Diagnostic Criteria For Diabetes Mellitus Research Articles

The evolution and future of diagnostic criteria for diabetes mellitus

Background: The diagnostic criteria for diabetes mellitus have evolved over time, taking into account new evidence. Here, the author would like to review the evolution of diagnostic criteria for diabetes mellitus, the current diagnostic criteria, and future perspectives.Current Concepts: For the first time, in 1965, the World Health Organization (WHO) recommended that a 2-hour plasma glucose concentration of 130 mg/dL or more after taking a 50-g or 100-g oral glucose bolus may be used to make the diagnosis in people younger than 45 years and that other clinical data might be used to make the diagnosis in people older than 45 years. The 2003 American Diabetes Association Diagnostic Criteria set the threshold for normal fasting glucose at 100 mg/dL. The International Expert Committee (IEC) in 2009, the American Diabetes Association in 2010, and the WHO in 2011 proposed new diagnostic criteria for diabetes: glycated hemoglobin (HbA1c) of 6.5% or higher. More recently, diabetes has been diagnosed via a fasting blood glucose of 126 mg/dL or higher after fasting for at least 8 hours, a 2-hour postprandial blood glucose of 200 mg/dL or higher, glycated hemoglobin of 6.5% or higher, or a random blood glucose of 200 mg/dL or higher with symptoms of hyperglycemia.Discussion and Conclusion: Further research is needed on the accuracy of other markers, such as HbA1c, fructosamine, and 1,5-anhydroglusitol, in the diagnosis of diabetes, and sufficient evidence is required to determine whether it is appropriate to use the same diagnostic criteria for diabetes in aged people and different ethnic groups.

Glycated albumin and post-transplant diabetes mellitus in kidney transplant recipients.

Post-transplant diabetes mellitus is one of the most important cardiovascular risk factors after solid organ transplantation. Factors other than hyperglycaemia found in patients post-transplant, affect the level of haemoglobin A1c (HbA1c), and new markers of hyperglycaemia are needed. Our aim was to establish a 95% reference interval for glycated albumin in kidney transplant recipients, and to compare glycated albumin concentrations to the diagnostic criteria for diabetes mellitus post-transplant using oral glucose tolerance test and HbA1c. A total of 341 non-diabetic kidney transplant recipients aged ≥18years who underwent an oral glucose tolerance test at 8weeks and 1year after transplantation were included. Glycated albumin was determined by liquid chromatography coupled with tandem mass spectrometry. The 95% reference interval for glycated albumin was 8.2 (90% CI: 7.2-8.5) to 12.8% (90% CI: 12.2-13.5) which is not significantly different from our laboratory's 95% reference interval for persons without diabetes. At both 8weeks and 1year after transplantation, 35 patients (10.3%) fulfilled one, two or all three diagnostic criteria for diabetes mellitus. One year after transplantation, eight additional patients had glycated albumin concentration >12.8%. Our findings are in accordance with the notion that kidney transplant recipients form glycation end products like normal controls as estimated by glycated albumin and HbA1c. Further studies should address glycated albumin as a supplemental tool for the diagnosis of post-transplant diabetes mellitus in kidney transplant recipients.

Insulin resistance improvement and serum metabolomics of Hibiscus esulentus L. in patients with impaired glucose tolerance

Background/Aim. Prediabetes (PD) refers to the condition in which the blood sugar level is higher than normal but has not reached the diagnostic criteria for diabetes mellitus (DM) yet. Impaired glucose tolerance (IGT) is a major prediabetic symptom since most patients with type 2 DM have progressed from the previous PD phase. The aim of the study was to observe the changes in serum metabolomics in patients with IGT treated with Hibiscus esculentus L. (H. esculentus) combined with the change of lifestyle. Methods. Sixty patients with IGT were divided into two groups. In one group, the subjects made a life-style change (LC group, simple diet control), and the other group of subjects made a lifestyle change combined with H. esculentus (LCH group) treatment with daily consumption of 20 g of dried H. esculentus fruit tea. The aim was to compare the blood glucose, homeostasis model assessment-estimated insulin resistance (HOMA-IR) index, and serum metabolomics after a 60-day clinical observation period. Results. There was no statistical significance in the glucose level between the two groups by the end of the observation period. The HOMA-IR index in the LCH group was lower than in the LC group (1.7 ? 1.1 vs. 2.4 ? 1.2, p = 0.030). Serum metabolomics revealed that the levels of d-galactose, d-glucose, turanose, and uric acid in the LCH group were significantly lower than those in the LC group (16.7 ? 3.9 mmol/L vs. 21.2 ?2.9 mmol/L, 101.5 ? 40.2 mmol/L vs. 132.9 ? 36.7 mmol/L, 1.8 ? 1.6 mmol/L vs. 3.76 ? 2.46 mmol/L, 44.56 ? 15.7 ?mol/L vs. 67.8 ? 23.5 ?mol /L, respectively). The levels of lactic acid and conjugated linoleic acid in the LCH group were significantly higher than those in the LC group (3.3 ? 0.5 mmol/L vs. 2.3 ? 0.8 mmol/L, 6.9 ? 6.1 mmol/L vs. 2.1 ? 1.2 mmol/L, respectively). Conclusion. H. esculentus, combined with a change of lifestyle, can reduce insulin resistance and the levels of multiple monosaccharides and blood uric acid in IGT patients. Regulation of the metabolism of lactic acid and conjugated linoleic acid may be the potential mechanism of how H. esculentus reduces insulin resistance.

