetes. The correlation of PPG2h with PCG2h was stronger in the obese group (BMI>or=25 kg/m2) than in the lean group (BMI<20 kg/m2). We conclude that the correlation between PPG2h and PCG2h was significant but not very tight. In evaluating PPG2h, if the cutoff point of 140 mg/dl (7.8 mmol/l) for PCG2h is extrapolated, the majority of subjects with dysglycemia could be overlooked.

Screening Copenhagen school children at risk of type 2 diabetes mellitus using random capillary blood glucose

AIM

To screen adolescents at risk of type 2 diabetes mellitus (T2DM) using random capillary blood glucose (RCBG).

METHODS

Ninth grade pupils who were overweight and/or had a family history of T2DM were offered to have RCBG measured and were referred for further investigation if the value was > or = 7.8 mmol/L.

RESULTS

Two thousand four hundred and eleven pupils were examined, 19% were overweight, 4% being obese. 589 met inclusion criteria and 384 participated. Ethnic minorities and pupils in low socio-economic school-areas (SESA) were significantly more overweight than ethnic Danes and pupils in high SESA. Compared to ethnic Danish pupils, the relative risk of having a positive parent history of T2DM was increased five-fold for ethnic Turkish and Arab pupils and 13-fold for ethnic Pakistani pupils. One pupil had a diagnosed T2DM. Two had elevated RCBG values. One of these had an undiagnosed T2DM.

CONCLUSION

Our study shows a high prevalence of overweight adolescents in Copenhagen, especially in school areas with low socio-economic standard and in pupils with Turkish, Pakistani and Arab ethnicity. Only three out of the 10 pupils with the highest risk participated. New strategies to reach and motivate risk groups to follow health recommendations and new methods of screening should be developed.

Glucose intolerance and other cardiovascular risk factors in Haiti (PREDIAH)

AIMS

To assess the prevalence of diabetes and other forms of glucose intolerance and to examine their relationship with some cardiovascular risk factors in a population representative of the capital of Haiti.

METHODS

This cross-sectional survey was conducted in the metropolitan area of Port-au-Prince, Haiti. A population-based sample of 1620 adults was randomly selected using a two-stage cluster method, stratified in 3 age groups: 20-39, 40-64 and > or =65 years of age. Diagnosis of diabetes and pre-diabetes (IFG and IGT) was based on the 2003 Expert Committee criteria.

RESULTS

The total response rate was 69%. The age-standardized prevalence of diabetes was 4.8% in men and 8.9% in women (P=0.0014), with, overall, 70.6% of previously diagnosed cases. Standardized for the Segi world population aged 30-64 years, its prevalence was 7.4% in men and 11.1% in women (NS). The age-standardized prevalence of pre-diabetes was 6.4% in men and 8.0% in women (NS). Hypertension was found in 48.7% in men and 46.5% in women (NS). Its rates in people > or =40 years old were 69.1% in men and 67.2% in women (NS). Abdominal obesity was strongly independently associated with diabetes and pre-diabetes in both genders. Hypertension was shown to be risk factor for pre-diabetes and total glucose intolerance in women. High education was associated with lower risk of diabetes in men.

CONCLUSION

Prevalence of diabetes and pre-diabetes is moderately high in Port-au-Prince, Haiti. In people aged > or =40 years, the rate of normal blood pressure is less than 25%. Intervention programs to prevent simultaneously and manage diabetes and hypertension are imperative, and prevention strategies through lifestyle modifications should be cost-effective.

Screening for Type 2 Diabetes Mellitus in Children and Adolescents: Attitudes, Barriers, and Practices Among Pediatric Clinicians

OBJECTIVE

The American Diabetes Association (ADA) recommends screening children at risk for type 2 diabetes with a fasting plasma glucose test or an oral glucose tolerance test. The purpose of this study was to describe attitudes, barriers, and practices related to type 2 diabetes screening in children among pediatric clinicians.

