Plasma Glucose Criteria Research Articles

Prevalence of prediabetes by the fasting plasma glucose and HbA1c screening criteria among the children and adolescents of Shenzhen, China.

Prediabetes is associated with an increased risk of cardiovascular diseases and all-cause mortality. Rare research in China has evaluated the prevalence of prediabetes among children and adolescents using the HbA1c criterion or the combined FPG-or-HbA1c diagnostic criterion, and researchers paid no attention to the distributions of blood glucose in Shenzhen, especially for juveniles. We conducted a school-based cross-sectional study based on the first-year students from 17 primary, middle, and high schools. Prediabetes was defined as FPG of 5.6-6.9 mmol/L or HbA1c of 5.7%-6.4%. The crude and standardized prevalence of prediabetes with 95% confidence interval (95% CI) was estimated. A total of 7519 participants, aged 6 to 17 years, were included. For all subjects, the crude prevalence (95% CI) of prediabetes was 1.49% (1.21-1.77), 8.72% (8.08-9.36), and 9.80% (9.13-10.47) by the FPG-only, HbA1c-only, and FPG-or-HbA1c criteria, respectively. Based on the 2010 Shenzhen census population, the standardized prevalence was 1.56% (males 1.85%, females 1.19%), 11.05% (males 11.47%, females 10.53%), and 12.19% (males 13.01%, females 11.15%) by the corresponding criteria. The proportion of prediabetes was higher for males than females, and the prevalence decreased with grade for males but increased for females. The association of BMI and prediabetes was U-shaped curve, indicating higher rates of prediabetes for underweight and obesity people. The blood glucose status of children and adolescents in Shenzhen is worrisome, and the early detection and management of prediabetes are imperative.

PSUN230 Concordance between HbA1c, eA1C and fasting plasma glucose criteria to define type 2 diabetes remission: Insights from the Six months of Digital Twin Intervention Trial

Abstract Introduction Twin Precision Treatment (TPT): a novel whole-body digital twin enabled precision nutrition that utilises 174 health markers and 3000 daily data points from blood tests and connected devices that measure weight, physical activity, sleep and sensor glucose values, for achieving remission. Methods Contemporary consensus statement defines remission as a return of hemoglobin A1c (HbA1c) to <6.5% and persists for at least three months in the absence of diabetes medication. Estimated HbA1c (eA1C) <6.5% or fasting plasma glucose (FPG) <126 mg/dl can be used as an alternative tool in determining remission when HbA1C<6.5% is not a reliable marker. The concordance in remission by the different criteria was obtained and Kappa agreement was calculated. We evaluated the data of the multicenter RCT that is based on the patented Whole-Body Digital Twin (WBDT) enabled precision treatment for reversing diabetes. The trial was approved by an independent ethics committee, the Medisys Ethics committee (MCERB/2020/07). Trial registration: Clinical Trials Registry India (CTRI) (CTRI/2020/08/027072). SPSS Version 28.0 was used for the statistical analysis. Results We analyzed the dataset of 199 patients. The mean age was 43.3 years (±8.7); diabetes duration was 3.7 years (±2.7). The mean baseline HbA1c (%) of 9 (±1.8) reduced to 5.7 (±0.5) (p<0.001). The mean baseline eA1C (%) of 8.1(±2.3) reduced to 4.9 (±0.6) (p<0.001). The mean baseline FPG of 170.2(±59.9) (mg/dl) reduced to 95.9 (±18.2) (mg/dl) (p<0.001). 167(83.9%) achieved remission by HbA1c criteria. 166 (83.4%) achieved eA1C<6.5%. 161 (80.9%) achieved remission for FPG <126 mg/dl. 167 (83.9%) achieved remission by for either FPG <126 mg/dl or eA1C<6.5%. For every person achieving remission based on HbA1c criteria there were equivalent number achieving remission by eA1C criteria (1: 1) and proportionally the same by FPG criteria (1: 0.96). Concordance of rate of remission by eA1c and HbA1c was 97.5% and their kappa agreement was 0.91 (95% CI 0.83 to 0.99, p<0.001) (almost perfect agreement). Concordance of rate of remission by FPG and HbA1c criteria was 94%, kappa 0.79 (95% CI 0.68-0.90, p<0.001) (moderate agreement). By either FPG or eA1C criteria, the concordance rate was 97%, kappa 0.89 (95% CI 0.80 to 0.98, p<0.001) (strong agreement). We benchmarked eA1C and FPG against HbA1c for achieving remission. Sensitivity (%), specificity (%), and kappa agreement for eA1C and FPG was 98.2, 93.8, 0.91 and 94.6, 90.6, 0.79, respectively. Conclusion There was high concordance irrespective of the criteria used to evaluate remission. This homogeneity in the criteria may positively affect, assessing remission by the independent yet flexible choice of markers of remission. Using patient-level data in RCT would be an important step in putting the remission guidelines to utility in the real world. It appears that HbA1c, eA1C and FPG are comparable and reliable markers for assessing remission of T2D Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Feasibility of Using a Factory-Calibrated Continuous Glucose Monitoring System to Diagnose Type 2 Diabetes.