Classification and prediction of the effects of nutritional intake on diabetes mellitus using artificial neural network sensitivity analysis: 7th Korea National Health and Nutrition Examination Survey.

This study aimed to predict the association between nutritional intake and diabetes mellitus (DM) by developing an artificial neural network (ANN) model for older adults. Participants aged over 65 years from the 7th (2016-2018) Korea National Health and Nutrition Examination Survey were included. The diagnostic criteria of DM were set as output variables, while various nutritional intakes were set as input variables. An ANN model comprising one input layer with 16 nodes, one hidden layer with 12 nodes, and one output layer with one node was implemented in the MATLAB® programming language. A sensitivity analysis was conducted to determine the relative importance of the input variables in predicting the output. Our DM-predicting neural network model exhibited relatively high accuracy (81.3%) with 11 nutrient inputs, namely, thiamin, carbohydrates, potassium, energy, cholesterol, sugar, vitamin A, riboflavin, protein, vitamin C, and fat. In this study, the neural network sensitivity analysis method based on nutrient intake demonstrated a relatively accurate classification and prediction of DM in the older population.

Knowledge of Diabetes Mellitus among Undergraduate Clinical Students of Sindh Medical College

Objective: To determine the knowledge of undergraduate students of Sindh Medical College regarding Diabetes Mellitus (DM) Methodology: This cross sectional study was conducted at Sindh Medical College, Jinnah Sindh Medical University (SMC-JSMU). The participants were students of 3rd year, 4th year and 5th year M.B.B.S. The sample size was calculated to be 282, using open EPI software. The data was collected through a scientifically designed questionnaire which included questions about the over all knowledge, risk factors, complications, diagnosis, treatment, methods of prevention, and WHO criteria of Diabetes Mellitus. SPSS version 22.0 was used for data analysis. Results: About 275 (98%) students had knowledge of the site of insulin production and 255 (90%) knew exactly how insulin produces its effects. Regarding the clinical presentation of DM, 262 (93%) of them agreed that hunger, thirst, and urination present as the major symptoms of this disease (p=0.005). Family history was considered as the prime risk factor by 93 (98%), 83 (95%) and 86 (86%) of final year, fourth, and third year students respectively (p=0.003). Furthermore, 254 (90%) selected retinopathy (p=0.00), 239 (85%) preferred nephropathy (p=0.003) and 224 (79%) considered neuropathy (p=0.024) as the most significant complication of DM. Moreover, the recall of the WHO diagnostic criteria for DM was comparatively lower in final year students (p=0.003). Conclusion: The over all knowledge of undergraduate medical students of Sindh Medical College was found to be satisfactory. Most of the students considered medical education as an adequate source of knowledge in this regard. However, capability of diagnosing DM was found to be comparatively low among final year M.B.B.S. students.

THE RELATIONSHIP BETWEEN KNOWLEDGE OF MOTIVATION AND FAMILY SUPPORT ON DIET COMPLIANCE IN FAMILIES WITH DIABETES MELLITUS

