Abstract
To estimate the prevalence of unknown impaired glucose metabolism, also referred to as prediabetes (PreD), and unknown type 2 diabetes mellitus (T2DM) among subjectively healthy Swiss senior citizens. The fasting plasma glucose (FPG) and glycated haemoglobin A(1c) (HbA(1c)) levels were used for screening. A total of 1 362 subjects were included (613 men and 749 women; age range 60-99 years). Subjects with known T2DM were excluded. The FPG was processed immediately for analysis under standardised preanalytical conditions in a cross-sectional cohort study; plasma glucose levels were measured by means of the hexokinase procedure, and HbA(1c) was measured chromatographically and classified using the current American Diabetes Association (ADA) criteria. The crude prevalence of individuals unaware of having prediabetic FPG or HbA(1c) levels, was 64.5% (n = 878). Analogously, unknown T2DM was found in 8.4% (n = 114) On the basis of HbA(1c) criteria alone, significantly more subjects with unknown fasting glucose impairment and laboratory T2DM could be identified than with the FPG. The prevalence of PreD as well as of T2DM increased with age. The mean HOMA indices (homeostasis model assessment) for the different age groups, between 2.12 and 2.59, are consistent with clinically hidden disease and are in agreement with the largely orderly Body Mass Indices found in the normal range. Laboratory evidence of impaired glucose metabolism and, to a lesser extent, unknown T2DM, has a high prevalence among subjectively healthy older Swiss individuals. Laboratory identification of people with unknown out-of-range glucose values and overt diabetic hyperglycaemia might improve the prognosis by delaying the emergence of overt disease.
Highlights
Chronic noncommunicable diseases are reaching epidemic proportions, and they affect people of all ages
The fasting plasma glucose (FPG) was processed immediately for analysis under standardised preanalytical conditions in a crosssectional cohort study; plasma glucose levels were measured by means of the hexokinase procedure, and haemoglobin A1c (HbA1c) was measured chromatographically and classified using the current American Diabetes Association (ADA) criteria
Each of the following categories, incidentally termed prediabetes (PreD), represents a status of impaired glucose metabolism associated with an increased risk to develop type 2 diabetes mellitus (T2DM): i
Summary
Chronic noncommunicable diseases are reaching epidemic proportions, and they affect people of all ages. The prevalence increases to 11.0% in subjects aged 65–74 years and to 12.5% in individuals ≥75 years. The prevalence of T2DM, defined as glycated haemoglobin A1c (HbA1c) ≥6.5% or fasting plasma glucose (FPG) ≥7.0 mmol/l, is rising in our country, with an increase of 1.4% over the last 15 years; the increase in the population aged ≥75 years is even higher (3.2%). Despite the wealth of epidemiological data on manifest diabetic disease, the prevalence data for impaired glucose regulation are limited. Each of the following categories, incidentally termed prediabetes (PreD), represents a status of impaired glucose metabolism associated with an increased risk to develop T2DM: i. In 2010, about one-third of adults in the USA (~79 million people) had PreD, a metabolic state of care seekers with FPG or HbA1c levels near the upper cut-off of the reference
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