Glucose Criteria Research Articles

Major components of metabolic syndrome and adiponectin levels: a cross-sectional study

BackgroundAdiponectin is a major regulator of glucose and lipid homeostasis by its insulin sensitizer properties. Since decreased insulin sensitivity is linked to metabolic syndrome (MS), decreased adiponectin levels may be related to its development. The purpose of the study was to investigate the relationship between adiponectin levels and MS.MethodsFirstly, we cross-sectionally examined subjects with or without MS submitted to an oral glucose tolerance test at Hospital de Clínicas de Porto Alegre (n = 172). A replication analysis was performed in subjects (n = 422) undergoing cardiac angiography at Hospital São Paulo. Subchronic inflammation (US-CRP), coagulation marker (fibrinogen), insulin sensitivity and resistance (Matsuda ISI and HOMA-IR) were estimated. Plasma total and high molecular weight (HMW) adiponectin were measured.ResultsTotal and HMW adiponectin levels were lower in MS subjects (P < 0.05). Total adiponectin levels were lower in the presence of high waist circumference, low HDL-cholesterol and elevated triglyceride criteria in both samples and by elevated blood pressure and glucose criteria in Porto Alegre. HMW adiponectin levels were lower in the presence of low HDL-cholesterol, elevated triglycerides, and glucose criteria. Total adiponectin levels were positively related with HDL-cholesterol and ISI Matsuda, negatively related with waist circumference, glucose, triglycerides, HOMA-IR, and US-CRP and not related with blood pressure. While adjusting for sex and age, increased adiponectin levels remained associated with a reduced prevalence ratio for MS in both cohorts (P = 0.001).ConclusionsAdiponectin levels decreased with increasing number of MS criteria, and it is in part determined by its relationship with HDL, triglycerides and abdominal adiposity.

Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review

To assess different diagnostic thresholds for gestational diabetes on outcomes for mothers and their offspring in the absence of treatment for gestational diabetes. This information was used to inform a National Institutes of Health consensus conference on diagnosing gestational diabetes. We searched 15 electronic databases from 1995 to May 2012. Study selection was conducted independently by two reviewers. Randomized controlled trials or cohort studies were eligible if they involved women without known pre-existing diabetes mellitus and who did not undergo treatment for gestational diabetes. One reviewer extracted, and a second reviewer verified, data for accuracy. Two reviewers independently assessed methodological quality. Thirty-eight studies were included. Three large, methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of Caesarean section and macrosomia. When data were examined categorically (i.e. women meeting or not meeting specific diagnostic thresholds), women with gestational diabetes across all glucose criteria had significantly more Caesarean sections, shoulder dystocia, macrosomia (except for International Association of Diabetes in Pregnancy Study Groups' criteria) and large for gestational age. Higher glucose thresholds did not consistently demonstrate greater risk for all outcomes. Higher glucose thresholds did not consistently demonstrate greater risk, possibly because studies did not compare mutually exclusive groups of women. A pragmatic approach for diagnosis of gestational diabetes using Hyperglycemia and Adverse Pregnancy Outcome Study odds ratio 2.0 thresholds warrants further consideration until additional analysis of the data comparing mutually exclusive groups of women is provided and large randomized controlled trials investigating different diagnostic and treatment thresholds are completed.

Clinical implications of various criteria for the biochemical diagnosis of insulinoma.

BackgroundAmong the various diagnostic criteria for insulinoma, the ratio criteria have been controversial. However, the amended insulin-glucose ratio exhibited excellent diagnostic performance in a recent retrospective cohort study, although it has not yet been validated in other patient cohorts. We examined the diagnostic performance of the current criteria of the Endocrine Society, insulin-glucose ratio, C-peptide-glucose ratio, and amended ratios in terms of differentiating insulinomas.MethodsWe reviewed the medical records of patients who underwent evaluation for hypoglycemia from 2000 to 2013. Fourteen patients with histopathologically confirmed insulinoma and 18 patients without clinical evidence of insulinoma were included. The results of a prolonged fast test were analyzed according to the abovementioned criteria.ResultsFulfilling all three Endocrine Society criteria-plasma levels of glucose (<3.0 mmol/L), insulin (≥8 pmol/L), and C-peptide (≥0.2 nmol/L)-exhibited 100% sensitivity and 89% specificity. Fulfilling the glucose and C-peptide criteria showed 100% sensitivity and 83% specificity, while fulfilling the glucose and insulin criteria showed 100% sensitivity and 72% specificity. Among the ratio criteria, the insulin-glucose ratio [>24.0 (pmol/L)/(mmol/L)] gave the highest area under the receiver operating characteristic curve, with 93% sensitivity and 94% specificity.ConclusionFulfilling the glucose, insulin, and C-peptide criteria of the Endocrine Society guidelines exhibited the best diagnostic performance for insulinoma. Nonetheless, the insulin-glucose ratio may still have a role in the biochemical diagnosis of insulinoma.