Diabetes mellitus has become a common health problem that can be found everywhere, the number of people with diabetes mellitus is increasing continuously. Even diabetes mellitus will tend to have a frightening effect when considering some complication caused by the eyes, heart, kidneys, nerves, or the possibility of amputation can occur as well. Diabetes mellitus is a world health problem because the prevalence and cases of this disease continue to increase, both in industrialized countries including Indonesia. WHO (Wordl Health Organization, 2018) explains the diagnostic criteria for diabetes mellitus (DM), namely if fasting blood glucose levels are > 126 mg/dl or random blood glucose > 200 mg/dl. The pancreas regulates glucose levels in the release of glucagon, glucagon is an insulin antagonist which has a role in increasing blood sugar levels and then accelerating the rate of release from the liver. Insulin also stimulates glucose into glycine (a form of glucose conversion to become energy reserves) and stores it in the cells. Purpose: to analyze the relationship between knowledge of motivation and family support for dietary compliance in families with diabetes mellitus. Method: the literature study used is where the collection is done through the database google scholar, research gate, and garuda portal. which the collection was carried out trought the database google scholar, research gate, and garuda portal. Research Results: from the total sample that was used for review from ten journals, there were 685 respondents who were given family support in dietary compliance. Most of the respondents who received family support could improve their dietary compliance. Conclusion: the results obtained from a review of ten journals showed that there was a significant relationship between knowledge of motivation and family support for dietary compliance so that it could improve dietary compliance by people with diabetes mellitus.

Glycated haemoglobin and the association with long-term survival among patients evaluated for stable angina – a prospective Norwegian cohort

Abstract Background and methods Recent guidelines have included glycated haemoglobin (HbA1c) ≥48 mmol/L as a diagnostic criterion for diabetes mellitus (DM) in addition to plasma glucose (PG) concentrations, mainly based on the relationship between hyperglycemia and microvascular disease [1]. However, increased HbA1c may stem not only from hyperglycemia, and the risk association between HbA1c and long-term survival in patients with stable coronary heart disease and HbA1c ≥48 mmol/L but no previous DM according to PG is uncertain. We explored the relationship between HbA1c and survival among patients with and without DM who were evaluated for stable angina in the period 2000–2004. Endpoints were obtained from the Norwegian Cause of Death Registry. Results In total, 4164 patients were evaluated by cardiac cathetherization, of whom 576 patients (13.8%) had DM (median HbA1c 55 mmol/L) according to self-report and/or baseline PG concentrations. Of the remaining 3588 patients 1026 had HbA1c ≥48 mmol/L; however, HbA1c did not correlate with the HOMA2 insulin resistance index or fasting PG in these patients. During median (25–75 percentile) follow-up time of 14.0 (12.1–15.4) years a total of 1328 patients (31.9%) died, of whom 582 from cardiovascular causes. In patients with DM according to PG, HbA1c trended towards positive associations with all-cause and CVD mortality when adjusted for age and gender (HRs (95% CIs) 1.13 (0.99–1.28) and 1.16 (0.98–1.39) per 1SD, respectively). However, HbA1c was not associated with survival in either the group of patients without DM and HbA1c <48 mmol/L (median HbA1c 38 mmol/L) (HRs (95% CIs) 0.99 (0.92–1.06) and 0.96 (0.86–1.08) for all-cause and CVD mortality, respectively) or patients without DM but having HbA1c ≥48 mmol/L (median HbA1c 53 mmol/L) (HRs (95% CIs) 0.99 (0.88–1.12) and 1.04 (0.88–1.22)). Conclusion In patients evaluated for stable angina pectoris about two decades ago, almost a third of patients with no history of DM according to PG still had HbA1c concentrations indicating DM according to current guidelines. Including these patients in the DM category yielded similar percentages of patients with DM as observed in recent populations with stable coronary disease [2]. However, as opposed to what we observed in patients with DM, HbA1c did not show any association with very long-term survival among patients without DM. Our findings therefore question the use of HbA1c in the diagnosis of DM, especially in terms of risk assessment for longevity among patients with chronic coronary syndrome. Funding Acknowledgement Type of funding sources: None.

Characteristics of children and adolescents with newly diagnosed Fibrocalculous pancreatitis diabetes (FCPD) and type 1 diabetes: A study from Eastern India

Background and aimsWe aimed to identify clinical characteristics and biochemical parameters at presentation in newly diagnosed children and adolescents with Fibrocalculous pancreatic diabetes (FCPD) and compare them with Type 1 Diabetes (T1D) children. MethodologyA retrospective chart review yielded 226 patients (below 18 years) who presented and fulfilled diagnostic criteria of diabetes mellitus. Classification of diabetes was based on American Diabetes Association (ADA), World Health Organization (WHO), International Society for Paediatric and Adolescent Diabetes (ISPAD), and Mohan's criteria and all patients underwent abdominal X-ray. ResultsA total of 31 (13.7%) patients fulfilled criteria of FCPD and 63 (27.9%) of autoantibody positive T1D. When comparing FCPD with T1D at presentation, FCPD patients were older, 14.23 years vs 11.32 years. Fewer FCPD patients presented with Diabetic Ketoacidosis (3.2% vs 34.9%), osmotic symptoms (54.8% vs 93.7%) with significantly longer median duration of symptoms (4.0 vs 1.0 months) and had more abdominal pain (58.06% vs 6.3%) & diarrhoea (38.71% vs 1.6%) as compared to patients with T1D”. FCPD patients had higher c-peptide levels (median-0.85 vs 0.61) and required higher mean dose of insulin compared to T1D (1.16 U/kg vs 1.01 U/kg). At presentation fasting plasma glucose was significantly higher in T1D than FCPD, but no difference was noted in post prandial glucose and HbA1c. ConclusionThere is a significant difference in clinical characteristics and biochemical parameters at presentation between FCPD and T1D patients with a longer symptom duration but insidious course in the former. To the best of our knowledge, this is the first study to report suitable cut-offs for age, c-peptide, duration of symptoms and insulin dose requirement which could be helpful for differentiating FCPD from T1DM patients.

