High Prevalence Of Undiagnosed Diabetes Research Articles

The magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town, northcentral Ethiopia: A community-based cross-sectional study

BackgroundDiabetes mellitus (DM) is a worldwide public health problem. The burden of diabetes has been continuously increasing from day to day, especially in developing countries like Ethiopia. Globally, half of all cases of diabetes mellitus are undiagnosed. Diabetes mellitus can be easily handled if it is detected early. There is limited evidence on the magnitude of undiagnosed diabetics and prediabetes at the community level in Ethiopia, particularly in the study area. ObjectiveTo assess the magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town. MethodsA community-based cross-sectional study was conducted in Debre Tabor town from October to December 2021. A total of 407 participants were selected using a multistage sampling technique. A pretested structural questionnaire was used to collect demographic, behavioral, and clinical data. Anthropometric measurements were taken with standardized and calibrated equipment. A fasting venous blood sample was collected for blood glucose level determination. Logistic regression was used to identify risk factors. A P-value ≤0.05 was considered statistically significant. ResultThe magnitude of undiagnosed diabetes mellitus and prediabetes was found to be 4.5% (95% CI: 2.9–7.4) and 14.5% (95% CI: 11.1–18.1), respectively. Older age (AOR: 6.50, 95% CI: 1.82–23.21), abnormal body mass index (AOR: 6.84, 95% CI: 1.91–24.54), systolic hypertension (AOR: 8.74, 95% CI: 2.53–30.19), and family history of diabetes mellitus (FHDM) (AOR: 12.45, 95% CI: 3.63–42.65) were significantly associated with undiagnosed diabetes mellitus. Using saturated oil (AOR: 1.97, 95% CI: 1.09–3.55), having a high waist circumference (AOR: 2.16, 95% CI: 1.20–3.87), and being hypertensive (AOR: 2.26, 95% CI: 1.04–4.96) were all significantly associated with Prediabetes. ConclusionAdults in Debre Tabor town have a high prevalence of undiagnosed diabetes and prediabetes. A variety of modifiable risk factors were also identified. As a result, focusing the prevention strategy on such modifiable risk factors may help to minimize the prevalence of undiagnosed diabetes mellitus and prediabetes as well as future disease complications.

The prevalence of diabetes and prediabetes: a population-based study.

Diabetes remains one of the top public health care priorities. Over 6% of the world's population is affected by type 2 diabetes; however, a similar number of individuals may be unaware of this diagnosis. Our population‑basedstudy aimed to investigate the true prevalence of diabetes and prediabetes in the general population of a medium‑sized city in Poland. The analysis included 1051 participants of the Bialystok PLUS population‑based cohort study. In those who did not report a history of diabetes, the oral glucose tolerance test (OGTT) was performed. Medical history data were gathered using standardized questionnaires, and anthropometric as well as body composition measurements were performed. According to the medical history data, a total of 75 participants had diabetes (7.14%). Prediabetes (impaired fasting glycemia [IFG] or impaired glucose tolerance [IGT]) was identified in 410 individuals, including 241 participants with IFG (22.9%) and 169 patients with IGT (16.1%). Moreover, there were 71 individuals (6.75%) who were newly diagnosed with diabetes based on OGTT results. Overall, 146 patients with diabetes (13.8%) were identified. The ratio of lean mass to fat mass differed significantly between the patients with newly diagnosed diabetes and those without impaired glucose metabolism. Our cohort study demonstrated a high prevalence of undiagnosed diabetes in the Białystok population. In addition, we showed that a large group of patients still remains undiagnosed for other hyperglycemic disorders. Abdominal obesity as well as imbalance between the fat and lean mass may predispose to diabetes.

Risk of Developing Diabetes in Patients Undergoing Coronary Artery Angiography Based on American Diabetes Association Risk Score: A Cross-Sectional Study

