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Wang Q, Gan Z, Gao Q, Wang M, Zhan B. The associations of risk of cardiovascular disease with development stages of diabetes in Chinese population: findings from a retrospective cohort study in QuZhou city. BMC Endocr Disord 2024; 24:18. [PMID: 38302943 PMCID: PMC10835855 DOI: 10.1186/s12902-024-01544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Risk analysis is an important area of research in diabetes and cardiovascular disease (CVD), both of which have significant global health burdens. Although there is evidence that patients with prediabetes and diabetes mellitus may have an increased risk of CVD, few studies have been conducted in mainland China. METHODS This retrospective cohort study utilized data from the Quzhou City Resident Health Information System and the Zhejiang Province Chronic Disease Surveillance System in China. Prediabetes and diabetes mellitus were the exposure interests, and the outcome event was defined as the onset of cardiovascular and cerebrovascular disease (including coronary heart disease and stroke). The start date of the study was January 1, 2015, and the follow-up deadline was December 31, 2020. Multivariate Cox proportional hazard model were used to assess the associations among prediabetes, diabetes, and CVD risk. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Our study used follow-up time as the time scale, while adjusting for age, sex, physical activity, smoking, alcohol consumption, BMI in the models Sensitivity analyses were conducted to assess the stability of the results, by excluding participants who smoked and drank alcohol, participants who developed CVD in the first year of follow-up. RESULTS In total, 138,970 participants were included in our study, with a mean follow-up of 5.8 years. The mean age of the participants was 58.82 ± 14.44 years, with 42.79% (n = 59,466) males and 57.21% (n = 79,504) females. During the study period 4357 cases of CVD were recorded. Participants with prediabetes (P = 0.003) and diabetes (P < 0.001) had a higher risk of CVD than those who were Normal (HR [95% CI]: 1.14 [1.05-1.24]; 1.68 [1.55-1.81], respectively). Prediabetes and patients living with diabetes had a 14% and 68% increased risk of CVD, respectively. The results of the sensitivity analyses were consistent with those of the main analyses after excluding those who developed CVD within one year of follow-up and those who were concurrent smokers or alcohol drinkers. CONCLUSIONS Our research found that prediabetes is significantly associated with the risk of diabetes and CVD.
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Affiliation(s)
- Qi Wang
- Zhejiang Chinese Medicine University, 548 Binwen Road, Binjiang District, 310053, Hangzhou, Zhejiang Province, China
| | - Zhijuan Gan
- Quzhou Center for Disease Control and Prevention , 154 Xi'an Road, Kecheng District, 324003, Quzhou , Zhejiang Province, China
| | - Qing Gao
- Zhejiang Chinese Medicine University, 548 Binwen Road, Binjiang District, 310053, Hangzhou, Zhejiang Province, China
| | - Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, China.
| | - Bingdong Zhan
- Zhejiang Chinese Medicine University, 548 Binwen Road, Binjiang District, 310053, Hangzhou, Zhejiang Province, China.
- Quzhou Center for Disease Control and Prevention , 154 Xi'an Road, Kecheng District, 324003, Quzhou , Zhejiang Province, China.
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023; 46:e151-e199. [PMID: 37471273 PMCID: PMC10516260 DOI: 10.2337/dci23-0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA
| | - George L. Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL
| | - David E. Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA
| | - Andrea R. Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E. Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - M. Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2023:hvad080. [PMID: 37473453 DOI: 10.1093/clinchem/hvad080] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA, United States
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, ILUnited States
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA, United States
| | - Andrea R Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL, United States
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA, United States
| | - M Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Yuan J, Jia P, Zhou JB. Comparison of Bone Mineral Density in US Adults With Diabetes, Prediabetes and Normoglycemia From 2005 to 2018. Front Endocrinol (Lausanne) 2022; 13:890053. [PMID: 35712240 PMCID: PMC9195625 DOI: 10.3389/fendo.2022.890053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Accumulating evidence has shown that diabetes has an impact on bone metabolism with conflicting results. Furthermore, little is known about the relationship of prediabetes with bone mineral density (BMD). Therefore, we explored the association between BMD and glucometabolic status in adults in the US. METHODS In this cross-sectional study, we extracted and analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. A total of 14610 subjects aged 40 ≥ years diagnosed with diabetes, prediabetes, or normal glucose regulation (NGR) and had available data on BMD were eligible. RESULTS The prevalence of prediabetes and diabetes in US adults aged 40 ≥ years were 39.2% and 26.4%, respectively. After multivariable adjustment, we found an increasing trend of BMD at the total hip, femoral neck, and lumbar spine with glucometabolic conditions from NGR and prediabetes to diabetes in adults aged ≥ 40 years in the US. This trend was more prominent in women than that in men. Fasting plasma glucose (FPG) and HbA1c levels were also positively correlated with BMD. CONCLUSIONS Glucometabolic conditions were significantly associated with BMD values in US adults.
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Affiliation(s)
- Jing Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Pu Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Pu Jia, ; Jian-Bo Zhou,
| | - Jian-Bo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Pu Jia, ; Jian-Bo Zhou,
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Witkowski M, Wu Y, Hazen SL, Tang WHW. Prognostic value of subclinical myocardial necrosis using high-sensitivity cardiac troponin T in patients with prediabetes. Cardiovasc Diabetol 2021; 20:171. [PMID: 34419046 PMCID: PMC8379781 DOI: 10.1186/s12933-021-01365-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/15/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Risk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes. METHODS hs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7-6.4% or fasting glucose 100-125 mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3 years and all-cause mortality over 5 years. RESULTS In our study cohort, hs-cTnT was highly prevalent with a median level of 13 ng/L (interquartile range 8.2-21.6 ng/L). Hs-cTnT was independently associated with incident MACE at 3 years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69-3.46], P < 0.001) and 5-year mortality (adjusted HR 3.8 [95% CI 2.55-5.67], P < 0.001). This association remained significant in all subsets after adjustment for traditional risk factors and multiple factors known to increase hs-cTnT levels. Moreover, hs-cTnT independently predicted event risk in primary prevention subjects (n = 557, HR 5.46 [95% CI 1.50-19.89), p < 0.01) for MACE; HR 9.53 [95% CI 2.08-43.73] for all-cause mortality) and secondary prevention subjects (n = 2074, HR 1.86 [95% CI 1.31-2.66], P < 0.001 for MACE; and 2.7 [95% CI 1.79-4.08), P < 0.001 for all-cause mortality). CONCLUSIONS In stable prediabetic subjects, the presence of subclinical myocardial necrosis as detected by hs-cTnT portends heightened long-term adverse cardiovascular event risk. Hs-cTnT levels may help to stratify risk and improve clinical decision making in patients with prediabetes. Trial registration ClinicalTrials.gov Identifier: NCT00590200.
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Affiliation(s)
- Marco Witkowski
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, OH, USA
| | - Stanley L Hazen
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - W H Wilson Tang
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. .,Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
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Lee JH, Chon S, Cha SA, Lim SY, Kim KR, Yun JS, Rhee SY, Yoon KH, Ahn YB, Woo JT, Ko SH. Impaired fasting glucose levels in overweight or obese subjects for screening of type 2 diabetes in Korea. Korean J Intern Med 2021; 36:382-391. [PMID: 32114752 PMCID: PMC7969057 DOI: 10.3904/kjim.2019.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND/AIMS We examined the concordance rate among fasting plasma glucose (FPG), 2-hour post-challenge glucose (2hr PG), and hemoglobin A1c (HbA1c) in the diagnosis of diabetes in a population with a high-risk for type 2 diabetes mellitus (T2DM) in Korea. METHODS Among the participants from the Korean Diabetes Prevention Study, individuals with FPG ≥ 100 mg/dL, body mass index (BMI) ≥ 23.0 kg/m2, and no previous history of T2DM were consecutively enrolled after a 75 g glucose tolerance test. We analyzed the differences in the clinical characteristics in subjects with stage 1 (FPG, 100 to 109 mg/dL) and stage 2 (FPG, 110 to 125 mg/dL) impaired fasting glucose (IFG). RESULTS Of 1,637 participants, 27.2% had T2DM and 59.3% had IFG and/or impaired glucose tolerance (IGT). The mean age was 55.0 ± 8.1 years and the mean BMI was 26.3 ± 2.7 kg/m2. Based on FPG criteria, 515 (31.4%) and 352 (21.5%) subjects were classified as having stage 1 and stage 2 IFG, respectively. The 19.0% of stage 1 and 43.5% of stage 2 subjects showed 2hr PG levels in the diabetic range. Even for those in the normal FPG range, 63 (9.5%) participants showed a 2hr PG level of ≥ 200 mg/dL. Of 446 subjects with newly-diagnosed diabetes, 340 (76.2%) showed FPG levels < 126 mg/dL. CONCLUSION The oral glucose tolerance test should be actively considered for Korean adults who are overweight or obese with the IFG range (FPG, 100 to 125 mg/ dL) to allow for early detection of diabetes and prompt intervention.
