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Ruiz PLD, Hopstock LA, Eggen AE, Njølstad I, Grimnes G, Stene LC, Gulseth HL. Undiagnosed diabetes based on HbA 1c by socioeconomic status and healthcare consumption in the Tromsø Study 1994-2016. BMJ Open Diabetes Res Care 2021; 9:9/2/e002423. [PMID: 34782335 PMCID: PMC8593698 DOI: 10.1136/bmjdrc-2021-002423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/21/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION We aimed to investigate whether the proportion of undiagnosed diabetes varies by socioeconomic status and healthcare consumption, in a Norwegian population screened with glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS In this cohort study, we studied age-standardized diabetes prevalence using data from men and women aged 40-89 years participating in four surveys of the Tromsø Study with available data on HbA1c and self-reported diabetes: 1994-1995 (n=6720), 2001 (n=5831), 2007-2008 (n=11 987), and 2015-2016 (n=20 170). We defined undiagnosed diabetes as HbA1c ≥6.5% (48 mmol/mol) and no self-reported diabetes. We studied the association of education, income and contact with a general practitioner on undiagnosed diabetes and estimated adjusted prevalence ratio (aPR) from multivariable adjusted (age, sex, body mass index) log-binomial regression. RESULTS Higher education was associated with lower prevalence of diagnosed and undiagnosed diabetes. Those with secondary and tertiary education had lower prevalence of undiagnosed diabetes (aPR for tertiary vs primary: 0.54, 95% CI: 0.44 to 0.66). Undiagnosed as a proportion of all diabetes was also significantly lower in those with tertiary education (aPR:0.78, 95% CI: 0.65 to 0.93). Household income was also negatively associated with prevalence of undiagnosed diabetes. Across the surveys, approximately 80% of those with undiagnosed diabetes had been in contact with a general practitioner the last year, similar to those without diabetes. CONCLUSIONS Undiagnosed diabetes was lower among participants with higher education. The hypothesis that those with undiagnosed diabetes had been less in contact with a general practitioner was not supported.
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Affiliation(s)
- Paz Lopez-Doriga Ruiz
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Laila Arnesdatter Hopstock
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
- Pandemic Unit, Tromsø Municipality, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Lars C Stene
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Hanne L Gulseth
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Jagannathan R, Neves JS, Dorcely B, Chung ST, Tamura K, Rhee M, Bergman M. The Oral Glucose Tolerance Test: 100 Years Later. Diabetes Metab Syndr Obes 2020; 13:3787-3805. [PMID: 33116727 PMCID: PMC7585270 DOI: 10.2147/dmso.s246062] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
For over 100 years, the oral glucose tolerance test (OGTT) has been the cornerstone for detecting prediabetes and type 2 diabetes (T2DM). In recent decades, controversies have arisen identifying internationally acceptable cut points using fasting plasma glucose (FPG), 2-h post-load glucose (2-h PG), and/or HbA1c for defining intermediate hyperglycemia (prediabetes). Despite this, there has been a steadfast global consensus of the 2-h PG for defining dysglycemic states during the OGTT. This article reviews the history of the OGTT and recent advances in its application, including the glucose challenge test and mathematical modeling for determining the shape of the glucose curve. Pitfalls of the FPG, 2-h PG during the OGTT, and HbA1c are considered as well. Finally, the associations between the 30-minute and 1-hour plasma glucose (1-h PG) levels derived from the OGTT and incidence of diabetes and its complications will be reviewed. The considerable evidence base supports modifying current screening and diagnostic recommendations with the use of the 1-h PG. Measurement of the 1-h PG level could increase the likelihood of identifying high-risk individuals when the pancreatic ß-cell function is substantially more intact with the added practical advantage of potentially replacing the conventional 2-h OGTT making it more acceptable in the clinical setting.
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Affiliation(s)
- Ram Jagannathan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - João Sérgio Neves
- Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Sa˜o Joa˜ o University Hospital Center, Porto, Portugal
| | - Brenda Dorcely
- NYU Grossman School of Medicine, Division of Endocrinology, Diabetes, Metabolism, New York, NY10016, USA
| | - Stephanie T Chung
- Diabetes, Obesity, and Endocrinology Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD20892, USA
| | - Mary Rhee
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta VA Health Care System, Atlanta, GA30322, USA
| | - Michael Bergman
- NYU Grossman School of Medicine, NYU Diabetes Prevention Program, Endocrinology, Diabetes, Metabolism, VA New York Harbor Healthcare System, Manhattan Campus, New York, NY10010, USA
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Glycated Hemoglobin in the Diagnosis of Diabetes Mellitus in a Semi-Urban Brazilian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193598. [PMID: 31561434 PMCID: PMC6801550 DOI: 10.3390/ijerph16193598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 01/10/2023]
Abstract
The study evaluated glycated hemoglobin (HbA1c) as a diagnostic tool for diabetes and pre-diabetes in the Brazilian population. Further, the homeostasis model assessment of insulin resistance (HOMA-IR) was also examined against HbA1c values to identify the most suitable cut-off points for HOMA-IR to predict the risk of diabetes. A cross-sectional study was conducted among 714 randomly selected subjects. HbA1c, fasting, and 2 h plasma glucose values were measured. Insulin resistance estimates were calculated with HOMA-IR. The receiver operating characteristic curve assessed HbA1c performance. The adjusted prevalence rate of diabetes mellitus was 14.7%, and pre-diabetes 14.2%. The optimal HbA1c cut-off value was ≥6.8% for the diagnosis of diabetes, and ≥6.0% for pre-diabetes. The area under the curve using HbA1c was 0.85 (95% CI: 0.80–0.90) for detecting diabetes and 0.61 (95% CI: 0.55–0.67) for pre-diabetes. The optimal HOMA-IR cut-off value was 2.06 for HbA1c at 6.8%. The HbA1c cut-off value of ≥6.8% may be suitable for diagnosing diabetes in the Brazilian population. Our results do not support the use of HbA1c to diagnose pre-diabetes. A HOMA-IR cut-off point of 2.06 was a sensitive marker to assess the risk of diabetes.
