Prevalence Of Undiagnosed Diabetes Research Articles

Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts.

To report the age- and sex-specific prevalences of diabetes and impaired glucose regulation (IGR) according to the revised 1999 World Health Organization criteria for diabetes in Europe. A total of 13 studies from nine European countries with 7,680 men and 9,251 women aged 30-89 years were included in the data analysis. In most of the study populations, the age-specific prevalences of diabetes were <10% in subjects younger than 60 years and between 10 and 20% at 60-79 years of age. Mean 2-h plasma glucose (2hPG) concentration increased linearly with age, but fasting plasma glucose (FPG) concentration did not. The increase in the prevalence of undiagnosed diabetes and IGR in the elderly was mainly a result of the large increase in 2hPG rather than FPG. Diabetes and impaired fasting glycemia defined by isolated fasting hyperglycemia was more common in men than in women 30-69 years of age, whereas the prevalence of isolated postload hyperglycemia, particularly impaired glucose tolerance, was higher in women than in men, especially in the elderly (individuals >70 years of age). More than half of the diabetes was undiagnosed in subjects younger than 50 years of age. Most European populations have a moderate to low prevalence of diabetes and IGR. Diabetes and IGR will be underestimated in Europe, particularly in women and in elderly men, if diagnoses are based on fasting glucose determination alone.

The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed Type 2 diabetes mellitus in primary hyperparathyroidism.

To evaluate the frequency of impaired glucose tolerance (IGT)and undiagnosed diabetes mellitus together with the indices of insulin resistance (IR) in primary hyperparathyroidism (pHPT). Out of 105 consecutive pHPT patients (F/M 78/27, asymptomatic/symptomatic 68/37, age (mean +/- s.d.) 60.7 +/- 12.7 years,body mass index 25.2 +/- 3.8 kg/m2, ionized calcium (iCa) 1.49 +/- 0.16 mmol/l,parathormone 200.4 +/- 233.9 pg/ml),59 without known diabetes mellitus and controls (n = 60) underwent an oral glucose tolerance test (OGTT, 75 g os). As indices of IR, homeostasis model assessment (HOMAIR)or OGTT data (insulin sensitivity index composite (ISI comp)) were evaluated. In pHPT the prevalence of IGT (mean, 95% confidence intervals (CI), 40.7%, 27.8-53.6) was higher than in controls (25.0%, 13.7-36.3, P < 0.03). Similarly,the prevalence of undiagnosed diabetes mellitus was higher in pHPT(15.3%, 5.8-24.7) than in controls (5.0%, 0-10.7, P < 0.05). Moreover,the prevalence of IGT and undiagnosed diabetes was higher in pHPT than that previously reported in the general population of Northern Italy(8.5% and 3.2%, respectively). The indices showed that insulin resistance was higher in pHPT than in controls: HOMAIR (median, 95% CI,2.6, 2.5-3.9 vs. 1.7, 1.6-2.5, respectively; P < 0.003); ISI comp (3.5, 3.4-4.6 vs. 5.1, 4.9-7.2, respectively; P < 0.002). Our data in a large and modern day pHPT series, with a preponderance of asymptomatic patients, confirm increased insulin resistance and pre-valence of IGT and undiagnosed diabetes.

The Performance of a Risk Score in Predicting Undiagnosed Hyperglycemia

Type 2 diabetes is a serious disease that is commonly undetected and for which screening is sometimes advocated. A number of risk factors are associated with prevalent undiagnosed diabetes. The use of routinely available information on these factors has been proposed as a simple and effective way of identifying individuals at high risk for having the disease. The objective of this study was to assess the effectiveness of the Cambridge risk score in a large and representative population. A risk score derived from data in a previous study was tested for its ability to detect prevalent undiagnosed hyperglycemia as measured by a GHb > or = 6.0, 6.5, or 7% in 6,567 subjects aged 39-78 years in the European Prospective Investigation of Cancer-Norfolk cohort. For a specificity of 78%, the risk score predicted a GHb of > or = 7.0% in subjects aged 39-78 years, with a sensitivity of 51% (95% CI 40-62). The areas under the receiver-operating characteristic (ROC) curve for GHb > or = 6.0, 6.5, and 7% were 65.7% (63.8-67.6), 71.2% (68.4-75.2), and 74.2% (69.5-79.0), respectively. The area under the ROC curve was not significantly reduced if data on family and smoking history were unavailable for any of the cut-offs for GHb. The risk score performed as well as other previously reported models in all age groups. We concluded that a simple risk score using data routinely available in primary care can identify people with an elevated GHb with reasonable sensitivity and specificity, and it could therefore form part of a strategy for early detection of type 2 diabetes.

