Previous Diagnosis Of Diabetes Research Articles

JBDS guideline for the use of VRIII in medical patients – a commentary

Variable rate intravenous insulin infusion (VRIII) – previously sliding scale insulin – is an established methodology to achieve normoglycaemia in hospital patients with severe hyperglycaemia. However there are several different sliding scales, even within the same hospital. This new guideline is designed for use by any healthcare professional responsible for the care of acutely unwell patients who present with hyperglycaemia – with or without a previous diagnosis of diabetes. It offers practical guidance on use of VRIII and patient transition to other glucose-lowering therapy on stabilisation.

Blood spot–based measures of glucose homeostasis and diabetes prevalence in a nationally representative population of young US adults

PurposeWe investigated understudied biomarker-based diabetes among young US adults, traditionally characterized by low cardiovascular disease risk. MethodsWe examined 15,701 participants aged 24 to 32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health, 2008). The study used innovative and relatively noninvasive methods to collect capillary whole blood via finger prick at in-home examinations in all 50 states. ResultsAssays of dried blood spots produced reliable and accurate values of HbA1c. Reliability was lower for fasting glucose and lowest for random glucose. Mean (SD) HbA1c was 5.6% (0.8%). More than a quarter (27.4%) had HbA1c-defined prediabetes. HbA1c was highest in the black, non-Hispanic race/ethnic group, inversely associated with education, and more common among the overweight/obese and physically inactive. The prevalence of diabetes defined by previous diagnosis or use of antidiabetic medication was 2.9%. Further incorporating HbA1c and glucose values, the prevalence increased to 6.8%, and among these participants, 38.9% had a previous diagnosis of diabetes (i.e., aware). Among those aware, 37.6% were treated and 64.0% were controlled (i.e., HbA1c < 7%). ConclusionsA contemporary cohort of young adults faces a historically high risk of diabetes but there is ample opportunity for early detection and intervention.

Waist-to-hip ratio, dyslipidemia, glycemic levels, blood pressure and depressive symptoms among diabetic and non-diabetic Chinese women: a cross-sectional study.

ObjectivesTo explore the relationship between depressive symptoms and waist-to-hip ratio, dyslipidemia, glycemic levels or blood pressure among diabetic and non-diabetic Chinese women.Methods11,908 women aged ≥40 years were enrolled in this cross-sectional study, including 2,511 with type 2 diabetes and 9,397 without. Depressive symptoms (defined as having mild-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 (PHQ-9) diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having depressive symptoms were estimated using logistic regression analysis.ResultsThe age-adjusted prevalence of depressive symptoms was significantly higher in non-diabetic subjects with waist-to-hip ratio (WHR) ≥0.9 (8.6%, age-adjusted OR 1.51 [95% CI 1.17, 1.95]), total cholesterol (TC)>6.22 mmol/L (8.8%, 1.58 [1.16, 2.15]), and Hemoglobin A1c (HbA1c) ≥6.00 mmol/L (7.7%, 1.69 [1.34, 2.14]), while it was significantly lower in non-diabetic subjects with diastolic blood pressure (DBP) between 80 to 89 mmHg (6.2%, 0.78 [0.64, 0.95]). These relationships remained significant even after controlling for multiple factors (WHR ≥0.9: multivariable-adjusted OR 1.39 [95% CI 1.07, 1.80]; TC>6.22 mmol/L: 1.56 [1.14, 2.12]; HbA1c ≥6.00 mmol/L: 1.64 [1.30, 2.08]; DBP 80-89 mmHg: 0.78 [0.64, 0.95]). However, no significant trend between depressive symptoms and WHC, TC, HbA1c, DBP was observed in diabetic women, and no significant trend relationship between depressive symptoms and BMI, WC, TG, or SBP was observed in both non-diabetic and diabetic women. Moreover, the prevalence of depressive symptoms was significantly higher in previously-diagnosed diabetes, compared with non-diabetic subjects, while no significant differences were observed between newly-diagnosed diabetes and non-diabetic subjects.ConclusionThe present study showed a relationship between WHR, TC, HbA1c, DBP and depressive symptoms among non-diabetic women, while no significant relationship between them was observed among diabetic women, even after controlling for multiple confounding factors.