Context: Plasma glucose or A1C criteria can be used to establish the diagnosis of type 2 diabetes (T2D). Objective: We examined whether continuous glucose monitoring (CGM) data from a single 10-day wear period could form the basis of an alternative diagnostic test for T2D. Design: We developed a binary classification diagnostic CGM (dCGM) algorithm using a dataset of 716 individual CGM sensor sessions from 563 participants with associated A1C measurements from seven clinical trials. Data from 470 participants were used for training and 93 participants for testing (49 normoglycemic [A1C <5.7%], 27 prediabetes, and 17 T2D [A1C ≥6.5%] not using pharmacotherapy). dCGM performance was evaluated against the accompanying A1C measurement, which was assumed to provide the correct diagnosis. Results: The dCGM algorithm's overall sensitivity, specificity, positive predictive value, and negative predictive value were 71%, 93%, 71%, and 93%, respectively. At other clinically relevant A1C thresholds, dCGM specificity among normoglycemic participants was 98% (48/49 correctly classified), and for participants with suboptimally controlled diabetes (A1C ≥7%, above the American Diabetes Association recommended A1C goal) the sensitivity was 100% (8/8 participants correctly diagnosed with T2D). Conclusions: Classifications based on the dCGM algorithm were in good agreement with traditional methods based on A1C. The dCGM algorithm may provide an alternative method for screening and diagnosing T2D, and warrants further investigation.

Community-level screening for type 2 diabetes risk in Mexicans living in Colorado

Introduction: Many Mexican immigrants to the US are medically underserved and have a higher risk for type 2 diabetes; early identification of risk factors can prompt referrals to lifestyle changes and primary care in this population. We used a cross-sectional study design to assess diabetes risk using an existing community partnership, a public health professional, and a lay health promoter model to identify individuals at high risk for diabetes without imposing tests that are difficult to perform or sustain in a community setting. Materials and Methods: Between January 1st, 2018, and December 31st, 2019, a community-based approach for type 2 diabetes-risk screening was conducted by lay health workers using a standard protocol including an educational component, the FINDRISC questionnaire, and capillary plasma glucose criteria. Basic descriptive statistics were obtained for demographic, lifestyle, and diabetes risk factors. Results: Our team screened 783 adult individuals (444 females and 339 males) for type 2 diabetes risk. 29% of participants (35.6% of females and 20.6% of males) were at high risk of type 2 diabetes because they had FINDRISC scores of 14 or higher. We also identified other risk factors, 79% of females and 86% of males were overweight or obese, and 39% had high blood pressure; consequently, we referred 427 patients to their PCP or a new medical home. Conclusions: The use of a community-based intervention using the FINDRISC type 2 diabetes risk assessment tool is a suitable, easy to perform intervention that can be applied in community settings by community lay health promoters.

Prediction of type 2 diabetes mellitus using fasting plasma glucose and HbA1c levels among individuals with impaired fasting plasma glucose: a cross-sectional study in Thailand

ObjectivesAbout 11%–30% of individuals with impaired fasting plasma glucose (IFG) have type 2 diabetes mellitus (T2DM), diagnosed by the 75 g oral glucose tolerance test (75 g OGTT). This study...