Diabetes Screening in Canada (DIASCAN) Study: prevalence of undiagnosed diabetes and glucose intolerance in family physician offices.

To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals > or =40 years of age who contacted their family physician for routine care. The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients > or =40 years of age were screened for diabetes. If a casual fingerprick blood glucose was >5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1-6.9 mmol/l, a 2-h 75-g post-glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories. Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients. Routine screening for diabetes by family physicians is justified in patients > or =40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients > or =40 years of age have known diabetes. This has important implications regarding health resources and physician education.

Plasma Concentration of Interleukin-6 and C-reactive Protein and the Risk of Developing Type 2 Diabetes Mellitus Among Healthy Middle-Aged Women

P02 Background Inflammation may play an important role in the development of type 2 diabetes mellitus. We studied whether plasma concentrations of the inflammatory markers, interleukin-6 (IL-6) and C-reactive protein (CRP), are related to the development of type 2 diabetes in women. Methods We conducted a prospective, nested case-control study among a cohort of middle-aged female health professionals free of diagnosed diabetes mellitus, cardiovascular disease, and cancer to assess the risk of incident type 2 diabetes over a four-year period associated with baseline levels of IL-6 and high-sensitivity CRP (hs-CRP). A diagnostic threshold of 6.5% for hemoglobin A1c (HbA1c) was used to exclude prevalent undiagnosed diabetes. Results Baseline levels of IL-6 (P&lt;0.001) and hs-CRP (P&lt;0.001) were significantly higher among women who subsequently developed diabetes mellitus compared to those who did not. The relative risks of future diabetes for women in the highest as compared to the lowest quartile of these inflammatory markers were 7.5 for IL-6 (95% CI, 3.7 to 15.4) and 15.7 for hs-CRP (95% CI, 6.5 to 37.9). These effects persisted after adjustment for body-mass index, family history of diabetes, smoking, exercise, use of alcohol and hormone replacement therapy; adjusted relative risks for the highest versus lowest quartile were 2.3 for IL-6 (95% CI, 0.9 to 5.6; P-trend = 0.066) and 4.2 for hs-CRP (95% CI, 1.5 to 12.0; P-trend = 0.001). Similar results were seen in analyses limited to individuals with HbA1c ≤ 6.0% and after adjustment for fasting insulin levels. Conclusions Plasma concentrations of interleukin-6 and C-reactive protein are associated with an increased risk of developing type 2 diabetes mellitus in middle-aged women. These data support the inflammatory hypothesis of diabetogenesis.

Plasma Concentration of Interleukin-6 and C-reactive Protein and the Risk of Developing Type 2 Diabetes Mellitus Among Healthy Middle-Aged Women

P02 Background Inflammation may play an important role in the development of type 2 diabetes mellitus. We studied whether plasma concentrations of the inflammatory markers, interleukin-6 (IL-6) and C-reactive protein (CRP), are related to the development of type 2 diabetes in women. Methods We conducted a prospective, nested case-control study among a cohort of middle-aged female health professionals free of diagnosed diabetes mellitus, cardiovascular disease, and cancer to assess the risk of incident type 2 diabetes over a four-year period associated with baseline levels of IL-6 and high-sensitivity CRP (hs-CRP). A diagnostic threshold of 6.5% for hemoglobin A1c (HbA1c) was used to exclude prevalent undiagnosed diabetes. Results Baseline levels of IL-6 (P

Prevalence of undiagnosed diabetes in Asian Indian population - evaluation of the new diagnostic criteria

Prevalence of undiagnosed diabetes in Asian Indian population - evaluation of the new diagnostic criteria

Diabetes ignorada y otras alteraciones del metabolismo glucídico en la población española de alto riesgo. El Estudio ITG

