Abstract
The efficacy of using fasting plasma glucose (FPG) alone as a preferred screening test for diabetes has been questioned. This study was aimed to evaluate whether the use of serum advanced glycation end products-peptides (sAGEP) would help to improve the efficacy of FPG in diabetes screening among high-risk Chinese subjects with FPG <7.0 mmol/L. FPG, 2-h plasma glucose (2h-PG), serum glycated haemoglobin A1c (HbA1c), and sAGEP were measured in 857 Chinese subjects with risk factors for diabetes. The areas under receiver operating characteristic (ROC) curves generated by logistic regression models were assessed and compared to find the best model for diabetes screening in subjects with FPG <7.0 mmol/L. The optimal critical line was determined by maximizing the sum of sensitivity and specificity. Among the enrolled subjects, 730 of them had FPG <7.0 mmol/L, and only 41.7% new diabetes cases were identified using the 1999 World Health Organization FPG criterion (FPG ≥7.0 mmol/L). The area under ROC curves generated by the model on FPG-sAGEP was the largest compared with that on FPG-HbA1c, sAGEP, HbA1c or FPG in subjects with FPG <7.0 mmol/L. By maximizing the sum of sensitivity and specificity, the optimal critical line was determined as 0.69×FPG + 0.14×sAGEP = 7.03, giving a critical sensitivity of 91.2% in detecting 2h-PG ≥11.1 mmol/L, which was significantly higher than that of FPG-HbA1c or HbA1c. The model on FPG-sAGEP improves the efficacy of using FPG alone in detecting diabetes among high-risk Chinese subjects with FPG <7.0 mmol/L, and is worth being promoted for future diabetes screening.
Highlights
Diabetes mellitus has become a widespread epidemic
Subjects were eligible for inclusion if they were considered at high-risk for diabetes according to the following criteria: (1) being diagnosed with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT); (2) being older than 40 years; (3) being overweight or obese; (4) having a first degree relative with diabetes; (5) having a history of giving birth to a baby weighing more than 4 kg, or being diagnosed with gestational diabetes; (6) having hypertension (140/90 mmHg or above) or taking antihypertensive drugs; (7) having hyperlipidemia or taking lipid-regulating drugs; (8) having a history of heart-cerebro-vascular disease, or being physically inactive (
It is worth noting that for those subjects whose Fasting plasma glucose (FPG) and serum advanced glycation end products-peptides (sAGEP) are below the optimal critical line but have IFG, an additional oral glucose tolerance test (OGTT) would be recommended for a final conformation, results from our study suggested that this was unnecessary as the probability for these IFG subjects turned out to be diabetes was zero
Summary
Diabetes mellitus has become a widespread epidemic. The prevalence of diabetes has rapidly increased from 9.7% in 2007 to 11.6% in 2010 among Chinese population [1,2]. Detection of diabetes could enable timely therapeutic or lifestyle interventions to prevent these complications, as well as to reduce the related death rates [6,7,8,9]. These facts greatly support the critical need to detect individuals with undiagnosed diabetes or those who are at risk of diabetes in a timely and efficient fashion. Fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) have been highly recommended to screen asymptomatic individuals. Current guidelines have not specified a screening or diagnostic strategy for this highly at-risk group
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