Fasting Plasma Glucose In Screening Research Articles

Oral glucose tolerance testing as a complement to fasting plasma glucose in screening for type 2 diabetes: population-based cross-sectional analyses of 146 000 health examinations in Västerbotten, Sweden

ObjectiveTo assess the effect of adding an oral glucose tolerance test (OGTT) to fasting plasma glucose (FPG) in terms of detection of type 2 diabetes (T2D) and impaired glucose tolerance...

Utility of HbA1c and fasting plasma glucose for screening of Type 2 diabetes: a meta-analysis of full ROC curves.

There is still debate on the optimal threshold for population-based screening of diabetes (diagnosed by the oral glucose tolerance test) using tests like HbA1c or fasting plasma glucose. Meta-analyses provide meaningful input in such situations. The aim of this article is to perform a meta-analysis that includes the complete information reported in the individual studies of two existing systematic reviews. We screened the individual studies from two systematic reviews and reconstructed the full four-fold tables for every reported threshold. Using a recently proposed meta-analysis model for the comparison of two diagnostic tests, we compared HbA1c with fasting plasma glucose, and estimated meta-analytic receiver operating characteristic curves for both tests using the 11.1 mmol/l threshold of the 2-h post-challenge glucose level (2 h-PG) as the gold standard. We included nine studies from two existing systematic reviews in our analysis. Based on our data set, the optimal threshold lies between 42 and 44 mmol/mol (6.0-6.2%) for HbA1c , and 6.2-6.4 mmol/l for fasting plasma glucose choosing the Youden index as the technical criterion. In addition, we found that there is no relevant difference in the performance of HbA1c and fasting plasma glucose. In our meta-analysis, we found that the optimal threshold with reference to the 2 h-PG should be chosen between 42 and 44 mmol/mol (6.0-6.2%) for HbA1c , and 6.2-6.4 mmol/l for fasting plasma glucose on the basis of maximal sensitivity and specificity.

GLYCATED HEMOGLOBIN (HbA1c)

HbA1c gives an integrated index of glycemia over the entire 120 days lifespan of red blood cells. Therefore, measuring HbA1c would be appropriate in diagnosing adisease characterized by chronic hyperglycemia and a gradual progression to complications.Objectives: our primary objective was to evaluate the use of HbA1c as screening test forundiagnosed diabetes (WHO criteria of Fasting plasma glucose (FPG) of ≥ 7mmol/l (126mg/dl))in healthy asymptomatic individuals in Pakistani population. Study Design and Methodology:A cross sectional population survey was carried on asymptomatic, healthy individuals withoutpast history of diabetes. Venous blood was obtained to measure fasting plasma glucose(fasting > 8 hours) and Hb A1c. Place and Duration of Study: Khan lab Sargodha from July2013 to March 2014. The test: It was performed by using NycoCard HbA1c in vitro diagnosticmedical device for quantitative determination of glycated hemoglobin in whole blood. Results:In our sample size of 775, the lowest HbA1c was found to be 5% and Highest 13.2%. Arithmeticmeans was 6.7565%, while the median value was 6.2% and standard deviation 1.3323. Whenusing FPG only, the detection rate of diabetes was 32.65% (female, 14.71%; male, 17.94%).When HbA1c was included as a diagnostic test, the detection rate increased to 40% (female,18.84%; male, 21.16 %). An additional 7.6% of participants were diagnosed with diabetes whenusing HbA1c criteria. ROC (A receiver operating characteristic) curve was used for analysis.At HbA1c cutoff of ≥6.5% it demonstrated sensitivity of 98.02% (95% CI) and specificity of88.12% (95% CI) for detection of undiagnosed diabetes mellitus in healthy asymptomaticindividuals in Pakistani population. Area under the ROC curve was 0.981354 with significancelevel P (Area=0.5) 0.0001. Conclusions: Our study reveals that HbA1c is a highly specific andconvenient alternative to fasting plasma glucose for screening of diabetes mellitus in Pakistanipopulation. A large scale survey should be carried out to set our own national standardizations.

