Predicting glucose intolerance with normal fasting plasma glucose by the components of the metabolic syndrome

Screening for Abnormalities of Carbohydrate Metabolism in Teens

Diabetes mellitus (DM) is a major public health problem in Oman. We evaluated the impact of the revised diagnostic criteria for DM adopted by the American Diabetes Association (ADA) on the prevalence of diabetes and impaired glucose tolerance (IGT), and on the classification of individuals among the Omani population. We used the dataset of the National Diabetes Survey, conducted in 1991 and involving 4682 subjects who did not have any missing data on fasting and 2-hour glucose. The subjects comprised 2002 males and 2680 females aged 20 years or above. Data were analyzed using the ADA criteria (diabetes as fasting plasma glucose [FPG] > or =7 mmol/L, impaired fasting glucose [IFG] as FPG > or =6.1 mmol/L and <7 mmol/L), and compared these with the World Health Organization (WHO) criteria (diabetes as FPG > or =7.8 mmol/L and/or 2-hour post-glucose load > or =11.1 mmol/L, IGT as FPG <7.8 mmol/L, and 2-hour post-load 7.8-11.1 mmol/L). Applying the ADA criteria on the Omani population resulted in an overall reduction of diabetes prevalence by 2.2% (95% confidence interval [CI] 1.6% to 2.8%), and a 4.8% reduction of IGT (95% CI 3.8% to 5.8%). Over 29% of diabetics classified by the WHO criteria were reclassified as being normal or having IFG by the ADA criteria. Around 3.6% of those who were normoglycemic by the WHO criteria were classified as having diabetes or IFG by the ADA criteria. In all but one region of Oman, the prevalence of diabetes and IFG using the ADA criteria was lower compared to the prevalence using the WHO criteria. Gender, age and body mass index did not seem to pose an increased risk to the probability of being diagnosed by one criteria or the other or both together. The adoption of the ADA criteria in Oman will significantly reduce the prevalence of diabetes and IGT. In addition, the glycemic status of a substantial number of individuals will be changed from normal to either being diabetic or having IGT.

To compare the ability of the metabolic syndrome (MetS), a diabetes prediction model (DPM), a noninvasive risk questionnaire and individual glucose measurements to predict future diabetes. Five-year longitudinal cohort study. Tools tested included MetS definitions [World Health Organization, International Diabetes Federation, ATPIII and European Group for the study of Insulin Resistance (EGIR)], the FINnish Diabetes RIsk SCore risk questionnaire, the DPM, fasting and 2-h post load plasma glucose. Adult Australian population. A total of 5842 men and women without diabetes > or =25 years. Response 58%. A total of 224 incident cases of diabetes. In receiver operating characteristic curve analysis, the MetS was not a better predictor of incident diabetes than the DPM or measurement of glucose. The risk for diabetes among those with prediabetes but not MetS was almost triple that of those with MetS but not prediabetes (9.0% vs. 3.4%). Adjusted for component parts, the MetS was not a significant predictor of incident diabetes, except for EGIR in men [OR 2.1 (95% CI 1.2-3.7)]. A single fasting glucose measurement may be more effective and efficient than published definitions of the MetS or other risk constructs in predicting incident diabetes. Diagnosis of the MetS did not confer increased risk for incident diabetes independent of its individual components, with an exception for EGIR in men. Given these results, debate surrounding the public health utility of a MetS diagnosis, at least for identification of incident diabetes, is required.

The Performance of the Revised Criterion for Diagnosis of Diabetes Mellitus in Jordan

Screening for Type 1 and Type 2 Diabetes

Prediabetes: A Prevalent and Treatable, but Often Unrecognized, Clinical Condition

To compare the prevalence of different categories of glucose tolerance in a Japanese-Brazihan population using World Health Organization (WHO) and American Diabetes Association (ADA) diagnostic criteria. RESEARCH DIVISION AND METHODS: The analyses were based on the data obtained from a study conducted in a representative sample of the Japanese-Brazilian population composed of 647 subjects (40-79 years) who were submitted to a 2-h oral glucose tolerance test. Prevalence of glucose tolerance categories and the level of agreement (K statistics) were obtained using WHO and ADA criteria. Cardiovascular risk profile of the subjects with different diagnostic categories were compared. Similar prevalences of diabetes were found considering both criteria (WHO, 20.3%; ADA, 19.2%). The prevalence of impaired glucose tolerance (IGT) by WHO criteria was 14.7%, contrasting with 7.4% of impaired fasting glucose (IFG) by ADA criteria. Subjects with discordant diagnostic categories by the criteria, considered at risk for diabetes (IGT/IFG), showed a worse metabolic profile than the concordant normal subjects. However, subjects with discordant diagnoses who had IGT or diabetes by WHO criteria but who were normal by ADA criteria exhibited a higher number of cardiovascular risk factors (higher blood pressure and triglyceride and low HDL cholesterol) than those who were discordant (IFG/diabetes) by ADA criteria but normal by WHO criteria. Although the number of diabetic subjects was similar between the criteria, those identified as being at risk for diabetes were quite distinct. Fewer subjects were classified as having IFG by ADA criteria than as having IGT by WHO criteria. Abnormal glucose tolerance based on WHO criteria seems to identify a worse cardiovascular profile than abnormal tolerance based on ADA criteria. Follow-up studies are necessary to know the prognostic significance of IFG to predict subsequent diabetes.