The correlation between blood glucose level and muscle mass, strength and function in an elderly population

Objective: To explore the correlation between blood glucose levels and the three factors of sarcopenia (muscle mass, strength and function) in older Chinese community dwellers. Methods: This is a retrospective study conducted by collecting the data of patients in Jiangsu Huaqiao Road Community Health Service Center from 2018 to 2019. Two hundred and fifty people aged 60 years or elder were selected. Among them, 101 were men and 149 were women. According to the American Diabetes Association diagnostic criteria for diabetes mellitus in 2018, they were divided into normal glucose tolerance (NGT) group, pre-diabetes group and diabetes group. The patients were assessed for sarcopenia as well. Results: Compared with those in the NGT group, muscle mass and upper limb muscle strength did not change in the diabetic group, but lower limb muscle strength and body function [walking speed, balance, short physical performance battery (SPPB)] decreased significantly in the diabetic group. Pearson correlation analyses showed that fasting plasma glucose(FPG) was negatively correlated with walking speed (r=-0.248, P=0.001), three-pose balance (r=-0.166, P=0.013) and SSPB (r=-0.213, P=0.001). Glycosylated hemoglobin A1c(HbA1c) was positively correlated with sitting and standing time (r=0.205, P=0.002), and negatively correlated with three-pose balance (r=-0.186, P=0.006) and SSPB (r=-0.154, P=0.024). Multiple regression analyses showed that FPG was negatively associated with walking speed (β=-0.125, P=0.005) and SPPB (β=-0.034, P=0.012), and that HbA1c was positively associated with sitting and standing time (β= 0.218, P =0.006) and negatively associated with three-pose balance (β=-0.143, P=0.012), and SPPB (β=-0.117, P =0.036). Conclusions: There is no significant correlation between blood glucose levels and muscle mass in the elderly; however, FPG is closely correlated with gait speed, and HbA1c is closely correlated with muscle strength of lower limbs and balance ability in the elderly.

The prevalence and clinical characteristics of diabetes mellitus in Chinese inpatients with chronic schizophrenia: a multicenter cross-sectional study.

BackgroundDiabetes mellitus (DM) is common among patients with schizophrenia. However, information on patients comorbid DM and schizophrenia is limited in China. The present study investigated the prevalence of DM and its clinical characteristics in Chinese inpatients with chronic schizophrenia.MethodsA cross-sectional study was performed in Chinese inpatients with chronic schizophrenia. Diagnosis of Diabetes was established using World Health Organization diagnostic criteria for diabetes mellitus (persistent fasting glucose levels ≥ 126 mg/dl or 2-h plasma glucose ≥ 200 mg/dL after a 75-g Oral Glucose Tolerance Test). Patients were also measured height, weight, waist circumference, hip circumference, triglyceride level, and cholesterol level. Patients’ psychiatric symptoms were measured by the Positive and Negative Syndrome Scale (PANSS). Binary logistic regression analysis was performed to examine the associated demographic and clinical variables in chronic schizophrenia.ResultsA total of 988 inpatients (64.6% male, average age of 47.19 ± 12.55) was recruited. The prevalence of DM in Chinese patients with chronic schizophrenia was 13.8% (95% CI [11.6–15.9]%). Logistic regression analysis showed that overweight (OR = 1.90, 95% CI [1.20–3.03], p = 0.006), obesity (OR = 1.85, 95% CI [1.07–3.21], p = 0.028), comorbid hypertension (OR = 2.14, 95% CI [1.34–3.42], p = 0.002), and course of schizophrenia (OR = 1.03, 95% CI [1.01–1.06], p = 0.040) were significantly associated with the DM risk in patients with schizophrenia.ConclusionThe findings indicated that diabetes mellitus was non-negligible in patients with chronic schizophrenia. Patients with schizophrenia should be regularly monitored for DM. Overweight/obesity, long duration of schizophrenia, and comorbid hypertension possibly were risk factors for diabetes.