To estimate the prevalence of undiagnosed diabetes and impaired glucose metabolism on high risk Spanish population, contrasting phenotypic features according to both sets of criteria, World Health Organization (WHO) and American Diabetes Association (ADA). Cross-sectional, multicentre (10 health-care centres, 230,000 inhabitants), selective risk-factor study. WHO diagnoses (normal, impaired glucose tolerance [IGT] and diabetes) were based on the 2 h plasma glucose (2hPG) following a 75 g oral glucose tolerance test (OGTT) and ADA diagnoses according the fasting plasma glucose (FPG) (normal, impaired FPG and diabetes). Prevalence, diagnostic overlap index and 22 clinical and biological parameters were compared. The study included 580 subjects (330 women), mean age 58.1 years and body mass index 31.2 kg/m2, 292 (50.3%) with only one risk factor and 288 (49.7%) with two or more risk factors. WHO diagnoses were: 291 (50.2%) normal glucose tolerance (95% CI: 46.2-54.2%), 157 (27.1%) IGT (23.5-30.7%) and 132 (22.7%) diabetes (19.3-26.1%). ADA diagnoses were: 355 (61.2%) normal FPG (57.2-65.2%), 146 (25.2%) IFG (21.7-28.7%) and 79 (13.6%) diabetes (10.9-16.3%). The prevalence of diabetes decreased 9.1% (from -11.4 to -6.8%). The diagnostic overlap was 33.5% for diabetes and 19.3% for impaired glucose homeostasis (IGT-FPG). Omitting the OGTT half the diabetic subjects with 2hPG > or = 200 mg/dl (11.1 mM) but FPG < 126 mg/dl (7 mM) would remain undiagnosed. By changing screening criteria (FPG instead of 2hPG) the risk related to traditional factors such as age or a first-degree relative with diabetes would reduce. Applying ADA criteria, the high prevalence of undiagnosed glucose abnormalities would decrease. These results suggest that it is strongly advisable the continued use of the 2hPG for diabetes screening on high risk Spanish population.

Comparison of the results between two diagnostic criteria by ADA and WHO among subjects with FPG 5.6–7.8 mmol/l in Kin-Hu and Kin-Chen, Kinmen, 1991–94

The objective of this study was to compare the results between two diagnostic criteria by ADA (1997) and WHO (1985) among those with fasting plasma glucose (FPG) level 5.6–7.8 mmol/l from a community-based survey in Kin-Hu and Kin-Chen, Kinmen conducted in 1991–94. According to official household registry, 10797 residents aged over 30 were eligible for screening. 7580 had completed FPG screening and 1855 with FPG 5.6–7.8 mmol/l were invited to receive a 75-g oral glucose tolerance test (OGTT). 78.5% (1456/1855) had completed OGTT. The prevalence of impaired fasting glucose (IFG, by ADA) was 15.7%; the prevalence of impaired glucose tolerance (IGT, by WHO) was 22.7%; the prevalence of undiagnosed diabetes was 7.4% by ADA criteria and 10.9% by WHO criteria. It should be noticed that, among subjects with FPG 5.6–7.8 mmol/l, 50.3% of individuals with undiagnosed diabetes and 67.6% of individuals with IGT by WHO criteria would be missed by ADA criteria. Based on the above findings, the two-step screening strategy using FPG as the first line screening and OGTT for high-risk group (FPG 5.6–7.8 mmol/l) only was recommended in epidemiological study and case finding in consideration of feasibility and validity.

Prevalence of undiagnosed diabetes and abnormalities of carbohydrate metabolism in a U.S. Army population.

The Third National Health and Nutrition Examination Survey (NHANES III) reported that 4.3-6.3% of adult Americans have undiagnosed diabetes. 15.6% have impaired glucose tolerance, and 10.1% have impaired fasting glucose. By design, NHANES III excluded people in the U.S. military. The purpose of this study was to determine the prevalence of undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose among U.S. Army soldiers. A 2-h, 75-g oral glucose tolerance test was performed on a prospective, consecutive sample of 625 asymptomatic soldiers presenting to a U.S. Army medical clinic for physical examinations. Age of subjects was 32 +/- 9 years (mean +/- SD), and 81.0% of subjects were male. BMI was 26.2 +/- 3.7 kg/m2. Race/ethnicity categories included Caucasian (54.4%), African-American (24.4%), Hispanic (17.4%), and other (3.7%). A family history of diabetes was reported by 25.4% of the subjects, and the number of exercise sessions per week was 4.0 +/- 1.5. The prevalence of undiagnosed diabetes was 3 of 625 (0.5%) (95% CI, 0.1-1.4): impaired glucose tolerance, 11 of 598 (1.8%) (0.9-3.3); and impaired fasting glucose 6 of 585 (1.0%) (0.4-2.2). In this low-diabetes risk U.S. Army population, the prevalence of undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose were 0.5, 1.8, and 1.0%, respectively. The prevalence rates found in this study are approximately one-tenth of those found in NHANES III.