Prevalence and Risk Factors of Prediabetes in Young Saudi Females in a University Setting.

Studies reporting prediabetes prevalence in young Saudis are almost a decade old. The present study determined prediabetes prevalence and its associated risk factors (body composition, lipid profile, blood pressure and physical activity) in young Saudi females. Three hundred Saudi females (18-20 years old), studying in year 2 and 3 at Imam Abdulrahman Bin Faisal University, were categorized as normoglycemic or prediabetic based on fasting plasma glucose criteria of World Health Organization (WHO) and American Diabetes Association (ADA). Anthropometric measurements, lipid profile, atherogenic indices, and physical activity data were compared. Association between fasting blood glucose and study variables was found by Bivariate analysis (Spearman Correlation for non-parametric variables and Pearson correlation for parametric) followed by Binary Logistic Regression analysis. Prevalence of prediabetes by WHO and ADA criteria were 11.3% and 18.7% respectively. Systolic, diastolic and mean arterial pressures, waist circumference, waist-hip and waist-stature-ratios were significantly raised in prediabetics compared to normoglycemic (WHO criteria p-values; 0.03, 0.003, 0.005, 0.01, 0.01, 0.04 respectively; ADA criteria 0.04, 0.001, 0.02, 0.02, 0.03, 0.01 respectively). For each unit increase in systolic, diastolic and mean arterial pressures, and waist circumference, the odds of becoming prediabetic increased by a factor of 1.02, 1.05, 1.04 and 1.03 respectively by WHO criteria: and 1.01, 1.03, 1.02, and 1.02 respectively by ADA criteria. Substantial numbers of young females in our university are suffering from prediabetes. An increase in systolic, diastolic, and mean arterial pressures and waist circumference are significant risk factors for prediabetes in young females.

Optimal fasting plasma glucose and haemoglobin A1c levels for screening of prediabetes and diabetes according to 2-hour plasma glucose in a high-risk population: The Korean Diabetes Prevention Study.

The primary aim of this study was to assess the utility of fasting plasma glucose (FPG) and HbA1c to identify diabetes by the 2-hour plasma glucose (PG) criterion in the Korean population at high risk for diabetes. A total of 1646 participants with a body mass index of ≥23 kg/m2 without having a history of diabetes were recruited in this study. The cut-off values of FPG and HbA1c for detecting diabetes were identified using the Youden index using receiver operating characteristic (ROC) analysis. The gold standard for diabetes prediction was defined by the 2-hour PG level of ≥200 mg/dL. The participants comprised 54.0% women, and the mean age of all participants was 55.0 ± 8.1 years. At baseline, FPG was 104.1 ± 14.2 mg/dL, the 2-hour PG value was 162.9 ± 55.3 mg/dL, and HbA1c was 5.9% ± 0.5%. Four hundred and forty-six subjects (27.1%) were diagnosed with diabetes and 976 subjects (59.3%) were determined to be at prediabetes. The area under the ROC curve (AUC) of FPG and HbA1c for diabetes were 0.776 and 0.802, while the AUC of FPG and HbA1c for prediabetes were 0.515 and 0.477. The optimal cut-off value for diagnosing diabetes of FPG and HbA1c were 104.5 mg/dL (sensitivity 75.8%, specificity 67.5%) and 5.9% (sensitivity 80.6%, specificity 63.8%), respectively. FPG of 104.5 mg/dL and HbA1c value of 5.9% (41 mmol/mol) can be used as an optimal screening value for diabetes by 2-hour PG criterion in the Korean population at high risk for diabetes.

Intermediate hyperglycaemia and 10-year mortality in resource-constrained settings: the PERU MIGRANT Study.

