Abstract
AimDiabetes (DM) and impaired glucose tolerance (IGT) detection are conventionally based on glycemic criteria. Skin autofluorescence (SAF) is a noninvasive proxy of tissue accumulation of advanced glycation endproducts (AGE) which are considered to be a carrier of glycometabolic memory. We compared SAF and a SAF-based decision tree (SAF-DM) with fasting plasma glucose (FPG) and HbA1c, and additionally with the Finnish Diabetes Risk Score (FINDRISC) questionnaire±FPG for detection of oral glucose tolerance test (OGTT)- or HbA1c-defined IGT and diabetes in intermediate risk persons.MethodsParticipants had ≥1 metabolic syndrome criteria. They underwent an OGTT, HbA1c, SAF and FINDRISC, in adition to SAF-DM which includes SAF, age, BMI, and conditional questions on DM family history, antihypertensives, renal or cardiovascular disease events (CVE).Results218 persons, age 56 yr, 128M/90F, 97 with previous CVE, participated. With OGTT 28 had DM, 46 IGT, 41 impaired fasting glucose, 103 normal glucose tolerance. SAF alone revealed 23 false positives (FP), 34 false negatives (FN) (sensitivity (S) 68%; specificity (SP) 86%). With SAF-DM, FP were reduced to 18, FN to 16 (5 with DM) (S 82%; SP 89%). HbA1c scored 48 FP, 18 FN (S 80%; SP 75%). Using HbA1c-defined DM-IGT/suspicion ≥6%/42 mmol/mol, SAF-DM scored 33 FP, 24 FN (4 DM) (S76%; SP72%), FPG 29 FP, 41 FN (S71%; SP80%). FINDRISC≥10 points as detection of HbA1c-based diabetes/suspicion scored 79 FP, 23 FN (S 69%; SP 45%).ConclusionSAF-DM is superior to FPG and non-inferior to HbA1c to detect diabetes/IGT in intermediate-risk persons. SAF-DM’s value for diabetes/IGT screening is further supported by its established performance in predicting diabetic complications.
Highlights
Despite the major, woldwide increase in type 2 diabetes mellitus (T2DM), and its preceding stages impaired fasting glucose (IFG) and glucose tolerance, almost half of those affected are not aware of having this condition (Eckardstein) [1,2,3]
Diagnosis of T2DM is still based on glycemic criteria, in the WHO criteria and Europe on glucose levels
An International Expert Committee (IEC) recently proposed new diagnostic criteria based on measurement of A1C, with A1C$6.5%/48 mmol/mol for diabetes and 6.0–6.4%/42–46 mmol/mol for ‘‘high risk’’ of progression to diabetes [4,5]
Summary
Woldwide increase in type 2 diabetes mellitus (T2DM), and its preceding stages impaired fasting glucose (IFG) and glucose tolerance, almost half of those affected are not aware of having this condition (Eckardstein) [1,2,3]. This leaves a long clinically latent period in which T2DM and IGT can be detected, for diabetes alone this is estimated to be 5 years.
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