Relationships of fasting and postload glucose levels to sex and alcohol consumption. Are American Diabetes Association criteria biased against detection of diabetes in women?

To compare, in men and women, the prevalence of undiagnosed type 2 diabetes assessed using criteria from the American Diabetes Association (ADA) and the World Health Organization (WHO) and to investigate risk factors associated with fasting and 2-h postload plasma glucose. Data from two companion surveys of Europeans, South Asians, and Afro-Caribbeans in west London were used. A total of 4,367 men and women aged 40-64 years who were not known to have diabetes underwent an oral glucose tolerance test after an overnight fast. The prevalence of undiagnosed diabetes was estimated using the ADA (fasting plasma glucose > or = 7.0 mmol/l) and WHO (2-h postload glucose > or = 11.1 mmol/l) criteria for epidemiologic studies. The association of body fat and usual alcohol intake with plasma glucose and diabetes prevalence was assessed. Compared with the WHO criterion, the ADA criterion gave a higher prevalence of diabetes in men (6.4 vs. 4.7%) but a lower prevalence in women (3.3 vs. 4.2%). In Afro-Caribbeans, the sex difference in diabetes prevalence was reversed. Women had significantly lower fasting glucose than men despite higher 2-h glucose levels. Alcohol intake was positively associated with fasting glucose in men and women but not with 2-h glucose levels. The new ADA criterion, based on fasting glucose alone, does not take account of sex differences in metabolic response to fasting or possible artifactual effects on fasting glucose. With the ADA criterion, alcohol intake was a significant risk factor for diabetes in our study population; this was not the case with the WHO criterion.

Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994.

To evaluate the prevalence and time trends for diagnosed and undiagnosed diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults by age, sex, and race or ethnic group, based on data from the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III) and prior Health and Nutrition Examination Surveys (HANESs). NHANES III contained a probability sample of 18,825 U.S. adults > or = 20 years of age who were interviewed to ascertain a medical history of diagnosed diabetes, a subsample of 6,587 adults for whom fasting plasma glucose values were obtained, and a subsample of 2,844 adults between 40 and 74 years of age who received an oral glucose tolerance test. The Second National Health and Nutrition Examination Survey, 1976-1980, and Hispanic HANES used similar procedures to ascertain diabetes. Prevalence was calculated using the 1997 American Diabetes Association fasting plasma glucose criteria and the 1980-1985 World Health Organization (WHO) oral glucose tolerance test criteria. Prevalence of diagnosed diabetes in 1988-1994 was estimated to be 5.1% for U.S. adults > or = 20 years of age (10.2 million people when extrapolated to the 1997 U.S. population). Using American Diabetes Association criteria, the prevalence of undiagnosed diabetes (fasting plasma glucose > or = 126 mg/dl) was 2.7% (5.4 million), and the prevalence of impaired fasting glucose (110 to < 126 mg/dl) was 6.9% (13.4 million). There were similar rates of diabetes for men and women, but the rates for non-Hispanic blacks and Mexican-Americans were 1.6 and 1.9 times the rate for non-Hispanic whites. Based on American Diabetes Association criteria, prevalence of diabetes (diagnosed plus undiagnosed) in the total population of people who were 40-74 years of age increased from 8.9% in the period 1976-1980 to 12.3% by 1988-1994. A similar increase was found when WHO criteria were applied (11.4 and 14.3%). The high rates of abnormal fasting and postchallenge glucose found in NHANES III, together with the increasing frequency of obesity and sedentary lifestyles in the population, make it likely that diabetes will continue to be a major health problem in the U.S.

Studies of postnatal diabetes mellitus in women who had gestational diabetes. Part 1. Estimation of the prevalence of unrecognized prepregnancy diabetes mellitus.

This study investigated the prevalence of undiagnosed diabetes in women in the reproductive age group in a Victorian population by analysis of the results of glucose tolerance testing in 57,563 pregnancies. Gestational diabetes (GD) was diagnosed in 4,243 pregnancies and in 2,957 (69.7%) of these, postnatal glucose tolerance testing was performed. Diabetes mellitus was diagnosed within 26 weeks of delivery in 59 women, 55 of whom were diagnosed by the postnatal glucose tolerance test (GTT). There were 4 women with GD who developed diabetic ketosis during pregnancy (3) or within 12 weeks of delivery (1). By consideration of the results of the antenatal and postnatal GTTs, it was deduced that 53% (31 of 59) of the women with diabetes diagnosed after delivery may have had unrecognized prepregnancy diabetes. Consideration of the entire glucose-tolerance tested population led to the conclusion that approximately 1 in 1,031 women in the reproductive age group in our community have unrecognized prepregnancy diabetes mellitus.