METHODS

Pediatricians, nurse practitioners and physician assistants from a multispecialty, group practice in Eastern Massachusetts completed a mailed survey. To assess screening practice, three vignettes were presented representing pediatric patients with low, moderately high, and high risk for type 2 diabetes. The moderately high-risk and high-risk patients met ADA criteria for screening. ADA-consistent practice was defined as only screening the moderately high-risk and high-risk patients; lower-threshold practice was defined as also screening the low-risk patient; and higher threshold practice was screening only the high-risk patient.

RESULTS

Sixty-two of 90 clinicians responded (69%). Based on intent to screen in the 3 vignettes, 21% of respondents reported ADA-consistent screening practice, 39% lower-threshold, and 35% higher-threshold screening practice. Five percent had incomplete or nonclassifiable responses. Many clinicians ordered screening tests other than those recommended by the ADA; few (< or =8% in any vignette) ordered only an ADA-recommended test. Preferences for nonfasting tests were influenced by nonmedical factors such as access to or cost of transportation. Inadequate patient education materials and unclear recommendations for appropriate screening methods were the most frequently reported moderate/strong barriers to screening.

CONCLUSIONS

Most respondents reported type 2 diabetes screening practices that differed from current ADA recommendations. Our findings suggest that type 2 diabetes screening tests must be practical for clinicians and patients if they are to be used in pediatric practice. Further study of the benefits and cost-effectiveness of type 2 diabetes screening in children is warranted to clarify the role and optimal methods for screening in pediatric primary care.

Strategies to identify adults at high risk for type 2 diabetes: the Diabetes Prevention Program

OBJECTIVE

The Diabetes Prevention Program (DPP) was a large, multicenter, randomized clinical trial testing interventions to prevent or delay type 2 diabetes. A major challenge was to identify eligible high-risk adults, defined by DPP as having both impaired glucose tolerance (IGT) (2-h glucose 140-199 mg/dl) and elevated fasting plasma glucose (EFG) (95-125 mg/dl).

RESEARCH DESIGN AND METHODS

We analyzed how screening yields would be affected by the presence of established risk factors such as age, sex, ethnicity, BMI, and family history of diabetes, and how much yields would be enhanced by preselecting individuals with elevated capillary blood glucose levels. Of 158,177 contacted adults, 79,190 were potentially eligible (no history of diabetes, age 25 years and older, BMI > or =24 kg/m2). We focus on the 30,383 participants who completed an oral glucose tolerance test (OGTT).

RESULTS

Based on OGTT, 27% had IGT with EFG, meeting DPP eligibility criteria for being at high risk of diabetes, and 13% had previously undiagnosed diabetes based on OGTT. Older age and higher BMI increased yield of high-risk individuals and those with newly discovered diabetes in most ethnic groups (whites, African Americans, Hispanics, and American Indians). In Asian Americans, age but not BMI predicted high risk and diabetes. Independent of age and BMI, the preliminary fasting capillary glucose predicted screening yield in all ethnic groups, with an inverted-U pattern defining DPP eligibility alone (IGT-EFG) and a steep curvilinear pattern defining either IGT-EFG or newly discovered diabetes. Fasting capillary glucose did not attenuate the affects of other participant characteristics in predicting IGT-EFG or the combination of IGT-EFG and newly discovered diabetes.

CONCLUSIONS

The DPP screening approach identified adults with or at high risk for type 2 diabetes across various ethnic groups and provided guidance to more efficient use of OGTTs. Fasting capillary glucose is a useful adjunct in screening programs combined with data on age and adiposity.

Point-of-care testing for diabetes

Point-of-care testing, or near patient testing, refers to testing of biochemical parameters with devices that provide rapid results so the data can be immediately used in clinical care. Because the diagnosis and, in particular, management, of diabetes mellitus is largely relegated to the outpatient setting (including self-care in the home, school and workplace), point-of-care testing is particularly relevant for this disease. Moreover, the need for timely (immediate) results for glucose monitoring makes point-of-care testing necessary for the management of diabetes in the inpatient and outpatient setting. The following review examines the role of various assays in the diagnosis and management of diabetes and discusses the role of point-of-care testing.