Mortality in Patients with Pad with Respect to Glycaemic Status: A Review

Peripheral arterial disease (PAD) is a manifestation of atherosclerosis. Atherosclerosis is a chronic inflammatory process and nonenzymatic glycation is a process of major interest in relation to how risk factors promote atherogenesis. A strong association between diabetes mellitus (DM) and PAD has been established, and the association is related to the duration of DM. Previous studies have revealed a higher prevalence of DM in patients with PAD compared to general populations and populations at risk of developing DM. The typical dyslipidaemia found in patients with PAD is similar to that found in patients with insulin resistance, and an association of HbA1c with atherogenic dyslipidaemia is described. HbA1c has been described as a predictor for DM and of micro and macrovascular disease. 5-year all-cause mortality in PAD is 19–37% and 10-year all-cause mortality is 42-54%. The mortality in PAD increases with age, with the severity of the peripheral vascular disease, and with the coexistence of PAD with coronary artery disease and DM. Patients with DM, defined by glucose criteria, and PAD have an increased mortality compared with patients with PAD alone. Recent studies have shown an association of HbA1c levels with vascular complications and death in patients with DM. No studies could be found that aimed to validate HbA1c against glucose criteria as a predictor for mortality in patients with PAD. Further studies on patients with PAD and DM are needed to identify which is the best diagnostic method to predict mortality in PAD with respect to glycaemic status: the glucose parameters or the HbA1c.

The impact of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) fasting glucose diagnostic criterion on the prevalence and outcomes of gestational diabetes mellitus in Han Chinese women

The International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposed that a one-time value of fasting plasma glucose of 5.1 mmol/l or over at any time of the pregnancy is sufficient to diagnose gestational diabetes. We evaluated the repercussions of the application of this threshold in pregnant Han Chinese women. This is a retrospective study of 5360 (72.3% of total) consecutively recruited pregnant Han Chinese women in one centre from 2008 to 2011. These women underwent a two-step gestational diabetes diagnostic protocol according to the previous American Diabetes Association criteria. The IADPSG fasting plasma glucose criterion was used to reclassify these 5360 women. The prevalence, clinical characteristics and obstetric outcomes were compared among the women classified as having gestational diabetes by the previous American Diabetes Association criteria (approximately 90% were treated), those reclassified as having gestational diabetes by the single IADPSG fasting plasma glucose criterion (untreated), but not as having gestational diabetes by the previous American Diabetes Association criteria, and those with normal glucose tolerance. There were 626 cases of gestational diabetes defined by the previous American Diabetes Association criteria (11.7%) and these cases were associated with increased risks of maternal and neonatal outcomes when compared with the women with normal glucose tolerance. With the IADPSG fasting plasma glucose criterion, another 1314 (24.5%) women were reclassified as having gestational diabetes. Gestational diabetes classified by the IADPSG fasting plasma glucose criterion was associated with gestational hypertension (P = 0.0094) and neonatal admission to nursery (P = 0.035) prior to adjustment for maternal age and BMI, but was no longer a predictor for adverse pregnancy outcomes after adjustment. The simple IADPSG fasting plasma glucose criterion increased the Chinese population with gestational diabetes by 200%. The increased population with gestational diabetes was not significantly associated with excess obstetric and neonatal morbidity.