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Affiliation(s)
- Jin-Hee Lee
- Catholic Institute of Smart Healthcare Center, Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sun-Young Lim
- Catholic Institute of Smart Healthcare Center, Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Korea
| | - Kook-Rye Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kun-Ho Yoon
- Catholic Institute of Smart Healthcare Center, Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jeong-Taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Korean Diabetes Prevention Study Investigators
- Catholic Institute of Smart Healthcare Center, Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mosili P, Mkhize BC, Ngubane P, Sibiya N, Khathi A. The dysregulation of the hypothalamic-pituitary-adrenal axis in diet-induced prediabetic male Sprague Dawley rats. Nutr Metab (Lond) 2020; 17:104. [PMID: 33308255 PMCID: PMC7731754 DOI: 10.1186/s12986-020-00532-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Altered function of the hypothalamic-pituitary-adrenal (HPA) axis in type 2 diabetic patients, a condition preceded by pre-diabetes, has been shown to increase the risk of depression as well as cause downstream effects resulting in upregulation of gluconeogenesis and dyslipidemia. In addition, stress, either psychological from managing diabetes or lifestyle related, further activates the HPA axis causing an exaggerated stress response. This study investigated the activity of the HPA axis in selected markers of glucose handling, and the stress response relative to components of the HPA axis in a diet-induced pre-diabetic rat model. METHODS Sprague Dawley Rats were randomly divided into non-pre-diabetic group (NPD) and pre-diabetic group (PD) (n = 6, per group) over a 20-week induction period and a further 12-week experimental period to get 32 weeks. At the end of the 20 and 32-week periods, glucose handling using the Homeostasis Model Assessment indices, adrenocorticotropic (ACTH) and corticosterone (CORT) concentrations were measured. Stress was induced and the forced swim test were performed in the 12-week experimental week. At the end of 32 weeks glucocorticoid and mineralocorticoid hippocampal receptors were also measured. RESULTS Impaired glucose handling in the PD group as well as increase in corticosterone was observed at the end of both 20 and 32-week periods by comparison to NPD groups. No changes were observed in ACTH concentration at week 20 while, at week 32, a decrease in plasma ACTH concentration was observed in the PD group by comparison to the NPD group. The stressed-induced animals were stressed using the forced swim test: the behaviour observed showed an increase in immobility time in the PD stressed group by comparison to the NPD group. This was followed by the observation of a decrease in ACTH and CORT concentration in the PD stressed group by comparison to the NPD stressed group. Mineralocorticoid and glucocorticoid receptors gene expression were elevated in the stressed PD group relative to the stressed NPD group. CONCLUSION These observations, together, suggest that diet-induced pre-diabetes is associated with impaired HPA axis activity and deteriorating response to stress.
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Affiliation(s)
- Palesa Mosili
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Room E2-401, Westville, 4000, South Africa.
| | - Bongeka Cassandra Mkhize
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Room E2-401, Westville, 4000, South Africa
| | - Phikelelani Ngubane
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Room E2-401, Westville, 4000, South Africa
| | - Ntethelelo Sibiya
- Pharmacology Division, Faculty of Pharmacy, Rhodes University, Grahamstown, 6140, South Africa
| | - Andile Khathi
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Room E2-401, Westville, 4000, South Africa
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Yalçınkaya Kara ZM, Serin E, Dağ İ, Serin Ö. Pre-diyabetik ve yeni tanı almış tip 2 diyabetli hastalarda serum apelin-36 düzeyleri. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.504415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chivese T, Werfalli MM, Magodoro I, Chinhoyi RL, Kengne AP, Norris SA, Levitt NS. Prevalence of type 2 diabetes mellitus in women of childbearing age in Africa during 2000-2016: a systematic review and meta-analysis. BMJ Open 2019; 9:e024345. [PMID: 31122965 PMCID: PMC6538083 DOI: 10.1136/bmjopen-2018-024345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The aim of this research was to estimate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in African women of childbearing age. STUDY DESIGN Systematic review and meta-analysis of relevant African studies published from January 2000 to December 2016. DATA SOURCES We searched several databases, including EMBASE, MEDLINE, CINAHL, grey literature and references of included studies. SETTING Studies carried out in African communities or any population-based studies were included. PARTICIPANTS We included studies, carried out in Africa, with non-pregnant women of childbearing age. Studies must have been published between the years 2000 and 2016. OUTCOMES The primary outcome was prevalent T2DM. The secondary outcomes were IFG and IGT. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and, using the adapted Hoy risk of bias tool, independently assessed for risk of bias. We used random-effects meta-analysis models to pool prevalence estimates across studies. We used Cochran's Q statistic and the I2 statistic to assess heterogeneity. RESULTS A total of 39 studies from 27 countries were included, totaling 52 075 participants, of which 3813 had T2DM. The pooled prevalence of T2DM was 7.2% (95% CI 5.6% to 8.9%) overall and increased with age. The pooled prevalence was 6.0% (95% CI 4.2% to 8.2%) for impaired fasting glycemia while the prevalence of IGT ranged from 0.9% to 37.0% in women aged 15-24 and 45-54 years, respectively. Substantial heterogeneity across studies was not explained by major studies characteristics such as period of publication, rural/urban setting or whether a study was nationally representative or not. CONCLUSION This review highlights the need for interventions to prevent and control diabetes in African women of childbearing age, in view of the significant prevalence of T2DM and prediabetes. PROSPERO REGISTRATION NUMBER CRD42015027635.
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Affiliation(s)
- Tawanda Chivese
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Biostatistics Unit, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mahmoud M Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Itai Magodoro
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rekai Lionel Chinhoyi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - A P Kengne
- Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Parizadeh D, Rahimian N, Akbarpour S, Azizi F, Hadaegh F. Sex-specific clinical outcomes of impaired glucose status: A long follow-up from the Tehran Lipid and Glucose Study. Eur J Prev Cardiol 2019; 26:1080-1091. [PMID: 30862232 DOI: 10.1177/2047487319834396] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS To investigate the sex-specific associations of prediabetes with major clinical outcomes including incident type 2 diabetes, chronic kidney disease, hypertension, coronary heart disease, stroke and all-cause mortality. METHODS Among 8498 Iranian adults from the Tehran Lipid and Glucose Study, aged ≥30 years and without diagnosed type 2 diabetes, gender-interactions were assessed for each outcome, followed by sex-separated multivariate-adjusted Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals (CIs) of different prediabetes categories, including impaired fasting glucose (IFG), defined by the American Diabetes Association (ADA) and World Health Organization (WHO), as fasting plasma glucose of 5.6-6.9 mmol/L and 6.1-6.9 mmol/L, respectively, and impaired glucose tolerance, defined as 2-h post challenge plasma glucose of 7.8-11 mmol/L. RESULTS Sex-specific associations existed for men between IFG-ADA and chronic kidney disease (hazard ratio: 1.28, 95% CI 0.99-1.65; pinteraction = 0.008) and between IFG-WHO and stroke (hazard ratio: 2.15, 95% CI 1.08-4.27; pinteraction = 0.21); and for women between IFG-ADA and hypertension (hazard ratio: 1.24, 95% CI 1.04-1.48; pinteraction = 0.06) and between impaired glucose tolerance and coronary heart disease (hazard ratio: 1.57, 95% CI 1.14-2.16; pinteraction = 0.05). Among both genders, all prediabetes definitions were associated with type 2 diabetes but none with mortality. CONCLUSIONS The hazards of prediabetes definitions may differ between genders depending on the outcome of interest. IFG-WHO among men and impaired glucose tolerance among women are particularly important because of their association with incident stroke and coronary heart disease, respectively. Considering these sex differences could improve personalized management of prediabetes.
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Affiliation(s)
- Donna Parizadeh
- 1 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Rahimian
- 2 Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- 3 Occupational Sleep Research Center (OSRC), Baharloo Hospital, Tehran University of Medical Sciences, Iran.,4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Fereidoun Azizi
- 5 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- 1 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Richter B, Hemmingsen B, Metzendorf M, Takwoingi Y. Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev 2018; 10:CD012661. [PMID: 30371961 PMCID: PMC6516891 DOI: 10.1002/14651858.cd012661.pub2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts. OBJECTIVES To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia. SEARCH METHODS We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining. SELECTION CRITERIA We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only. DATA COLLECTION AND ANALYSIS One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework. MAIN RESULTS We included 103 prospective cohort studies. The studies mainly defined IH by IFG5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG5.6, IFG6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG6.1 and IFG5.6. Limited data showed a higher T2DM incidence associated with HbA1c6.0 compared to HbA1c5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018. AUTHORS' CONCLUSIONS Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.
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Affiliation(s)
- Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Bianca Hemmingsen
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
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Lim WY, Ma S, Heng D, Tai ES, Khoo CM, Loh TP. Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore. Sci Rep 2018; 8:12419. [PMID: 30127499 PMCID: PMC6102285 DOI: 10.1038/s41598-018-29998-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022] Open
Abstract
The prevalence of diabetes in Singapore is high. Screening to facilitate early detection and intervention has been shown to be cost-effective. Current clinical practice guidelines in Singapore recommend screening with fasting plasma glucose (FPG), followed by an oral glucose tolerance test (OGTT) in those with FPG 6.1-6.9 mmol/L. Glycated haemoglobin A1c (HbA1c) has robust stability at ambient temperature, and can be performed on non-fasted capillary blood samples, making it an attractive potential alternative for screening. However, limitations of HbA1c include differential performance in different races, and its performance as a screening test has not been well characterized in Asian populations. This study compares HbA1c and FPG as diabetes screening modalities in 3540 community-dwelling Singapore residents of Chinese, Malay and Indian race to detect diabetes mellitus diagnosed based on blood glucose (FPG ≥ 7.0 mmol/L, 2 hr OGTT ≥ 11.1 mmol/L). The area under the receiver-operating-characteristic curve (AUC) was higher for FPG compared to HbA1c in the overall population and age, race and age-race strata, but these differences were not statistically significant. HbA1c > = 7.0% identified 95% of individuals with diabetes mellitus, and the remainder had impaired glucose tolerance (IGT). HbA1c cut-off at 6.1% had better sensitivity (0.825) to FPG at 6.1 mmol/L. The positive predictive value of HbA1c at 6.1% was 40-50% in different age-race combinations with a negative predictive value of about 98%. If follow-up screening with FPG is used, a lower cut-off at 5.6 mmol/L is appropriate in identifying people with pre-diabetes, as about 85% of people with HbA1c 6.1-6.9% and FPG 5.6-6.9 mmol/L had IFG/IGT or diabetes in the study sample. HbA1c is an appropriate alternative to FPG as a first-step screening test, and the combination of Hba1c > = 6.1% and FPG > = 5.6 mmol/L would improve the identification of individuals with diabetes mellitus and prediabetes.
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Affiliation(s)
- Wei-Yen Lim
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore, Singapore
| | - Derrick Heng
- Public Health Group, Ministry of Health, Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Chin Meng Khoo
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Tze Ping Loh
- Department Laboratory Medicine, National University Hospital, Singapore, Singapore.
- Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore, Singapore.
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13
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Hwang YC, Fujimoto WY, Kahn SE, Leonetti DL, Boyko EJ. Predictors of Incident Type 2 Diabetes Mellitus in Japanese Americans with Normal Fasting Glucose Level. Diabetes Metab J 2018; 42:198-206. [PMID: 29885113 PMCID: PMC6015963 DOI: 10.4093/dmj.2017.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/19/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Little is known about the natural course of normal fasting glucose (NFG) in Asians and the risk factors for future diabetes. METHODS A total of 370 Japanese Americans (163 men, 207 women) with NFG levels and no history of diabetes, aged 34 to 75 years, were enrolled. Oral glucose tolerance tests were performed at baseline, 2.5, 5, and 10 years after enrollment. RESULTS During 10 years of follow-up, 16.1% of participants met criteria for diabetes diagnosis, and 39.6% of subjects still had NFG levels at the time of diabetes diagnosis. During 5 years of follow-up, age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01 to 1.10; P=0.026) and family history of diabetes (OR, 3.24; 95% CI, 1.42 to 7.40; P=0.005) were independently associated with future diabetes diagnosis; however, fasting glucose level was not an independent predictor. During 10 years of follow-up, family history of diabetes (OR, 2.76; 95% CI, 1.37 to 5.54; P=0.004), fasting insulin level (OR, 1.01; 95% CI, 1.00 to 1.02; P=0.037), and fasting glucose level (OR, 3.69; 95% CI, 1.13 to 12.01; P=0.030) were associated with diabetes diagnosis independent of conventional risk factors for diabetes. CONCLUSION A substantial number of subjects with NFG at baseline still remained in the NFG range at the time of diabetes diagnosis. A family history of diabetes and fasting insulin and glucose levels were associated with diabetes diagnosis during 10 years of follow-up; however, fasting glucose level was not associated with diabetes risk within the relatively short-term follow-up period of 5 years in subjects with NFG.
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Affiliation(s)
- You Cheol Hwang
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Wilfred Y Fujimoto
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Donna L Leonetti
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
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Brannick B, Dagogo-Jack S. Prediabetes and Cardiovascular Disease: Pathophysiology and Interventions for Prevention and Risk Reduction. Endocrinol Metab Clin North Am 2018; 47:33-50. [PMID: 29407055 PMCID: PMC5806140 DOI: 10.1016/j.ecl.2017.10.001] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prediabetes is a state characterized by impaired fasting glucose or impaired glucose tolerance. This review discusses the pathophysiology and macrovascular complications of prediabetes. The pathophysiologic defects underlying prediabetes include insulin resistance, alpha- and beta-cell dysfunction, increased lipolysis, inflammation, and suboptimal incretin effect. Recent studies have revealed that the long-term complications of diabetes manifest in some people with prediabetes; these complications include microvascular and macrovascular disorders. Finally, we present an overview of randomized control trials aimed at preventing progression from prediabetes to type 2 diabetes and discuss their implications for macrovascular risk reduction.
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Affiliation(s)
- Ben Brannick
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, 920 Madison Avenue, Suite 300A, Memphis, TN 38163, USA
| | - Sam Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, 920 Madison Avenue, Suite 300A, Memphis, TN 38163, USA.
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15
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Kagawa R, Kawazoe Y, Ida Y, Shinohara E, Tanaka K, Imai T, Ohe K. Development of Type 2 Diabetes Mellitus Phenotyping Framework Using Expert Knowledge and Machine Learning Approach. J Diabetes Sci Technol 2017; 11:791-799. [PMID: 27932531 PMCID: PMC5588819 DOI: 10.1177/1932296816681584] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Phenotyping is an automated technique that can be used to distinguish patients based on electronic health records. To improve the quality of medical care and advance type 2 diabetes mellitus (T2DM) research, the demand for T2DM phenotyping has been increasing. Some existing phenotyping algorithms are not sufficiently accurate for screening or identifying clinical research subjects. OBJECTIVE We propose a practical phenotyping framework using both expert knowledge and a machine learning approach to develop 2 phenotyping algorithms: one is for screening; the other is for identifying research subjects. METHODS We employ expert knowledge as rules to exclude obvious control patients and machine learning to increase accuracy for complicated patients. We developed phenotyping algorithms on the basis of our framework and performed binary classification to determine whether a patient has T2DM. To facilitate development of practical phenotyping algorithms, this study introduces new evaluation metrics: area under the precision-sensitivity curve (AUPS) with a high sensitivity and AUPS with a high positive predictive value. RESULTS The proposed phenotyping algorithms based on our framework show higher performance than baseline algorithms. Our proposed framework can be used to develop 2 types of phenotyping algorithms depending on the tuning approach: one for screening, the other for identifying research subjects. CONCLUSIONS We develop a novel phenotyping framework that can be easily implemented on the basis of proper evaluation metrics, which are in accordance with users' objectives. The phenotyping algorithms based on our framework are useful for extraction of T2DM patients in retrospective studies.
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Affiliation(s)
- Rina Kagawa
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yoshimasa Kawazoe
- Department of Healthcare Information Management, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Ida
- Department of Healthcare Information Management, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Emiko Shinohara
- Department of Healthcare Information Management, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Katsuya Tanaka
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Imai
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiko Ohe
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Healthcare Information Management, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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16
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Nakagami T, Tanaka Y, Oya J, Kurita M, Isago C, Hasegawa Y, Ito A, Hirota N, Tsuzura R, Uchigata Y. Associations of HbA1c and fasting plasma glucose with incident diabetes: Implications for pre-diabetes thresholds in a Japanese population. Prim Care Diabetes 2016; 10:407-414. [PMID: 27515716 DOI: 10.1016/j.pcd.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/02/2016] [Accepted: 07/16/2016] [Indexed: 02/03/2023]
Abstract
AIMS This study assessed pre-diabetes (pre-DM) cutoffs for HbA1c and fasting plasma glucose (FPG) that were associated with an increased risk of incident DM. METHODS We evaluated 2267 non-diabetic Japanese health-check examinees (HbA1c: <6.5% [<48mmol/mol] and FPG: <7.0mmol/L) who were 30-79 years old and were followed-up for 5 years. Incident DM was defined as HbA1c of ≥6.5% (≥48mmol/mol), FPG of ≥7.0mmol/L, or physician-diagnosed DM. RESULTS During 11047 person-years, we identified 99 incident DM cases (4.3%). The incidence of DM increased with increasing baseline HbA1c or FPG levels, and the change points (95% confidence intervals) were 5.7% (5.6-5.7%; 39mmol/mol [38-39mmol/mol]) for HbA1c and 5.5mmol/L (5.5-5.6mmol/L) for FPG. The adjusted hazard ratios (HRs) for incident DM per one standard deviation-increase in HbA1c and FPG were 5.5 (4.4-6.8) and 4.0 (3.2-4.8), respectively. The adjusted HRs for incident DM were significantly higher at HbA1c of 5.7-6.4% (39-46mmol/mol) or FPG of 5.5-6.9mmol/L, compared to HbA1c of <5.7% (<39mmol/mol) or FPG of <5.5mmol/L. CONCLUSION The lower cut-offs for pre-DM may be 5.7% (39mmol/mol) for HbA1c and 5.5mmol/L for FPG in this Japanese population.
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Affiliation(s)
- Tomoko Nakagami
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
| | - Yuki Tanaka
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junko Oya
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Moritoshi Kurita
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Chisato Isago
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yukiko Hasegawa
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Arata Ito
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naoki Hirota
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Reika Tsuzura
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ 2016; 355:i5953. [PMID: 27881363 PMCID: PMC5121106 DOI: 10.1136/bmj.i5953] [Citation(s) in RCA: 577] [Impact Index Per Article: 72.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality. DESIGN Meta-analysis of prospective cohort studies. DATA SOURCES Electronic databases (PubMed, Embase, and Google Scholar). SELECTION CRITERIA Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovascular disease, coronary heart disease, stroke, all cause mortality, and prediabetes. REVIEW METHODS Two authors independently reviewed and selected eligible studies, based on predetermined selection criteria. Prediabetes was defined as impaired fasting glucose according to the criteria of the American Diabetes Association (IFG-ADA; fasting glucose 5.6-6.9 mmol/L), the WHO expert group (IFG-WHO; fasting glucose 6.1-6.9 mmol/L), impaired glucose tolerance (2 hour plasma glucose concentration 7.8-11.0 mmol/L during an oral glucose tolerance test), or raised haemoglobin A1c (HbA1c) of 39-47 mmol/mol : (5.7-6.4%) according to ADA criteria or 42-47 mmol/mol (6.0-6.4%) according to the National Institute for Health and Care Excellence (NICE) guideline. The relative risks of all cause mortality and cardiovascular events were calculated and reported with 95% confidence intervals. RESULTS 53 prospective cohort studies with 1 611 339 individuals were included for analysis. The median follow-up duration was 9.5 years. Compared with normoglycaemia, prediabetes (impaired glucose tolerance or impaired fasting glucose according to IFG-ADA or IFG-WHO criteria) was associated with an increased risk of composite cardiovascular disease (relative risk 1.13, 1.26, and 1.30 for IFG-ADA, IFG-WHO, and impaired glucose tolerance, respectively), coronary heart disease (1.10, 1.18, and 1.20, respectively), stroke (1.06, 1.17, and 1.20, respectively), and all cause mortality (1.13, 1.13 and 1.32, respectively). Increases in HBA1c to 39-47 mmol/mol or 42-47 mmol/mol were both associated with an increased risk of composite cardiovascular disease (1.21 and 1.25, respectively) and coronary heart disease (1.15 and 1.28, respectively), but not with an increased risk of stroke and all cause mortality. CONCLUSIONS Prediabetes, defined as impaired glucose tolerance, impaired fasting glucose, or raised HbA1c, was associated with an increased risk of cardiovascular disease. The health risk might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA1c of 39 mmol/mol.