AimTo determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA1c criteria, is associated with mortality in a 10‐year cohort of people in a Latin American country.MethodsAnalysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural‐to‐urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow‐up assessment in 2018. The outcome was all‐cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6–6.9 mmol/l (100–125 mg/dl)]; (2) intermediate hyperglycaemia defined according to American Diabetes Association criteria [HbA1c levels 39–46 mmol/mol (5.7–6.4%)]; and (3) intermediate hyperglycaemia defined according to the International Expert Committee criteria [HbA1c levels 42–46 mmol/mol (6.0–6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models.ResultsAt baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural‐to‐urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA1c‐based definition and the American Diabetes Association HbA1c‐based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all‐cause mortality using the HbA1c‐based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59–4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62–5.28) according to the International Expert Committee], whereas American Diabetes Association‐defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26–2.68)]. In the adjusted model, however, only the American Diabetes Association HbA1c‐based definition was associated with all‐cause mortality [hazard ratio 1.91 (95% CI 1.03–3.53)], whereas the International Expert Committee HbA1c‐based and American Diabetes Association impaired fasting glucose‐based definitions were not [hazard ratios 1.42 (95% CI 0.75–2.68) and 1.09 (95% CI 0.33–3.63), respectively].ConclusionsIntermediate hyperglycaemia defined using the American Diabetes Association HbA1c criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA1c appears to be a factor associated with mortality in this Peruvian population.

Reproducibility of a prediabetes classification in a contemporary population

AimsTo assess whether meeting both fasting plasma glucose (FPG) and HbA1c criteria for prediabetes in people at high risk indicates with near certainty the presence of dysglycemia on repeat testing. MethodsObservational study using data from Vitamin D and Type 2 Diabetes (D2d) study. HbA1c, FPG were measured at screening visit 1; FPG, HbA1c and 2 h plasma glucose (2hPG) measured at screening visit 2 (a median of 21 days later); participants classified as having normal glucose regulation (all 3 tests in normal range), prediabetes or diabetes (at least 1 of 3 tests in diabetes range). A predictive model was developed to estimate the probability of confirming dysglycemia and for detecting diabetes at screening visit 2 based on values of FPG and HbA1c at screening visit 1. ResultsOf 1271 participants who met both FPG and HbA1c criteria for prediabetes at screening visit 1, 98.6% exhibited dysglycemia (defined as prediabetes or diabetes) on repeat testing (84.5% were classified as having prediabetes, 14.1% were reclassified as having diabetes). Of those with diabetes, 62.6% were identified by 2hPG alone. ConclusionsCombined measurement of FPG and HbA1c is a reliable and reproducible measure to identify presence of dysglycemia among people at high risk. A prediction model is provided to help clinicians decide whether an oral glucose tolerance test will provide value in detecting diabetes based on the 2hPG criterion.

Preanalytical issues related to routine and diagnostic glucose tests: Results from a survey in Spain.

IntroductionDiabetes mellitus (DM) is one of the most prevalent diseases worldwide. The objective of this study was to find out under what preanalytical conditions routine and diagnostic glucose tests are performed across Spanish laboratories; and also what criteria are used for DM diagnosis.Materials and methodsAn online survey was performed by the Commission on Quality Assurance in the Extra-Analytical Phase of the Spanish Society of Laboratory Medicine (SEQC-ML). Access to the questionnaire was available on the home page of the SEQC-ML website during the period April-July 2018. Data analysis was conducted with the IBM SPSS© Statistics (version 20.0) program.ResultsA total of 96 valid surveys were obtained. Most laboratories were in public ownership, serving hospital and primary care patients, with high and medium workloads, and a predominance of mixed routine-urgent glucose testing. Serum tubes were the most used for routine glucose analysis (92%) and DM diagnosis (54%); followed by lithium-heparin plasma tubes (62%), intended primarily for urgent glucose testing; point-of-care testing devices were used by 37%; and plasma tubes with a glycolysis inhibitor, mainly sodium fluoride, by 19%. Laboratories used the cut-off values and criteria recognized worldwide for DM diagnosis in adults and glucose-impaired tolerance, but diverged in terms of fasting plasma glucose and gestational DM criteria.ConclusionPreanalytical processing of routine and DM diagnostic glucose testing in Spain does not allow a significant, non-quantified influence of glycolysis on the results to be ruled out. Possible adverse consequences include a delay in diagnosis and possible under-treatment.