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Naseribafrouei A, Eliassen BM, Melhus M, Svartberg J, Broderstad AR. Estimated 8-year cumulative incidence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - The SAMINOR Study. BMC Endocr Disord 2019; 19:66. [PMID: 31234837 PMCID: PMC6591838 DOI: 10.1186/s12902-019-0399-7] [Citation(s) in RCA: 2] [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: 10/05/2018] [Accepted: 06/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The aim of the study was to estimate and compare the 8-year cumulative incidence of diabetes mellitus (DM) among Sami and non-Sami inhabitants of rural districts in Northern Norway. METHODS Longitudinal study based on linkage of two cross-sectional surveys, the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014). Ten municipalities in rural Northern Norway were included in the study. DM-free participants aged 30 and 36-71 years in SAMINOR 1 were followed from 2 years after SAMINOR 1 to attendance in SAMINOR 2. The average follow-up time was 8.1 years. Of 5875 subjects who had participated in SAMINOR 1 and could potentially be followed to SAMINOR 2, 3303 were included in the final analysis. Self-reported DM and/or HbA1c ≥ 6.5% were used to identify incident cases of DM. RESULTS At baseline, body mass index (BMI) and waist-to-height ratio (WHtR) were higher among Sami than among their non-Sami counterparts. After 8 years of follow-up, 201 incident cases of DM were identified (6.1% both Sami and non-Sami subjects). No statistically significant difference was observed in the cumulative incidence of DM between the Sami and non-Sami. CONCLUSIONS No statistically significant difference in the 8-year cumulative incidence of DM among Sami and non-Sami was observed, although Sami men and women had higher baseline BMI and WHtR.
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Affiliation(s)
- Ali Naseribafrouei
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
| | | | - Marita Melhus
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Johan Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ann Ragnhild Broderstad
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Medicine, University Hospital of North Norway, Harstad, Norway
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Naseribafrouei A, Eliassen BM, Melhus M, Svartberg J, Broderstad AR. Prevalence of pre-diabetes and type 2 diabetes mellitus among Sami and non-Sami men and women in Northern Norway - The SAMINOR 2 Clinical Survey. Int J Circumpolar Health 2018; 77:1463786. [PMID: 29697016 PMCID: PMC5917894 DOI: 10.1080/22423982.2018.1463786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to determine and compare the prevalence of pre-diabetes and type 2 diabetes mellitus (T2DM) among Sami and non-Sami men and women of rural districts in Northern Norway. The SAMINOR 2 Clinical Survey is a cross-sectional population-based study performed in 2012–2014 in 10 municipalities of Northern Norway. A total of 12,455 Sami and non-Sami inhabitants aged 40–79 years were invited to participate and 5878 were included in the analyses. Participants with self-reported T2DM and/or a glycated haemoglobin (HbA1c) result ≥6.5% were categorised as having T2DM. Those with 5.7%≤HbA1c<6.5% were categorised as pre-diabetics. In men, the total age-standardised prevalence of pre-diabetes (37.9% vs 31.4%) and T2DM (10.8% vs 9.5%) were higher in Sami compared with non-Sami; the ethnic difference was statistically significant for both pre-diabetes (OR 1.42, p < 0.001) and T2DM (OR 1.31, p = 0.042). In women, pre-diabetes (36.4% vs 33.5%) and T2DM (8.6% vs 7.0%) were also more common in Sami than non-Sami; the differences in both pre-diabetes (OR 1.20, p = 0.025) and T2DM (OR 1.38, p = 0.021) were also statistically significant. The observed ethnic difference in the waist-to-height ratio (WHtR) was a plausible explanation for the ethnic difference in the prevalence of pre-diabetes and T2DM.