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Affiliation(s)
- Yuli Huang
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
| | - Xiaoyan Cai
- Clinical Medicine Research Centre, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, China
| | - Weiyi Mai
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meijun Li
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
- Department of Cardiology, Graduate College, Guangdong medical university, Zhanjiang, China
| | - Yunzhao Hu
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
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Affiliation(s)
- Mayer B Davidson
- Charles R. Drew University (M.B.D.), Los Angeles, California 90059; and University of North Carolina School of Medicine (R.A.K.), Chapel Hill, North Carolina 27599
| | - Richard A Kahn
- Charles R. Drew University (M.B.D.), Los Angeles, California 90059; and University of North Carolina School of Medicine (R.A.K.), Chapel Hill, North Carolina 27599
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Ezerarslan H, Çandar T, Özdemir S, Ataç GK, Kocatürk S. Plasma Glycated Albumin Levels Clearly Detect Hearing Loss and Atherosclerosis in Patients with Impaired Fasting Glucose. Med Princ Pract 2016; 25:309-15. [PMID: 27165099 PMCID: PMC5588429 DOI: 10.1159/000446478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 04/27/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the relationship between atherosclerosis and hearing thresholds in prediabetic patients with impaired fasting glucose (IFG) and to determine the efficacy of glycated albumin in predicting carotid artery atherosclerosis in patients with isolated IFG. SUBJECTS AND METHODS The study included 82 patients (aged 53.73-80 years) divided into two groups based on fasting glucose levels, the IFG group: 59 patients (32 females, 54.2%), and the normal fasting plasma glucose level group: 23 patients (12 females, 52.2%). Patients underwent audiological testing to determine hearing thresholds, and carotid intima-media thickness (CIMT) was measured using carotid artery Doppler sonography. Multivariate analyses were performed to determine whether or not the plasma glycated albumin levels could predict hearing loss and CIMT. RESULTS Patients in the IFG group (mean age: 59.8 ± 9.5 years) had higher hearing thresholds and pure-tone average scores (PTA) than those in the group with normal glucose levels (mean age: 56.2 ± 10.1 years) (left ear: 27.65 ± 8.85 vs. 25.75 ± 21.96 dB, p = 0.021; right ear: 29.22 ± 8.51 vs. 22.39 ± 6.99 dB, p = 0.001). The CIMT was significantly higher in the IFG group than the control group (0.75 ± 0.26 vs. 0.56 ± 0.16 mm, p < 0.001 for the left and 0.74 ± 0.26 vs. 0.51 ± 0.19 mm, p < 0.001 for the right carotid arteries). Glycated albumin levels were independently related with increased CIMT (left CIMT: r = 0.32, p = 0.003; right CIMT: r = 0.42, p < 0.001), and serum glycated albumin levels were significantly associated with PTA (left ear: r = 0.28, p = 0.01; right ear: r = 0.30, p = 0.006). CONCLUSION Sensorineural hearing loss was more common in patients with IFG. Plasma glycated albumin levels were strongly correlated with CIMT and carotid plaques as a marker of atherosclerosis and with hearing impairment thought to develop due to atherosclerosis in patients with IFG.
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Affiliation(s)
| | | | | | - Gökçe Kaan Ataç
- Department of Radiology, Ufuk University Medical School, Ankara, Turkey
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Xu T, Liu W, Cai X, Ding J, Tang H, Huang Y, Hu Y. Risk of Coronary Heart Disease in Different Criterion of Impaired Fasting Glucose: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1740. [PMID: 26448033 PMCID: PMC4616744 DOI: 10.1097/md.0000000000001740] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The cut-point for diagnosing impaired fasting glucose (IFG) had been dispute, as reports about the associated clinical events are inconsistent. This meta-analysis evaluated the risk of coronary heart disease (CHD) in association with different criterion of IFG according to the American Diabetes Association (ADA) or the World Health Organization (WHO) Expert Group. We included prospective cohort studies with multivariate-adjusted data on IFG and CHD for analysis. The relative risks (RRs) of CHD were calculated and reported with 95% confidence intervals (95% CIs). Seventeen prospective cohort studies, comprising 527,021 individuals were included. The risks of CHD were increased in both participants with IFG defined as the ADA or WHO criterion (RR 1.11, 95% CI 1.02-1.21; and RR 1.18, 95% CI 1.10-1.28, respectively). Subgroup analyses showed that in both definition of IFG, the risk of CHD was only increased in studies with possibility of enrolling patients with increased 2 hours plasma glucose (2-h PG), or in studies with inadequate adjustment, but not in studies excluded participants with increased 2-h PG or in those with adequate adjustment of other risk factors. Our meta-analysis demonstrates that the presence of IFG was significantly associated with future risk of CHD. The risk of CHD was increased when fasting plasma glucose was as low as 100 mg/dL according to the lower cut-point of IFG by the ADA criterion. However, the risk maybe confounded by the undetected increased 2-h PG or other cardiovascular risk factors.
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Affiliation(s)
- Tianyu Xu
- From the Clinical Medicine Research Institute, The Affiliated Hospital at Shunde, Southern Medical University, Foshan (TX, XC, JD, HT, YH, YH); First School of Clinical Medicine, Southern Medical University (TX, JD); Department of Pediatrics, The First Affiliated Hospital, SUN Yat-sen University, Ghangzhou (WL); and Department of Cardiology, the First People's Hospital of Shunde, Foshan, P.R. China (YH)
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Bao C, Zhang D, Sun B, Lan L, Cui W, Xu G, Sui C, Wang Y, Zhao Y, Wang J, Li H. Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China. PLoS One 2015; 10:e0119510. [PMID: 25785585 PMCID: PMC4364753 DOI: 10.1371/journal.pone.0119510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/14/2015] [Indexed: 01/06/2023] Open
Abstract
To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.
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Affiliation(s)
- Chundan Bao
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Dianfeng Zhang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
- Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China
| | - Bo Sun
- Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China
| | - Li Lan
- Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China
| | - Wenxiu Cui
- Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China
| | - Guohua Xu
- Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China
| | - Conglan Sui
- Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China
| | - Yibaina Wang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Yashuang Zhao
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
- * E-mail: (YZ); (JW); (HL)
| | - Jian Wang
- Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China
- * E-mail: (YZ); (JW); (HL)
| | - Hongyuan Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
- * E-mail: (YZ); (JW); (HL)
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Esteghamati A, Zandieh A, Hafezi-Nejad N, Sheikhbahaei S, Abbasi M, Gouya MM, Nakhjavani M. Revising the fasting glucose threshold for detection of cardiovascular risk factors: analysing two representative population-based studies of more than 50,000 Iranians in 3 years: The National Survey of Risk Factors for Non-Communicable Diseases of Iran. Ann Hum Biol 2014; 42:150-8. [PMID: 25019345 DOI: 10.3109/03014460.2014.932011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To study the prevalence of cardiovascular risk factors across different glycaemia strata and to assess the optimal cut-off value of fasting plasma glucose (FPG) to identify the constellation of cardiovascular risk factors. METHODS Data of the National Survey of Risk Factors for Non-Communicable Diseases of Iran (SURFNCD 2005-2007) were analysed. Prevalence rates of obesity, central obesity, hypertension and hypercholesterolemia of individuals with Impaired Fasting Glucose (IFG) were compared with those of individuals with normal fasting glycaemia and newly diagnosed diabetes. Optimal FPG cut-point to diagnose subjects with cardiovascular risk factors was assessed. RESULTS Prevalence of each and combinations of cardiovascular risk factors were higher among subjects with IFG compared to those with normal fasting glycaemia. The areas under the curve (AUC) for detecting cardiovascular risk were highest at FPG values of 90 mg/dL. FPG of 90 mg/dL was the optimal cut-off and, in comparison to 100 mg/dL, corresponds to correct detection of 26-29% of obese, 22-27% of centrally obese, 26-29% of hypertensive and 25-30% of hypercholesterolemic individuals. CONCLUSIONS IFG and even lower levels of FPG are associated with high prevalence of cardiovascular risk factors in Iranian adults. This study suggests the FPG cut-off to be revised at 90 mg/dL to identify people with increased cardiovascular risk.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS) , Tehran , Iran
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Ziegler D, Papanas N, Vinik AI, Shaw JE. Epidemiology of polyneuropathy in diabetes and prediabetes. ACTA ACUST UNITED AC 2014; 126:3-22. [DOI: 10.1016/b978-0-444-53480-4.00001-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Siewko K, Popławska-Kita A, Telejko B, Maciulewski R, Zielińska A, Nikołajuk A, Górska M, Szelachowska M. Insulin resistance and fasting plasma glucose in first degree relatives of patients with type 1 diabetes. J Diabetes Complications 2013; 27:593-6. [PMID: 23890682 DOI: 10.1016/j.jdiacomp.2013.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 02/06/2013] [Accepted: 02/06/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND We analyzed the relationship between fasting plasma glucose (FPG), the presence of autoantibodies, first phase of insulin secretion and insulin resistance in the first degree relatives of patients with type 1 diabetes. MATERIALS AND METHODS The group studied consisted of 90 healthy relatives, divided into two groups: "high-normal" FPG group (≥88mg/dl) and "low-normal" FPG group (<88/mg/dl). All subjects underwent an intravenous glucose tolerance test, and the 1st phase insulin response (FPIR) and FPIR-to-HOMA-IR-ratio were calculated. Additionally, islet autoantibodies (GADA, IAA and IA-2A) were determined by radioimmunoassays. RESULTS The subjects with "high-normal" FPG were older (p=0.0009), had higher BMI (p<0.0001) and lower HOMA%B (p=0.0004), FPIR (p=0.006) and FPIR-to-HOMA-IR-ratio (p=0.004) in comparison with the "low-normal" FPG group. Autoantibodies were present in 40.9% and in 21.7% of the subjects with "high-normal" and "low-normal" FPG, respectively. In the "high-normal" FPG group, FPG correlated positively with GADA (r=0.31, p=0.04), and HOMA-IR (r=0.19, p=0.02), and negatively with HOMA%B (r=-0.36, p=0.001), whereas FPIR correlated positively with HOMA%B (r=0.55, p=0.0001) and BMI (r=0.30, p=0.04). After an adjustment for BMI, the difference in FPIR between the "high-normal" and "low-normal" FPG groups remained significant (p=0.025), whereas the difference in FPIR-to-HOMA-IR-ratio became insignificant. CONCLUSIONS Our results suggest that taking into account the impact of age and BMI on insulin sensitivity, it would be expected that the relatives of patients with type 1 diabetes with "high-normal" glucose levels would become gradually unable to compensate for increasing insulin resistance.