Glucose peaks – the hidden danger in type 2 diabetes

The 1997 American Diabetes Association (ADA) and 1999 World Health Organization (WHO) criteria for diabetes and hyperglycemia were evaluated and compared with respect to prediction of microvascular and macrovascular disease and mortality The prevalence of retinopathy and nephropathy at baseline and during the subsequent 10 years and mortality rates were examined in relation to baseline fasting plasma glucose (FPG) and 2-h postload plasma glucose (2-h PG) among 5,023 Pima Indian adults and in relation to the cut points defined by the ADA and WHO criteria. The frequencies of retinopathy and nephropathy were directly related to baseline FPG and 2-h PG with approximate thresholds near or below the current diagnostic criteria for diabetes (FPG > or =7.0 and 2-h PG > or = 11.1 mmol/l). The rates of retinopathy were 4.7% in impaired fasting glucose (IFG) and 20.9% in diabetes by ADA criteria; 1.6% for impaired glucose tolerance (IGT) and 19.7% for diabetes by 1985 WHO criteria; and 1.2% for IGT and 19.2% for diabetes by the 1999 WHO criteria. Mortality rates from cardiovascular-renal-related diseases were higher in diabetic individuals (FPG > or =7.0 or 2-h PG > 11.1 mmol/l) than in those with normal FPG and 2-h PG but were not elevated in those with IFG or IGT. Retinopathy and nephropathy were directly related to higher FPG or 2-h PG. FPG, which identifies those at high risk of microvascular disease and mortality, can be used to predict these outcomes and to diagnose diabetes when oral glucose tolerance testing is not practical.

Objective To explore the value of blood glycosylated hemoglobin detection in identifying patients with impaired glucose tolerance (IGT) from those undergoing health examination.Methods 489 residents in Guangzhou region undergoing health examination suffered an oral glucose tolerance test (OGTT)as well as blood glycosylated hemoglobin (HbA1c) detection.Based on the results of OGTT as diagnostic standards,receiver operating characteristic (ROC) analysis were performed to obtain the Area under the ROC curve (AUC),the optimal thresholds,the thresholds of having about 95％ sensibility and the thresholds of having about 95％ specificity when using HbA1c and fasting plasma glucose (FPG) alone as a diagnostic test,respectively.Some indexes,such as youden index (YI),sensitivity (Sn),specificity (Sp),positive predictive value (+PV),negative predictive value (-PV),positive likelihood ratio (+LR) and negative likelihood ratio (-LR),were computed when IGT was diagnosed with HbA1c alone,FPG alone and combination tests that one of the three thresholds metioned above from HbA1c was matched with that from FPG each other,respectively.Results The AUC for HbA1c and FPG to diagnose IGT was 0.605 and 0.679,respectively.At the optimal threshold of 6.05％ for HbAlc and 5.465 mmol/L for FPG,YI was 0.186 and 0.265,Sn was 40.3％ and 56.9％,Sp was 78.3％ and 69.6％,+PV was 43.6％ and 43.9％,-PV was 75.8％ and 79.5％,+LR was 1.853 and 1.871,-LR was 0.763 and 0.619,for HbA1c and FPG,respectively.Of the combination tests the best one had a YI of 0.282,a Sn of 61.8％,a Sp of 66.4％,a +PV of 43.4％,a-PV of 80.6,a +LR of 1.838 and a-LR of 0.575.Conclusion Neither HbA1c alone nor HbAIc combined with FPG is available in screening patients with impaired glucose tolerance among subjects undergoing health examination. Key words: Glycosylated hemoglobin; Impaired glucose tolerance (IGT); Screening