Aims The high prevalence of undiagnosed diabetes and the high risk for diabetes in the general population is alarming. In addition, the frequency of coronary artery diseases (CAD) in patients with undiagnosed diabetes is higher than in non-diabetic patients. This study aimed to investigate the frequency of people at risk of diabetes in patients undergoing coronary artery angiography (CAG) in a university referral hospital in Guilan Province, Iran. Methods & Materials In this cross-sectional study, data from 300 non-diabetic patients who were candidates for CAG were collected using a simple sampling method. The risk of developing diabetes was calculated according to American Diabetes Association (ADA) risk score. ADA scores higher than five were considered high risk, and ADA scores equal to 4 and lower than 4 were as moderate and low risk, respectively. Findings The mean age of the study population was 59.44±15.7 years. Most subjects were male (59.3%). Only 24.3% of patients were in the low-risk group while 32% were in moderate risk and 43.7% were in the high-risk group. The frequency of patients with at least two coronary artery involvement was significantly higher in the high-risk group (43.1%) than in the moderate group (34.4%), and the low-risk (22.5%) group. Conclusion A high proportion of the patients undergoing CAG were at high risk of developing diabetes. Hence, it seems essential to address cardiometabolic risk factors in coronary artery diseases (CAD) after discharge from the hospital.

Sociodemographic factors associated with knowledge of type 2 diabetes in rural Tamil Nadu, India.

This study aimed to investigate awareness of type 2 diabetes and how sociodemographic factors influence diabetes knowledge in a rural population of Tamil Nadu, India. Previous research has identified poor awareness of diabetes in several low and middle-income countries, which can lead to a high prevalence of undiagnosed diabetes. India having the second highest prevalence of diabetes globally, it is increasingly important to assess how diabetes can be addressed in rural Indian populations. Systematic random sampling was used to gather study participants in 17 villages within the Krishnagiri district of Tamil Nadu, India. Data on diabetes knowledge was collected using a validated questionnaire. Knowledge score range was 0-8; a score of zero was designated as 'low knowledge', scores 1-4 as 'moderate knowledge', and scores 5-8 as 'good knowledge'. Associations between sociodemographic factors and composite diabetes knowledge score were assessed using a multinomial logistic GLLAMM model in Stata. A total of 753 individuals participated in the study. The average age of participants was 47 years and 55% were women. Overall awareness of diabetes was low, with 66% of individuals having no knowledge of diabetes. Only 16% and 17% achieved a moderate and a good knowledge score, respectively. Achieving a moderate knowledge score was significantly positively associated with education, wealth, participation in the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), and business ownership as a source of income. Achieving a good knowledge score was significantly positively associated with education, wealth, rurality, participation in MGNREGA, business ownership as a source of income, and frequency of healthcare utilization. Rurality was significantly negatively associated (relative risk ratio (95% confidence interval)) with both moderate knowledge score (0.34 (0.19-0.59)), and good knowledge score (0.43 (0.24-0.74)). The strongest predictor of having a good knowledge score was having a high-school graduate or post-secondary education (11.07 (4.44-27.61)). Enrolment in MGNREGA employment was the strongest predictor for having a moderate knowledge score (3.27 (1.93-5.54)), as well as strongly associated with having a good knowledge score (2.39 (1.31-4.36)). The low awareness of diabetes among participants of this study raises serious concerns for public health in India. Public health efforts must prioritize health equity to lessen the impacts of diabetes in rural populations, where individuals face systemic barriers to receiving prevention and treatment for conditions such as diabetes.

Risk assessment for type 2 diabetes mellitus among participants in a market survey at Ebonyi State, South East Nigeria, using finnish diabetes risk score questionnaire

Background: Type 2 diabetes mellitus is a metabolic disorder arising from insulin resistance and/or decreased insulin secretion and has continued to affect people across all economic levels in society. Due to the high prevalence of undiagnosed diabetes, it has become very imperative to emphasize screening in any given population, especially in developing countries. Aim: The aim of the study was to determine the risk factors and prevalence of diabetes mellitus among participants using the FINDRISC questionnaire. Materials and Methods: The study was a cross-sectional study which involved 200 participants but 197 had complete data. Anthropometric, blood pressure, and fasting/random blood glucose measurements were carried out. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. Results: The mean age of respondents was 41.8 ± 16.3 years. There were 104 males and 93 females. Most of the respondents were traders constituting 51.8% of the study population. The 10-year risk categorization of respondents showed that 57.9% had low risk, 17.8% with slightly elevated risk, 12.2% had moderate risk, 10.7% with high risk, and 1.5% with a very high risk of developing diabetes. The average risk score was 7.4 ± 5.4 with a range of 0.0–24.0. The mean weight, height, and body mass index were 69.6 ± 14.4 kg, 165.3 ± 8.6 cm, and 25.5 ± 5.2 kg/m2, respectively. The mean systolic and diastolic blood pressures were 126.9 ± 20.3 mmHg (range: 80–205) and 76.6 ± 12.9 mmHg (range of 50–130), respectively. Conclusion: Approximately, 25% of respondents have a moderate-to-very high risk which emphasizes the need for continuous screening of the population, especially in public gatherings.