Глікемічний скринінг і вторинні порушення вуглеводного обміну при ендокринній патології

Причиною поганого глікемічного контролю при цукровому діабеті може бути надлишкова секреція контрінсулярних гормонів при різних ендокринопатіях. А отже, глікемічний скринінг і скринінг ендокринних захворювань, які супроводжуються порушеннями вуглеводного обміну, повинні проводитися паралельно.

Basic principles of management of patients with diabetes mellitus type 2 in outpatient practice. Part 1. Diagnostics

Worldwide, there is a high rate of growth in the incidence of diabetes mellitus. In the Russian Federation, the prevalence of diabetes is also high. According to some data, the number of patients with this disease in the Russian Federation can reach at least 9 million people (about 6% of the population).
 The most dangerous consequences of the global epidemic of diabetes mellitus are the development of its systemic vascular complications-nephropathy, retinopathy, lesions of the main vessels of the heart, brain, and arteries of the lower extremities.
 To prevent the development of complications of diabetes mellitus, its timely diagnosis is extremely important. Primary care physicians play a key role in early detection of diabetes.
 In this lecture, the risk factors for the development of diabetes mellitus, prevention of this disease, diagnostic approaches that allow timely detection of diabetes mellitus and start its treatment are considered. Diagnostic criteria for various disorders of the glycemic profile are presented. The role of glycated hemoglobin as a diagnostic criterion for diabetes mellitus is noted.

Association of hemoglobin H (HbH) disease with hemoglobin A1c and glycated albumin in diabetic and non-diabetic patients.

Hemoglobin A1c (HbA1c) and glycated albumin (GA) are glycemic control status indicators in patients with diabetes mellitus. Hemoglobin H (HbH) disease is a moderately severe form of α-thalassemia. Here we examine the usefulness of HbA1c and GA in monitoring glycemic control in patients with HbH disease. HbA1c, GA, and an oral glucose tolerance test were performed in 85 patients with HbH disease and 130 healthy adults. HbA1c was measured using five methods, including two systems based on cation-exchange high-performance liquid chromatography (Variant II Turbo 2.0 and Bio-Rad D100), a capillary zone electrophoresis method (Capillarys 3 TERA), a boronate affinity HPLC method (Premier Hb9210), and an immunoassay (Cobas c501). Significant lower levels of HbA1c were observed in patients with HbH disease than in healthy adults. In contrast, GA showed no statistically significant differences between participants with and without HbH disease. A considerable number of diabetic patients with HbH disease would be missed if using HbA1c as a diagnostic criterion for diabetes mellitus. GA but not HbA1c is suitable for monitoring glycemic control in patients with HbH disease that can modify the discriminative ability of HbA1c for diagnosing diabetes.

The influence of changing gestational diabetes mellitus diagnostic criteria on the prevalence of cases, mode of delivery and postnatal outcomes

Abstract Background Gestational diabetes mellitus (GDM) is the most common endocrinopathy of pregnancy. Adequate detection of GDM can prevent maternal and foetal adverse outcomes. In 2014 changes in GDM diagnostics and management in Poland were implemented. Aim The comparison of frequency of gestational diabetes mellitus diagnosis, rates of foetal growth, birth mode and the condition of the newborn before and after the implementation of the new standards. Methods Study group included 626 diabetic parturients: Group A n = 107, diagnosed with previous criteria, and Group B n = 519, tested with the use of the new standards. We analysed frequency of GDM class occurrence (G1, treated with diet only and G2, treated with diet and insulin) maternal age and parity, gestational age at birth, mode of birth and the condition of the newborn. Results In period I women with gestational diabetes mellitus accounted for 1,69% of all birth givers, while in period II the percentage was as high as 6,38%. In Group A we found class more prevalent, while most of women in Group B was classified as G1. Most women in Group B had caesarean section (60,89%), which were performed mostly due to maternal indications. Large for gestational age newborns were more frequent in Group B, while small for gestational age infants were more prevalent in Group A. Conclusions The introduction of new GDM diagnostic criteria influenced the number of detected cases and classification of gestational diabetes mellitus, as well as pregnancy duration, birth mode, type of indications for caesarean section and neonatal birth weight.