Dental Findings and Identification of Undiagnosed Hyperglycemia

A change in the American Diabetes Association guidelines added hemoglobin A1c (HbA1c) to the assays for diabetes diagnosis, but evidence suggests that glucose vs. HbA1c criteria may identify different segments of the affected population. We previously demonstrated that oral findings offer an opportunity for the detection of undiagnosed abnormal fasting plasma glucose (FPG) among dental patients who present with diabetes risk factors. In this new cross-sectional study, we sought to extend these observations. The first goal, using data from 591 new participants, was to assess our previously identified hyperglycemia detection models when HbA1c is used for case definition. The second goal, using data from our total cohort of 1,097 participants, was to evaluate the models’ performance regardless of whether an FPG or an HbA1c is used for diagnosis. The presence of ≥ 26% teeth with deep pockets or ≥ 4 missing teeth correctly identified 72% of pre-diabetes or diabetes cases in the HbA1c sample and 75% in the total population. The addition of a point-of-care HbA1c ≥ 5.7% increased correct identification to 87% and 90%, respectively. These results demonstrate the validity of our prediction models regardless of the test used for diabetes or pre-diabetes diagnosis in the clinical setting and underscore the contribution dentists can make.

HbA1c as a diagnostic tool in diabetes mellitus

Hemoglobin A1c (HbA1c) expresses the ratio between glycated HbA1 and total HbA1 and reflects the average plasma glucose concentration the preceding 2-3 months. It has become the most important marker of chronic hyperglycemia and is closely correlated to late complications of diabetes. The analysis has now been standardized and traceable to an international reference material and reference methods. Standardization of the HbA1c analyses paved the way for it to become the primary tool for diagnosing diabetes. Despite some limitations in which HbA1c is not representative of average glucose concentration, the inclusion of HbA1c as a diagnostic tool will simplify the diagnostics of diabetes compared with the glucose criteria, and hopefully improve the prevention of late complications of diabetes.

Management of Acute Coronary Syndromes

Management of Acute Coronary Syndromes

Abstract MP58: Type 2 Diabetes Prediction with 17-, 40-, and 62-variant Genotype Risk Scores: The Framingham Offspring Study

Background A recent genome-wide association study (GWAS) meta-analysis for type 2 diabetes (T2D) increased by 50% the number of common T2D-associated single-nucleotide polymorphisms (SNPs). We hypothesized that a genotype risk score (GRS) consisting of more SNPs improves T2D prediction achieved by published 17-SNP and 40-SNP scores. Methods We used data from four 8-year periods of the Framingham Offspring Study to test the association between effect-weighted 17-SNP, 40-SNP, and 62-SNP GRSs and incident T2D, defined by medication use and fasting glucose criteria. We used pooled logistic regression models with generalized estimating equations adjusted for 1) age and sex and 2) age, sex, parental T2D, BMI, systolic blood pressure, fasting glucose, HDL cholesterol, and triglyceride levels. Model improvement by the addition of each GRS was assessed with C statistics, integrated discrimination improvement (IDI) indices, and net reclassification improvement (NRI) indices with category thresholds at 2% and 8% cumulative incidence. Results Mean baseline age was 46, and 46.5% were men. There were 446 cases of incident T2D among 11,358 person-exams. In all models, the inclusion of a GRS resulted in significant T2D risk reclassification (NRI range 22.3-29.8%, see Table). The inclusion of a greater number of SNPs in the GRS increased the C statistics and relative IDI of the age- and sex-adjusted model, but the 62-SNP GRS did not result in a higher NRI than the 40-SNP GRS (28.6% vs. 29.8%). Similarly, the 62-SNP score did not result in a higher NRI for the fully adjusted clinical model than the 40-SNP score (25.6% vs. 29.0%). Conclusions A GRS of common susceptibility SNPs from GWAS improves T2D risk reclassification in a prospective study of adults, but incorporating a greater number of SNPs with smaller individual effect sizes may not result in additional reclassification improvement. Further advances in genotype prediction of T2D may require the identification and incorporation of functional risk variants putatively tagged by GWAS SNPs.