Disparities in diabetes between US-born and foreign-born population: using three diabetes indicators

ABSTRACT We investigated disparities in diabetes between the US-born and foreign-born populations using three diabetes measures: diagnosed diabetes, undiagnosed diabetes, and total diabetes, either diagnosed or undiagnosed diabetes. We analyzed adults aged 30–84 years drawn from the National Health and Nutrition Examination Survey 2009–2018 (n = 21,390). Of cohorts in 2009–2018, foreign-born adults had significantly higher age-standardized prevalence of diagnosed (12.6% vs. 10.6%) and undiagnosed diabetes (4.5% vs. 2.6%), and total diabetes (17.1% vs. 13.2%) than US-born adults. Results from logistic and multinomial regressions adjusting for age, sex, race/ethnicity, limited access to healthcare and BMI showed that the foreign-born had significantly higher odds of total diabetes (OR: 1.25, 95% CI: 1.04–1.50) and undiagnosed diabetes (OR: 1.83, 95% CI: 1.44–2.32) compared to the US-born. There was no significant difference in diagnosed diabetes by nativity (OR: 1.12, 95% CI: 0.96–1.53). Our results show that foreign-born adults were at higher risk of diabetes than US-born adults, and the difference by nativity was largely attributable to BMI and racial/ethnic composition. In addition, we demonstrated the importance of choosing measures of diabetes in studying diabetes mainly due to the foreign-born group’s high prevalence of undiagnosed diabetes, which biases the prevalence of diabetes downward when diagnosed diabetes is used.

Examining social determinants of undiagnosed diabetes in Namibia and South Africa using a behavioral model of health services use

AimsTo examine factors associated with undiagnosed diabetes in Namibia and South Africa. MethodsThis study used the most recent Demographic and Health Surveys (DHS) from Namibia (2013) and South Africa (2016). This study focused on adults at 35–64 years old. Using Andersen’s Behavioral Model, potential contributing factors were categorized into predisposing factors (sex and education), enabling factors (wealth, health insurance, and residence), and a need factor (age, BMI, and high blood pressure). Separate multivariable logistic regression models were used to examine factors associated with undiagnosed diabetes in Namibia (N = 242) and South Africa (N = 525). ResultsIn Namibia, higher odds of having undiagnosed diabetes were associated with rural residence (adjusted odds ratio (aOR) = 2.21) and age younger than 45 years old (aOR = 3.20). In South Africa, odds of having undiagnosed diabetes were higher among the poorest-to-poorer group than it was in the richer-to-richest group (aOR = 2.33). In both countries, having high blood pressure was associated with lower odds of having undiagnosed diabetes (aOR = 0.31 in Namibia; aOR = 0.21 in South Africa). DiscussionDifferent enabling and need factors were associated with undiagnosed diabetes in these two countries, which implies potentially-different mechanisms driving the high prevalence of undiagnosed diabetes, as well as the needs for different solutions.

1447-P: Random Glucose May Be an Effective Tool to Screen for Undiagnosed Diabetes: The Africans in America Study

