Fasting Plasma Glucose Cutoff Research Articles

First-trimester fasting plasma glucose levels and progression to type 2 diabetes: A 5-year cohort study.

Impaired fasting glucose is a prediabetic condition defined as glucose levels of 100-125 mg/dL and is considered a risk factor for type 2 diabetes. However, this definition does not confer to pregnancy. The significance of first-trimester fasting glucose and future progression to diabetes is not well defined. Therefore, we aimed to evaluate the progression to type 2 diabetes according to first- trimester fasting plasma glucose levels, as compared with gestational diabetes, a well-established risk factor for diabetes, in up to 5-year follow-up postpartum. A retrospective analysis of 69 001 parturients, evaluating fasting plasma glucose levels measured during the first trimester. The primary outcome was the incidence of type 2 diabetes within 5 years post-delivery. Fasting plasma glucose levels were categorized in 10 mg/dL increments. Receiver operating characteristic-area under the curve (ROC-AUC) statistics and the Youden index were employed to identify the optimal fasting plasma glucose cutoff for progression to type 2 diabetes. Survival analysis was applied to calculate the adjusted hazard ratios (aHRs) for type 2 diabetes progression with further stratification to maternal obesity status. The identified fasting plasma glucose cutoff for progression to type 2 diabetes was 86.5 mg/dL. This cut-off demonstrated superior performance compared with gestational diabetes diagnosis. Stratification by maternal obesity revealed enhanced predictive capabilities for type 2 diabetes, particularly among patients without obesity. Increased first-trimester fasting plasma glucose levels are associated with progression to type 2 diabetes, at least as gestational diabetes. For patients without obesity, first-trimester fasting plasma glucose has a more pronounced impact on progression to diabetes.

The Incidence of Metabolic Syndrome in People Over 40 Years Old with Normal Fasting Plasma Glucose and the Predictive Cutoff Value of Effective Fasting Plasma Glucose for Metabolic Syndrome in Guiyang.

This study aimed to investigate the incidence of metabolic syndrome (MS) in people over 40 years of age with normal blood glucose levels in Guiyang's urban areas and determine the effective glycemic cutoff value for predicting MS. The analysis was based on anthropometric and biochemical indicators of residents aged 40 years or older in urban areas of Guiyang City who participated in the "Epidemiological Study of Tumor Risk in Chinese Patients with Type 2 Diabetes" in 2011. This study included 3509 patients (2567 females and 942 males) with normal fasting plasma glucose (FPG) and no MS. Multivariate logistic regression was used to analyze the correlation between FPG and MS ROC was used to analyze the effective cutoff value of FPG for the incidence of MS. After 3-year follow-up, 675 patients had MS (567 females and 108 males). MS incidence in the total population was 19.24%, 11.46% in males, and 22.09% in females, and it increased with FPG. After multivariate logistic regression analysis, the risk of MS corresponding to FPG in females and males was OR=4.607,95% CI (3.477-6.105) and OR=2.944, 95% CI (1.785-4.855), respectively. ROC results demonstrated that FPG could predict the onset of MS (AUC: 0.720 in males and 0.666 in females). Increased FPG correlated with the incidence of metabolic syndrome. Subjects with FPG in the normal range still had a high incidence of MS. The population cutoff value for predicting effective FPG for metabolic syndrome was 5.545 mmol/L in men and 5.605 mmol/L in women. Epidemiological investigations are needed to determine whether a lower FPG cutoff value is required to diagnose MS. FPG not only diagnoses diabetes but also serves as a cost-effective and convenient screening method for developing of MS in the general Chinese population.

High maternal glucose exacerbates the association between prenatal per- and polyfluoroalkyl substance exposure and reduced birth weight