Performance of HbA1c and Fasting Plasma Glucose in Screening for Diabetes in Patients Undergoing Coronary Angiography

OBJECTIVEThe performance of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) was compared in screening for diabetes by an oral glucose tolerance test (OGTT) in patients undergoing coronary angiography (CAG).RESEARCH DESIGN AND METHODSPatients without known diabetes admitted for CAG were eligible. OGTT and HbA1c were assessed 2–4 weeks after hospital discharge. The performance of HbA1c and FPG was evaluated by using receiver operating characteristic (ROC) analysis.RESULTSDiabetes was diagnosed in 83 of 400 patients (20.8%). The area under the ROC curve was higher for FPG than for HbA1c (0.81 vs. 0.73, P = 0.032). We proposed a screening algorithm and validated it in another 170 patients. Overall, this algorithm reduced the number of OGTTs by 71.4% (sensitivity 74.4%, specificity 100%).CONCLUSIONSFPG performed better than HbA1c in screening for diabetes in patients undergoing CAG. A screening algorithm might help to reduce the number of OGTTs.

Use of HbA1c in Screening for Cuban-Americans with Undiagnosed Type 2 Diabetes

This study evaluated the use of HbA(1c) as a screening tool for undiagnosed type 2 diabetes (fasting plasma glucose ≥7.0 mmol/l) in a sample of Cuban-Americans aged ≥ 30 years old. Subjects were randomly recruited from Miami-Dade and Broward counties, FL. Fasting plasma glucose was measured by hexokinase enzymatic method. HbA(1c) was measured by the DCA2000 + system using the monoclonal antibody method. HbA(1c) demonstrated a high predictive value in detecting undiagnosed diabetes. The area under the receiver operating characteristics (ROC) curve was 0.87. Also, HbA(1c) had high sensitivity and specificity when using a cut off value of 6.37 (71 and 86%, respectively). Moderate sensitivity and very high specificity were shown with a cut off value of 6.84 (57 and 96%, respectively). HbA(1c) is a reliable alternative to fasting plasma glucose in screening for undiagnosed diabetes in Cuban-Americans.

The importance of postpartum glucose tolerance testing after pregnancies complicated by gestational diabetes

To review postpartum glucose tolerance in women with gestational diabetes and evaluate the role of formal 75 g oral glucose tolerance testing vs. fasting plasma glucose in screening for persistent abnormalities. Retrospective study of 985 pregnancies over a 10 year period in a mixed ethnic cohort of women who underwent follow-up glucose tolerance testing at 6 weeks postpartum. Diagnosis obtained by oral glucose tolerance test was tested against that from the fasting plasma glucose value. There were 272 abnormal postpartum oral glucose tolerance test results (27.6%), with 109 women identified as having frank diabetes. Eleven of these (10%) had fasting plasma glucose < or =6.0 mmol/l, as did 62 of 114 cases of impaired glucose tolerance. A fasting plasma glucose concentration of > or =6.1 mmol/l correctly identified abnormal glucose tolerance in 199 of 272 cases (sensitivity 0.73). South Asian women were much more likely to have persistent abnormalities of glucose tolerance than were Europeans (32 vs. 15%, chi(2)P < 0.0001). A postpartum fasting plasma glucose measurement alone is not sensitive enough in our population to classify glucose tolerance status accurately. A formal postpartum oral glucose tolerance test is therefore needed to facilitate early detection and treatment.