The high prevalence of undiagnosed diabetes (DM) in Africa calls for the identification of effective, efficient, and feasible screening tests. Emerging data suggests that random plasma glucose≥100 mg/dL (RPG≥100) may be a valuable screening tool and equivalent to or better than standard ADA criteria, which requires fasting blood samples, knowledge of family history, anthropometrics and blood pressure. Since RPG≥100 as a screening tool for DM has not been tested in Africans, our goals were twofold: first, to compare the diagnostic performance of RPG≥100 to ADA criteria; second, to determine for RPG≥100 the number needed to screen to find a single case of DM. Hence, African-born blacks who self-identified as healthy and were living in America (n=469, 66% male, age: 38±10y (mean±SD), BMI: 27.6±4.5 kg/m2) had random plasma glucose levels measured. One week later, an OGTT was performed. Glucose criteria for the OGTT was used to diagnose DM. Area under the receiver operating characteristic curve (AROC) was used to assess the performance of RPG≥100 and ADA criteria (age≥45y, BMI≥25 kg/m2, HDL<35mg/dL, TG>250mg/dL, SBP≥140mmHg, DBP≥90mmHg, and family history of DM). The number of people needed to screen to correctly identify one case of undiagnosed DM was calculated by the formula: 1/(proportion correctly diagnosed - proportion incorrectly diagnosed). DM was identified in 7% (31/469) of the participants; whereas RPG≥100 occurred in 15% (68/469). For the prediction of DM, RPG≥100 tended to be superior to the ADA criteria (AROC 0.80 vs. 0.68, P=0.09). RPG≥100 was 71% sensitive and 89% specific. ADA criteria was 90% sensitive and 37% specific. For RPG≥100, the number needed to screen to correctly identify a single case of DM was two. Overall, RPG≥100 as a screening tool for DM is effective, more cost-efficient, and less time-consuming than ADA criteria. In short, RPG≥100 may be an important way forward for the detection of DM in Africans and further study is warranted. Disclosure E.M. Shoup: None. N.H. Osei-Tutu: None. T. Hormenu: None. A.F. Hobabagabo: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. M.F. Horlyck-Romanovsky: None. A.E. Sumner: None.

Undiagnosed hypertension and diabetes among the elderly in Amirkola, North of Iran.

Background:As populations of elderly grow, the prevalence of type 2 diabetes and hypertension increases. These diseases can be asymptomatic for a long time and cause irreversible damages to organs. Therefore the aim of this study was to evaluate the prevalence of undiagnosed hypertension and diabetes among the elderly in Amirkola.Methods:This is a descriptive/analytical cross-sectional study and a part of the first phase of a cohort study on the health status of the elderly in Amirkola (a city in the North of Iran) which has been conducted on all people aged 60 and over since 2011. The demographic information was collected using a questionnaire, the hypertension was diagnosed by measuring blood pressure in lying down- position and the diabetes was diagnosed by measuring fasting blood glucose level.Results:This study was conducted on 1568 elderly participants including 703 (44.8%) females and 865 (55.2%) males. The overall prevalence of diabetes was 30.6% of which, 23.3% was diagnosed and 7.4% was undiagnosed. Nearly one-fourth (24.1%) of the participants with diabetes were unaware of their disease. Thirty-one percent of the people with undiagnosed diabetes also had undiagnosed hypertension. The overall prevalence of hypertension in this study was 62.8%, including 41.2% diagnosed and 21.5% undiagnosed hypertension.Conclusion:Regarding the results of this study and the high prevalence of undiagnosed diabetes and hypertension in elderly, improving the individual’s general awareness and screening in older adults for timely management are necessary.

Fasting Plasma Glucose and the HbA1c Are Not Optimal Screening Modalities for the Diagnosis of New Diabetes in Previously Undiagnosed Asian Indian Community Participants.

There is no definitive consensus on the screening algorithm in high-risk communities for diabetes. The aims of our study were to determine the prevalence of undiagnosed diabetes in a high-risk community using the oral glucose tolerance test (OGTT), as well as determine the value of anthropometric measurements and other measures of glycemia in the detection of diabetes. All participants from the Phoenix Lifestyle project without known diabetes, and who had undergone an OGTT were selected for study. Anthropometric measurements were collected according to accepted guidelines. Diabetes was diagnosed if fasting plasma glucose (FPG) ≥7.0 mmol/l, if 2-hour plasma glucose level during OGTT was ≥ 11.0 mmol/l, or if HbA1c ≥ 6.5%. The prevalence of newly diagnosed diabetes was 14.3% (11.7 % age standardized) (women=15.4%; men=11.8%). The prevalence rates were underestimated using FPG criteria, but overestimated when using the HbA1c. The AUC (area under the receiver-operator characteristics curve) was highest for FPG (.879), HbA1c (.855), then anthropometry measures (BMI=.621; waist circumference=.627). For diabetes, at levels >6.3, the discriminant ability (DA) of HbA1c was highest (79%), while a cut-point of ≥5.5mmol/l for FPG yielded a DA= 81.5% (82% sensitivity; 81%; specificity of 81%). There was a low level of agreement between the FPG (Kappa = .506), HbA1c (Kappa = .537), and the OGTT. Age- and sex-adjusted independent determinants of diabetes using stepwise backward logistic regression were age, triglyceride levels and a positive family history for diabetes. Neither the HbA1c nor the FPG approached adequate predictive accuracy in the diagnosis of diabetes. In view of the high prevalence of undiagnosed diabetes, this study underscores the need for ongoing national surveillance data.