Electrophysiological evaluation in 4 patients with diabetic pseudotabes

BACKGROUNDResearches on diabetic nervous system lesion are mainly focus on peripheral nerve and vegetative nerve, so there are few investigations on diabetic pseudotabes. OBJECTIVETo investigate the electrophysiological examinations on the diagnosis of diabetic pseudotabes. DESIGNCase study. SETTINGDepartment of Electrophysiology and Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTSA total of 4 patients with type 2 diabetes mellitus, including 3 males and 1 female aged from 50 to 72 years, were selected from Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University from March 2002 to February 2005. All accepted subjects met the modified diagnostic criteria of diabetes mellitus, which was set by American Diabetes Mellitus Association (ADA) in 1997. Otherwise, the subjects had typical symptoms and physical signs of spinal posterior funiculus damage. However, patients with spinal cord lesion which was caused by other factors were excluded. All accepted subjects provided the confirmed consent. METHODSNicolet NT electromyography (EMG)/evoked potential meter (made in the USA) was used to detect spinal cord conduction velocity (SCCV), somatosensory evoked potential (SEP) of lower limbs, motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of extremities. Determining criteria: Measurements were performed based on the laboratory standards. SCCV, which was less than lower limit of normal value (T2–12: 40 – 55 m/s, T12 – L4: 20 – 41 m/s, T2 – L4: 36 – 45 m/s), was regarded as abnormal. SEP value of lower limbs: P40, P60 and PF, which were more than standard deviation of normal value (x+2.5), were regarded as the abnormality. Normal value of P40, P60 and PF latencies (x±s) in this study: P40, P60 and PF in males were (37.6±1.9) ms, (59.8±3.9) ms and (7.6±0.9) ms, respectively; meanwhile, those in females were (35.5±1.7) ms, (55.2±2.7) ms and (6.3±0.7) ms, respectively. MNCV and SNCV, which were less than 50 m/s in upper limbs and 40 m/s in lower limbs, were regarded as the abnormality. MAIN OUTCOME MEASURESElectrophysiological examinations. RESULTSAll 4 patients with type 2 diabetes mellitus were involved in the final analysis. (1) SCCV: Among 4 patients, SCCV of three patients was decreased in T2 – 12, T12 – L4 and T2 – L4, and that of the other one was decreased in T2–12 and T2 – L4; however, SCCV in T12 – L4 was normal. There was significant difference as compared with normal value (P < 0.01). (2) SEP of lower limbs: SEP values of lower limbs were abnormal in all 4 patients. Among them, P40, P60 and PF latencies of two patients were delayed; P40 of one patient was delayed and PF was not drained out; P40 and P60 of the last one were delayed and PF was normal. (3) MNCV and SNCV: The MNCV and SNCV were normal in one patient and abnormal in three patients. The results demonstrated that MNCV and SNCV of extremities decreased; especially, sensory nerve action potential (SNAP) of both lower extremities of one patient were not drained out. CONCLUSIONDetections of SCCV, SEP of lower limbs, MNCV and SNCV of extremities are helpful to investigate whether peripheral nerve and deep sensory passage are damaged or not and determine whether deep sensory damage is caused by peripheral nerve and spinal posterior funiculus.

Is it suitable for DM diagnosis using an abnormal two-hour glucose value only after 24th gestational weeks in China

Objective To investigate the postnatal outcomes of diabetes mellitus (DM) women diagnosed according to two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks in China, and to evaluate if it is suitable for DM diagnosis using the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks only. Research design and methods: We conducted a retrospective cohort study of the pregnant women with gestational hyperglycemia participated in gestational hyperglycemia day care and delivered in Peking University First Hospital from June 2016 to May 2018. A total of 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks were included, and 75 DM women did the oral glucose tolerance test (OGTT) from 6 weeks to 1 year postpartum. The general information collected and analyzed included age, prepregnancy body mass index (BMI), prepregnancy weight, gestational weight gain (GWG), OGTT value during pregnancy, OGTT value of postpartum, gestational weeks, and neonatal birth weight. Results There were 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, and 75 (75/168, 44.6%) women underwent an OGTT from 6 weeks to 1 year postpartum. Among the women followed-up, 56 (56/75, 74.7%) women were diagnosed as hyperglycemia and 19 (19/75, 25.3%) women were diagnosed as normal glucose metabolism. In hyperglycemia women, there are eight (8/56, 10.7%) women diagnosed as DM, 24 (24/56, 32.0%) women diagnosed as impaired glucose tolerance (IGT), eight (8/56, 10.7%) women diagnosed as impaired fasting glucose (IFG), and 16 (16/56, 21.3%) women diagnosed as IFG and IGT. Compared with normal glucose metabolism women, the age of hyperglycemia women is higher significantly (34.8 ± 3.8 versus 32.7 ± 4.7). The incidence of IFG, pharmacy treatment, and the value of HbA1c is also higher in hyperglycemia women than the normal glucose metabolism women, in which it is not statistically significant but clinically significant. Conclusion In DM women diagnosed according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, there were only eight (10.7%) women could meet DM diagnostic criteria according to the OGTT value of postpartum. Moreover, 25% women had normal OGTT value postpartum. Due to the characteristics of glucose metabolism in Asian population, an abnormal two-hour glucose value in OGTT may not be suitable to diagnose DM during pregnancy in China.