Opportunistic screening for diabetes in routine clinical practice

OBJECTIVE

Since 1997, the American Diabetes Association has recommended that nondiabetic individuals >/=45 years of age be screened for diabetes at least every 3 years. We sought to characterize the frequency, methods, and results of diabetes screening in routine clinical practice.

RESEARCH DESIGN AND METHODS

We studied opportunistic screening in nondiabetic members of a health maintenance organization >/=45 years of age who were assigned to a large, integrated, academic health care delivery system. Screening was defined as the first glucose, HbA(1c), or oral glucose tolerance test (OGTT) performed between 1 January 1998 and 31 December 2000. Chart review was performed to determine the prevalence of diabetes risk factors and to describe follow-up.

RESULTS

Of 8,286 nondiabetic patients >/=45 years of age, 69% (n = 5,752) were screened. The frequency of screening was greater in patients with one or more primary care visits and increased with age. Women were more likely to be screened than men, and patients with at least one diabetes risk factor were more likely to be screened than those without risk factors. Random plasma glucose was the most common screening test (95%). Four percent (n = 202) of those screened had abnormal results. Only 38% (n = 77) of those with abnormal results received appropriate follow-up, and 17% (n = 35) were diagnosed with diabetes within 6 months of screening. The yield of screening was very low (0.6%, 35 of 5,752).

CONCLUSIONS

Despite frequent screening and appropriate targeting of high-risk patients, follow-up of patients with abnormal results is uncommon and the yield of screening is low. Interventions are needed to help physicians recognize and provide appropriate follow-up for patients with potentially abnormal random glucose levels.

Screening for diabetes in general practice

The prevalence of type 2 diabetes is rising rapidly worldwide. Evidence suggests that between one third and one half of cases are undiagnosed and patients may have preclinical disease for as long as 12 years. At diagnosis, 50% of patients have microvascular complications (retinopathy, neuropathy, or nephropathy) and patients have twice the risk of macrovascular disease compared to the background population. Screening for type 2 diabetes would allow earlier recognition of cases, with the potential to intervene earlier in the disease course, but whether this would result in improved long-term outcomes is unknown. The debate continues about who should be considered for screening, how we should screen, and whether we should screen for diabetes at all. The authors review the evidence, particularly in light of the recent position statement on diabetes screening published by the American Diabetes Association. If we do start screening for diabetes, one of the major challenges ahead is to ensure resources are in place to allow optimization of treatment for the increasing number of patients. This is important both in those found to have diabetes and in those with lesser degrees of glucose intolerance who are at high risk of developing diabetes and are at increased risk of macrovascular disease.

Screening for Type 2 diabetes--should it be now?

AIMS

Screening for Type 2 diabetes has been recommended in several countries due to the increasing prevalence of diabetes. This review evaluates whether Type 2 diabetes is a disease that fulfils the criteria for screening set by the World Health Organization.

METHODS

Literature search was performed on the literature bases MedLine, Pub Medical, NIDDK, Cochrane Library and CINAHL using the MeSH terms 'non-insulin-dependent-diabetes-mellitus' and mass screening. Using this strategy we identified studies specifically evaluating screening strategies and diagnostic tests for Type 2 diabetes. The evaluation of psychosocial consequences included studies related to other chronic diseases. This literature was used to evaluate whether the WHO criteria for screening were fulfilled.

RESULTS

The papers were reviewed but a meta-analysis was not possible, as no randomized controlled clinical trials were performed in the area of screening.

CONCLUSION

Type 2 diabetes does not fulfil the criteria for population-based mass screening. No screening and intervention studies have been performed, systematically evaluating the positive and negative effects of screening. Furthermore, intervention studies up until now have been restricted to clinically diagnosed patients with diabetes, and most of these have recruited patients with long diabetes duration and early complications. These groups will have a worse prognosis and thus probably show greater benefits of such intervention. Finally, the psychosocial and health economic consequences of screening and intervention for Type 2 diabetes are largely unknown. Thus, systematic screening and intervention trials should be encouraged, and meanwhile intensified case finding and opportunistic screening in high-risk groups should be performed.