Diabetes Mellitus Among Adults in Herat, Afghanistan: A Cross-Sectional Study.

Diabetes is reaching epidemic levels in Afghanistan. This study identifies the risk factors associated with diabetes in Herat City, Afghanistan, and explores the prevalence of previously undiagnosed diabetes. A cross-sectional study was conducted using multistage cluster sampling by adopting the World Health Organization's (WHO) STEPwise approach to Surveillance (STEPS). We enrolled 1129 participants aged 25-70 years between May and June of 2015 (47.4% males, 52.6% females). A structured questionnaire was used for data collection of demographic, socioeconomic, and behavioral factors. Investigators collected anthropometric measurements and blood samples from study participants. A multivariable logistic regression model was used to identify factors associated with diabetes prevalence. We found that the prevalence of diabetes in Herat City was 9.9% (9.8% in males and 10.1% in females). Of the 1129 respondents, only 3.3% were previously diagnosed with diabetes or were under treatment, whereas 6.6% of respondents were previously undiagnosed. The multivariable analyses showed that age, frequency of rice consumption, type of cooking oil, and systolic blood pressure were associated with diabetes. This is one of the first studies to discuss the high prevalence of undiagnosed diabetes in Herat, Afghanistan. This study found several modifiable factors that were associated with diabetes in Herat, Afghanistan. Future reduction of disease burden should focus on these factors in the development of the most optimal diabetes prevention programs.

High awareness of diabetes in the health care system in Greenland measured as a proportion of population tested with glycated haemoglobin within 2\xa0years

BackgroundSixty years ago diabetes was almost non-existent in Greenland and until the beginning of this century awareness of diabetes was quite minimal. A high prevalence of undiagnosed diabetes has been reported in repeated population surveys. Increased focus on diabetes has been made a priority within the health care system since 2008, and in 2010 glycated haemoglobin was introduced as a diagnostic tool to further facilitate the diagnosis of diabetes.ObjectiveThe aim of this study was to estimate the age and gender specific use of glycated haemoglobin in 2014 and 2015, as an indicator of diagnostic activity and awareness of diabetes, and to estimate the prevalence of diagnosed pre-diabetes and diabetes among adults in Greenland aged 20–79 years of age.MethodsThe study was performed as an observational, cross sectional register study based on information gleaned from the electronically laboratory system used in Greenland including all patients tested with glycated haemoglobin at least once in 2014 or 2015.ResultsA total of 10,127 patients were tested with glycated haemoglobin in 2014 or 2015 corresponding to 18.1% of the whole population. Among adults aged 20–79 years 9506 patients were tested corresponding to 24.0% of the total adult population. More females (32.5%) than males (16.5%) aged 20–79 years old were tested (p < 0.001). The prevalence of diagnosed diabetes and high risk pre-diabetes among adults aged 20–79 years was 4.3 and 6.8% respectively.ConclusionIn conclusion use of glycated haemoglobin is widely used in the health care system in Greenland indicating a high awareness of diabetes in the population and by the health care system. Still, awareness of undiagnosed diabetes remains an important issue and additional strategies targeting males under 70 years old must be considered.

High prevalence of undiagnosed diabetes among tuberculosis patients in peripheral health facilities in Kerala.

Two tertiary care hospitals and 12 peripheral health institutions (PHIs) in Trivandrum, Kerala, India. To determine factors associated with the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients and examine differences in the proportion of new DM cases among TB patients diagnosed at tertiary care centres and PHIs. A descriptive study: TB patients diagnosed during March-September 2012 were screened for known DM. Those with unknown DM status were tested for random blood glucose and fasting blood glucose (FBG); FBG ≥ 126 mg/dl was diagnosed as new DM. Of 920 TB patients, 689 (72%) were male and the mean (standard deviation) age was 47.6 (16.4) years. Of these, 298 (32.4%) were diabetic: 235 (26%) had previously known DM and 63 (7%) were newly diagnosed. During the screening at PHIs and tertiary care hospitals, respectively 30/183 (16.4%) and 33/737 (4.5%) were newly diagnosed with DM (OR 3.71; 95%CI 2.17-6.32). Overall, age >50 years and pulmonary tuberculosis were independently associated with a higher prevalence of diabetes. As nearly one in three TB patients had DM, we recommend that TB patients should be routinely screened for DM in Kerala. As the proportion of new DM was higher among TB patients diagnosed at PHIs, we would recommend that specific attention and investment be directed to PHIs.