BackgroundPer- and polyfluoroalkyl substances (PFAS) exposure has been associated with reduced birth weight. However, the association may be complicated by glucose status due to PFAS impact on fetal growth and placental transport. ObjectivesTo examine whether maternal glucose status modifies the association between prenatal PFAS exposure and birth weight z-score. MethodsWe analyzed data of 1405 mother-child pairs from the prospective Shanghai Birth Cohort. Plasma concentrations of six PFAS were quantified in the first trimester. Fasting plasma glucose (FPG) was collected at 24–28 gestation weeks. A range of FPG cutoffs (4.9–5.4 mmol/L) covering current recommendations for gestational diabetes mellitus were used to define high and low FPG groups. Association between PFAS concentration and birth weight z-score was evaluated using multivariate linear regression in two FPG groups respectively, and the dose-response relationship was estimated with cutoffs ranging from low to high. We then used propensity score to counterbalance the effects of different PFAS concentrations between the high and low FPG groups, and run the regression again. ResultsA doubling increase in concentrations of several PFAS was inversely associated with birth weight z-score. The association was more evident in high FPG groups and the magnitudes intensified when FPG cutoff increased. The strongest association was observed for PFOA, with the magnitude increased from −0.34 (95 % CI: −0.66, −0.03) for 5.0 mmol/L cutoff, to −0.41 (95 % CI: −0.77, −0.05) for 5.1 mmol/L cutoff, and further to −0.51 (95 % CI: −0.98, −0.03) for 5.3 mmol/L. Propensity score matching yielded similar results. ConclusionsHigh maternal glucose level may increase the risk of reduced birth weight z-score related to prenatal PFAS exposure. Moreover, exploring the effects with different FPG cutoffs may contribute to providing intervention strategies for pregnant women with high PFAS exposure.

Oral glucose tolerance outcomes among pregnant women receiving antenatal care in Calabar and environs – A pilot study

Objectives: Dysglycemia is a common metabolic alteration during pregnancy with adverse effects on both mother and fetus. This is related to the fact that pregnancy is associated with insulin resistance which is a harbinger for hyperglycemia. This study was carried out to find out the prevalence of gestational diabetes mellitus (GDM) among pregnant women in Calabar area using International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic values. Material and Methods: This was a prospective, observational, cross-sectional study among pregnant women attending antenatal care in four health facilities in Calabar and adjoining areas conducted from September 2018 to August 2019. All consenting pregnant women were given 75 g glucose in 250–300 mL of water after 8–10 h overnight fast, without regard to the presence or absence of GDM risk factors. GDM diagnosis was made if any of the following glucose values were met or exceeded: (1) Fasting >92 mg/dl, (2) 1 h post-glucose load >180 mg/ dl, and (3) 2 h post-glucose load >153 mg/dl. Data were analyzed using IBM Statistical Package for the Social Sciences version 20.0 and results were presented using tables and a Venn diagram. Results: There were 345 pregnant women aged 18–50 (28.7 ± 6.3) years at 24–41 (29.6 ± 4.1) completed weeks of gestation. GDM was diagnosed in 48 (13.9%) women. Fasting plasma glucose cutoff diagnosed 81% while 37.5% and 50.0% met the diagnostic cutoff for 1 h and 2 h, respectively, and 15 (31.3%) women were positive for all three diagnostic cutoffs. Diabetes mellitus in a first-degree relative was the most common risk factor identified while hypertension in a first-degree relative and history of GDM was the least. Some 36.5% of women had no identifiable risk factors. Those who had positive fasting plasma glucose only (6.1%) were more than twice those diagnosed by 1 and 2 h only (2.6%) combined. The number of women with glucose values in the diabetic range was 6 (1.72%) but was classified as GDM since they were not previously known diabetics. Conclusion: This study has shown that the prevalence of GDM is 13.9% among women in Calabar and environs using the IADPSG criteria. Fasting plasma glucose can identify more than twice GDM patients than 1 and 2 h values combined. GDM still remains a major health issue among pregnant women hence there should be a national policy on routine screening for GDM with more studies being encouraged to determine the preferred glucose cutoff among Nigerians.

Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study.