A multivariate logistic regression equation to screen for diabetes: development and validation

OBJECTIVE

To develop and validate an empirical equation to screen for diabetes.

RESEARCH DESIGN AND METHODS

A predictive equation was developed using multiple logistic regression analysis and data collected from 1,032 Egyptian subjects with no history of diabetes. The equation incorporated age, sex, BMI, postprandial time (self-reported number of hours since last food or drink other than water), and random capillary plasma glucose as independent covariates for prediction of undiagnosed diabetes. These covariates were based on a fasting plasma glucose level >/=126 mg/dl and/or a plasma glucose level 2 h after a 75-g oral glucose load >/=200 mg/dl. The equation was validated using data collected from an independent sample of 1,065 American subjects. Its performance was also compared with that of recommended and proposed static plasma glucose cut points for diabetes screening.

RESULTS

The predictive equation was calculated with the following logistic regression parameters: P = 1/(1 - e(-x)), where x = -10.0382 + [0.0331 (age in years) + 0.0308 (random plasma glucose in mg/dl) + 0.2500 (postprandial time assessed as 0 to >/=8 h) + 0.5620 (if female) + 0.0346 (BMI)]. The cut point for the prediction of previously undiagnosed diabetes was defined as a probability value >/=0.20. The equation's sensitivity was 65%, specificity 96%, and positive predictive value (PPV) 67%. When applied to a new sample, the equation's sensitivity was 62%, specificity 96%, and PPV 63%.

CONCLUSIONS

This multivariate logistic equation improves on currently recommended methods of screening for undiagnosed diabetes and can be easily implemented in a inexpensive handheld programmable calculator to predict previously undiagnosed diabetes.

The performance of a risk score in predicting undiagnosed hyperglycemia

OBJECTIVE

Type 2 diabetes is a serious disease that is commonly undetected and for which screening is sometimes advocated. A number of risk factors are associated with prevalent undiagnosed diabetes. The use of routinely available information on these factors has been proposed as a simple and effective way of identifying individuals at high risk for having the disease. The objective of this study was to assess the effectiveness of the Cambridge risk score in a large and representative population.

RESEARCH DESIGN AND METHODS

A risk score derived from data in a previous study was tested for its ability to detect prevalent undiagnosed hyperglycemia as measured by a GHb > or = 6.0, 6.5, or 7% in 6,567 subjects aged 39-78 years in the European Prospective Investigation of Cancer-Norfolk cohort.

RESULTS

For a specificity of 78%, the risk score predicted a GHb of > or = 7.0% in subjects aged 39-78 years, with a sensitivity of 51% (95% CI 40-62). The areas under the receiver-operating characteristic (ROC) curve for GHb > or = 6.0, 6.5, and 7% were 65.7% (63.8-67.6), 71.2% (68.4-75.2), and 74.2% (69.5-79.0), respectively. The area under the ROC curve was not significantly reduced if data on family and smoking history were unavailable for any of the cut-offs for GHb.

CONCLUSIONS

The risk score performed as well as other previously reported models in all age groups. We concluded that a simple risk score using data routinely available in primary care can identify people with an elevated GHb with reasonable sensitivity and specificity, and it could therefore form part of a strategy for early detection of type 2 diabetes.

Performance of recommended screening tests for undiagnosed diabetes and dysglycemia

OBJECTIVE

To evaluate the performance, in settings typical of opportunistic and community screening programs, of screening tests currently recommended by the American Diabetes Association (ADA) for detecting undiagnosed diabetes.

RESEARCH DESIGN AND METHODS

Volunteers aged > or =20 years without previously diagnosed diabetes (n = 1,471) completed a brief questionnaire and underwent recording of postprandial time and measurement of capillary blood glucose (CBG) with a portable sensor. Participants subsequently underwent a 75-g oral glucose tolerance test; fasting serum glucose (FSG) and 2-h postload serum glucose (2-h SG) concentrations were measured. The screening tests we studied included the ADA risk assessment questionnaire, the recommended CBG cut point of 140 mg/dl, and an alternative CBG cut point of 120 mg/dl. Each screening test was evaluated against several diagnostic criteria for diabetes (FSG > or =126 mg/dl, 2-h SG > or =200 mg/dl, or either) and dysglycemia (FSG > or =110 mg/dl, 2-h SG > or =140 mg/dl, or either).