Added sugars and periodontal disease in young adults: an analysis of NHANES III data

Added sugar consumption seems to trigger a hyperinflammatory state and may result in visceral adiposity, dyslipidemia, and insulin resistance. These conditions are risk factors for periodontal disease. However, the role of sugar intake in the cause of periodontal disease has not been adequately studied. We evaluated the association between the frequency of added sugar consumption and periodontal disease in young adults by using NHANES III data. Data from 2437 young adults (aged 18-25 y) who participated in NHANES III (1988-1994) were analyzed. We estimated the frequency of added sugar consumption by using food-frequency questionnaire responses. We considered periodontal disease to be present in teeth with bleeding on probing and a probing depth ≥3 mm at one or more sites. We evaluated this outcome as a discrete variable in Poisson regression models and as a categorical variable in multinomial logistic regression models adjusted for sex, age, race-ethnicity, education, poverty-income ratio, tobacco exposure, previous diagnosis of diabetes, and body mass index. A high consumption of added sugars was associated with a greater prevalence of periodontal disease in middle [prevalence ratio (PR): 1.39; 95% CI: 1.02, 1.89] and upper (PR: 1.42; 95% CI: 1.08, 1.85) tertiles of consumption in the adjusted Poisson regression model. The upper tertile of added sugar intake was associated with periodontal disease in ≥2 teeth (PR: 1.73; 95% CI: 1.19, 2.52) but not with periodontal disease in only one tooth (PR: 0.85; 95% CI: 0.54, 1.34) in the adjusted multinomial logistic regression model. A high frequency of consumption of added sugars is associated with periodontal disease, independent of traditional risk factors, suggesting that this consumption pattern may contribute to the systemic inflammation observed in periodontal disease and associated noncommunicable diseases.

Performance of glycated haemoglobin (HbA1c) as a screening test for diabetes and impaired glucose tolerance (IGT) in a high risk population—The Brazilian Xavante Indians

AimsTo examine the properties of HbA1c to detect diabetes and IGT in adult Brazilian Xavante Indians, a high risk population for diabetes. MethodsThe survey was carried out between October 2010 and January 2012 and based on a 75g oral glucose tolerance test (OGTT). Basal and 2h capillary glycaemia were measured by HemoCue Glucose 201+; HbA1c using an automated high-performance liquid chromatography analyzer (Tosoh G7). Results630 individuals aged ≥20 years were examined and 80 had a previous diagnosis of diabetes. Sensitivity, specificity and accuracy for HbA1c≥6.5% (≥48mmol/mol) were 71.3%, 90.5% and 87.2%. The areas under the ROC curve (AUC) was 0.88 (95%CI: 0.83–0.93). To identify IGT, HbA1c values between 5.7% and 6.4% (39–47mmol/mol) presented sensitivity, specificity and accuracy of 87.2%, 24.7% and 51.4%, with an AUC of 0.62 (95%CI: 0.57–0.67). ConclusionsThe ADA/WHO proposed cut-off of 6.5% (48mmol/mol) for HbA1c was adequate to detect diabetes among the Xavante. However, the performance of the ADA proposed cut-off points for pre-diabetes, when used to detect IGT was inadequate and should not be recommended.

Long-term mortality after community-acquired pneumonia—impacts of diabetes and newly discovered hyperglycaemia: a prospective, observational cohort study

ObjectivesCommunity-acquired pneumonia is associated with a significant long-term mortality after initial recovery. It has been acknowledged that additional research is urgently needed to examine the contributors to this long-term mortality....

Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality

Hyperglycaemia is common in the critically ill. The objectives of this study were to determine the prevalence of critical illness-associated hyperglycaemia (CIAH) and recognised and unrecognised diabetes in the critically ill as well as to evaluate the impact of premorbid glycaemia on the association between acute hyperglycaemia and mortality. In 1,000 consecutively admitted patients we prospectively measured glycated haemoglobin (HbA1c) on admission, and blood glucose concentrations during the 48 h after admission, to the intensive care unit. Patients with blood glucose ≥7.0 mmol/l when fasting or ≥11.1 mmol/l during feeding were deemed hyperglycaemic. Patients with acute hyperglycaemia and HbA1c <6.5% (48 mmol/mol) were categorised as 'CIAH', those with known diabetes as 'recognised diabetes', and those with HbA1c ≥6.5% but no previous diagnosis of diabetes as 'unrecognised diabetes'. The remainder were classified as 'normoglycaemic'. Hospital mortality, HbA1c and acute peak glycaemia were assessed using a logistic regression model. Of 1,000 patients, 498 (49.8%) had CIAH, 220 (22%) had recognised diabetes, 55 (5.5%) had unrecognised diabetes and 227 (22.7%) were normoglycaemic. The risk of death increased by approximately 20% for each increase in acute glycaemia of 1 mmol/l in patients with CIAH and those with diabetes and HbA1c levels <7% (53 mmol/mol), but not in patients with diabetes and HbA1c ≥7%. This association was lost when adjusted for severity of illness. Critical illness-associated hyperglycaemia is the most frequent cause of hyperglycaemia in the critically ill. Peak glucose concentrations during critical illness are associated with increased mortality in patients with adequate premorbid glycaemic control, but not in patients with premorbid hyperglycaemia. Optimal glucose thresholds in the critically ill may, therefore, be affected by premorbid glycaemia.

Pesticide use and incident diabetes among wives of farmers in the Agricultural Health Study

ObjectiveTo estimate associations between use of specific agricultural pesticides and incident diabetes in women.MethodsWe used data from the Agricultural Health Study, a large prospective cohort of pesticide applicators and their...

MP69-10 GLYCATED HEMOGLOBIN (HBA1C) LEVELS ARE INDEPENDENTLY ASSOCIATED WITH UNFAVOURABLE PROSTATE CANCER AND DISEASE RECURRENCE AFTER RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: Previous studies have shown that diabetic patients diagnosed with prostate cancer (PCa) and treated with radical prostatectomy (RP) may be at higher risk of harbouring unfavourable PCa at final pathology. We hypothesized that glycated haemoglobin (HbA1c) levels, regardless of a previous diagnosis of diabetes, may be associated with adverse PCa features and higher risk of recurrence after RP. METHODS: The study included 1,249 patients treated with RP for clinically localized PCa between 2008 and 2011 at a single tertiary care center. Pre-operative HbA1c was measured in all patients the day before surgery. Uniand multivariable logistic regression models tested the association between HbA1c and pathological stage, defined as extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node involvement (LNI). Univariable and multivariable Cox regression analyses evaluated the role of HbA1c in predicting biochemical recurrence (BCR), defined as PSA 0.2 ng/ml and rising. Covariates consisted of total PSA at diagnosis, biopsy Gleason sum and clinical stage. HbA1c was tested as both continuous and categorical variable, according to the WHO classification (namely 6.5%) RESULTS: Mean and median pre-operative HbA1c levels were 5.73 and 5.60%, respectively (range 4.0-10.8%). Overall, HbA1c was 6.5% in 643 (51.5%), 500 (40%) and 106 (8.5%) patients, respectively. According to patient medical history, 124 (9.9%) had a diagnosis of diabetes. Mean and median PSA were 12.3 and 6.8 ng/mL, respectively. Clinical stage was T1 in 54.7%, T2 in 30.4% and T3 in 14.9% of the patients. Biopsy Gleason sum was 6 in 58.2%, 7 in 30.1% and 8-10 in 11.7% of the patients. Median follow up was 34 months (range 1-118). At multivariable logistic regression analyses, after adjusting for PSA, clinical stage and biopsy Gleason sum, HbA1c was an independent predictor of SVI (OR 1.43; p1⁄40.003) and LNI (OR 1.38, p1⁄40.01). At multivariable Cox regression analyses, HbA1c categorized according to the WHO definition was independently associated with the risk of BCR (p1⁄40.02), after accounting for confounders. Patients with HbA1c >6.5% had a 2.01 higher risk of BCR as compared to those with HbA1c <5.7%, after accounting for all confounders. CONCLUSIONS: Increased levels of HbA1c are independently positively associated with more adverse pathological features and higher BCR rates. These results should be taken into account when diabetic patients are considered for curative treatments of PCa.