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Affiliation(s)
- Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Poland.
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Chin CWL, Chia EHS, Ma S, Heng D, Tan M, Lee J, Tai ES, Salim A. The ARIC predictive model reliably predicted risk of type II diabetes in Asian populations. BMC Med Res Methodol 2012; 12:48. [PMID: 22497781 PMCID: PMC3353252 DOI: 10.1186/1471-2288-12-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/13/2012] [Indexed: 11/12/2022] Open
Abstract
Background Identification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown. Methods Using data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model. Results The San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. However, the Framingham model did not perform significantly better than fasting glucose or the 2-hour post-challenge glucose. All published models suffered from poor calibration. After recalibration, the Atherosclerosis Risk in Communities model achieved good calibration, the San Antonio Health Study model showed a significant lack of fit in females and the Framingham model showed a significant lack of fit in both females and males. Conclusions We conclude that adoption of the ARIC model for Asian populations is feasible and highly recommended when local prospective data is unavailable.
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Mukai N, Doi Y, Ninomiya T, Hata J, Hirakawa Y, Fukuhara M, Iwase M, Kiyohara Y. Cut-off values of fasting and post-load plasma glucose and HbA1c for predicting Type 2 diabetes in community-dwelling Japanese subjects: the Hisayama Study. Diabet Med 2012; 29:99-106. [PMID: 21726278 DOI: 10.1111/j.1464-5491.2011.03378.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS We examined the optimal cut-off values of fasting plasma glucose, 2-h post-load glucose and HbA(1c) for predicting Type 2 diabetes in community-dwelling Japanese subjects. METHODS A total of 1982 subjects without diabetes aged 40-79 years who underwent a 75-g oral glucose tolerance test were followed prospectively for 14 years by annual health examination. RESULTS During the follow-up, 295 subjects developed Type 2 diabetes. Compared with the first decile, the crude hazard ratio for incident Type 2 diabetes was significantly higher in the fifth fasting plasma glucose decile [5.4-5.4 mmol/l (97-98 mg/dl)] or higher, in the seventh 2-h post-load glucose decile [6.9-7.2 mmol/l (124-131 mg/dl)] or higher, and in the fifth HbA(1c) decile [34-36 mmol/mol (5.3-5.4%)] or higher. These associations remained substantially unchanged even after adjustment for confounding factors. The receiver operating characteristic curve analysis showed that the optimal cut-off values for predicting Type 2 diabetes were 5.6 mmol/l (101 mg/dl) for fasting plasma glucose, 6.9 mmol/l (124 mg/dl) for 2-h post-load glucose and 37 mmol/mol (5.5%) for HbA(1c). In a stratified analysis, the cut-off values were approximately 5.6 mmol/l (101 mg/dl) for fasting plasma glucose and 37 mmol/mol (5.5%) for HbA(1c), and these values were unchanged over BMI quartile levels, whereas the 2-h post-load glucose cut-off values declined with decreasing BMI levels. CONCLUSIONS Our findings suggest that the cut-off value for predicting Type 2 diabetes in the Japanese population is 5.6 mmol/l (101 mg/dl) for fasting plasma glucose and 37 mmol/mol (5.5%) for HbA(1c), while the 2-h post-load glucose cut-off value is lower than the diagnostic criterion for impaired glucose tolerance.
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Affiliation(s)
- N Mukai
- Department of Environmental Medicine Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sui X, Lavie CJ, Hooker SP, Lee DC, Colabianchi N, Lee CD, Blair SN. A prospective study of fasting plasma glucose and risk of stroke in asymptomatic men. Mayo Clin Proc 2011; 86:1042-9. [PMID: 21911559 PMCID: PMC3202993 DOI: 10.4065/mcp.2011.0267] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the association between levels of fasting plasma glucose (FPG) and incidence of stroke outcomes in a large cohort of asymptomatic men. PATIENTS AND METHODS Participants were 43,933 men (mean ± SD age, 44.3 ± 9.9 years) who were free of known cardiovascular disease at baseline and whose FPG levels were assessed during a preventive medical examination at the Cooper Clinic, Dallas, TX, between January 7, 1971, and March 11, 2002. Patients with diagnosed diabetes mellitus (DM) or low FPG (<80 mg/dL [to convert to mmol/L, multiply by 0.0555]) were excluded. Fatal stroke was identified through the National Death Index, and nonfatal stroke was ascertained from mail-back surveys. RESULTS A total of 595 stroke events (156 fatal and 456 nonfatal strokes; 17 men reported a nonfatal stroke before they died of stroke) occurred during 702,928 person-years of exposure. Age-adjusted fatal, nonfatal, and total stroke event rates per 10,000 person-years for normal FPG (80-109 mg/dL), impaired fasting glucose (110-125 mg/dL), and undiagnosed DM (≥ 126 mg/dL) were 2.1, 3.4, and 4.0 (P(trend)=.002); 10.3, 11.8, and 18.0 (P(trend)=.008); and 8.2, 9.6, and 12.4 (P(trend)=.008), respectively. After further adjusting for potential confounders, the direct association between FPG and fatal, nonfatal, or total stroke events remained significant (P(trend)=.02, .03, and .01, respectively). For FPG levels of 110 mg/dL or greater, each 10-unit increment of FPG was associated with a 6% higher risk of total stroke events (P=.05). CONCLUSION Hyperglycemia (FPG, ≥ 110 mg/dL), even below the DM threshold (such as with impaired fasting glucose), was associated with a higher risk of fatal, nonfatal, or total stroke events in asymptomatic men.
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Affiliation(s)
- Xuemei Sui
- Department of Exercise Science, Arnold Schoolof Public Health, University of South Carolina, Columbia, USA.
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Nasr G, Sliem H. Silent myocardial ischemia in prediabetics in relation to insulin resistance. J Cardiovasc Dis Res 2011; 1:116-21. [PMID: 21187864 PMCID: PMC2982198 DOI: 10.4103/0975-3583.70903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Myocardial perfusion imaging (MPI) is a powerful diagnostic and prognostic tool for evaluating coronary artery disease (CAD). Several studies have shown Type 2 diabetics are at increased risk for having CAD. In addition, insulin resistance is generally considered to be of major importance in the pathophysiology of Type 2 diabetes mellitus. However, the area of screening prediabetics for CAD remains unclear. Given that glucose intolerance and insulin resistance precede the development of overt diabetes, these factors would be associated with CAD. Aim: This study was designed to evaluate the state of myocardial perfusion in prediabetic adults detected by single photon emission computed tomography (SPECT) in relation to insulin resistance. Patients and Methods: A descriptive study was performed. Out of 113 consecutive prediabetic adults, 32 had insulin resistance (Group A) and 81 had insulin sensitivity (Group B). All were subjected to full medical history and clinical examination including blood pressure, waist circumference, and body mass index. Biochemical studies including lipids profile, fasting blood glucose, and homeostasis model assessments (HOMA) test. Exercise treadmill technetium (99mTC) sestamibi SPECT scintigraphy were done for assessment of myocardial perfusion assessed by summed difference score as well as occurrence of transient left ventricular dilatation. Results: Significant increase in summed difference score as well as transient left ventricular dilatation was observed in Group A than Group B. It is correlated with insulin resistance, and the correlation appears to be independent of glucose tolerance status and obesity. Similar correlations were observed with age, triglycerides, and waist circumference. Conclusion: Prediabetics have myocardial perfusion defects which represent a pattern of cardiovascular risk. These are predominantly observed in prediabetics with increased HOMA IR and visceral obesity independent of glucose levels.
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Affiliation(s)
- Gamela Nasr
- Department of Cardiology Suez Canal University, Ismailia, Egypt
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Zolotov S, Ben Yosef D, Rishe ND, Yesha Y, Karnieli E. Metabolic profiling in personalized medicine: bridging the gap between knowledge and clinical practice in Type 2 diabetes. Per Med 2011; 8:445-456. [DOI: 10.2217/pme.11.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes mellitus (DM2) is the most commonly diagnosed metabolic disease and its prevalence is expected to increase. Epidemiological studies clearly show excess mortality associated with DM2, as well as an increased risk of DM2-related complications. Advances in personalized medicine would greatly improve patient care in the field of diabetes and other metabolic diseases. Prediction of the disease in asymptomatic patients as well as its harsh complications in patients already diagnosed is becoming a necessity, with the considerable increase in the cost of the treatment. In the current article, we review the known clinical, molecular metabolic and genetic biomarkers that should be integrated in a future bioinformatic platform to be used at the point-of-care, and discuss the challenges we face in applying this vision of personalized medicine for diabetes into reality.
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Affiliation(s)
- Sagit Zolotov
- Institue of Endocrinology, Diabetes & Metabolism, Rambam Medical Center & Galil Center for Telemedicine, Medical Informatics & Personalized Medicine, RB Rappaport Faculty of Medicine – Technion, 12 Ha’alya St, Sami Ofer Tower, #8 Fl, PO Box 9602 Haifa 31096, Israel
| | - Dafna Ben Yosef
- Institue of Endocrinology, Diabetes & Metabolism, Rambam Medical Center & Galil Center for Telemedicine, Medical Informatics & Personalized Medicine, RB Rappaport Faculty of Medicine – Technion, 12 Ha’alya St, Sami Ofer Tower, #8 Fl, PO Box 9602 Haifa 31096, Israel
| | | | - Yelena Yesha
- University of Maryland, Baltimore County, MD, USA
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011; 34:e61-99. [PMID: 21617108 PMCID: PMC3114322 DOI: 10.2337/dc11-9998] [Citation(s) in RCA: 316] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (HbA(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA.