RESULTS

Among all participants, 10.7% had undiagnosed diabetes (FSG > or =126 or 2-h SG > or =200 mg/dl), 52.1% had a positive result on the questionnaire, 9.5% had CBG > or =140 mg/dl, and 18.4% had CBG > or =120 mg/dl. The questionnaire was 72-78% sensitive and 50-51% specific for the three diabetes diagnostic criteria; CBG > or =140 mg/dl was 56-65% sensitive and 95-96% specific, and CBG > or =120 mg/dl was 75-84% sensitive and 86-90% specific. CBG > or =120 mg/dl was 44-62% sensitive and 89-90% specific for dysglycemia.

CONCLUSIONS

Low specificity may limit the usefulness of the ADA questionnaire. Lowering the cut point for a casual CBG test (e.g., to 120 mg/dl) may improve sensitivity and still provide adequate specificity.

Random capillary plasma glucose measurement in the screening of diabetes mellitus in high-risk subjects in Thailand

To assess the usefulness of random capillary plasma glucose (RCPG) measurement in screening for diabetes mellitus in high-risk subjects, a RCPG measurement and a 75-g oral glucose tolerance test (OGTT) were performed in 684 women and 164 men, aged 16-76 years (mean+/-SD: 41.9+/-11.3 years). Risk factors included family history of diabetes in first degree relatives (53.8%), obesity (BMI > or =27 kg/m(2)) in 37.9%, dyslipidemia (78.4%), hypertension, i.e. BP > or =140/90 mmHg (28.5%), and history of gestational diabetes mellitus (16.6%). According to the 1997 ADA/1998 WHO Consultation criteria for a full OGTT, 118 cases (13.9%) were found to have diabetes. Each of 19 cases with RCPG > or =13.3 mmol/l had diabetes according to OGTT, 4.7% of 427 cases with RCPG<6.1 mmol/l had diabetes. Among 402 subjects with RCPG between 6.1 and <13.3 mmol/l, 19.7% were found to have diabetes. Thus, 446 (52.6%) of 848 subjects would have been saved from OGTT if RCPG was used as a screening test, in comparison to 33.1% if the cutpoints for RCPG (12.2 and 5.5 mmol/l) recommended by WHO Study Group (1985)/WHO Consultation (1998) were applied. Therefore, RCPG measurement is a useful screening test for the screening of diabetes mellitus in high-risk subjects.

Diabetes risk score: towards earlier detection of type 2 diabetes in general practice

BACKGROUND

Type 2 diabetes is common, costly and often goes unrecognised for many years. When patients are diagnosed, the majority exhibit associated tissue damage or established cardiovascular risk. Evidence is accumulating that earlier detection and management of diabetes and related metabolic abnormalities may be beneficial. We aimed to develop and evaluate a score based on routinely collected information to identify people at risk of having undetected diabetes.

METHODS

A population-based sample of 1077 people, aged 40 to 64 years, without known diabetes, from a single Cambridgeshire general practice, underwent clinical assessment including an oral glucose tolerance test. In a separate 12-month study, 41 practices in southern England reported clinical details of patients aged 40 to 64 years with newly diagnosed Type 2 diabetes. A notional population was created by random selection and pooling of half of each dataset. Data were entered into a regression model to produce a formula predicting the risk of diabetes. The performance of this risk score in detecting diabetes was tested in an independent, randomly selected, population-based sample.

RESULTS

Age, gender, body mass index, steroid and antihypertensive medication, family and smoking history contributed to the score. In the test population at 72% specificity, the sensitivity of the score was 77% and likelihood ratio 2.76. The area under the receiver-operating characteristic curve was 80%.

CONCLUSIONS

A simple score, using only data that are routinely collected in general practice, can help identify those at risk of diabetes. This score could contribute to efficient earlier detection through case-finding or targeted screening.