An observational cohort study to assess glycosylated hemoglobin screening for elective surgical patients

Uncontrolled blood glucose is associated with a higher incidence of surgical site infections, greater utilization of resources, and increased mortality. Preoperative screening for diabetes in elective surgical patients is not routinely performed. The purpose of this study was to examine blood glucose control in a preoperative surgical population. Following ethics approval, adults presenting to the pre-surgical screening clinic in preparation for elective surgery were recruited. Data collection included a self-administered questionnaire on diabetic risk factors and blood glucose testing, including glycosylated hemoglobin (HbA1c). Descriptive analyses were conducted. Seventy of the 402 participants (17.4%) had a previous diagnosis of diabetes (diabetics). Among those without a history of diabetes (n=332 non-diabetics), 23.2% (n=77) were considered very high risk for diabetes (HbA1c=6.0-6.4%), and 3.9% (n=13) had a provisional diagnosis of diabetes (HbA1c≥6.5%). Fifty-six percent (n=39/70) of diabetics had suboptimal glycemic control (HbA1c>7.0%), and 51.3% (n=20/39) of this subgroup presumed their blood sugars were reasonably or very well controlled. Fifteen percent (n=2/13) of patients with a provisional diagnosis of diabetes (HbA1c≥6.5%) had an elevated random blood sugar (RBS) (≥11.1mmol·L(-1)), while 67% (n=8/12) had an elevated fasting blood sugar (FBS) (≥7.0mmol·L(-1)). Forty-two percent (n=16/38) of suboptimally controlled diabetics (HbA1c>7.0%) had an elevated RBS (≥11.1mmol·L(-1)), and 86% (n=31/36) had an elevated FBS (≥7.0mmol·L(-1)). Many elective surgical patients are at risk for unrecognized postoperative hyperglycemia and associated adverse outcomes. Random blood sugar testing has limited value and HbA1c may be a more appropriate test for the preoperative assessment of diabetic patients.

Disproportionately elevated proinsulinemia is observed at modestly elevated glucose levels within the normoglycemic range

We aimed to evaluate disproportional proinsulinemia in the pre-diabetic state by analyzing the cross-sectional differences between proinsulin (PI) ratios across the entire range of fasting and 2-h plasma glucose. The study sample was 1,016 participants in the insulin resistance atherosclerosis study, who had no previous diagnosis of diabetes. Insulin sensitivity index (SI) and acute insulin response (AIR) were measured by the frequently sampled intravenous glucose tolerance test. Fasting intact and split PI-to-insulin ratios (PI/I, SPI/I), intact and split PI-to-C-peptide ratios (PI/C-pep, SPI/C-pep), and SI-adjusted AIR were assessed as a function of fasting and 2-h glucose levels. SI-adjusted AIR was decreased (fasting glucose 96-98mg/dl; 2-h glucose 120-131mg/dl) and SPI/C-pep increased at modestly elevated fasting glucose and 2-h glucose within the normal glucose tolerance range (fasting glucose 96-98mg/dl; 2-h glucose 132-142mg/dl). PI/I was not increased until plasma glucose values were in the diabetic range of fasting glucose (>126mg/dl) or the impaired glucose tolerance range of 2-h glucose (143-156mg/dl). SPI/I and PI/C-pep as a function of fasting and 2-h glucose were situated between the curves for SPI/C-pep and PI/I. In conclusion, inappropriate amounts of PI and conversion intermediaries are demonstrated at modestly elevated glucose levels within the normoglycemic range. Ratios that use SPI in the numerator or C-pep in the denominator (and especially SPI/C-pep) are more sensitive to early glycemic excursions than PI/I. Disordered processing of PI may accompany derangements in early insulin secretory response.

Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

BackgroundDiabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate.ObjectiveTo analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention.MethodsProspective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score.ResultsAmong the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01).ConclusionIn ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

Abstract 19037: Impact of Stress Hyperglycemia on Coronary Flow Reserve Following Successfully Recanalized Primary Acute Myocardial Infarction in Non-Diabetic Patients

Background: Stress hyperglycemia (SH) is associated with adverse outcome and reduction in myocardial salvage after acute myocardial infarction (AMI), especially in non-diabetic patients. However, no relationship has been identified between admission blood glucose level and coronary flow reserve (CFR) as an index of microvascular function in non-diabetic patients with AMI. Methods: This study assessed 73 consecutive patients with a first anterior AMI who underwent successful percutaneous coronary intervention within 24 h from onset of symptoms. Plasma blood glucose was measured on admission. SH was defined as blood glucose ≥10 mmol/L (180 mg/dl). We excluded the patients with a previous or current diagnosis of diabetes or an abnormal oral glucose tolerance test (OGTT, 75-g) 5 days after admission. CFR was calculated as the ratio of hyperemic, which was induced by intravenous adenosine administration, to baseline diastolic coronary flow velocity of the left anterior descending artery using transthoracic echocardiography 7 days after AMI. Results: In 73 non-diabetic patients (mean age: 65 years, 48 males), 14 patients showed SH (218±48mg/dl). Baseline diastolic coronary flow velocity in patients with SH (24±11cm/s) was higher than those without SH(19±6 cm/s, p=0.04), while there was no significant difference in hyperemic coronary flow velocity between the patients with (50±26 cm/s) and without SH (48±20 cm/s). Calculated CFR of the patients with stress hyperglycemia (2.0±0.4) was significantly lower than those without stress hyperglycemia (2.4±0.6, p=0.02). Conclusions: CFR was impaired in non-diabetic patients with hyperglycemia on admission. Impaired coronary microcirculation may partly contribute to reduced myocardial salvage and adverse outcome in patients with SH.

Increased Glycemic Variability Is Independently Associated With Length of Stay and Mortality in Noncritically Ill Hospitalized Patients

OBJECTIVETo investigate the association between glycemic variability (GV) and both length of stay (LOS) and 90-day mortality in noncritically ill hospitalized patients.RESEARCH DESIGN AND METHODSThis study retrospectively analyzed 4,262 admissions to the general medicine or surgery services during a 2 year period. Patients with point-of-care glucose monitoring and a minimum of two glucose values per day on average were selected. GV was assessed by SD and coefficient of variation (CV). Data were analyzed with linear and logistic multivariate regression analysis in separate models for SD and CV. Analysis was performed with generalized estimating equations to adjust for correlation between multiple admissions in some individual cases.RESULTSAfter exclusions, 935 admissions comprised the sample. Results of adjusted analysis indicate that for every 10 mg/dL increase in SD and 10–percentage point increase in CV, LOS increased by 4.4 and 9.7%, respectively. Relative risk of death in 90 days also increased by 8% for every 10-mg/dL increase in SD. These associations were independent of age, race, service of care (medicine or surgery), previous diagnosis of diabetes, HbA1c, BMI, the use of regular insulin as a sole regimen, mean glucose, and hypoglycemia occurrence during the hospitalization.CONCLUSIONSOur results indicate that increased GV during hospitalization is independently associated with longer LOS and increased mortality in noncritically ill patients. Prospective studies with continuous glucose monitoring are necessary to investigate this association thoroughly and to generate therapeutic strategies targeted at decreasing GV.