The addition of maternal age to fasting plasma glucose (FPG) at 24-28 gestational weeks improves the performance of GDM screening as maternal age increases. However, this method delays the diagnosis of GDM. Since FPG at the first prenatal visit (FPV) is a screening option for pre-existing diabetes, we evaluated the performance of age plus FPG at the FPV to reduce the need for the OGTT. Pregnant women were recruited consecutively in 2013-2018 (the training cohort) and 2019 (the validation cohort). We excluded women with twin pregnancies, unavailable FPG at the FPV or OGTT data, pre-pregnancy diabetes, or a history of GDM. All participants underwent FPG and haemoglobin A1c (HbA1c) at the FPV and received 75-g OGTT at 24-28 gestational weeks if FPG at the FPV was <92 mg/dL. GDM was diagnosed by the IADPSG criteria. Two algorithms were developed with the cutoffs determined when the percentage requiring OGTT (OGTT%) was the lowest and the sensitivity was ≥90%. The incidence of GDM increased with age. The "FPG at the FPV" algorithm reduced OGTT% to 68.8% with the FPG cutoff at 79 mg/dl. The "age plus FPG at the FPV" algorithm, with the cutoff of 114, further reduced OGTT% to 58.3%, with the sensitivity of 90.7% (9.3% GDM missed) and the specificity of 100%. These findings were replicated in the validation cohort. Screening GDM by maternal age plus FPG at the FPV can reduce OGTT%, especially in populations with a significant proportion of pregnant women with advanced ages.

661: Gestational diabetes mellitus: Comparison of random and fasting plasma glucose as modalities of screening

To compare fasting plasma glucose (FPG) with random plasma glucose (RPG) among pregnant women as methods of screening for gestational diabetes mellitus A comparative cross-sectional study of 100 pregnant women who were selected to have screening for GDM done betwwen gestational ages of 24 to 28 weeks using random plasma glucose and fasting plasma glucose. All the subjects had 75g oral glucose tolerance test as the gold standard. Venous plasma glucose assay was performed using glucose oxidase method. During this study, a total of 100 eligible pregnant women were screened for GDM using FPG, RPG and the 75g -OGTT. The mean age±standard deviation (sd) of the participants was 34.81±4.04 yrs; mean BMI was 31.46±7.29 kg/m2 and mean parity was 1.38±1.15 (Table I). The mean RPG of the participants was 5.53±1.57 mmol/L while the mean FPG was 4.70±1.02 mmol/L. The prevalence of GDM was 29% using FPG cut off≥ 5.1 mmol/L; 16% using FPG cut off≥5.3 mmol/L and 6% using RPG cut off≥7.8 mmol/L. The RPG cut off ≥ 11.1 mmol/L gave the lowest prevalence rate of 2% while 75g-OGTT (Gold standard test) gave the highest prevalence rate of 30%. The primary outcome was measured as the accuracy of GDM screening using RPG which revealed sensitivity of 13.8%, specificity of 97.1%, positive predictive value of 66.7% and negative predictive value of 72.3% as compared with FPG threshold of 5.1 mmol/L which gave sensitivity of 90%, specificity of 97.1%, PPV of 93.1% and NPV of 95.8%. The receiver operating characteristics curve (ROC) plotted for both screening tets gave AUC of 0.845 for RPG and 0.920 for FPG. The findings from this study reveal that FPG threshold of 5.1 mmol/L has a high sensitivity of 90% and specificity of 97.1% as well as AUC of 0.920, which is excellent for a screening test. The use of RPG threshold of 7.8 mmol/L gave sensitivity of 13.8% and specificity of 97.1% with an AUC of 0.845 which was inferior to FPG.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Assessment of the optimal cutoff value of fasting plasma glucose to establish diagnosis of gestational diabetes mellitus in Chinese women

Our aim is to assess the optimal cutoff value of fasting plasma glucose (FPG) in Chinese women at 24–28 weeks’ gestation by performing oral glucose tolerance test (OGTT) to improve diagnostic rate of gestational diabetes mellitus (GDM). Data were derived from the Medical Birth Registry of Xiamen. A FPG cutoff value of 5.1 mmol/L confirmed the diagnosis of GDM in 4,794 (6.10%) pregnant women. However, a FPG cutoff value of 4.5 mmol/L should rule out the diagnosis of GDM in 35,932 (45.73%) pregnant women. If we use this cutoff value, the diagnosis of GDM to about 27.3% of pregnant women will be missed. Additionally, a 75-g OGTT was performed in pregnant women with FPG values between 4.5 and 5.1 mmol/L, avoiding the performance of formal 75-g OGTT in about 50.37% pregnant women. Meanwhile, according to maternal age and pre-pregnancy BMI categories, with FPG values between 4.5 mmol/L and 5.1 mmol/L, which had high sensitivity, to improve the diagnostic rate of GDM in all groups. Further researches are needed to present stronger evidences for the screening value of FPG in establishing the diagnosis of GDM in pregnant women.