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Affiliation(s)
- Ali Naseribafrouei
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway
| | - Bent-Martin Eliassen
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway
| | - Marita Melhus
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway
| | - Johan Svartberg
- b Division of Internal Medicine , University Hospital of North Norway , Tromsø , Norway.,c Tromsø Endocrine Research Group, Department of Clinical Medicine , UiT The Arctic University of Norway , Tromsø , Norway
| | - Ann Ragnhild Broderstad
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway.,d Department of Medicine , University Hospital of North Norway , Harstad , Norway
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Katchunga PB, Mirindi PN, Kishabongo AS, Cikomola JC, Bwanamdogo S, Philippé J, Speeckaert MM, Delanghe JR. Glycated nail proteins as a new biomarker in management of the South Kivu Congolese diabetics. Biochem Med (Zagreb) 2015; 25:469-73. [PMID: 26526975 PMCID: PMC4622194 DOI: 10.11613/bm.2015.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/23/2015] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Diagnosis and monitoring of diabetes mellitus in sub-Saharan Africa, based on blood analyses, are hampered by infrastructural and cultural reasons. The first aim of this study was to evaluate the diagnostic accuracy of glycated nail proteins for diabetes mellitus. The second aim was to compare the course of short- and long-term glycemic biomarkers after 6 months of antidiabetic treatment. These objectives should support our hypothesis that glycated nail proteins could be used as an alternative glycemic biomarker. MATERIALS AND METHODS This case-control study consisted of 163 black diabetics and 67 non-diabetics of the South Kivu (Democratic Republic of Congo). Diagnostic accuracy of glycated nail proteins was evaluated using ROC curve analysis. At the start of the study, glycated nail protein concentrations were compared between diabetics and non-diabetics, using a nitro blue tetrazolium (NBT) colorimetric method. In a subgroup of 30 diabetics, concentrations of glycated nail proteins, fasting glucose (Accu-Chek® Aviva), serum fructosamine (NBT) and HbA1c (DCA-2000+®) were measured at start and after 6 months. RESULTS ROC analysis yielded an AUC of 0.71 (95% confidence interval (CI): 0.65-0.76) and a cut-off point of 3.83 μmol/g nail. Concentration of glycated nail proteins was significantly higher (P<0.001) in diabetics in comparison with non-diabetics. After 6 months of antidiabetic treatment, a significant drop in the fasting glucose concentration (P=0.017) and concentration of glycated nail proteins (P=0.008) was observed in contrast to serum fructosamine and HbA1c. CONCLUSIONS Measurement of glycated nail proteins could be used to diagnose and monitor diabetes mellitus in sub-Saharan Africa.
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Affiliation(s)
- Philippe B Katchunga
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Division of Endocrinology and Diabetology, Department of Internal Medicine, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Patrick N Mirindi
- Regional School of Public Health (ERSP), Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Antoine S Kishabongo
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Biology, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Justin C Cikomola
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Division of Endocrinology and Diabetology, Department of Internal Medicine, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Socrate Bwanamdogo
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Biology, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo
| | - Jan Philippé
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | | | - Joris R Delanghe
- Observatory NCDs VLIR-UOS/UBC, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province, Democratic Republic of Congo ; Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
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Hutchinson MS, Joakimsen RM, Njølstad I, Schirmer H, Figenschau Y, Svartberg J, Jorde R. Effects of Age and Sex on Estimated Diabetes Prevalence Using Different Diagnostic Criteria: The Tromsø OGTT Study. Int J Endocrinol 2013; 2013:613475. [PMID: 23365572 PMCID: PMC3556443 DOI: 10.1155/2013/613475] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/04/2012] [Accepted: 12/05/2012] [Indexed: 12/30/2022] Open
Abstract
HbA(1c) 6.5% has recently been recommended as an alternative diagnostic criterion for diabetes. The aims of the study were to evaluate the effects of age, sex, and other factors on prevalence of diabetes and to compare risk profiles of subjects with diabetes when defined by HbA(1c) and glucose criteria. Subjects were recruited among participants in the longitudinal population-based Tromsø Study. HbA(1c), fasting plasma glucose, and 2-hour plasma glucose were measured in 3,476 subjects. In total, 294 subjects met one or more of the diagnostic criteria for diabetes; 95 met the HbA(1c) criterion only, 130 met the glucose criteria only, and 69 met both. Among subjects with diabetes detected by glucose criteria (regardless of HbA(1c)), isolated raised 2-hour plasma glucose was more common in subjects aged ≥ 60 years as compared to younger subjects and in elderly women as compared to elderly men. Subjects with diabetes detected by glucose criteria only had worse cardiometabolic risk profiles than those detected by HbA(1c) only. In conclusion, the current HbA(1c) and glucose criteria defined different subjects with diabetes with only modest overlap. Among a substantial proportion of elderly subjects, and especially elderly women, the 2-hour plasma glucose was the only abnormal value.
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Affiliation(s)
- Moira Strand Hutchinson
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
- *Moira Strand Hutchinson:
| | - Ragnar Martin Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, University of Tromsø, 9037 Tromsø, Norway
| | - Henrik Schirmer
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Yngve Figenschau
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
- Department of Medical Biology, University of Tromsø, 9037 Tromsø, Norway
- Division of Laboratory Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Johan Svartberg
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
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