Prevalence, sociodemographic distribution, treatment and control of diabetes mellitus in Panama

BackgroundTo estimate the prevalence, socio-demographic distribution, treatment and control of diabetes mellitus in Panama.MethodsA cross-sectional, descriptive study was conducted in the provinces of Panama and Colon, applying a survey on cardiovascular risk factors and analyzing biochemical indicators in 3590 persons. A single-stage, probabilistic, and randomized sampling strategy with a multivariate stratification was used. Individuals with a previous medical diagnosis of diabetes, glycemia ≥ 126 mg/dl and/or glycosylated hemoglobin ≥ 6.5% (≥ 48 mmol/mol) were considered with diabetes mellitus. The prevalence estimates were calculated as percentages with 95% confidence intervals and a p value. Logistic regression was used to identify the sociodemographic variables that were significantly associated with diabetes. Odds ratio and p values were calculated using 2 x 2 tables, and a value of p ≤ 0.05 was considered statistically significant.ResultsOf the participants, 7.3% (262/3590) were aware of having diabetes and 2.2% (78/3590) were unaware. The estimated prevalence of diabetes mellitus was 9.5% (340/3590) and increased in proportion to increasing age. The logistic regression revealed relationships between diabetes and age, sex, area of residence and sociocultural groups. 77.9% of the people aware of having diabetes received treatment and 53.4% have not stabilized the disease.ConclusionsThe research evidenced a high prevalence of diabetes mellitus in Panama, where being Afro-Panamanian and 50 years of age or older are sociodemographic risk factors for DM. Due to the complications that the disease may present we recommend actively searching for such cases to increase diagnosis of people unaware of having diabetes.

Acute-Phase Glucose Fluctuation Is Negatively Correlated With Myocardial Salvage After Acute Myocardial Infarction

It remains unclear whether glycemic fluctuation immediately after acute myocardial infarction (AMI) can affect myocardial damage. This study investigated the impact of glucose fluctuation on myocardial salvage following successful recanalization of primary AMI. A total of 36 consecutive patients with AMI were studied. Glycemic variability, as indicated by the mean amplitude of glycemic excursion (MAGE), was measured on a continuous glucose monitoring system. Three subsets (CD14(+)CD16(-), CD14(++)CD16(+) and CD14(+-)CD16(+)) were measured on flow cytometry 1, 2, 3, 4 and 5 days after AMI onset. A 2-h oral glucose test was performed in 23 patients who had no previous diagnosis of diabetes and/or glycated hemoglobin <6.5%, after the onset of AMI at 2 weeks. Plasma active glucagon-like peptide (GLP)-1 level was measured in each sample. The extent of myocardial salvage 7 days after AMI was evaluated on cardiovascular magnetic resonance imaging. MAGE and the peak CD14(+)CD16(-) monocyte level were significantly negatively correlated with myocardial salvage index (MSI). MAGE was significantly correlated with peak CD14(+)CD16(-) monocyte level. Of interest, plasma GLP-1 level was significantly positively correlated with MSI and significantly negatively correlated with MAGE. Glucose fluctuations during the acute phase of AMI affect MSI, indicating that manipulation of glucose variability from peak to nadir might be a potential therapeutic target for salvaging ischemic damage.

The rs266729 single-nucleotide polymorphism in the adiponectin gene shows association with gestational diabetes

Gestational diabetes mellitus (GDM) is a condition of impaired glucose tolerance during pregnancy in women without previous diagnosis of diabetes. It is associated with serious complications for both mother and child in the pre- and postnatal period. Moreover, women with GDM are at an increased risk of developing type 2 diabetes. Adiponectin is an important factor involved in the regulation of both carbohydrate and lipid metabolism. Polymorphisms in its gene (ADIPOQ) are known to affect the individual's predisposition to metabolic syndrome and type 2 diabetes. The aim of the current study was to investigate the possible association between three common single-nucleotide polymorphisms in ADIPOQ and gestational diabetes. A total of 394 individuals were recruited to the study-130 pregnant women with GDM, 130 pregnant women without glucose intolerance and 134 female population controls. All subjects were genotyped for rs266729, rs2241766 and rs1501299 in the ADIPOQ gene. A significant association with the disease was observed for rs266729 (p=0.0037). The rare G allele was found to be over-represented among controls (pregnant, population and pooled). While no association was found for rs2241766 and rs1501299, a GTG haplotype formed by the three polymorphisms was found to be more common among controls (0.004). The adiponectin promoter polymorphism rs266729 is associated with gestational diabetes. The minor G allele appears to confer protection against pregnancy-related diabetes mellitus. This effect is probably due to the influence of the variant on the adiponectin transcription regulation during gestation.