Early diabetes screening in women with previous gestational diabetes: a new insight.

BackgroundGestational diabetes mellitus (GDM) is a risk factor for the development of diabetes mellitus (DM). However, there is a low return rate for this screening, so it is important to search for earlier methods for evaluation after delivery, to increase the number of pregnant women screened, so you can start the treatment or prevention of these early comorbidities. To determine the accuracy of the 75 g 2-h oral glucose tolerance test (OGTT) performed between 48–72 h after delivery for the diagnosis of DM using the OGTT after 6 weeks as the gold standard criterion, and to identify the optimal cutoff points for this exam for diabetes screening after a pregnancy complicated by GDM.Methods82 women with previous GDM underwent an OGTT between 48–72 h postpartum and repeated the test 6 weeks after delivery.ResultsThe prevalence of DM and prediabetes based on the first OGTT was 3.7 and 32.9 %, respectively, and 8.5 and 20.7 %, respectively, at the second OGTT. For those with DM, the area under the curve (AUC) based on the fasting plasma glucose (FPG) was 0.77 (95 % CI 0.61–0.92), and based on 2-h OGTT was 0.82 (95 % CI 0.66–0.97). For patients with prediabetes, the AUC based on the FPG was 0.73 (95 % CI 0.59–0.86) and based on the 2-h OGTT was 0.74 (95 % CI 0.61–0.87). Using a FPG cutoff value of 78 mg/dl (4.3 mmol/L) and a 2-h OGTT cutoff value of 130 mg/dl (7.2 mmol/L) for DM, the specificity was 58.7 and 60 %, the sensitivity was 71.4 and 85.7 %, the positive predictive value was 13.9 and 16.7 and the negative predictive value was 95.7 and 97.9 %, respectively.ConclusionsOGTT performed early in postpartum is a useful tool for identifying women with previous GDM who must perform an OGTT 6 weeks after delivery.

Serum Glycated Albumin to Guide the Diagnosis of Diabetes Mellitus.

In the diagnosis of diabetes mellitus, hemoglobin A1c (HbA1c) is sometimes measured to determine the need of an oral glucose tolerance test (OGTT). However, HbA1c does not accurately reflect glycemic status in certain conditions. This study was performed to test the possibility that measurement of serum glycated albumin (GA) better assesses the need for OGTT. From 2006 to 2012, 1559 subjects not known to have diabetes or to use anti-diabetic medications were enrolled. Serum GA was measured, and a 75-g OGTT was then performed to diagnose diabetes. Serum GA correlated significantly to age (r = 0.27, p<0.001), serum albumin (r = –0.1179, age-adjusted p = 0.001), body mass index (r = -0.24, age-adjusted p<0.001), waist circumference (r = -0.16, age-adjusted p<0.001), and plasma GA (r = 0.999, p<0.001), but was unaffected by diet (p = 0.8). Using serum GA at 15% for diagnosis of diabetes, the sensitivity, specificity, and area under the receiver-operating characteristic curve were 74%, 85%, and 0.86, respectively. Applying a fasting plasma glucose (FPG) value of < 100 mg/dL to exclude diabetes and of ≥ 126 mg/dL to diagnose diabetes, 14.4% of the study population require an OGTT (OGTT%) with a sensitivity of 78.8% and a specificity of 100%. When serum GA value of 14% and 17% were used to exclude and diagnose diabetes, respectively, the sensitivity improved to 83.3%, with a slightly decrease in specificity (98.2%), but a significant increase in OGTT% (35%). Using combined FPG and serum GA cutoff values (FPG < 100 mg/dL plus serum GA < 15% to exclude diabetes and FPG ≥ 126 mg/dL or serum GA ≥ 17% to diagnose diabetes), the OGTT% was reduced to 22.5% and the sensitivity increased to 85.6% with no change in specificity (98.2%). In the diagnosis of diabetes, serum GA measurements can be used to determine the need of an OGTT.