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2011; 57:e1-e47. [PMID: 21617152 DOI: 10.1373/clinchem.2010.161596] [Citation(s) in RCA: 306] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (Hb A(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892-1508, USA.
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Glucose levels are associated with cardiovascular disease and death in an international cohort of normal glycaemic and dysglycaemic men and women: the EpiDREAM cohort study. Eur J Prev Cardiol 2011; 19:755-64. [DOI: 10.1177/1741826711409327] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: In an international prospective cohort study we assessed the relationship between glucose levels and incident cardiovascular events and death. Methods and results: 18,990 men and women were screened for entry into the DREAM clinical trial from 21 different countries. All had clinical and biochemical information collected at baseline, including an oral glucose tolerance test (OGTT), and were prospectively followed over a median (IQR) of 3.5 (3.0–4.0) years for incident cardiovascular (CV) events including coronary artery disease (CAD), stroke, congestive heart failure (CHF) requiring hospitalization, and death. After OGTT screening, 8000 subjects were classified as normoglycaemic, 8427 had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and 2563 subjects had newly diagnosed type 2 diabetes mellitus (DM). There were incident events in 491 individuals: 282 CAD, 54 strokes, 19 CHF, and 164 died. The annualized CV or death event rate was 0.79/100 person-years in the overall cohort, 0.51/100 person-years in normoglycaemics, 0.92/100 person-years among subjects with IFG and/or IGT at baseline, and 1.27/100 person-years among those with DM ( p for trend <0.0001). Among all subjects, a 1 mmol/l increase in fasting plasma glucose (FPG) or a 2.52 mmol/l increase in the 2-h post-OGTT glucose was associated with a hazard ratio increase in the risk of CV events or death of 1.17 (95% CI 1.13–1.22). Conclusions: In this large multiethnic cohort, the risk of CV events or death increased progressively among individuals who were normoglycaemic, IFG or IGT, and newly diagnosed diabetics. A 1 mmol/l increase in FPG was associated with a 17% increase in the risk of future CV events or death. Therapeutic or behavioural interventions designed to either prevent glucose levels from rising, or lower glucose among individuals with dysglycaemia should be evaluated.
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Bartoli E, Fra GP, Carnevale Schianca GP. The oral glucose tolerance test (OGTT) revisited. Eur J Intern Med 2011; 22:8-12. [PMID: 21238885 DOI: 10.1016/j.ejim.2010.07.008] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/06/2010] [Accepted: 07/12/2010] [Indexed: 12/16/2022]
Abstract
The oral glucose tolerance test (OGTT) has been the mainstay for diagnosing diabetes for decades. Recently, the American Diabetes Association (ADA) suggested abandoning the OGTT, while resorting to a simpler screening test, exclusively based on baseline fasting blood glucose concentration. This review article rewinds the history of OGTT and its recent advancements, and compares its power in detecting early diabetes with that of fasting blood glucose alone. The key point is that there are more diabetics originating from a population with normal fasting blood glucose than from subjects with impaired fasting glucose, those who can be detected by the new ADA recommendations. Conversely, the OGTT detects more efficiently early diabetes as well as subjects with IGT, as the glycemia at the second hour seems crucial as a diagnostic tool. We discuss the different significance of fasting versus second hour glycemia during OGTT, according to different mechanisms of glucose homeostasis. Finally, we provide recent evidence on very simple additional information that can be obtained from the OGTT, which renders this test even more useful, discussing pathophysiologic significance.
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Affiliation(s)
- E Bartoli
- Clinica Medica, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Via Solaroli 17, 28100 Novara, Italy
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Silent ischemia in relation to insulin resistance in normotensive prediabetic adults: early detection by single photon emission computed tomography (SPECT). Int J Cardiovasc Imaging 2010; 27:335-41. [PMID: 20730497 DOI: 10.1007/s10554-010-9682-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
Myocardial perfusion imaging (MPI) is a powerful diagnostic and prognostic tool for evaluating coronary artery disease (CAD). Several studies have shown that it is increased in individuals with type 2 diabetes. Also, insulin resistance is generally considered to be of major importance in the pathophysiology of type 2 diabetes mellitus. However the area of screening prediabetics for coronary artery disease remains unclear. Given that glucose intolerance and insulin resistance precede the development of overt diabetes, these factors would be associated with ischemic heart disease. Evaluate the state of myocardial perfusion in prediabetic adults detected by Single photon emission computed tomography (SPECT) in relation to insulin resistance. A descriptive study was performed. For 163 consecutive prediabetic adults of whom 62 had insulin resistance (group A) and 101 had insulin sensitivity (group B). All were subjected to full medical history and clinical examination including blood pressure, waist circumference body mass index. Biochemical studies including lipids profile, fasting glucose and HOMA test. Exercise treadmill technetium 99 sestamibi SPECT scintigraphy were done for assessment of myocardial perfusion assessed by summed difference score as well as occurrence of transient left ventricular dilatation. Significant increase in summed difference score as well as transient left ventricular dilatation were observed in group A than group B. It is correlated with insulin resistance and the correlation appears to be independent of glucose tolerance status and obesity. Similar correlations were observed with age, triglycerides and waist circumference. Prediabetics have myocardial perfusion defects which represent a pattern of cardiovascular risk factors. These changes are predominantly observed in these prediabetics with increased HOMA IR and visceral obesity independent of glucose levels.
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Wang Z, Hoy WE, Si D. Incidence of type 2 diabetes in Aboriginal Australians: an 11-year prospective cohort study. BMC Public Health 2010; 10:487. [PMID: 20712905 PMCID: PMC2931471 DOI: 10.1186/1471-2458-10-487] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 08/17/2010] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetes is an important contributor to the health inequity between Aboriginal and non-Aboriginal Australians. This study aims to estimate incidence rates of diabetes and to assess its associations with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) among Aboriginal participants in a remote community. METHODS Six hundred and eighty six (686) Aboriginal Australians aged 20 to 74 years free from diabetes at baseline were followed for a median of 11 years. During the follow-up period, new diabetes cases were identified through hospital records. Cox proportional hazards models were used to assess relationships of the incidence rates of diabetes with IFG, IGT and body mass index (BMI). RESULTS One hundred and twenty four (124) new diabetes cases were diagnosed during the follow up period. Incidence rates increased with increasing age, from 2.2 per 1000 person-years for those younger than 25 years to 39.9 per 1000 person-years for those 45-54 years. By age of 60 years, cumulative incidence rates were 49% for Aboriginal men and 70% for Aboriginal women. The rate ratio for developing diabetes in the presence of either IFG or IGT at baseline was 2.2 (95% CI: 1.5, 3.3), adjusting for age, sex and BMI. Rate ratios for developing diabetes were 2.2 (95% CI: 1.4, 3.5) for people who were overweight and 4.7 (95% CI: 3.0, 7.4) for people who were obese at baseline, with adjustment of age, sex and the presence of IFG/IGT. CONCLUSIONS Diabetes incidence rates are high in Aboriginal people. The lifetime risk of developing diabetes among Aboriginal men is one in two, and among Aboriginal women is two in three. Baseline IFG, IGT and obesity are important predictors of diabetes.
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Affiliation(s)
- Zhiqiang Wang
- Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, 4029 QLD, Australia
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Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. J Am Coll Cardiol 2010; 55:1310-7. [PMID: 20338491 DOI: 10.1016/j.jacc.2009.10.060] [Citation(s) in RCA: 346] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 10/15/2009] [Accepted: 10/26/2009] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Our objective was to estimate the magnitude of the relative risk (RR) for cardiovascular disease associated with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) from published prospective observational studies. BACKGROUND Hyperglycemia is a known risk factor for cardiovascular disease. However, the magnitude of the RR for cardiovascular disease associated with IFG and IGT is unclear. METHODS We searched PubMed from 1997 through 2008 for relevant publications and performed a meta-analysis. RESULTS In 18 publications with information about IFG (110 to 125 mg/dl) (IFG 110), estimates of RR ranged from 0.65 to 2.50. The fixed-effects summary estimate of RR was 1.20 (95% confidence interval [CI]: 1.12 to 1.28). In 8 publications with information about IFG (100 to 125 mg/dl) (IFG 100), estimates of RR ranged from 0.87 to 1.40. The fixed-effects summary estimate of RR was 1.18 (95% CI: 1.09 to 1.28). In 8 publications with information about IGT, estimates of RR ranged from 0.83 to 1.34. The fixed-effects summary estimate of RR was 1.20 (95% CI: 1.07 to 1.34). Five studies combined IFG and IGT, yielding a fixed-effects summary estimate of RR of 1.10 (95% CI: 0.99 to 1.23). No significant difference between the summary estimates for men and women were detected (IFG 110: men: 1.17 [95% CI: 1.05 to 1.31], women: 1.30 [95% CI: 1.10 to 1.54]; IFG 100: men: 1.23 [95% CI: 1.06 to 1.42], women: 1.16 [95% CI: 0.99 to 1.36]). CONCLUSIONS Impaired fasting glucose and IGT are associated with modest increases in the risk for cardiovascular disease.