High prevalence of undiagnosed diabetes and high risk for diabetes using HbA1c criteria in middle-aged patients undergoing cataract surgery

AimThis study assessed the prevalence of undiagnosed diabetes and a high risk for diabetes using glycated haemoglobin (HbA1c) values in middle-aged patients undergoing cataract surgery. MethodsThe study comprised 137 consecutive patients, aged 40 to 65 years, with no known diabetes undergoing cataract surgery at a French national eye centre. Fasting glucose, obesity parameters, and vascular and ocular cataract risk factors were recorded. HbA1c was measured on the day of cataract surgery. Prevalence of undiagnosed diabetes (HbA1c≥6.5%) and a high risk of diabetes (≥6.0% but<6.5%) in the study population was compared with recently published estimates from general French, Dutch and US populations. ResultsIn the study population, undiagnosed diabetes was found in 12 patients (9%; 95% CI: 4–14%) and a high risk for diabetes in 47 (34%; 95% CI: 26–42%). These prevalences were four to 11 times higher than the corresponding population-based estimates, whereas obesity parameters recorded in the general populations and in our study population were similar according to HbA1c subcategories. Of the 125 patients with HbA1c less than 6.5%, values were higher in patients without ocular cataract risk factors (n=73; 58%) than in those with cataract risk factors (n=52; 42%) at 5.92±0.30% and 5.57±0.29%, respectively (P<0.001), thereby suggesting a significant role for blood glucose levels in cataractogenesis. ConclusionMiddle-aged patients undergoing cataract surgery showed a high prevalence of diabetes and a high risk for diabetes not recognized before surgery, suggesting that this patient population should be targeted for diabetes screening and prevention.

An unexpectedly high prevalence of undiagnosed diabetes in patients awaiting lung transplantation

Diabetes mellitus (DM) is a common complication after lung transplantation but its prevalence prior to transplantation has not been determined. We sought to determine the prevalence of and risk factors for DM in adults awaiting lung transplantation and to determine whether pre-transplant DM could be diagnosed by hemoglobin A1c (HbA1c) alone. All patients wait-listed for lung transplantation over a 2-year period had HbA1c measured. Those not known to have DM also underwent an oral glucose tolerance test (OGTT) with insulin levels. Of 190 patients listed for lung transplantation, 30 (16%) had been diagnosed previously with DM. Twelve patients received transplants and 1 came off the waiting list before having an OGTT. The remaining patients underwent OGTT: 14 were newly diagnosed with DM and 29 with pre-diabetes. One patient vomited during the test and was excluded from analyses. Thus, 41% of all screened waiting list patients had DM (known or newly diagnosed) or pre-diabetes. Neither age, BMI, prednisolone dose nor family history correlated with dysglycemia. Patients with newly diagnosed DM and pre-diabetes were more insulin-resistant than those with normoglycemia. HbA(1c) correlated poorly with OGTT. Patients awaiting lung transplantation have unexpectedly high rates of DM and pre-diabetes despite close medical follow-up. Screening for DM with an OGTT will allow early intervention, which may improve outcomes after transplantation.

High prevalence of diabetes mellitus and metabolic syndrome in a South African coloured population: Baseline data of a study in Bellville, Cape Town