Use of high‐normal levels of haemoglobin A1C and fasting plasma glucose for diabetes screening and for prediction: a meta‐analysis

Using high-normal levels of haemoglobin A1C (Abnormal-A1C ) or fasting plasma glucose (FPG) (Abnormal-FPG) for diabetes screening are expected to improve the ability to detect persons with or at high risk of diabetes. We assessed the diagnostic and predictive capacity for diabetes of Abnormal-A1C and Abnormal-FPG. We compared these to the combined use of the two measures to the single use of either measurement. We analysed 31 eligible cross-sectional or cohort studies that assessed diagnostic or predictive ability, respectively, by using lower A1C and FPG cutoff values than recommended by current diabetes criteria. Positive and negative likelihood ratios (LR+ and LR-) were calculated to assess the ability to confirm or exclude diabetes, respectively, on the basis of a bivariate random-effects model. With both Abnormal-A1C and Abnormal-FPG, the pooled LR+ was above 4 for diagnosing diabetes and above 3 for predicting diabetes. However, the pooled LR- for predicting diabetes was higher with Abnormal-A1C (0.48) and Abnormal-FPG (0.49) in comparison with that for diagnosing diabetes (0.27, Abnormal-A1C ; 0.28, Abnormal-FPG). In eight studies that assessed the predictive ability of the combination of A1C and FPG, using either Abnormal-A1C or Abnormal-FPG could lower LR- to 0.17 from 0.43 for only Abnormal-A1C and from 0.38 for only Abnormal-FPG. Accordingly, LR+ was also lowered to 2.37 from 3.36 for only Abnormal-A1C and from 3.84 for only-Abnormal-FPG. The use of the two blood glucose tests had insufficient capacity to identify subjects at high risk for diabetes but had considerable capacity to identify undiagnosed diabetes.

Comment on: Zhu et al. Fasting Plasma Glucose at 24–28 Weeks to Screen for Gestational Diabetes Mellitus: New Evidence From China. Diabetes Care 2013;36:2038–2040

The article by Zhu et al. (1) published in Diabetes Care concludes that a fasting plasma glucose (FPG) at 24–28 weeks’ gestation can be used in low-resource regions as a screening test to identify gestational diabetes mellitus (GDM) in Chinese patients. However, in their experience, a screening protocol using FPG cutoff points of ≥4.4 and ≤5.0 mmol/L would fail to identify about 12% of the GDM cases and require a formal oral glucose tolerance test (OGTT) to be performed in about half of the pregnant population (1). These observations contrast with our findings in a circum-Mediterranean population (2). In our …

Fasting Plasma Glucose at 24–28 Weeks to Screen for Gestational Diabetes Mellitus

OBJECTIVETo evaluate the usefulness of a fasting plasma glucose (FPG) at 24–28 weeks’ gestation to screen for gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSThe medical records and results of a 75-g 2-h oral glucose tolerance test (OGTT) of 24,854 pregnant women without known pre-GDM attending prenatal clinics in 15 hospitals in China were examined.RESULTSFPG cutoff value of 5.1 mmol/L identified 3,149 (12.1%) pregnant women with GDM. FPG cutoff value of 4.4 mmol/L ruled out GDM in 15,369 (38.2%) women. With use of this cutoff point, 12.2% of patients with mild GDM will be missed. The positive predictive value is 0.322, and the negative predictive value is 0.928.CONCLUSIONSFPG at 24–28 weeks’ gestation could be used as a screening test to identify GDM patients in low-resource regions. Women with an FPG between ≥4.4 and ≤5.0 mmol/L would require a 75-g OGTT to diagnose GDM. This would help to avoid approximately one-half (50.3%) of the formal 75-g OGTTs in China.

Assessment of plasma glucose cutoff values to predict the development of type 2 diabetes in a Japanese sample: the Funagata Study