Ende Diabetes Study: diabetes and its characteristics in rural area of East Nusa Tenggara

Background: There are only few studies about diabetes in rural area in Indonesia. Epidemiological study are needed to formulate health policy of disease management in specific area. The aim of this study was to find the prevalence of diabetes and knowledge of diabetes among the community in Nangapanda Village, Ende District, East Nusa Tenggara. Methods: A cross-sectional study “Ende Diabetes Study” was conducted in Nangapanda Village. This study use cluster random sampling method to a total number of 19756 residents in Nangapanda village. From the sampling frame of 1800 adult subjects who underwent screening with glucometer in 2008 and 2009, 125 subjects have been diagnosed as diabetes or impaired fasting glucose (IFG). All of the subjects who were diagnosed as diabetes or IFG from the previous screening and 218 subjects from control (normal subjects in the 2008 and 2009 screening) were included in the present study. Each subject underwent general anamnesis, nutritional interview, complete physical examinations, and laboratory test (blood and urine). The data were analyzed using SPSS 13.0. Ressult: There were 343 subjects in this study. The prevalence of diabetes in Nangapanda using blood glucose criteria (using fasting and post-glucose load values) was 2%; using post glucose load criteria, the prevalence of DM was 1.56%; while with HbA1c criteria, the prevalence was 2.83%. The prevalence of impaired glucose tolerance (IGT) was 2.2%, and IFG was 6.2%. A number of 71.1% Nangapanda residents have sufficient knowledge about diabetes. Conclusion: Prevalence of diabetes in Nangapanda (using fasting and post-glucose load criteria) was 2% and 1.56% (using post-glucose load values). As much as 71.1% of Nangapanda residents have sufficient knowledge about diabetes. (Med J Indones. 2013;22:30-8) Keywords: Diabetes mellitus, Ende Diabetes Study, prevalence, rural Indonesia

Prevalence of unsuspected glucose intolerance in coronary artery disease (CAD) patients: Importance of HbA1c

BackgroundThe mortality and morbidity rates are two to fourfold higher among Coronary Artery Disease (CAD) patients with type 2 diabetes mellitus (DM). American Diabetes Association (ADA) and World Health Organization (WHO) define different criteria for the diagnosis of glucose intolerance. This study compares the available diagnostic criteria for DM in Indian men and their importance in CAD patients. MethodsThis cross-sectional study was done on 794 male volunteers; 483 individuals from general population and 311 patients undergoing angiography for evaluation of CAD. Individuals with previous clinical history of diabetes mellitus were excluded. ResultsMore than 90% of diabetics by ADA criteria could be diagnosed by Fasting plasma glucose (FPG) and HbA1c criteria while FPG and pg2h plasma glucose (WHO criteria) could detect only 74%. Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT) was present in 36.7% of individuals diagnosed to be diabetic based on HbA1c; more in CAD +ve group (53.8%) than in general population (23.6%). ROC analysis suggests >121 mg/dl of FPG or >6.2% of HbA1c as optimum cut-off for the diagnosis of DM. FPG and HbA1c criteria have higher Relative Risk for presence of coronary artery occlusion and HOMA-IR. ConclusionInclusion of HbA1c in the criteria for diagnosis of DM (ADA criteria) can detect large number of cases with persistent hyperglycemia in the non-diagnostic range of DM (IFG or IGT) among general population and CAD patients. This has special relevance to epidemiological studies as the diagnosis of DM can be made on single fasting blood sample.

Effects of Age and Sex on Estimated Diabetes Prevalence Using Different Diagnostic Criteria: The Tromsø OGTT Study

HbA1c 6.5% has recently been recommended as an alternative diagnostic criterion for diabetes. The aims of the study were to evaluate the effects of age, sex, and other factors on prevalence of diabetes and to compare risk profiles of subjects with diabetes when defined by HbA1c and glucose criteria. Subjects were recruited among participants in the longitudinal population-based Tromsø Study. HbA1c, fasting plasma glucose, and 2-hour plasma glucose were measured in 3,476 subjects. In total, 294 subjects met one or more of the diagnostic criteria for diabetes; 95 met the HbA1c criterion only, 130 met the glucose criteria only, and 69 met both. Among subjects with diabetes detected by glucose criteria (regardless of HbA1c), isolated raised 2-hour plasma glucose was more common in subjects aged ≥ 60 years as compared to younger subjects and in elderly women as compared to elderly men. Subjects with diabetes detected by glucose criteria only had worse cardiometabolic risk profiles than those detected by HbA1c only. In conclusion, the current HbA1c and glucose criteria defined different subjects with diabetes with only modest overlap. Among a substantial proportion of elderly subjects, and especially elderly women, the 2-hour plasma glucose was the only abnormal value.