The coloured population has the second-highest prevalence of diabetes in South Africa. However, the data were based on a study conducted almost 20 years ago in a peri-urban coloured population of the Western Cape. We aimed to determine the prevalence of diabetes mellitus and metabolic syndrome in an urban coloured population in South Africa. In a cross-sectional survey, 642 participants aged ≥31 years were drawn from an urban community of Bellville South, Cape Town, from mid-January 2008 to March 2009. Type 2 diabetes was assessed according to the WHO criteria, and metabolic syndrome was based on the International Diabetes Federation (IDF), ATP III and 2009 Joint Interim Statement (JIS) definition. The crude prevalence of 28.2% (age-adjusted 26.3%, 95% confidence interval (CI) 22.0 - 30.3) for type 2 diabetes was: 4.4% (age-adjusted 3.2%, 95% CI 1.6 - 4.9) for impaired fasting glycaemia, and 15.3% (age-adjusted 15.0%, 95% CI 11.4 - 18.6) for impaired glucose tolerance. Undiagnosed type 2 diabetes was present in 18.1% (age-adjusted 16.8%, 95% CI 13.3 - 20.4). The crude prevalence of metabolic syndrome was higher with the JIS definition (62.0%) than the IDF (60.6%), and the National Cholesterol Education Program (NCEP) ATP III (55.4%). There was good overall agreement between the MetS criteria, k=0.89 (95% CI 0.85 - 0.92). The prevalence of diabetes has increased hugely in the coloured community, and the high prevalence of undiagnosed diabetes portends that cardiovascular diseases might grow to epidemic proportions in the near future in South Africa.

Abstract 5608: Recognition of Abnormal Glucose Metabolism and Its Impact on Treatment in Patients With Acute Myocardial Infarction in Germany: Results of the SWEETHEART Registry

Background: Recent reports from epidemiological studies demonstrated a high prevalence of undiagnosed diabetes in patients with coronary artery disease. These findings led to joint guidelines by the ESC and the EASD on diabetes, pre-diabetes and cardiovascular disease. Methods: Since 2007, 1,773 consecutive patients with STEMI or NSTEMI were enrolled into the MI-registry SWEETHEART to document patients’ characteristics and treatment in clinical practice with special emphasis on the identification of abnormal glucose metabolism. In patients with previously unknown diabetes, oral glucose tolerance test was performed at day 4 after the acute MI. We examined the prevalence of abnormal glucose metabolism and its impact on treatment in clinical practice. Results: Out of 1,773 consecutive patients with MI, 919 (52.3%) presented with STEMI and 837 (47.7%) with NSTEMI. Diabetes was already known in 33.0% of patients. Oral glucose tolerance tests identified another 16.1% of patients with manifest diabetes and 22.4% with impaired fasting glucose or impaired glucose tolerance (pre-diabetes). Only 28.5% of the MI population had no signs of abnormal glucose tolerance. Medical treatment for secondary prevention at discharge was quite well according to guidelines for antiplatelet therapy, betablockers, statins, ACE-inhibitors and ARB for all patients. Nevertheless, only 61.1% of patients with newly diagnosed diabetes did receive treatment for diabetes at discharge, in whom 74.0% only received diet. Conclusion: There was a high prevalence of newly diagnosed diabetes and pre-diabetes in consecutive patients with myocardial infarction in Germany. Despite new guidelines by the ESC and the EASD with clear recommendations for early and aggressive therapy of diabetes in patients with cardiovascular disease, 40% of myocardial infarction patients with newly diagnosed diabetes did not receive diet or an antidiabetic treatment at discharge.

Point‐of‐care Glucose and Hemoglobin A1c in Emergency Department Patients without Known Diabetes: Implications for Opportunistic Screening

The objectives were to evaluate the correlation between random glucose and hemoglobin A1c (HbA1c) in emergency department (ED) patients without known diabetes and to determine the ability of diabetes screening in the ED to predict outpatient diabetes. This was a cross-sectional study at an urban academic ED. The authors enrolled consecutive adult patients without known diabetes during eight 24-hour periods. Point-of-care (POC) random capillary glucose and HbA1c levels were tested, as well as laboratory HbA1c in a subset of patients. Participants with HbA1c > or = 6.1% were scheduled for oral glucose tolerance test (OGTT). The 265 enrolled patients were 47% female and 80% white, with a median age of 42 years. Median glucose and HbA1c levels were 93 mg/dL (interquartile range [IQR] = 82-108) and 5.8% (IQR = 5.5-6.2), respectively. The correlation between POC and laboratory HbA1c was r = 0.96, with mean difference 0.33% (95% confidence interval [CI] = 0.27% to 0.39%). Glucose threshold > or = 120 mg/dL had 89% specificity and 26% sensitivity for predicting the 76 (29%) patients with abnormal HbA1c; > or = 140 mg/dL had 98% specificity and 14% sensitivity. The correlation between random glucose and HbA1c was moderate (r = 0.60) and was affected by age, gender, prandial status, corticosteroid use, and current injury. Only 38% of participants with abnormal HbA1c returned for OGTTs; 38% had diabetes, 34% had impaired fasting glucose/impaired glucose tolerance, and 28% had normal glucose tolerance. ED patients have a high prevalence of undiagnosed diabetes. Although screening with POC random glucose and HbA1c is promising, improvement in follow-up with confirmatory testing and initiation of treatment is needed before opportunistic ED screening can be recommended.