MON-210 Diagnostic Concordance of Hemoglobin A1c for Insulin Sensitivity Testing in Polycystic Ovarian Syndrome

Background: Polycystic ovarian syndrome (PCOS) as defined by the Rotterdam criteria is the most common endocrinopathy in reproductive aged women. Insulin resistance and hyperinsulinemia while not part of the diagnostic criteria occur in about 50% of PCOS and are associated with increased fertility, pregnancy and metabolic risks (Karakas, et al., 2010). The gold standard hyperinsulinemic euglycemic clamp is impractical for use in the clinical setting. Other methods include hemoglobin A1c (HbA1c), oral glucose tolerance tests (OGTT) and serum insulin levels. HbA1c is the most convenient, cost-effective and provides a three month assessment of plasma glucose. Current PCO guidelines do not recommend insulin sensitivity testing due to a lack of a standard diagnostic consensus. This is unfortunate because this information could aid in early identification of at-risk patients. To our knowledge there are no comparative studies of insulin sensitivity testing methods in PCO patients. Objective: To determine concordance of HbA1c with OGTT and insulin levels in the diagnosis of insulin resistance in an urban, predominantly African American, obese PCO population. Methods: Retrospective cohort study of PCO patients from 2015 to 2017. Fasting and 2-hour 75-gram OGTT with insulin levels, HbA1c, androgens and demographics were reviewed. Patients with diabetes, taking insulin sensitizing agents or pregnant were excluded. Insulin resistance was defined as a fasting glucose/insulin ratio <4.5, 2-hour glucose/insulin ratio <1, or 2-hour insulin > 150 µU/mL. Prediabetes was defined per American Diabetes Association (ADA). Results: 55 obese women were recruited with a mean BMI 34.9 kg/m2 of which 54.5% were hyperandrogenic. Insulin resistance was diagnosed in 54% by fasting glucose /insulin ratio, 45% by 2-hour glucose/insulin ratio and 44% by 2-hour insulin level. A significant percentage were not detected by hemoglobin A1c 44%, 41%, 43%, respectively. Prediabetes was diagnosed in 45% by HbA1c however, fewer patients were detected with fasting plasma glucose and 2 hour plasma glucose criteria 9% and 24%, respectively. Conclusion: HgbA1c detects prediabetes more often in PCO as compared to fasting or 2-hour plasma glucose. However, approximately 40% of patients with insulin resistance were not detected with HgbA1c test. Insulin resistance is earliest in the diagnostic spectrum of insulin sensitivity disorders. At current thresholds, HgbA1c is highly discordant for detecting insulin resistance in this population. This is a missed opportunity to identify an at-risk population that deserves early screening. Future studies are warranted to better define this subset of PCO patients. Reference:Karakas SE, Kim K, Duleba AJ. Determinants of Impaired Fasting Glucose Versus Glucose Intolerance in Polycystic Ovary Syndrome. Diabetes Care 2010;33: 887-893.

Management of Acute Coronary Syndromes

Management of Acute Coronary Syndromes

Effect of age on the diagnostic efficiency of HbA1c for diabetes in a Chinese middle-aged and elderly population: The Shanghai Changfeng Study