Prevalence of NIDDM and impaired glucose tolerance in Italy: an OGTT-based population study

To provide complete prevalence data on diabetes mellitus in Italy (diagnosed and undiagnosed), a population survey was performed in the Health District of Cremona, a representative area of the Po river (north Italy). The survey is characterised by particular attention being paid to methodology, non-responders being investigated for possible selection biases affecting diagnosed and undiagnosed diabetes prevalence estimations. Out of a population aged 44 years or older from three municipalities, a random sample of 3097 subjects was selected to undergo an oral glucose tolerance test. In addition, past medical history, clinical and laboratory data were collected. A total of 1797 subjects participated (58%), and information on known diabetes status was obtained for 2618 persons (85%), also including 826 interviewed non-participating subjects. Overall rates were age-standardised according to the 1991 Italian census. Overall prevalence and 95% confidence interval of diagnosed diabetes was 8.5% (6.9-10.1) in males and 7.9% (6.7-9.3) in females over the age of 44 years; previously undiagnosed diabetes was 2.5% (1.4-3.6) in males and 3.4% (2.1-4.7) in females; glucose intolerance was 7.7% (5.7-9-7) in males and 8.9% (7.0-10.8) in females. Total diabetes prevalence above age 44 years, developed-world age, and sex standardised, was 10.7%. This study provides the first reliable prevalence estimation of impaired glucose tolerance, diagnosed and undiagnosed diabetes in Italy, according to World Health Organization criteria, and one of the few figures for Southern Europe. The role of body mass index on both prevalence of diabetes and cluster of cardiovascular risk factors is considered, with implications for prevention.

Prevalence of diabetes and impaired glucose tolerance in Funagata area, Japan.

To determine the prevalence of diabetes mellitus and IGT in the Funagata area of Japan. The total eligible subjects was 1163, all were > or = 45 yr of age, and 52 were known diabetic patients. Data collected included body height, weight, and answers to medical questionnaires. A 75-g OGTT was done in the morning. WHO criteria were used to classify the current diabetes status of study participants. Of the 1111 scheduled for the OGTT, 868 took the test; the participation rate was 77.8%. The prevalence of diabetes was 10.5 and 12.9%, and the prevalence of IGT was 14.7 and 18.0% for men and women, respectively. The prevalence of undiagnosed diabetes (4.9%) was almost equal to that of previously diagnosed diabetes (4.5%). The prevalence of diabetes in the Funagata area was two to four times higher than that of previous reports in Japan, in which many investigators used a urinary glucose test as a preliminary test. This difference is attributed to the method of determining the prevalence of diabetes.

Stroke topography and outcome in relation to hyperglycaemia and diabetes.

In a prospective study to analyse stroke topography and outcome in diabetics and to determine the prognostic value of blood glucose and glycosylated haemoglobin estimation, we evaluated 176 patients with acute stroke. The patients were classified into four groups on the basis of history, fasting glucose, and glycosylated haemoglobin: euglycaemic patients with no history of diabetes, stress hyperglycaemia, newly diagnosed diabetics, and known diabetics. A high prevalence of undiagnosed diabetes was shown. No difference was found in the type or site of stroke between the four groups. No difference was found in the site of symptomatic or incidental lesions on computerised axial tomography. Patients with stress hyperglycaemia and known diabetics had more severe strokes. Mortality was higher in patients with stress hyperglycaemia, newly diagnosed diabetics, and the combined diabetes groups. This increased mortality was evident in the hyperglycaemic and diabetic groups, even after excluding patients with cerebral haemorrhage. Stroke severity and mortality also increased independently with blood glucose in the euglycaemic group. We conclude that there is a correlation between admission glucose concentration, diabetes, and poor stroke outcome, which may not be attributed to stroke type or location.