800 – Prevalence of prediabetes and diabetes in patients treated with antipsychotics

Introduction Treatment with antipsychotic drugs is associated with an increased risk for glucose dysregulation.Hyperglycemia that does not fulfil diagnostic criteria for diabetes mellitus (DM) is known as prediabetes (preDM). PreDM is a strong risk factor for the development of DM and cardiovascular events. Objectives To assess the prevalence of preDM and DM in patients on antipsychotic treatment. Aims To compare cardiometabolic parameters between patients with normoglycemia, preDM and DM. In addition, incidence and reversal rates for preDM and DM were calculated in a one year follow-up. Methods In a naturalistic cohort of 383 patients the fasting glucose and hemoglobin A1c criteria were applied. In addition, cardiometabolic parameters were measured. After one year, a second assessment was performed in 169 patients out of the total sample. Results In the total sample, preDM and DM were present in 39% and 6% of antipsychotic treated patients, respectively. As compared to patients with normoglycemia, cardiometabolic parameters were more prevalent in patients with preDM. Although the majority of patients were diagnosed by the fasting glucose criterion, hemoglobin A1c contributed significantly to the number of patients identified. In a one-year follow-up, it was shown that the course of glucose metabolism can be dynamic. Conclusions Systematic evaluation of glucose parameters in antipsychotic treated patients is warranted, in order to recognize glucose abnormalities at an early stage. Especially since fasting laboratory assessments are not required, including hemoglobin A1c as a diagnostic test is of additional value in identifying psychiatric patients (at risk for) DM.

Is A1C Less Concordant with OGTT in Children as Compared in Adults? Data from a Hispanic Community in Arizona

Early efforts to identify hyperglycemia and those at risk for developing type 2 diabetes (T2DM) are warranted. For decades, the diagnosis of T2DM has been based on plasma glucose (PG) criteria but recent recommendations include the use of A1C for identifying hyperglycemia. These recommendations are based upon adult studies and data suggests that A1C may be less concordant in children, as compared to adults. The purpose of our study was to compare A1C, fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) between adolescents and adults in Hispanic population at disproportionate risk for developing T2DM. Methods: Data from self-identified as Latino, 91 overweight adolescents, and 406 overweight adults were assessed after an overnight fast for A1C, FPG and OGTT results. Receiver Operator Characteristics Curves for A1C vs. any hyperglycemia (prediabetes or diabetes) were then developed. Result: 26 (28.6%) of the adolescents and 209 (51.5%) of adults exhibited hyperglycemia according to FPG and/OGTT. The prevalence of hyperglycemia as defined by an A1C>5.7% was 30.8% in adolescents and 55.6% in adults. Of the 26 adolescents, hyperglycemic on FPG and /or OGTT only 9 had A1C>5.7% for a sensitivity of 34.6%. This in contrast to adults, where the sensitivity of A1C>5.7% was 74.2%. Positive predictive value (PPV) for the A1C threshold of 5.7% was 32.1% in adolescents vs. 73.7% in adults. Conclusion: Concordance of A1C with other measures of hyperglycemia is lower in overweight Hispanic adolescents, as compared to overweight Hispanic adults.

Validity and Reliability of Self-reported Diabetes in the Atherosclerosis Risk in Communities Study

The objective of this study was to assess the validity of prevalent and incident self-reported diabetes compared with multiple reference definitions and to assess the reliability (repeatability) of a self-reported diagnosis of diabetes. Data from 10,321 participants in the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996-1998) were analyzed. Prevalent self-reported diabetes was compared with reference definitions defined by fasting glucose and medication use obtained at visit 4. Incident self-reported diabetes was assessed during annual follow-up telephone calls and was compared with reference definitions defined by fasting glucose, hemoglobin A1c, and medication use obtained during an in-person visit attended by a subsample of participants (n = 1,738) in 2004-2005. The sensitivity of prevalent self-reported diabetes ranged from 58.5% to 70.8%, and specificity ranged from 95.6% to 96.8%, depending on the reference definition. Similarly, the sensitivity of incident self-reported diabetes ranged from 55.9% to 80.4%, and specificity ranged from 84.5% to 90.6%. Percent positive agreement of self-reported diabetes during 9 years of repeat assessments ranged from 92.7% to 95.4%. Both prevalent self-reported diabetes and incident self-reported diabetes were 84%-97% specific and 55%-80% sensitive as compared with reference definitions using glucose and medication criteria. Self-reported diabetes was >92% reliable over time.