Background and aimsGlycated hemoglobin A1c (HbA1c) ≥6.5% (or 48mmol/mol) has been recommended as a new diagnostic criterion for diabetes; however, limited literature is available regarding the effect of age on the HbA1c for diagnosing diabetes and the causes for this age effect remain unknown. In this study, we investigated whether and why age affects the diagnostic efficiency of HbA1c for diabetes in a community-based Chinese population.MethodsIn total, 4325 participants without previously known diabetes were enrolled in this study. Participants were stratified by age. Receiver operating characteristic curve (ROC) was plotted for each age group and the area under the curve (AUC) represented the diagnostic efficiency of HbA1c for diabetes defined by the plasma glucose criteria. The area under the ROC curve in each one-year age group was defined as AUCage. Multiple regression analyses were performed to identify factors inducing the association between age and AUCage based on the changes in the β and P values of age.ResultsThe current threshold of HbA1c (≥6.5% or 48mmol/mol) showed low sensitivity (35.6%) and high specificity (98.9%) in diagnosing diabetes. ROC curve analyses showed that the diagnostic efficiency of HbA1c in the ≥75 years age group was significantly lower than that in the 45–54 years age group (AUC: 0.755 vs. 0.878; P<0.001). Pearson correlation analysis showed that the AUCage of HbA1c was negatively correlated with age (r = -0.557, P = 0.001). When adjusting the red blood cell (RBC) count in the multiple regression model, the negative association between age and AUCage disappeared, with the regression coefficient of age reversed to 0.001 and the P value increased to 0.856.ConclusionsThe diagnostic efficiency of HbA1c for diabetes decreased with aging, and this age effect was induced by the decreasing RBC count with age. HbA1c is unsuitable for diagnosing diabetes in elderly individuals because of their physiologically decreased RBC count.

OP.1B.10] INTRACRANIAL STENOSIS IN FIRST-GENERATION CHINESE MIGRANTS WITH NEWLY DIAGNOSED DIABETES

Objective: Ethnic differences might influence the value of current approach to cardiovascular risk stratification. Intracranial atherosclerotic disease was indeed reported as a common cause of ischemic stroke among patients of Asian ancestry and stroke incidence in China is high. However, no study investigated the prevalence of intracranial stenosis (ICS) in Chinese migrants with newly diagnosed DM and the screening of vascular lesions is still mainly focused on the more accessible extracranial carotid artery. Present survey was thus performed to determine the prevalence of intracranial stenosis in Chinese migrants with newly diagnosed diabetes. Design and method: A cross-sectional community-based survey enrolled Chinese first generation migrants (n = 1200) and native Italians (n = 291) aged 35–59 years. Hypertension was diagnosed according to ESH guidelines. Diagnosis of DM was based on fasting plasma glucose criteria (more than 125 mg/dl confirmed by repeat testing), and/or current treatment with glucose-lowering drugs. Chinese patients with newly diagnosed diabetes were screened for intracranial stenosis using Doppler ultrasound. ICS (any degree of stenosis) was diagnosed when the peak flow velocity at Transcranial Doppler (TCD) was higher than: 120 cm/s for anterior cerebral arteries (ACA); 155 cm/s for middle cerebral arteries (MCA); 100 cm/s for posterior cerebral arteries (PCA); 100 cm/s for basilar artery (BA); 90 cm/s for intracranial vertebral arteries (VA). Results: DM was diagnosed in 168 (14.0%) and 21 (7.3%) participants in the Chinese and Italian cohorts respectively (age- and gender adjusted OR 2.29; 95% C.L. 1.41 to 3.72). Difference was not reduced when obesity and socioeconomic indexes were included in the model. Ninety-six Chinese patients with newly diagnosed DM accepted to undergo the screening of cerebral vascular lesions. No patient had carotid stenosis of any degree wheres per-person prevalence of intracranial stenosis was 18.2%. Nine out of the 17 patients with any intracranial stenosis (52%) had more than 1 intracranial lesions. Conclusions: The high prevalence of asymptomatic intracranial stenosis in Chinese patients with newly diagnosed diabetes emphasizes the importance of paying attention to intracranial vessels in this minority group.

Diagnosis and Clinical Implications of Diabetes in Liver Cirrhosis: A Focus on the Oral Glucose Tolerance Test.

The liver and skeletal muscles are responsible for maintaining glucose metabolism. As chronic liver disease progresses to cirrhosis, the loss of liver function is exacerbated and leads to the deterioration of skeletal muscle. Consequently, impaired glucose tolerance (IGT) and insulin resistance are often observed in patients with liver cirrhosis. Early stage cirrhosis with hepatogenous diabetes is characterized by marked postprandial hyperglycemia and hyperinsulinemia. Generally, it is possible to underestimate IGT when using either the conventional fasting plasma glucose (FPG) criterion or hemoglobin A1c (HbA1c) levels despite their status as the gold standard for diagnosing diabetes. The number of cirrhotic patients with diabetes tends to be underestimated because many of these patients show lower FPG levels or HbA1c, which masks their IGT. In such cases, the oral glucose tolerance test is recommended to evaluate patients with suspected postprandial hyperglycemia who present with a normal FPG. Moreover, in addition to the Child–Pugh score, the early detection of diabetes may be a useful prognostic marker for patients with liver cirrhosis.