Use of HbA1c in Screening for Cuban‐Americans with Undiagnosed Type 2 Diabetes

The study evaluated the use of HbA1c as a screening tool for undiagnosed type 2 diabetes (fasting plasma glucose &gt; 7.0 mmol/l) in a sample of Cuban‐Americans. Subjects were randomly recruited from Miami‐Dade and Broward counties, FL. Fasting plasma glucose (FPG) was measured by hexokinase enzymatic method. HbA1c was measured by the DCA2000+ system using the monoclonal antibody method. HbA1c demonstrated a high predictive value in detecting undiagnosed diabetes. The area under the receiver operating characteristics (ROC) curve was 0.87. Additionally, HbA1c had high sensitivity and specificity when using a cut off value of 6.37(%) (71% and 86% respectively). Moderate sensitivity and very high specificity were shown with a cut off value of 6.84 (57% and 96% respectively). In addition, the mean HbA1c for subjects with normal FPG (&lt;6.1) was 5.9 ± 0.47 which is higher than the mean HbA1c reported in The National Health and Nutrition Examination Survey (NHANES) for other ethnic groups. HbA1c is a reliable alternative to FPG in screening for undiagnosed diabetes in Cuban‐Americans. An HbA1c cut off value of 6.37 shows high sensitivity and specificity for detecting subjects with undiagnosed diabetes in Cuban‐Americans. Supported by a grant from NIH/SCORE.

Utility of A1C for Diabetes Screening in the 1999–2004 NHANES Population

Thirty percent of people with diabetes are undiagnosed (1), and up to 25% already have microvascular complications at diagnosis (2). The American Diabetes Association recommends screening adults ≥45 years of age, especially those with a BMI ≥25 kg/m2, at 3-year intervals with a fasting plasma glucose (FPG) measurement (3). However, physicians infrequently use an FPG for screening. For example, in a large health maintenance organization within the University of Michigan health system, 184 physicians at 22 separate locations screened 5,752 (69%) of 8,286 people without diabetes over a 3-year period. Ninety-five percent of the screening tests were random glucose measurements, 3% were FPGs, and 2% were A1Cs (4). Random glucose levels depend on the length of time after the previous meal and the carbohydrate content of that meal. There is no agreement on what random glucose values should lead to further investigations. Because A1C levels reflect average glycemia during the preceding 3–4 months, meal issues are not a factor. To determine what A1C level should lead to further tests to diagnose diabetes, we examined the 1999–2004 National Health and Nutrition Examination Survey (NHANES) population of those not known to have diabetes to determine the sensitivity and specificity with which various A1C levels identified people with diabetes. NHANES oversampled African-American and Hispanic individuals to obtain enough data for analysis in this minority subset. Accordingly, results were weighted to reflect the …

Die Messung des Nüchternblutzuckers als Screeningmethode für Gestationsdiabetes - Voraussetzungen für eine erfolgreiche Durchführung

Purpose: In 1999 we could demonstrate that fasting plasma glucose is a useful new screening test for gestational diabetes (Perucchini et al., 1999). In this study we wanted to evaluate the effectiveness of this method in clinical practice. Patients and Methods: 637 pregnant women who had attended antenatal clinics at the University Hospital in Zurich between 2000 and 2003, and had been screened for gestational diabetes with fasting plasma glucose after 24 weeks of gestation were included. The retrospectively obtained results were analyzed by descriptive statistical methods. A cut-off value of ≥4.8 mmol/l as proposed by Perucchini et al. was used to prescribe an oral glucose tolerance test. Results: 179 patients had a fasting plasma glucose of ≥4.8 mmol/l, of which 141 cases could be analyzed. We could reproduce our earlier results to a large degree: the rate of oral glucose tolerance test was 28.1% (1st study 30.0%), the positive predictive value was 20.6% (1st study 25.4%), with a difference in prevalence of 4.6% (low risk population) to 10.2% (1st study, high risk population). However, we also found that a substantial number of the patients who had elevated screening fasting plasma glucose levels had normal results in the oral glucose tolerance test (false positive rate 79.4%, 1st study 22%). Conclusion: Fasting plasma glucose at a cut-off value of ≥4.8 mmol/l offers an alternative method to screen for gestational diabetes with good implementation in clinical practice. The lower fasting plasma glucose levels in the oral glucose tolerance test in a substantial part of the pregnant women seems to indicate that a lot of patients, despite having been instructed orally, had not fasted before the screening test. Thus providing detailed oral and written instructions to the patients is mandatory to obtain valid results.