Prevalence and associated factors of gestational diabetes mellitus among rural pregnant women in southern Tanzania.

Gestational diabetes mellitus (GDM) is a potential risk factor for both maternal and foetal complications during pregnancy. This study aimed to determine the prevalence and factors associated with GDM among pregnant women in Southern Tanzania. A cross-sectional study was conducted among 612 randomly selected pregnant women attending routine antenatal clinics in Southern Tanzania from September to October 2017. Detailed medical and gynaecological history was taken using pre-tested questionnaires. Blood samples were collected for fasting and oral glucose tolerance tests. We diagnosed GDM using the World Health Organization 2013 diagnostic criteria for diabetes mellitus. We performed statistical analysis using SPSS v24.0. Possible associations and statistical significance were measured using odds ratio at 95% confidence interval, and p-values of <0.05 were considered statistically significant. The mean age and standard deviation of the study subjects was 24.5±6.9 years. The prevalence of GDM was 4.3%. GDM was significantly associated with: being overweight or obese (p<0.001), past history of pre-term delivery (p<0.001), past history of stillbirths (p<0.001), history of macrosmia (p<0.001), alcohol consumption (p=0.001), and having a first degree relative with diabetes mellitus (p<0.001). Prevalence of Gestational Diabetes Mellitus is low in this study setting. We recommend close attention to at risk women to prevent development of GDM. None declared.

171-LB: Evaluation of Universal Diabetes Diagnostic Testing at First Prenatal Visit

Diabetes mellitus (DM) in pregnancy is not routinely screened for in Haiti. If done, screening relies on OGTT at 24-28 weeks (w) of gestation. It is unclear whether this is an optimal approach in Haiti. We aimed to evaluate the implications of a universal DM diagnostic testing before 24 w. All consecutive pregnant women aged ≥18 y without known DM attending their first pregnancy visit in 4 prenatal clinics of Port-au-Prince and surroundings were invited to participate. Using a Contour NextR glucometer, eligible subjects underwent: Fasting blood glucose (FBG) test at 1-23 w and ≥36 w, 75g 2-h OGTT at 24-28 w for FBG &amp;lt;126 mg/dL before 24 w or at 24-35 w-first visit. We used WHO/IADPSG diagnostic criteria for DM in pregnancy (DIP) (FBG ≥126 mg/dL and/or 2h ≥200 mg/dL) and for gestational DM (GDM) (1 or more: FBG 92-125 mg/dL, 1-h BG ≥180 mg/dL, 2-h BG 153-199 mg/dL). A total of 945 women (mean age 29.78 ± 5.77 y, parity 2.04 ± 1.29, pre-eclampsia: 3.80%, caesarian section: 18.75%, preterm birth: 7.13%, single or living alone: 10.13%, family history of DM: 10.11%) were studied. Women with first visit at &amp;lt; and ≥24 w were 332 and 613, respectively. Prevalence of DIP and GDM by first screening period was: 7.20% and 13.02% overall, 12.35% and 13.86% at &amp;lt;24 w, and 4.40% and 12.56% at ≥24 w. Median FBG progressively decreased from 83 mg/dL at ≤5 w to 73 mg/dL at ≥36 w, p=0.0000. Of the 40 women with GDM at &amp;lt;24 w, 20 had GDM confirmed and 20 were normal on OGTT. A cut-off value of FBG &amp;gt;100 mg/dL at &amp;lt;24 w for DM (DIP and GDM) diagnosis on OGTT had: specificity (SP) 98.8%, sensitivity (SE) 19.3%, and positive predictive value (PPV) 78.6%. A cut-off value of FBG &amp;lt;72 mg/dL at &amp;lt;24 w to rule out DM on OGTT had: SP 12.2%, SE 98.3%, and NPV 96.8%. Women with these cut-offs represented 14.9% of those undergoing OGTT after the &amp;lt;24 w screening. Our findings suggest that universal screening for DM before 24 w of gestation leads to diagnosis of DM in about 20% of pregnant women. A rule in/rule out approach using FBG &amp;lt;72 mg/dL and &amp;gt;100 mg/dL values at &amp;lt;24 w can help reduce the number of OGTT at ≥24 w. Disclosure P. Larco: None. E. Jean Baptiste: None. K. Moise: None. M. Charles Larco: None. B.S. Jerome: None. J.E. von Oettingen: None. R. Charles: None.