Comparing glucose and hemoglobin A1c diagnostic tests among a high metabolic risk Hispanic population.

Compare glycated hemoglobin (HbA1c ) diagnostic tests for prediabetes and diabetes with plasma glucose criteria and compare the metabolic profiles of people classified by HbA1c versus by glucose levels. Participants were recruited for the San Juan Overweight Adults Longitudinal Study. The participants were primarily Hispanic (98%), without previously diagnosed diabetes, and aged 40 to 65years. Participants classified as normal glycemic, prediabetes, or diabetes on the basis of baseline HbA1c and plasma glucose criteria were compared with respect to baseline cardiometabolic factors. The 1342 participants had a mean age of 50.5±6.8years and 28% were men. Thirty-one percent were diagnosed with prediabetes by plasma glucose criteria and 53.4% by HbA1c , and 8.1% were diagnosed with diabetes by plasma glucose criteria and 6.3% by HbA1c ; overall concordance rate was 55.1%. The area under the receiver operating characteristic curve of HbA1c compared to plasma glucose criteria was 0.62 for impaired glucose and 0.76 for diabetes. A worse cardiometabolic profile was seen within subgroups that met HbA1c and plasma glucose criteria for diabetes or prediabetes. Those diagnosed with prediabetes by plasma glucose criteria had significantly higher systolic blood pressure and higher homeostatic model assessment than those diagnosed using HbA1c . Participants diagnosed with diabetes by plasma glucose criteria had lower body mass index, smaller waist circumference, and lower insulinogenic and disposition indices, but higher homeostatic model assessment of insulin resistance, than those diagnosed by HbA1c . Low concordance was seen between HbA1c and glucose measurements. The HbA1c is not a good test for prediabetes but shows reasonable validity for diabetes in this high-risk predominantly female Hispanic population. People classified by HbA1c , plasma glucose criteria, or both show different metabolic profiles; a combined test may be ideal.

Comparison of the clinical characteristics of diabetes mellitus diagnosed using fasting plasma glucose and haemoglobin A1c: The 2011 Korea National Health and Nutrition Examination Survey

We compared the characteristics of a Korean adult population diagnosed with diabetes using only a fasting plasma glucose criterion or an HbA1c criterion. The single difference between these two groups was age. Further studies should be undertaken to clarify whether age-specific diagnostic criteria would be appropriate in Korean populations.

Impact of metabolic syndrome and its components on heart rate variability during hemodialysis: a cross-sectional study.

BackgroundBoth uremia and metabolic syndrome (MetS) affect heart rate variability (HRV) which is a risk factor of poor prognoses. The aim of this study was to evaluate the impact of MetS on HRV among chronic hemodialysis patients.MethodsThis cross-sectional study was carried out in a teaching hospital in Northern Taiwan from June to August, 2010. Adult patients on chronic hemodialysis without active medical conditions were enrolled. HRV were measured for 4 times on the index hemodialysis day (HRV-0, -1, -2, and -3 at before, initial, middle, and late phases of hemodialysis, respectively), and the baseline demographic data and clinical parameters during the hemodialysis session were documented. Then we evaluated the impacts of MetS and its five components on HRV.ResultsOne hundred and seventy-five patients (100 women, mean age 65.1 ± 12.9 years) were enrolled and included those with MetS (n = 91, 52 %) and without MetS (n = 84, 48 %). The patients with MetS(+) had significantly lower very low frequency, total power, and variance in HRV-0, total power and variance in HRV-2, and variance in HRV-3. (all p ≦ 0.05) When using the individual components of MetS to evaluate the impacts on HRV indices, the fasting plasma glucose (FPG) criterion significantly affected most indices of HRV while other four components including “waist circumference”, “triglycerides”, “blood pressure”, and “high-density lipoprotein” criteria exhibited little impacts on HRV. FPG criterion carried the most powerful influence on cardiac ANS, which was even higher than that of MetS. The HRV of patients with FPG(+) increased initially during the hemodialysis, but turned to decrease dramatically at the late phase of hemodialysis.ConclusionsThe impact of FPG(+) outstood the influence of uremic autonomic dysfunction, and FPG criterion was the most important one among all the components of MetS to influence HRV. These results underscored the importance of interpretation and management for abnormal glucose metabolism.