Work Stress is Associated with Diabetes and Prediabetes: Cross-Sectional Results from the MIPH Industrial Cohort Studies

Diabetes is rapidly rising globally, and the relation of psychosocial stress in workplace to diabetes and prediabetes is not well investigated. The aim of the study was to examine the association of work stress with diabetes and prediabetes in a sample of German industrial workers. In this cross-sectional survey of an occupational cohort (n = 2,674, 77% male), work stress was measured by the Effort-Reward Imbalance (ERI) Questionnaire. Diabetic status, i.e., diabetes and prediabetes, were diagnosed by glycated hemoglobin A1c criterion or fasting plasma glucose criterion supplemented by self-reports. The overall prevalence rates of diabetes and prediabetes were 3.5 and 42.2%, respectively. Using ordinal logistic regression with adjustment for potential confounding factors, high ERI at work was associated with diabetes-related ordinal variable (odds ratio [OR], 1.27; 95% confidence interval [95% CI], 1.02-1.58) and prediabetes-related ordinal variable (OR, 1.26; 95% CI, 1.01-1.58) in men, whereas the associations in women were somewhat less pronounced and did not reach statistical significance. The findings indicate that work stress in terms of ERI is associated with diabetes and prediabetes in German industrial male workers. If supported by prospective evidence, results point to a new approach towards primary prevention of diabetes.

Prevalence of Diabetes in Asian Indians Based on Glycated Hemoglobin and Fasting and 2-H Post-Load (75-g) Plasma Glucose (CURES-120)

With the introduction of glycated hemoglobin (A1c) as a method of screening for diabetes, it is essential to study how use of A1c would affect the prevalence of diabetes in different ethnic groups. We compared the prevalence of diabetes by fasting (FPG) and 2-h post-load (75-g) plasma glucose (2-h PG) and A1c criteria in an Asian Indian population. Subjects (n=2,188) without known diabetes were drawn from the Chennai Urban Rural Epidemiological Study, a population-based study in Chennai, South India. FPG, 2-h PG, and A1c estimations were carried out. Prevalence rates of diabetes were compared using as cut points FPG ≥7 mmol/L (126 mg/dL), 2-hr PG ≥11.1 mmol/L (200 mg/dL), or A1c ≥6.5% criteria. Prevalence of diabetes was 6.1% (n=134) using the FPG criterion, 10.1% (n=221) by the 2-h PG criterion, and 12.8% (n=281) by the A1c criterion. Thus the prevalence of diabetes by the A1c criterion was 110% and 27% higher than the FPG and 2-hr PG criteria, respectively. Only 121 of these subjects were identified by all three criteria. Subjects diagnosed by the A1c criteria had the lowest FPG, 2-h PG, A1c, and serum triglyceride levels. In Asian Indians, use of A1c criteria would result in markedly higher prevalence rates of diabetes. It also identifies a different set of individuals with milder glucose intolerance and lower serum triglyceride levels.

Hemoglobin A1c Versus Oral Glucose Tolerance Test in Postpartum Diabetes Screening

OBJECTIVETo determine the usefulness of measuring hemoglobin A1c (A1C), alone or combined with the fasting glucose test, compared with the oral glucose tolerance test (OGTT) for the reassessment of the carbohydrate metabolism status in postpartum women with a history of gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSWe evaluated the status of carbohydrate metabolism by performing the OGTT and fasting glucose and A1C tests in 231 postpartum women with prior GDM 1 year after delivery.RESULTSThe prevalence of abnormal carbohydrate metabolism was 45.89% by the OGTT criterion, 19.05% by the A1C test criterion, 38.10% by the fasting glucose test criterion, and 46.75% by the A1C-fasting glucose test criteria. Using the OGTT as the gold standard, abnormal carbohydrate metabolism according to the A1C test criterion had 22.64% sensitivity and 54.55% positive predictive value; abnormal carbohydrate metabolism by the fasting glucose criterion had 83.02% sensitivity and 100% positive predictive value. The A1C-fasting glucose test criteria classified 18 women with normal carbohydrate metabolism as having abnormal carbohydrate metabolism. Abnormal carbohydrate metabolism by the A1C-fasting glucose test criteria had 83.02% sensitivity and 81.48% positive predictive value.CONCLUSIONSOur results seem to indicate that the A1C test criterion alone or in combination with fasting glucose test criterion does not provide a sensitive and specific diagnosis of abnormal carbohydrate metabolism in women who have had GDM.