1. We studied beta-cell function in 40 hypopituitary adults and in 36 matched control subjects. Hypopituitary patients were studied again at 1, 3 and 6 months during a double-blind placebo-controlled trial of growth replacement lasting for 6 months. Biosynthetic human growth hormone was given subcutaneously in a daily dose of 0.02-0.05 i.u./kg at bed time. Fasting insulin, intact proinsulin and 32-33 split proinsulin were measured by two-site immunoradiometric assays. 2. Hypopituitary patients were aged 19-67 years and had a body mass index of 27.7 (18.0-41.1) kg/m2. They were receiving replacement thyroxine, adrenal steroids and sex hormones and they were growth hormone deficient. Control subjects were matched for age, sex and body mass index. Hypopituitary patients with normal glucose tolerance and with impaired glucose tolerance were compared separately with subgroups of control subjects matched for age and body mass index. 3. Twenty-six hypopituitary patients had normal glucose tolerance and 14 had impaired glucose tolerance. All control subjects had normal glucose tolerance by World Health Organization criteria. Patients with impaired glucose tolerance were significantly older than those with normal glucose tolerance (P < 0.03). Hypopituitary patients with normal glucose tolerance compared with normal control subjects had a significantly lower fasting plasma glucose concentration (P < 0.01), a lower fasting insulin concentration (P < 0.006), a lower insulin-glucose ratio (P < 0.02) and a lower percentage of insulin to total insulin-like molecules [hypopituitary patients, 90% (81-96%); control subjects, 93% (78-97%); P < 0.02]. Hypopituitary patients with impaired glucose tolerance had similar glucose and insulin concentrations and insulin-glucose ratios as matched control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study is to compare hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) tests as a mass screening tool for pre-diabetes and diabetes as defined by standard oral glucose tolerance test (OGTT). The study was community-based cross-sectional and carried out in urban field practice area of the Department of Community Medicine at Rohtak. A day before the study, subjects were advised to observe overnight fasting (at least 8 h) and were called at the nearest health center in the morning. Initial evaluation included detailed history and clinical examination to exclude any systemic diseases. FPG and 2-h plasma glucose after 75 g OGTT was used to diagnose pre-diabetes and diabetes in 1008 participant. Fasting plasma glucose and 2-h post glucose load were estimated by glucose oxidase method. HbA1c was measured using Cone lab 30i autoanlyser based on latex agglutination inhibition assay (EIA). The American Diabetic Association (ADA) criteria were used to categorize the subjects into pre-diabetes and diabetes (American Diabetes Association. Diabetes Care; 33 Suppl 1:S62–9, 2010). Performance of HbA1c and FPG was evaluated against the results of OGTT by receiver operating characteristics (ROC) curve analysis. The prevalence of pre-diabetes and newly diagnosed diabetes was found 20.6 and 12.5 %, respectively. For pre-diabetes, the area under the ROC curve was 0.831 for HbA1c and 0.807 for FPG (p value 0.205), whereas for diabetes, these values were 0.957 for HbA1c and 0.942 for FPG (p value 0.11). At the optimal HbA1c cutoff points of 5.4 % for pre-diabetes and of 6.2 % for newly diagnosed diabetes, sensitivities and specificities were 79.02, 79.31 and 94.24, 90.52 %, respectively. Similarly, FPG optimal cutoff points of ≥97 mg/dl for pre-diabetes and ≥119 mg/dl for diabetes were found to have maximum sensitivities (specificities) of 93.13 (63.32) and 93.53 (89.64), respectively. It is observed that at optimal cutoff of FPG ≥97 mg/dl and HbA1c ≥5.4 % for pre-diabetes and ≥119 mg/dl and 6.2 % for newly diagnosed diabetes, more true-positive cases are identified as compared to currently recommended ADA criteria when both were compared with results of 75 g OGTT. As a screening tool for newly diagnosed pre-diabetes and diabetes, the HbA1c measurement did not perform inferior than FPG. In this study population, FPG and HbA1c values lower than the currently recommended values of ADA were found to be better predictor of pre-diabetes and diabetes.

To evaluate the impact of lowering of cut-point value for impaired fasting glucose (IFG) from 6.1 mmol/L to 5.6 mmol/L. by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, US, on the prevalence rates of different impaired glucose regulation (IGR) subcategories in Chinese adults, and to explore the ability of the new cut-point to diagnose IGR. The data of 15 564 persons undergoing standard 75 g oral glucose tolerance test (OGTT) in the National Diabetes Mellitus Survey (1994) in Chinese adults (>or= 25 years) were reanalyzed. The prevalence of isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), and combined IFG and IGT (IFG/IGT) were calculated by the new criteria of 5.6 mmol/L <or= fasting plasma glucose (FPG) < 7.0 mmol/L and old criteria of 6.1 mmol/L <or= FPG < 7.0 mmol/L. The sensitivity and specificity of different FPG to diagnosis of IGR were analyzed with the value of blood sugar 2 hour after OGTT as 7.8 mmol/L <or= PG2 h < 11.1 mmol/L as the gold standard. Receiver operator characteristic curve (ROC) was used to determine the best FPG cut-point value for diagnosing IGR. (1) The prevalence of I-IFG, I-IGT, and IFG/IGT were 8.71%, 12.08% and 5.95% when classified by the old criteria, and 21.25%, 6.89% and 11.13% by the new criteria respectively. (2) ROC analysis showed an optimum FPG cut-point to diagnose IGR of 5.6 mmol/L, which yielded a sensitivity of 61.9% and specificity of 63.9%. The decrease of the lower cut-point value for IFG from 6.1 mmol/L to 5.6 mmol/L is associated with a 1.2 time increase of IFG prevalence among Chinese adults. From the viewpoint of minimizing the discrepancy between IFG and IGT, it may be suitable to lower the IFG cut-point value.