Evaluation of the gestational diabetes mellitus diagnostic criteria recommended by the international association of diabetes and pregnancy study group for long-term maternal postpartum outcomes in mainland China.

The gestational diabetes mellitus (GDM) diagnostic criteria recommended by the International Association of Diabetes and Pregnancy Study Group (IADPSG) were established based on the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and have been the most commonly used criteria for determining GDM worldwide. Although individuals from mainland China were not included in the HAPO study, the IADPSG criteria have been used in China since 2011. However, the appropriateness of the criteria for evaluating maternal postpartum outcomes in mainland China are unknown. We conducted this study to determine whether the IADPSG criteria are appropriate for Chinese patients for evaluating long-term maternal postpartum outcomes.Eighty-four patients who were diagnosed with hyperglycemia during pregnancy and had delivery in Peking University First Hospital from February 2007 to December 2009 were enrolled in the study. For patients in Group A, GDM was diagnosed using both the National Diabetes Data Group (NDDG) and the IADPSG criteria, while patients in Group B, gestational impaired glucose tolerance (GIGT) was diagnosed using the NDDG criteria while GDM was diagnosed based on the IADPSG criteria. Anthropometric data, glucose metabolism, lipid profiles, β cell function, and insulin resistance index were evaluated and compared to baseline after 5- to 6-year postpartum period.Patients in group A had significantly higher oral glucose tolerance test (OGTT) fasting, 2-hour and 3-hour plasma glucose levels compared to patients in group B at 24 to 28 weeks of gestation (P < .05). No significant differences were observed between the groups for anthropometric data, postpartum abnormal glucose metabolism (50.91% vs 44.83%, P = .596), type 2 diabetes mellitus (T2DM) (16.36% vs 3.45%, P = .167), lipid profiles, β cell function (homeostasis model assessment β-cell function index (HOMA-β) 1.04 vs 0.99, P = .935) and insulin resistance (homeostasis model assessment insulin resistance index (HOMA-IR) 2.01 vs 1.69, P = .583).Patients diagnosed with GDM using either the NDDG or IADPSG criteria had abnormal glucose levels and lipid metabolism after delivery. Patients with mild hyperglycemia had similar postpartum β-cell functional impairment and insulin resistance to those with moderate hyperglycemia during pregnancy. Hence, with respect to maternal long-term postpartum outcomes, the IADPSG diagnostic criteria for GDM could be appropriate for patients in mainland China.

The Role of Hba1c In Severity and Mortality Rate of St Segment Elevation Myocardial Infarction For Hospitalized Libyan Non Diabetic Patients

Background:The severity of coronary artery disease (CAD) is directly related to the quality of glucose controlindiabetic patient. Additionally diabetes is associated with increased mortality following acute myocardial infarction compared to general population.Objectives:To evaluate the association of HbA1c level and severity of CAD, and outcome of non-diabetic patient with STEMI In our hospital.Patients and methods:60 consecutive non diabetic patient with acute ST elevationmyocardial infarction were treated with thrombolytic therapy included in the present prospective study. Blood glucose and HbA1c level of all patients were measured within 3 hours ofadmission. Patient were divided in to 3 groups according to HbA1c level: with cut-off 6.5% as diagnostic criteria of diabetes mellitus according to (American diabetes association) group (1) 6.5% , group (2) 6.5 to 8.5% , group (3) 8.5% and above.In hospital .mortality and morbidities of acute STEMI were compared between groups.Result :The mean age was 63±15 year and mean body mass index was 26. 6±6 kg/m² , 24 patients (40%) had history of hypertension , 27 patients (45%) of dyslipidemia, 36 patients (60%) were smoker.We found 45 patients with HbA1c ≤ 6 5%, 5 patients with HbA1c 6.5 -8.5 %, 10 patients with HbA1c ≥ 8.5%.There was strong correlation between admission of HbA1c and admission glucose level (P&lt; 0.001). Infarct size as measured by peak creatinin kinase, was not correlated with HbA1c level.Conclusion:HbA1c is an important risk marker in the absence of history of diabetes mellitus in patients with AMI . The optimal management in these patients may contribute in decrease hospital mortality.