The lower cutoff limit used to define impaired fasting glucose (IFG) varies between countries/organizations and is usually 100 or 110 mg/dl. Therefore, we evaluated the cutoff value for IFG that predicted the development of type 2 diabetes among the participants of the Funagata Study, a Japanese population-based, longitudinal study. Overall, 3,413 individuals (age 56.2 ± 12.1 years) without diabetes at baseline and who attended follow-up examinations were included in this analysis. Diabetes was diagnosed based on 75-g oral glucose tolerance tests according to the 1998 World Health Organization criteria. Follow-up visits were completed in 2007 (mean follow-up 147 months). The development of diabetes was used as the endpoint. During the follow-up period, 156 individuals developed diabetes. Life-table method analysis showed significantly decreased diabetes-free survival in individuals with fasting plasma glucose (FPG) ≥ 96 mg/dl (p = 0.002). Cox’s proportional hazard model analyses showed a high risk for the development of diabetes in individuals with FPG ≥ 101 mg/dl. The hazard ratio for patients with an FPG of 101–105 mg/dl was 5.50 (95% confidence interval (CI) 2.12–14.25; p < 0.001). The 5-year incidence of diabetes was also substantially increased in individuals with FPG ≥ 101 mg/dl. The odds ratio for patients with FPG 101–105 mg/dl was 10.9 (95% CI 2.6–46.0; p < 0.001). Receiver operating characteristic curve analysis showed an optimal FPG cutoff value of 100 mg/dl. Based on these results, the optimal FPG cutoff value used to define IFG in Japanese individuals should be 100 mg/dl rather than 110 mg/dl.

Hypertension and hypercholesterolemia aggregate in nondiabetic children and adolescents with higher fasting plasma glucose levels

To investigate how hypertension and hypercholesterolemia aggregate at different fasting plasma glucose (FPG) levels in children aged 6-16 yr. In a nationwide survey conducted between 1992 and 2000, all schoolchildren aged 6-18 yr with abnormal results in repeated urine samples were included. In this study, we recruited 27 535 students aged 6- to 16-yr whose FPG levels were 90-125 mg/dL. Another 17 907 children were randomly selected as control from schoolchildren with FPG <90 mg/dL by stratification to reflect the age- and sex-specific proportion of the whole student population. The risk of having hypertension or hypercholesterolemia increased at FPG level above 90 mg/dL compared with children with FPG <90 mg/dL [6-10 yr, odd ratios (OR) = 1.51 and 1.82 for FPG 90-99 and 100-125 mg/dL for girls, OR = 1.35 and 2.03 for FPG 90-99 and 100-125 mg/dL for boys; 10-16 yr, OR = 1.24 and 1.66 for FPG 90-99 and 100-125 mg/dL for girls, OR = 1.17 and 1.41 for FPG 90-99 and 100-125 mg/dL for boys, all p < 0.05]. The risk of having both hypertension and hypercholesterolemia elevated at FPG 100-125 mg/dL (6-10 yr, OR = 2.76 for girls and 2.75 for boys; 10-16 yr, OR = 2.19 for girls and 1.74 for boys, all p < 0.05). Aggregation of hypertension, hypercholesterolemia, and abnormal glycemia was found at FPG level above 100 mg/dL, which supported the definition of abnormal glycemia in metabolic syndrome by the International Diabetes Federation in 10- to 16-yr-old children. These findings also suggest that this FPG cutoff is reasonable for 6- to 10-yr-old children.

RELATIONSHIP BETWEEN FASTING GLUCOSE AND RETINOPATHY FOR DIAGNOSIS OF DIABETES

The purpose of this study was to assess the relationship between the fasting plasma glucose cutoff of 7 mmol/L and the presence of retinopathy in a population in China. The Beijing Eye Study 2006 is a population-based study, which included 3,251 subjects aged >or= 45 years. By using fundus photographs, retinopathy was assessed according to the Early Treatment of Diabetic Retinopathy Study. The correlation between fasting plasma glucose concentration and retinopathy suggested a continuous relation instead of a uniform glycemic threshold for prevalent retinopathy. For the diabetes plasma glucose concentration cutoffs of 7.0 mmol/L, 5.6 mmol/L, and 7.8 mmol/L to differentiate between subjects with or without retinopathy, the sensitivities were 18.8%, 44.0%, and 15.4%, respectively, and the specificities were 94.3%, 73.8%, and 96.6%, respectively. After excluding subjects with known diabetes and/or subjects on antidiabetic treatment, the sensitivities of diabetes plasma glucose concentration cutoffs of 7.0 mmol/L, 5.6 mmol/L, and 7.8 mmol/L to differentiate between subjects with or without retinopathy were 7.9%, 34.2%, and 6.3%, respectively, and the specificities were 96.5%, 77.1%, and 98.1%, respectively. Confirming a recent study from Australian and North American populations, the results suggest that also for the Chinese population, a uniform glycemic threshold for prevalent retinopathy does not exist.

Can Admission and Fasting Glucose Reliably Identify Undiagnosed Diabetes in Patients With Acute Coronary Syndrome?