Which is responsible for cardiac autonomic dysfunction in non-diabetic patients with metabolic syndrome: Prediabetes or the syndrome itself?

AimsCardiac autonomic dysfunction (CAD) is associated with both prediabetes and metabolic syndrome (MS). Heart rate variability (HRV) and heart rate turbulence (HRT) are reliable 24-h Holter-ECG findings of cardiac autonomic function. This study aimed to investigate the relation between MS and its components and CAD using HRV and HRT. Materials and methodsThe study included 80 non-diabetic patients with MS and 70 control subjects. All study population and the patients with MS were further analyzed for each diagnostic component of MS to investigate which criteria impaired HRV and HRT. ResultsHRV and HRT parameters were disturbed in patients in the MS group. While impairment in HRV and HRT was significantly related to the presence of the fasting plasma glucose (FPG) criterion, there were no differences between groups in terms of the other 4 MS criteria. Moreover, FPG level was significantly correlated with SDNN (r=−0.352, p<0.001), SDNN index (r=−0.423, p<0.001), SDANN (r=−0.301, p<0.001), RMSSD (r=−0.237, p<0.001), pNN50 (r=−0.237, p<0.001), turbulence onset (TO) (r=0.365, p<0.001) and turbulence slope (TS) (r=−0.365, p<0.001). Among the MS diagnostic criteria, only FPG level was an independent determinant of all HRV and HRT parameters. ConclusionsThis study confirms the relation between MS and CAD. Increased FPG alone appears to be responsible for the mentioned findings among the 5 diagnostic criteria. Accordingly, CAD may be the result of prediabetes, not MS in patients with MS.

Using Serum Advanced Glycation End Products-Peptides to Improve the Efficacy of World Health Organization Fasting Plasma Glucose Criterion in Screening for Diabetes in High-Risk Chinese Subjects.

The efficacy of using fasting plasma glucose (FPG) alone as a preferred screening test for diabetes has been questioned. This study was aimed to evaluate whether the use of serum advanced glycation end products-peptides (sAGEP) would help to improve the efficacy of FPG in diabetes screening among high-risk Chinese subjects with FPG <7.0 mmol/L. FPG, 2-h plasma glucose (2h-PG), serum glycated haemoglobin A1c (HbA1c), and sAGEP were measured in 857 Chinese subjects with risk factors for diabetes. The areas under receiver operating characteristic (ROC) curves generated by logistic regression models were assessed and compared to find the best model for diabetes screening in subjects with FPG <7.0 mmol/L. The optimal critical line was determined by maximizing the sum of sensitivity and specificity. Among the enrolled subjects, 730 of them had FPG <7.0 mmol/L, and only 41.7% new diabetes cases were identified using the 1999 World Health Organization FPG criterion (FPG ≥7.0 mmol/L). The area under ROC curves generated by the model on FPG-sAGEP was the largest compared with that on FPG-HbA1c, sAGEP, HbA1c or FPG in subjects with FPG <7.0 mmol/L. By maximizing the sum of sensitivity and specificity, the optimal critical line was determined as 0.69×FPG + 0.14×sAGEP = 7.03, giving a critical sensitivity of 91.2% in detecting 2h-PG ≥11.1 mmol/L, which was significantly higher than that of FPG-HbA1c or HbA1c. The model on FPG-sAGEP improves the efficacy of using FPG alone in detecting diabetes among high-risk Chinese subjects with FPG <7.0 mmol/L, and is worth being promoted for future diabetes screening.