Objective To investigate features of fasting plasma glucose (FPG) during different trimesters and hemoglobin A1c (HbA1c) in the third trimester of pregnant women in Zhujing Region of Shanghai. Methods A total of 606 cases of pregnant women who received prenatal examination and 75 g oral glucose tolerance test (OGTT) in Jinshan Branch of Shanghai Sixth People′s Hospital from January 1 to December 31, 2014 were collected as research subjects. According to the results of 75 g OGTT, they were divided into gestational diabetes mellitus (GDM) group (n=136) and non-GDM group (n=470). The clinical data, such as age, body mass index (BMI), as well as the concentration of FPG during different pregnancy trimesters and level of HbA1c in the third trimester were collected retrospectively in both two groups by retrospective analysis method. According to the quartile method, level of HbA1c in the third trimester of all subjects were divided into four ranges: Q1 (HbA1c level<5.1%), Q2 (5.1%≤HbA1c level<5.2%), Q3 (5.2%≤HbA1c level<5.5%), and Q4 (HbA1c level≥5.5%), respectively. The age, BMI, concentrations of FPG and the level of HbA1c between two groups were compared by independent-samples t test. Chi-square test was used to compare the GDM incidence of all subjects with different ranges of HbA1c level in the third trimester, and further comparison was conducted by adjusting inspection level. Then receiver operator characteristic (ROC) curve of HbA1c level in the third trimester for predicting the incidence of GDM was drawn, and the area under ROC curve (ROC-AUC) was calculated. The optimal critical value of HbA1c level in the third trimester for predicting the incidence of GDM was obtained when the Youden index reaching the maximum value. And its sensitivity and specificity were calculated. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results ①The age and BMI of GDM group were higher than those in non-GDM group, and there were statistically significant differences (t=5.306, 5.250; P<0.001). Among the subjects in GDM group, the concentration of FPG in second trimester was the highest among 3 trimesters, which was (4.9±0.6) mmol/L, and the concentration of FPG in second trimester was higher than that in first and third trimester, respectively, and both the differences were statistically significant (t=2.087, 1.960; P=0.039, 0.041). Among the subjects in non-GDM group, the concentration of FPG in first trimester was the highest among 3 trimesters, which was (4.6±0.3) mmol/L, and the concentration of FPG in first trimester was higher than that in second and third trimester, respectively, and both the differences were statistically significant (t=15.230, 5.613; P<0.001). The concentration of FPG in first, second and third trimesters of GDM group were higher than those of non-GDM group, respectively, and there were statistically significant differences (t=5.416, 15.526, 4.471; P<0.001). Besides, HbA1c level in third trimester of GDM group was (5.6±0.4)%, which was higher than that of non-GDM group (5.4±0.4)%, and there was significant difference (t=5.845, P<0.01). ②There was statistical difference in GDM incidences in all subjects with different ranges of HbA1c levels in third trimester (χ2=22.707, P<0.001). Multiple comparison results showed that the incidences of GDM in all subjects with Q1 and Q2 ranges of HbA1c levels in third trimester were higher than that in subjects with Q4 range of HbA1c levels in third trimester, respectively, and both the differences were statistically significant (χ2=15.071, 16.785; P<0.001). ③The results of ROC curve analysis of HbA1c level in third trimester in predicting the incidence of GDM showed that the ROC-AUC was 0.647 (95%CI: 0.625-0.672, P<0.001), and the optimal cut-off value of HbA1c level in third trimester to predict GDM incidence was 5.5%, and the sensitivity of HbA1c level in predicting the incidence of GDM was 63.4%, and the sensitivity was 69.7%. Conclusions The concentrations of FPG in GDM pregnant women in Zhujing Region of Shanghai begin to increase from the first trimester and peak during the second trimester, and decrease during the third trimester after lifestyle intervention. It is advisable for GDM pregnant women to control HbA1c levels below 5.5% during the third trimester. Key words: Diabetes, gestational; Fasting plasma glucose; Hemoglobin A, glycosylated; Glucose tolerance test; ROC curve; Forecasting; Pregnant women

Abdominal fat distribution and insulin resistance in Indian women with polycystic ovarian syndrome