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Periodontal disease might be associated even with impaired fasting glucose. Br Dent J 2010; 208:E20. [PMID: 20339371 DOI: 10.1038/sj.bdj.2010.291] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2009] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether there is an association between fasting plasma glucose level and periodontal condition in a non-diabetic male population. METHODS Data of periodic medical examinations of 815 non-diabetic male adults (mean age 38.1 + or - 7.0 years) were analysed. Blood samples were drawn from each subject following a 14-hour fast. The distance between the cement-enamel-junction to alveolar bone crest was measured at inter-proximal sites on two standardised posterior bitewing radiographs. RESULTS Higher prevalence of alveolar bone loss was found among individuals with a fasting glucose level of > or = 100 mg/dL than among individuals with <100 mg/dL (p = 0.032) and among individuals with BMI > or = 25 than among individuals with BMI <25 (p = 0.025). Associations were found between bone loss prevalence and serum triglyceride levels of > or = 200mg/dL, total cholesterol level of > or = 200mg/dL and LDL-cholesterol level of > or = 130 mg/dL (p = 0.010, p <0.001, p = 0.009, respectively). CONCLUSIONS In the studied non-diabetic adult population, periodontal disease was associated with impaired glucose level. Periodontal disease could serve as a predictor for future diabetes mellitus, or play a possible role in the glucose imbalance and diabetes mellitus development.
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Metabolic syndrome: A review of emerging markers and management. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2009. [DOI: 10.1016/j.dsx.2009.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Doi Y, Ninomiya T, Hata J, Fukuhara M, Yonemoto K, Iwase M, Iida M, Kiyohara Y. Impact of glucose tolerance status on development of ischemic stroke and coronary heart disease in a general Japanese population: the Hisayama study. Stroke 2009; 41:203-9. [PMID: 19940278 DOI: 10.1161/strokeaha.109.564708] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Few studies have shown the association between glucose tolerance status defined by a 75-g oral glucose tolerance test and the development of different types of cardiovascular disease. METHODS A total of 2421 community-dwelling Japanese subjects aged 40 to 79 years who underwent the oral glucose tolerance test were followed up for 14 years. RESULTS In multivariable analysis, the risks of ischemic stroke in both sexes and coronary heart disease (CHD) in women were significantly higher in subjects with diabetes determined by the World Health Organization criteria than in those with normal glucose tolerance even after adjustment for other confounding factors, but such association was not seen for CHD in men (ischemic stroke: adjusted hazard ratio [HR]=2.54, P=0.002 in men; adjusted HR=2.02, P=0.03 in women; CHD: adjusted HR=1.26, P=0.47 in men; adjusted HR=3.46, P=0.002 in women). Similar associations were observed for fasting plasma glucose levels of >or=7.0 mmol/L (ischemic stroke: adjusted HR=2.15, P=0.03 in men; adjusted HR=2.10, P=0.045 in women; CHD: adjusted HR=1.29, P=0.47 in men; adjusted HR=3.83, P=0.003 in women) and for 2-hour postload glucose levels of >or=11.1 mmol/L (ischemic stroke: adjusted HR=2.71, P=0.003 in men; adjusted HR=2.19, P=0.03 in women; CHD: adjusted HR=1.58, P=0.16 in men; adjusted HR=4.44, P<0.001 in women). The age-adjusted incidences of ischemic stroke and CHD did not significantly increase in subjects with impaired fasting glycemia or impaired glucose tolerance in either sex. CONCLUSIONS Our findings suggest that diabetes is an independent risk factor for ischemic stroke in both sexes and CHD in women in the Japanese population.
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Affiliation(s)
- Yasufumi Doi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
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Ilany J, Marai I, Cohen O, Matetzky S, Gorfine M, Erez I, Hod H, Karasik A. Glucose homeostasis abnormalities in cardiac intensive care unit patients. Acta Diabetol 2009; 46:209-16. [PMID: 19023513 DOI: 10.1007/s00592-008-0077-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to characterize the abnormalities in glucose homeostasis in intensive care unit patients following an acute coronary event. The study population included all non-diabetic patients ages 20-80 years that were admitted to a coronary intensive unit. Glucose, insulin and C-peptide levels during an oral glucose tolerance test (OGTT) were measured during the acute admission. From January to September 2003, 277 patients were admitted to the coronary unit. Of these, 127 patients underwent an OGTT. Of these, only 29 patients (23%) exhibited normal glucose metabolism. The remainder had type 2 diabetes (32%), impaired glucose tolerance (37%) or isolated impaired fasting glucose (8%, 100-125 mg/dl). Based on homeostasis model assessment (HOMA) calculations, diabetic patients had impaired beta-cell function and patients with elevated fasting glucose levels were insulin resistant. Beta-cell dysfunction during the acute stress seems to contribute to the glucose abnormalities. Most patients who experience an acute coronary event demonstrate abnormal glucose metabolism. Post glucose-load abnormalities are more common than abnormal fasting glucose level in this situation. It is postulated that the acute stress of a coronary event may contribute to the dysglycemia.
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Affiliation(s)
- Jacob Ilany
- Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel.
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Kadowaki T. [Diagnostic standard for fasting and postprandial hyperglycemia]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2009; 98:717-724. [PMID: 19469090 DOI: 10.2169/naika.98.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Rambod M, Hosseinpanah F, Ardakani EM, Padyab M, Azizi F. Fine-tuning of prediction of isolated impaired glucose tolerance: a quantitative clinical prediction model. Diabetes Res Clin Pract 2009; 83:61-8. [PMID: 19012984 DOI: 10.1016/j.diabres.2008.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Revised: 08/28/2008] [Accepted: 09/23/2008] [Indexed: 11/23/2022]
Abstract
In this cross-sectional study, we evaluated results of oral glucose tolerance test (OGTT) from 4742 women and 3470 men, participated in the Tehran Lipid and Glucose Study, aged >or=20 years and without diabetes, to determine the diagnostic value of subjects' clinical traits with isolated impaired glucose tolerance (isolated-IGT) defined as fasting plasma glucose (FPG) <5.6 mmol/L and 2-h plasma glucose between 7.8 and 11.1 mmol/L. The overall prevalence of IGT was 13.6% (n=1120); of these subjects, 59.6% (n=668) had isolated-IGT. The adjusted odds ratios for having isolated-IGT among 7012 subjects with FPG <5.6 mmol/L were significant for age >or=40 years (2.5), hypertension (1.9), abnormal waist circumference (1.9), obesity (1.5), and family history of diabetes (1.3). Adding the lipid profiles to the clinical model increased the area under the ROC curve only slightly (73.2% vs. 72.1%, respectively; P=0.002). In summary, this study showed that in adults with FPG <5.6 mmol/L, older age, family history of diabetes, abnormal waist circumference and obesity, and hypertension were significantly associated with a higher likelihood of isolated-IGT; OGTT could hence be recommended in subjects who have most of these characteristics to find Isolated-IGT, especially if the findings are supported by appropriately designed clinical trials.
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Affiliation(s)
- Mehdi Rambod
- Research Institute for Endocrine Sciences, Shahid Beheshti University (MC), Tehran, Iran
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Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, Jang HC, Cho YM, Song KH, Ahn CW, Sung YA, Park JY, Shin C, Lee HK, Park KS. A report on the diagnosis of intermediate hyperglycemia in Korea: A pooled analysis of four community-based cohort studies. Diabetes Res Clin Pract 2008; 80:463-8. [PMID: 18339440 DOI: 10.1016/j.diabres.2008.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 01/17/2008] [Indexed: 11/16/2022]
Abstract
Many studies show poor agreement between fasting plasma glucose (FPG)-based and 2-h postchallenge glucose (2-h PG)-based criteria to assess glucose metabolism. We examined the rate of agreement between FPG- and 2-h PG-based criteria in the diagnosis of intermediate hyperglycemia in four representative cohort studies in South Korea and compared the clinical characteristics and biochemical parameters in subjects with impaired fasting glucose (IFG) according to their FPG values. Of 6234 subjects from four population-based studies performed from 1993 to 2000, 4610 individuals with data from a 75g oral glucose tolerance test (OGTT) and no previous history of diabetes were selected. We examined the concordance rate between the FPG and 2-h PG-based criteria. We also investigated the differences in the clinical characteristics and biochemical parameters between individuals with IFG according to their FPG values. The fasting and 2-h PG criteria had large discordance rates in the diagnosis of diabetes and impaired glucose tolerance (IGT) in Korean adults. When individuals with IFG were classified into stage 1 [5.6-6.1mmol/L (100-109mg/dL)] and stage 2 [6.1-7.0mmol/L (110-125mg/dL)] IFG, individuals with stage 2 IFG are more obese and had higher blood pressure and total cholesterol and triglycerides concentrations compared with those with stage 1 IFG. In addition, more individuals with stage 2 IFG were with diabetes as determined by a 2-h PG>or=11.1mmol/L (14.1% vs. 1.9%) (P<0.05). Considering the poorer metabolic profile and higher percentage of people with diabetes by OGTT, these data indicate that, in the Korean population, individuals with stage 2 IFG should be treated differently from those with stage 1 IFG. To detect more cases of diabetes, the OGTT is recommended for all individuals with stage 2 IFG and cases with stage 1 IFG with some additional risk factors for diabetes.
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Affiliation(s)
- Jee-Young Oh
- Department of Internal Medicine, School of Medicine Ewha Womans University, Seoul, Korea
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Seghieri G, Tesi F, Anichini R, De Bellis A, Fabbri G, Malagoli R, Franconi F. Gender modulates the relationship between body weight and plasma glucose in overweight or obese subjects. Diabetes Res Clin Pract 2008; 80:134-8. [PMID: 18077049 DOI: 10.1016/j.diabres.2007.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 10/24/2007] [Indexed: 11/24/2022]
Abstract
Obesity and weight increase during adult life are strong predictors of type 2 diabetes. Whether fasting plasma glucose (FPG) is likewise related to body weight as well as with its increase during the adult life in obese-overweight people and whether this relationship is different between the genders is the question asked by the present study. We measured FPG in 1063 overweight-obese subjects (395M/668F) with BMI > or =25 kgm(-2) and classified with no history of diabetes and with a FPG< 7 mmol/l, who consequently came to the Outpatient Clinic of our Diabetes Unit to obtain dietetic advice. Weight increase was determined as the difference between actual weight and weight at 18 years (weight-diff), including only patients with weight-diff> 0. By univariate analysis age, BMI, waist circumference and weight change were loosely related to FPG in both sexes, even if the relation between plasma glucose and anthropometric variables was more consistent in females. By multivariate regression analysis, after adjusting for age, waist circumference, menopausal status and smoking habit, FPG was significantly related to both waist circumference and weight-diff only in women. Odds Ratio for fasting hyperglycaemia (FPG> 6.11 mmol/l), for each S.D. unit increase in weight-diff, after adjusting for age, waist circumference, smoking habit and menopausal status was 1.272; 95% CI: 0.863-1.901 (p=ns) for males and 1.800; 95% CI: 1.239-2.652 (p=0.002) for women. In conclusion our findings suggest that in non-diabetic overweight-obese people, after controlling for main cofounders, anthropometric variables and in particular waist circumference and weight change after 18 years are linearly related to FPG in women, independently predicting the risk of fasting hyperglycaemia only in these latter.