Diabetes and pre-diabetes as determined by glycated haemoglobin A1c and glucose levels in a developing southern Chinese population.

BackgroundThe American Diabetes Association and World Health Organization have recently adopted the HbA1c measurement as one method of diagnostic criteria for diabetes. The change in diagnostic criteria has important implications for diabetes treatment and prevention. We therefore investigate diabetes using HbA1c and glucose criteria together, and assess the prevalent trend in a developing southern Chinese population with 85 million residents.MethodsA stratified multistage random sampling method was applied and a representative sample of 3590 residents 18 years of age or above was obtained in 2010. Each participant received a full medical check-up, including measurement of fasting plasma glucose, 2-hour post-load plasma glucose, and HbA1c. Information on history of diagnosis and treatment of diabetes was collected. The prevalence of diabetes obtained from the present survey was compared with the data from the survey in 2002.ResultsThe prevalence of diabetes based on both glucose and HbA1c measurements was 21.7% (95% CI: 17.4%–26.1%) in 2010, which suggests that more than 1 in 5 adult residents were suffering from diabetes in this developing population. Only 12.9% (95% CI: 8.3%–17.6%) of diabetic residents were aware of their condition. The prevalence of pre-diabetes was 66.3% (95% CI: 62.7%–69.8%). The prevalence of diabetes and pre-diabetes which met all the three diagnostic thresholds (fast plasma glucose, 2 hour post-load plasma glucose, and HbA1c) was 3.1% and 5.2%, respectively. Diabetes and pre-diabetes as determined by HbA1c measurement had higher vascular risk than those determined by glucose levels. The prevalence of diabetes increased from 2.9% (95% CI: 2.0%–3.7%) in 2002 to 13.8% (95% CI: 10.2%–17.3%) in 2010 based on the same glucose criteria.ConclusionsOur results show that the diabetes epidemic is accelerating in China. The awareness of diabetes is extremely low. The glucose test and HbA1c measurement should be used together to increase detection of diabetes and pre-diabetes.

Cardiometabolic Risk Profiles and Carotid Atherosclerosis in Individuals With Prediabetes Identified by Fasting Glucose, Postchallenge Glucose, and Hemoglobin A1c Criteria

OBJECTIVEWe evaluated whether cardiometabolic risk profiles differ for subjects identified as having prediabetes by A1C, fasting glucose (FPG), or 2-h postchallenge glucose (2-PG) criteria.RESEARCH DESIGN AND METHODSAtherosclerosis risk factors, oral glucose tolerance test, and ultrasound measurement of carotid intima–media thickness (IMT) were analyzed in 780 nondiabetic individuals.RESULTSPoor agreement existed for A1C and FPG criteria for identification of subjects with prediabetes (κ coefficient = 0.332). No differences in cardiometabolic risk profiles were observed among the three groups of individuals with prediabetes by A1C only, FPG only, and both A1C and FPG. Poor agreement also existed for A1C and 2-PG criteria for identification of individuals with prediabetes (κ coefficient = 0.299). No significant differences in cardiometabolic risk factors were observed between IGT-only and individuals with prediabetes by A1C and 2-PG. Compared with subjects with prediabetes identified by A1C only, IGT-only individuals exhibited a worse cardiometabolic risk profile, with significantly higher systolic blood pressure, pulse pressure, 2-h postchallenge insulin, triglycerides, high-sensitivity C-reactive protein, and carotid IMT, and lower HDL cholesterol levels and insulin sensitivity.CONCLUSIONSThese results suggest that considerable discordance between A1C, FPG, and 2-PG exists for the identification of individuals with prediabetes and that the cardiometabolic risk profile of these individuals varies by metabolic parameter, with 2-PG showing the stronger association with cardiometabolic risk factors and subclinical atherosclerosis than FPG or A1C.