Opportunistic pathology-based screening for diabetes

ObjectiveTo determine the potential of opportunistic glycated haemoglobin (HbA1c) testing of pathology samples to detect previously unknown diabetes.DesignPathology samples from participants collected for other reasons and suitable for HbA1c testing...

Hyperglycaemia during exacerbations of asthma and chronic obstructive pulmonary disease

Hyperglycaemia is a well-known phenomenon among patients with an exacerbation of asthma or chronic obstructive pulmonary disease (COPD). It may be associated with increased risks of death and complications. To define the prevalence and determinants of hyperglycaemia in patients with an exacerbation of asthma or COPD. This was a prospective, cross-sectional study including 153 hospitalised patients with an exacerbation of asthma or COPD. All received inhaled beta-2-adrenergic bronchodilators and oral glucocorticoids in internationally recommend doses. Plasma glucose was measured seven times during the first day. Hyperglycaemia was defined as fasting glucose >6.9 mmol/L or postprandial glucose >11.1 mmol/L. In addition, the family history for diabetes and the Karnofsky performance score were assessed. Height, weight, waist circumference, oxygen saturation, blood pressure, temperature and heart rate were measured. Glycosylated haemoglobin A1c (gHbA1c), C-reactive protein, leucocytes, urea and arterial blood gas values were analysed. Eighty-two per cent of the patients demonstrated hyperglycaemia, with similar prevalence between asthma and COPD. Of the 130 patients without a previous diagnosis of diabetes, 79% showed hyperglycaemia. In binary logistic regression analysis, high gHbA1c, high C-reactive protein and Karnofsky score less than 80% associated with the presence of fasting hyperglycaemia. High gHbA1c and current smoking associated with postprandial hyperglycaemia. Hyperglycaemia is very common among hospitalised patients with an exacerbation of asthma or COPD. It is probably triggered by the medication and the patient's metabolic predisposition mainly determines its presence. Current smoking is the main treatable contributor to hyperglycaemia.

Prevalence of Diagnosed and Undiagnosed Type 2 Diabetes Mellitus Among US Adolescents: Results From the Continuous NHANES, 1999–2010

Although prevalence and incidence of type 2 diabetes mellitus (T2DM) are reportedly increasing among adolescents, national data are lacking, particularly in regard to undiagnosed T2DM. To estimate the prevalence of diagnosed and undiagnosed T2DM among US adolescents, we analyzed a nationally representative cross-section of 11,888 adolescents aged 12-19 years who received a diabetes interview in the Continuous National Health and Nutrition Examination Survey during 1999-2010. Among them, a random subsample of 4,661 adolescents also had fasting blood samples collected. Persons who reported a previous diabetes diagnosis and were either taking no medication or taking an oral hypoglycemic agent (with or without insulin) were classified as having T2DM; persons who reported using insulin alone were classified as having type 1 diabetes. Undiagnosed diabetes was defined as a fasting plasma glucose concentration of ≥126 mg/dL and was assumed to be type 2. In the fasting subsample, 31 diabetes cases (types 1 and 2) were identified, representing a prevalence of 0.84% (weighted 95% confidence interval (CI): 0.51, 1.40) (276,638 cases; 95% CI: 134,255, 419,020). Estimates of the prevalences of type 1 and type 2 diabetes were 0.48% (95% CI: 0.23, 1.02) and 0.36% (95% CI: 0.20, 0.67), respectively, indicating that T2DM accounted for 43% of all cases. Further, undiagnosed T2DM prevalence was 0.12% (95% CI: 0.05, 0.31), representing 34% of T2DM cases (40,611 cases; 95% CI: 2,850, 78,373). T2DM accounts for approximately half of adolescent diabetes in the United States, and one-third of these cases are undiagnosed.