High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study

BackgroundTo estimate the prevalence of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT in a large urban Iranian population aged ≥ 20 years.MethodsThe study population included 9,489 participants of the Tehran Lipid and Glucose Study with full relevant clinical data. Age-standardized prevalence of diabetes and glucose intolerance categories were reported according to the 2003 American Diabetes Association definitions. Age-adjusted logistic regression models were used to estimate the numbers needed to screen (NNTS) to find one person with undiagnosed diabetes.ResultsThe prevalence of diagnosed and undiagnosed diabetes, isolated IFG, isolated IGT, and combined IFG/IGT were 8.1%, 5.1%, 8.7%, 5.4% and 4.0% in men and 10%, 4.7%, 6.3%, 7.6%, and 4.5% in women respectively. Participants with undiagnosed diabetes had higher age, body mass index (BMI), waist circumference, systolic and diastolic blood pressures, triglycerides (all p values <0.001) and lower HDL-cholesterol (only in women, p < 0.01) compared to normoglycemic subjects. Undiagnosed diabetes was associated with family history of diabetes, increased BMI (≥ 25 kg/m2), abdominal obesity, hypertriglyceridemia, hypertension and low HDL-cholesterol levels. Among men, a combination of increased BMI, hypertension, and family history of diabetes led to a NNTS of 1.6 (95% CI: 1.57–1.71) and among women a combination of family history of diabetes and abdominal obesity, yielded a NNTS of 2.2 (95% CI: 2.1–2.4).ConclusionIn conclusion, about one third of Tehranian adults had disturbed glucose tolerance or diabetes. One- third of total cases with diabetes were undiagnosed. Screening individuals with BMI ≥ 25 kg/m2 (men), hypertension (men), abdominal obesity (women) and family history of diabetes may be more efficient.

Community-Based screening for cardiovascular disease and diabetes using HbA1c

Background Persons from inner-city immigrant and mixed-ethnic communities are known to be at high risk for cardiovascular disease and diabetes. Such communities may also be underserved for preventive medical care. The authors hypothesized that hemoglobin A1c (HbA1c) could be used as a screening test for a community-based program to detect new cases of diabetes and persons at risk for diabetes and cardiovascular disease. Methods Screenings took place in churches, group homes, shelters, community centers, and street corners of the Bronx. Screening data included history of diabetes, age, ethnicity, body mass index, blood pressure, lipid panel, random glucose, and HbA1c. Data were analyzed for number of cases of new diabetes (HbA1c ≥7%), for patients at risk for diabetes (HbA1c 6%–6.99%), and for associations between HbA1c and other variables. The effect of location of screening and self-reported ethnicity on outcome variables was also analyzed. Results Seven hundred four persons were screened in 25 different sessions. HbA1c and lipid profile were obtained on 539 persons, which formed the cohort for analysis. Mean HbA1c for the cohort was 6.00%. Thirty-two percent of the cohort had HbA1c of more than 6%, and 11.4% had HbA1c of more than 7%. Excluding known diabetics (13% of cohort), 24% had HbA1c of more than 6%, and 3.4% had HbA1c of more than 7%. HbA1c was significantly correlated with total cholesterol, triglycerides, low-density lipoprotein, systolic blood pressure, body mass index, and age; in all cases, correlation coefficients were higher with HbA1c than with random glucose. In addition, significantly higher cardiovascular disease risk factors were found in persons with HbA1c of more than 6%; 6% may be a threshold value for the metabolic syndrome. Mean HbA1c was higher in persons from the South Bronx (which has a higher poverty rate) than the North Bronx (6.08% v 5.74%, p=0.013). There were no statistically significant differences between self-reported ethnic groupings. Conclusions There was a high prevalence of undiagnosed diabetes, and of patients at risk for diabetes, in this community setting. Community-based screening can be used as a method for identifying high percentages of patients at risk for diabetes or with undiagnosed diabetes in an inner city, immigrant, mixed-ethnic population.