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Affiliation(s)
- Giuseppe Seghieri
- Department of Internal Medicine, Spedali Riuniti, Viale Matteotti 9/D, 51100 Pistoia, Italy.
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Sesti G, Andreozzi F, Bonadonna RC, De Mattia G, Leonetti F, Luzi L, Marini MA, Natali A, Vettor R, Bonora E. Impact of lowering the criterion for impaired fasting glucose on identification of individuals with insulin resistance. The GISIR database. Diabetes Metab Res Rev 2008; 24:130-6. [PMID: 17922529 DOI: 10.1002/dmrr.775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We assessed the accuracy of the American Diabetes Association (ADA)2003 definition of impaired fasting glucose (IFG) in identifying subjects with low insulin sensitivity, and determined cardiovascular risk factors in ADA2003 IFG subjects. RESEARCH DESIGN AND METHODS This study included 930 non-diabetic Italian Caucasians from the GISIR database in which subjects underwent a hyperinsulinaemic-euglycaemic clamp performed with a standard technique. Low insulin sensitivity was defined as being in the lower quartile of glucose metabolized during the last hour of the clamp (M). Subjects were stratified in the following groups: normal fasting glucose (NFG) (<100 mg/dL), IFG100 (100-109 mg/dL), ADA1997 IFG110 (110-125 mg/dL), and ADA2003 IFG (100-125 mg/dL). RESULTS The sensitivity of identifying subjects with low insulin sensitivity increased adopting the ADA2003 criterion. After Bonferroni correction for multiple comparisons, both IFG100 and ADA1997 IFG110 showed significantly higher body mass index (BMI), waist, systolic blood pressure (SBP) and diastolic blood pressure (DBP), triglyceride, fasting plasma insulin (FPI) and fasting plasma glucose (FPG), and lower insulin sensitivity as compared with NFG. As compared with IFG100, ADA1997 IFG110 showed significantly higher BMI, waist, SBP, FPI, FPG, and lower insulin sensitivity. ADA2003 IFG group showed significantly higher BMI, waist, SBP and DBP, triglyceride, cholesterol, FPI, and FPG, but lower HDL levels and insulin sensitivity compared with NFG subjects. CONCLUSIONS Although neither the ADA2003 nor the ADA1997 definition of IFG appears to be particularly efficacious for the identification of subjects' low insulin sensitivity, lowering the criterion to the ADA2003 glucose threshold increased the sensitivity without affecting the specificity. ADA2003 IFG showed a worse cardiovascular risk profile compared with NFG.
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Affiliation(s)
- Giorgio Sesti
- Department of Experimental and Clinical Medicine, University of Catanzaro, Italy.
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Impact of Impaired Fasting Glucose on Cardiovascular Disease. J Am Coll Cardiol 2008; 51:264-70. [DOI: 10.1016/j.jacc.2007.09.038] [Citation(s) in RCA: 211] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 09/12/2007] [Accepted: 09/17/2007] [Indexed: 11/20/2022]
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Gao W, Dong Y, Nan H, Tuomilehto J, Qiao Q. The likelihood of diabetes based on the proposed definitions for impaired fasting glucose. Diabetes Res Clin Pract 2008; 79:151-5. [PMID: 17825938 DOI: 10.1016/j.diabres.2007.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 07/25/2007] [Indexed: 10/22/2022]
Abstract
The current study aimed to evaluate whether individuals with fasting plasma glucose (FPG) of 5.6-6.0 mmol/l has a similar risk profiles for diabetes or impaired glucose tolerance (IGT) to those with FPG of 6.1-6.9 mmol/l. A community-based cross-sectional survey in Chinese adults (20-74 years) was conducted during April-July in 2002. Participants without a prior history of diabetes underwent a standardized 2-h 75 g oral glucose tolerance test. Positive likelihood ratios were calculated to estimate the odds of having diabetes or IGT for subjects with different FPG levels. Among 1856 participants, prevalence of IFG increased from 12.4 to 28.2% with the cut-off value of FPG lowered from 6.1 to 5.6 mmol/l. Individuals with FPG of 6.1-6.9 mmol/l were more obese and insulin resistant than those with FPG of 5.6-6.0 mmol/l. The positive likelihood ratio for diabetes and IGT were 1.83 (1.28-2.61) and 2.60 (1.96-3.44) in subjects with FPG of 6.1-6.9 mmol/l, and 0.54 (0.30-0.95) and 1.47 (1.11-1.95) for those with FPG of 5.6-6.0 mmol/l, respectively. In conclusion, the likelihood of diabetes and IGT was lower in subjects with FPG of 5.6-6.0 mmol/l than in those with FPG of 6.1-6.9 mmol/l. The clinical and social implication of labelling more individuals with impaired fasting glucose needs to be further studied.
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Affiliation(s)
- Weiguo Gao
- Department of Public Health, University of Helsinki, Helsinki, Finland.
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Andreozzi F, Succurro E, Mancuso MR, Perticone M, Sciacqua A, Perticone F, Sesti G. Metabolic and cardiovascular risk factors in subjects with impaired fasting glucose: the 100 versus 110 mg/dL threshold. Diabetes Metab Res Rev 2007; 23:547-50. [PMID: 17311284 DOI: 10.1002/dmrr.724] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2003, the American Diabetes Association (ADA) established a new cutoff for impaired fasting glucose (IFG) by reducing it from 110 to 100 mg/dL. This change was challenged as to its appropriateness. A few studies have examined the impact of the ADA(2003) threshold of IFG on metabolic and cardiovascular risk factors. METHODS We examined whether metabolic and cardiovascular risk factors, including inflammatory biomarkers, differ in subjects with the new ADA(2003) threshold of IFG (IGF100) as compared with subjects with the old ADA(1997) threshold of IFG (IFG110) in a cohort of 946 nondiabetic Italian Caucasians (fasting plasma glucose < 126 mg/dL). RESULTS As compared with normal fasting glucose (NFG), subjects with IFG100 and IFG110 had higher body mass index (BMI), waist circumference, total and low density lipoprotein (LDL) cholesterol, triglyceride, fasting and 2-h post-challenge plasma glucose, fasting insulin, systolic blood pressure, and lower levels of high density lipoprotein (HDL) and insulin-like growth factor I (IGF-I). In a logistic regression analysis with adjustment for age and gender, IFG110 was associated with higher risk of post-challenge glucose intolerance as compared with IFG100. As compared with IFG100, subjects with IFG110 have significantly lower levels of circulating IGF-I. As compared with NFG, IFG110, but not IFG100, showed a significant association with increased levels of inflammatory markers including white blood cell count (WBCC), and C-reactive protein (CRP). Both CRP and WBCC were correlated with 2-h plasma glucose but not with fasting plasma glucose (FPG). CONCLUSIONS The data show that IFG110 is associated with a worse metabolic and cardiovascular risk profile as compared with IFG100.
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Affiliation(s)
- Francesco Andreozzi
- Department of Experimental and Clinical Medicine, University Magna Grzecia of Catanzaro, 88100 Catanzaro, Italy
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Hadaegh F, Harati H, Ghasemi A, Tohidi M, Zabetian A, Mehrabi Y, Azizi F. Using common clinical data improves the prediction of abnormal glucose tolerance by the new criteria of impaired fasting glucose: Tehran lipid and glucose study. Diabetes Res Clin Pract 2007; 77:459-64. [PMID: 17350133 DOI: 10.1016/j.diabres.2007.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Accepted: 02/10/2007] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To identify a subgroup of individuals with impaired fasting glucose (IFG) based on the new 2003 criteria that would most likely benefit from performance of oral glucose tolerance test. METHODS A cross-sectional study was carried out in 1999-2001 in an Iranian urban population which enrolled 8766 individuals over 20 years. Fasting and 2-h plasma glucose was measured in all subjects after exclusion of diabetic subjects. Logistic regression and receiver operation characteristic (ROC) curve analysis were used to determine the independent clinical risk factors and their optimal cut-points associated with impaired glucose tolerance (IGT) and dysglycemia (IGT or diabetes). RESULTS Application of the new criteria decreased positive likelihood ratio (LR+) of IFG for detecting IGT (from 6.68 to 3.86) or dysglycemia (from 9.90 to 4.46) but slightly improved their agreement (Kappa increased from 0.158 to 0.286 for IGT and 0.238 to 0.354 for dysglycemia). When the clinical data (age >45 years, BMI >28 kg/m(2) and systolic blood pressure >125 mm Hg) were added to the new criteria, the agreement of IFG with IGT and dysglycemia significantly improved (Kappa=0.470 and 0.574, respectively). This also increased the LR(+) to 14.5 and 17.4, respectively, for detecting IGT or dysglycemia. CONCLUSION The new IFG definition in combination with common clinical risk factors constitutes a group that most likely predicts IGT or dysglycemia and may be a target for which preventive strategies should be considered.
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Affiliation(s)
- F Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational diabetes after delivery. Short-term management and long-term risks. Diabetes Care 2007; 30 Suppl 2:S225-35. [PMID: 17596477 DOI: 10.2337/dc07-s221] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- John L Kitzmiller
- Division of Maternal-Fetal Medicine, Santa Clara County Health System, San Jose, California, USA.
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