The rural health care workforce implications of practice guideline implementation

BACKGROUND

Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines.

PURPOSE

To estimate the impact of a practice guideline for a single health condition on the needs of a rural health professional workforce.

METHODS

The current care of a cohort of rural Medicare recipients with diabetes mellitus was compared with the care recommended by a diabetes practice guideline. The additional tests and visits that were needed to comply with the guideline were translated into additional hours of physician services and total physician full-time equivalents.

RESULTS

The implementation of a practice guideline for Medicare recipients with diabetes in rural Minnesota would require over 30,000 additional hours of primary care physician services and over 5,000 additional hours of eye care professionals' time per year. This additional need represents a 1.3% to 2.4% increase in the number of primary care physicians and a 1.0% to 6.6% increase in the number of eye-care clinicians in a state in which the rural medical provider to population ratios already meet some recommended workforce projections.

CONCLUSIONS

The implementation of practice guidelines could result in an increased need for rural health care physicians or other providers. That increase, caused by guideline implementation, should be accounted for in future rural health care workforce predictions.

Australian Diabetes Screening Study: impaired glucose tolerance and non-insulin-dependent diabetes mellitus

In preventing non-insulin-dependent diabetes mellitus (NIDDM) and its complications, screening high-risk individuals complements public health measures. Our screening instrument for patients of general practitioners was a questionnaire for self-determined high-risk groups plus a laboratory measurement of a random venous plasma glucose level. Collaborating practitioners evaluated 100 consecutive outpatients aged 40 years or older. The questionnaire identified patients with two or more diabetic symptoms or with two or more risk factors, and they were recommended to have their blood tested. For those with a random plasma glucose greater than 5.5 mmol/L, oral glucose tolerance tests (OGTTs) were advised. Of 50,859 subjects completing the study, there were 1,013 cases (2.0%) of new diabetes, 1,704 cases (3.4%) of impaired glucose tolerance (IGT), and 5,508 cases (10.8%) of previously diagnosed diabetes. Symptoms alone were a relatively poor discriminant. Almost all newly identified NIDDM and IGT patients had two or more risk factors for NIDDM. The risk ratios for abnormal glucose tolerance were as follows: high blood pressure, 2.4; overweight, 2.0; and positive family history, 1.7. Selection of cutoff points higher than 5.5 mmol/L would have substantially reduced the rate of newly discovered NIDDM and IGT. Screening for NIDDM and IGT in general practice is feasible and can be achieved with little disruption of office procedures. In preventive programs of this nature, the low screening threshold of 5.5 mmol/L for random venous plasma glucose maximizes the case-finding rate.

Diabetes mellitus in Egypt: risk factors and prevalence

Major sociodemographic changes have occurred in Egypt to promote the development of noncommunicable diseases. We have performed a cross-sectional, population-based survey of persons > or = 20 years of age in Cairo and surrounding rural villages to describe the prevalence of diabetes risk factors, diagnosed diabetes, previously undiagnosed diabetes, and impaired glucose tolerance by age, sex, rural and urban residence, and socioeconomic status (SES). In the survey, we identified 6052 eligible households: 76% of household respondents completed a household examination and 72% of selected household respondents subsequently completed a medical examination. Exercise was assessed by questionnaire; adiposity by measurement of height, weight, and girths; and diabetes by history and 2-h 75 g oral glucose tolerance test. In rural areas, 52% of persons > or = 20 years of age were sedentary, 16% were obese, and 4.9% had diabetes. In lower SES urban areas, 73% were sedentary, 37% were obese, and 13.5% had diabetes. In higher SES urban areas, 89% were sedentary, 49% were obese, and 20% had diabetes. The combined prevalence of diagnosed and undiagnosed diabetes in the Egyptian population > or = 20 years of age was estimated to be 9.3%. Approximately half the diabetes was diagnosed and the other half was previously undiagnosed. The prevalence of diabetes in Egypt is high, and the gradient in risk factors and disease from rural to urban areas and in urban areas from lower to higher SES suggest that diabetes is a major, emerging clinical and public health problem in Egypt.