Lipid effects of glyburide/metformin tablets in patients with type 2 diabetes mellitus with poor glycemic control and dyslipidemia in an open-label extension study

Background: Because both type 2 diabetes and elevated plasma lipid levels are important independent risk factors for cardiovascular disease and coronary heart disease, the choice of an antihyperglycemic agent for patients with type 2 diabetes—in whom abnormal plasma lipid levels are often seen—should take into account effects on lipids as well as on markers of glycemic control. Objective: This study assessed the effects on lipid levels of glyburide/metformin tablets in the treatment of type 2 diabetes, particularly in a group of patients who had poor glycemic control and dyslipidemia at baseline. Methods: This 52-week, open-label study was an extension of a 32-week, double-blind, placebo-controlled study. The patient population was drawn from 3 groups: those who completed the double-blind study, those who were discontinued from the double-blind study, and those who were ineligible for the double-blind study based on predefined measures of glycemic control (screening fasting plasma glucose >240 mg/dL and glycosylated hemoglobin [HbA 1c] ≤12%, or HbA 1c 11%–12%) and were directly enrolled in the open-label extension study. Patients with an HbA 1c of <9% received glyburide/ metformin tablets 1.25 mg/250 mg BID; those with an HbA 1c ≥9% received glyburide/ metformin tablets 2.5 mg/500 mg BID. Changes in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels were assessed for 52 weeks. Results: The study population included 828 patients: 515 who completed the double-blind study, 138 who were discontinued from the double-blind study, and 175 who were enrolled directly. Direct enrollees had poor glycemic control and dyslipidemia at baseline. Improvements in plasma lipid levels were seen as early as week 13. At week 52, the mean change in TC from baseline was −8.0 mg/dL for the total population (95% CI, −10.9 to −5.2; P < 0.05) and −23.2 mg/dL for direct enrollees (95% CI, −30.1 to −16.4; P < 0.05). The mean decrease in LDL-C from baseline for the total population was 2.86 mg/dL (95% CI, −5.3 to −0.4; P < 0.05), compared with a reduction of 13.3 mg/dL for direct enrollees (95% CI, −18.5 to −8.1; P < 0.05). Mean HDL-C levels were minimally affected. Mean TG levels decreased by 27.8 mg/dL for the entire population (95% CI, −42.9 to −12.8; P < 0.05) and by 99.7 mg/dL for direct enrollees (95% CI, −152.5 to −46.8; P < 0.05). Conclusion: In this open-label extension study, treatment with glyburide/metformin tablets for type 2 diabetes had a durable, favorable effect on lipid levels, particularly in those with poor glycemic control and dyslipidemia at baseline.

Fasting plasma glucose in screening for diabetes in the Taiwanese population.

To reveal the relationship between fasting and 2-h postload plasma glucose and to examine the appropriate fasting glucose cutoff as the primary screening test for diabetes. We recruited 5,303 subjects from preventive services of the National Cheng Kung University Hospital. Exclusion criteria were age <20 years, pregnancy, known diabetes, and a history of recent surgery, trauma, or illness. All subjects received the 75-g oral glucose tolerance test. The relationship between fasting and 2-h glucose was examined. Sensitivities, specificities, efficiency, and predictive values were assessed at different cutoffs of fasting glucose for prediction of diabetes. The best fit model for the relationship between fasting and 2-h glucose was fasting glucose = 4.914-0.060 x (2-h glucose) + 0.0144 x (2-h glucose)2. From this model, the fasting glucose was 6.0 mmol/l when 2-h glucose was 11.1 mmol/l. A fasting glucose with 6.25 mmol/l gave the same diabetes prevalence as the World Health Organization 2-h glucose criterion. When 7.8 mmol/l was the fasting glucose cutoff, the sensitivity was 28.5%. Lowering the cutoff from 7.8 to 7.0 mmol/l increased the sensitivity by 11.2% and slightly reduced the specificity and positive predictive value. If the cutoffs were 6.25 and 6.0 mmol/l, the sensitivity increased and the specificity and the positive predictive value decreased accordingly. Our results suggest that fasting glucose as a screening criterion for diabetes could be revised downward to 7.0 mmol/l, because the slight reduction of positive predictive value was more than balanced by an apparent increase of sensitivity and insignificant change of specificity.