High prevalence of undiagnosed diabetes among Chinese patients with ischaemic stroke

We reviewed the prevalence of diabetes mellitus, hypertension and cigarette smoking in 176 Chinese patients with acute stroke, classified, on computed tomographic findings, as intracerebral haemorrhage or cerebral infarction. In all patients with no known history of diabetes, a 75 g OGTT was done 3–6 months after ictus and interpreted using WHO criteria. The overall prevalence of diabetes and impaired glucose tolerance (IGT) was 33.5% and 21.0%, respectively, with a higher prevalence being found in patients with cerebral infarction ( P < 0.05). Forty percent of those with diabetes were previously undiagnosed — all but 2 had ischaemic stroke. Compared to reported findings in the general population, an increased prevalence of hypertension, and possibly also cigarette smoking was found in patients with both stroke categories. On the other hand, significant hypercholesterolaemia was not found in patients of either category. In view of the high prevalence of undiagnosed diabetes among these stroke patients and the increased morbidity and mortality associated with diabetes mellitus, screening for diabetes is recommended especially in those with ischaemic stroke. If a fasting plasma glucose of ≥ 6 mmol/l was used for the initial screening of undiagnosed diabetes in this group of patients, the sensitivity and specificity values would have been 78% and 94%, respectively. Whether this cut-off value can be cost-effectively employed for mass screening remains to be confirmed by studies involving larger numbers of stroke patients.

Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20-74 yr.

The prevalence of physician-diagnosed diabetes and of undiagnosed diabetes and impaired glucose tolerance (IGT) that meet National Diabetes Data Group (NDDG) and World Health Organization (WHO) criteria have been estimated for the U.S. population aged 20-74 yr from the 1976-1980 National Health and Nutrition Examination Survey. This survey included a demographic/medical history questionnaire administered in the participant's home and a detailed examination composed of a physician's exam, special clinical procedures, other tests, and collection of blood and urine specimens. Survey participants were selected from 1970 census data through a stratified multistage probability sampling scheme. Of 17,390 eligible residents aged 20-74 yr, 15,357 (88.3%) participated in the interview and are the basis for estimates of diagnosed diabetes; 11,858 (68%) participated in the exam. A half sample of 5901 examinees was selected to receive a 75-g oral glucose tolerance test (OGTT) performed in the morning after an overnight 10- to 16-h fast. Of these examinees, valid OGTT data were obtained for 3772 people without a medical history of diabetes, and these are the basis for estimates of undiagnosed diabetes and IGT. The major reasons for incomplete OGTT data were inability of participants to attend the examination center in the morning and lack of adherence to the fasting instructions. Despite the relatively low response rates, evidence is presented that data on both the interviewed sample and those receiving the OGTT, when adjusted for the 1970-1980 census characteristics by age, race, sex, income, and geographic location, are representative of the U.S. population. Extrapolation of these data to the U.S. population aged 20-74 yr indicates a total diabetes prevalence of 6.6% by NDDG criteria, or more than 8 million people with diabetes. The prevalence of undiagnosed diabetes (3.2%) was almost equal to that of previously diagnosed diabetes (3.4%). Total rates of diabetes increased with age, from 2.0% at age 20-44 yr to 17.7% at age 65-74 yr. Rates were approximately equal by sex but were greater in Blacks than in Whites. The prevalence of undiagnosed diabetes by WHO criteria (3.4%) was similar to that by NDDG criteria, but the rate of impaired glucose tolerance (11.2%) was more than twice the NDDG estimate (4.6%). Both obesity and parental history of diabetes were associated with significantly higher rates of diabetes and IGT. Fasting plasma glucose was relatively insensitive to age, but 1-h and 2-h post-75-g glucose values increased significantly with age.

Prevalence of hyperglycaemia and undiagnosed diabetes mellitus in patients with acute myocardial infarction.

The prevalence of hyperglycaemia and undiagnosed diabetes mellitus was assessed in 214 consecutive patients admitted to the coronary care units with acute myocardial infarction (AMI). On admission, 16 patients (7.5%) had known diabetes, and 19 patients, not previously known to be diabetic, had blood glucose concentrations of greater than or equal to 9 mmol/l. Fifteen patients survived for 2 months at which time a 75 g oral glucose tolerance test showed diabetes in 9 (60%) and impaired glucose tolerance in 4 (27%). Ten of these 13 patients (77%) with abnormal glucose tolerance had elevated glycosylated haemoglobin (HbA1c) on admission, indicating pre-existing glucose intolerance or diabetes. The prevalence of undiagnosed diabetes was 4.5% (9/198). However, we may have overlooked undiagnosed diabetes in a small number of patients on admission, since only a random blood glucose less than 8 mmol/l rules out diabetes, WHO criteria. Elevated blood glucose in patients with AMI is more likely to reflect a stationary pre-existing abnormal glucose tolerance than a temporary stress-induced phenomenon.