OBJECTIVE—Our objectives were to determine the prevalence of previously undiagnosed abnormal glucose tolerance, i.e., diabetes and impaired glucose tolerance (IGT) in patients with acute coronary syndrome and to assess the utility of admission and fasting glucose in identifying diabetes in these patients.RESEARCH DESIGN AND METHODS—Glycemic status was characterized on the basis of admission plasma glucose (APG), fasting plasma glucose (FPG), and an oral glucose tolerance test (OGTT) in 140 patients admitted to the hospital with acute coronary syndrome, who were not known to have diabetes (mean ± SD age 67.3 ± 13.4 years; 79% men). OGTTs were performed on days 5–7 after admission.RESULTS—The prevalences of diabetes and IGT were 27 and 39%, respectively, according to OGTT criteria. Receiver operating characteristic curves showed that the area under the curve for diagnosing diabetes was 0.83 (P < 0.001) for FPG, 0.79 (P < 0.001) for APG, and 0.84 (P < 0.001) for FPG and APG applied in combination. A FPG cutoff ≥5.6 mmol/l (100 mg/dl) and/or APG ≥7.8 mmol/l (140 mg/dl) yielded a sensitivity of 89.5% and a positive predictive value of 43.6% for detecting diabetes.CONCLUSIONS—A high prevalence of abnormal glucose tolerance was seen in patients with acute coronary syndrome. The combination of FPG ≥5.6 mmol/l (100 mg/dl) and/or APG ≥7.8 mmol/l (140 mg/dl) was highly sensitive for identifying diabetes. Although weakly specific, this simple algorithm could offer a practical initial screening tool at the acute setting in the high-risk population with acute coronary syndrome.

Fasting Plasma Glucose Cutoff for Diagnosis of Diabetes in a Japanese Population

We examined the relationship between fasting plasma glucose (FPG) and 2-h post-load glucose (PG) levels, and the optimal FPG cutoff level to correspond to a 2-h PG of 11.1 mmol/liter, the gold standard diagnostic criterion, in a general Japanese population. Cross-sectional study populations of 2421 subjects in 1988 and 2698 subjects in 2002, aged 40-79 yr and without antidiabetic medication, were tested with an oral glucose tolerance test. The relationship between FPG and 2-h PG was investigated by various regression models and a receiver operating characteristic curve. The best-fit model for the relationship between FPG and 2-h PG was a quadratic regression model. The FPG cutoff levels corresponding to the 2-h PG of 11.1 mmol/liter by this model were 6.2 mmol/liter in 1988 and 6.3 mmol/liter in 2002. In the combined populations, the FPG cutoff point was 6.3 mmol/liter; the sensitivity and specificity of this cutoff point for detecting a 2-h PG of 11.1 mmol/liter were 75.2 and 88.6%, respectively. The receiver operating characteristic curve analysis confirmed that the corresponding FPG point was 6.2 mmol/liter in both the 1988 and 2002 populations. In a stratified analysis, the FPG cutoff level increased with increasing body mass index levels; however, even in subjects with body mass index more than or equal to 30 kg/m2, the FPG cutoff level was lower than 7.0 mmol/liter. Our findings suggest that the FPG cutoff level corresponding to the 2-h PG of 11.1 mmol/liter in the general Japanese population is lower than the current diagnostic criterion.

Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies

The WHO and American Diabetes Association criteria for diagnosing diabetes mellitus assume the presence of a glycaemic threshold with high sensitivity for identifying retinopathy. However, this assumption is based on data from three previous studies that had important limitations in detecting retinopathy. We aimed to provide updated data for the relation between fasting plasma glucose (FPG) and retinopathy, and to assess the diagnostic accuracy of current FPG thresholds in identifying both prevalent and incident retinopathy. We examined the data from three cross-sectional adult populations: those in the Blue Mountains Eye Study (BMES, Australia, n=3162), the Australian Diabetes, Obesity and Lifestyle Study (AusDiab, Australia, n=2182), and the Multi-Ethnic Study of Atherosclerosis (MESA, USA, n=6079). Retinopathy was diagnosed from multiple retinal photographs of each eye, and graded according to the modified Airlie House Classification system. Plasma glucose concentrations were measured from fasting venous blood samples. The overall prevalence of retinopathy was 11.5% in BMES (95% CI 10.4-12.6%), 9.6% in AusDiab (8.4-10.9), and 15.8% in MESA (14.9-16.7). However, we found inconsistent evidence of a uniform glycaemic threshold for prevalent and incident retinopathy, with analyses suggesting a continuous relation. The widely used diabetes FPG cutoff of 7.0 mmol/L or higher had sensitivity less than 40% (range 14.8-39.1) for detecting retinopathy, with specificity between 80.8% and 95.8%. The area under receiver operating characteristic curves for FPG and retinopathy was low and ranged from 0.56 to 0.61. We saw no evidence of a clear and consistent glycaemic threshold for the presence or incidence of retinopathy across different populations. The current FPG cutoff of 7.0 mmol/L used to diagnose diabetes did not accurately identify people with and without retinopathy. These findings suggest that the criteria for diagnosing diabetes could need reassessment.

Suitability of recommended limits for fasting glucose tests in women with polycystic ovary syndrome

The Canadian and American Diabetes Associations recommend the use of an oral glucose tolerance test to screen for abnormal glucose tolerance among women with polycystic ovary syndrome when their fasting plasma glucose level is 5.7 mmol/L or more (Canadian guideline) and 5.6 mmol/L or more (American). Our objective was to determine the predictive value of 5.6 mmol/L as a fasting plasma glucose cutoff for detecting abnormal glucose tolerance in women with polycystic ovary syndrome, and then to define the optimal cutoff for this population. An oral glucose tolerance test was administered to 105 consecutive women with polycystic ovary syndrome referred to an academic reproductive endocrine clinic. We calculated sensitivity, specificity and likelihood ratios. The sensitivity of a 5.6 mmol/L cutoff was 48% (95% confidence interval [CI] 30%-67%); its specificity, 98.7% (95% CI 96.1%-100%). With this cutoff, 52% of women with polycystic ovary syndrome whose glucose tolerance is abnormal would be missed. The prevalence of abnormal glucose tolerance was 28%, with a positive predictive value of 93% (95% CI 81%-100%) and a negative predictive value of 83% (95% CI 76%-91%). The likelihood ratio for a positive test was 36.7 (95% CI 5.0-267), and for a negative test, 0.5 (95% CI 0.4-0.7). The optimal fasting plasma glucose cutoff value was 5.0 mmol/L, with a 79% sensitivity (95% CI 65%-94%) and 66% specificity (95% CI 55%-77%). If this cutoff were used, 24% of women with abnormal glucose tolerance would still be missed. The Canadian and American recommendations--of screening for abnormal glucose tolerance with an oral glucose tolerance test only when the results of a fasting plasma glucose test are 5.7 mmol/L (or 5.6 mmol/L) or more--are inappropriate for women with polycystic ovary syndrome. We therefore recommend that all women with polycystic ovary syndrome have an oral glucose tolerance test.

Fasting Plasma Glucose Cutoff Value for the Prediction of Future Diabetes Development: A Study of Middle-Aged Koreans in a Health Promotion Center

We determined optimal fasting plasma glucose (FPG) cutoff values predictive of future diabetes development in a group of middle-aged Koreans who visited a health promotion center. The medical records of 2,964 subjects, who attended the Health Promotion Center in 1998 and 2003, were examined. Subjects were classified into four groups according to their baseline FPG values (Group 1:FPG <5.0 mM/L; Group 2: 5.0≤FPG <5.6 mM/L; Group 3: 5.6≤FPG <6.1 mM/L; Group 4: 6.1≤FPG <7.0 mM/L). No significant difference was observed between Group 1 and Group 2 in terms of diabetes incidence. However, incidence in Group 3 was significantly higher than that in Group 1 [hazards ratio 4.88 (1.65-14.41), p=0.004] and the hazards ratio in Group 4 for diabetes was 36.91 (13.11-103.61), p<0.001, versus Group 1. Receiver operator characteristics curve analysis showed that an FPG of 5.97 mM/L represents the lower limit and gives the best combination of sensitivity and specificity. Our data shows that the risk of future diabetes development started to increase below an FPG of 6.1 mM/L and suggests the importance of efforts to modify diabetes development risk factors at lower impaired fasting glucose levels.