Random Plasma Glucose Levels Research Articles

The impact of postadmission glycemia on stroke outcome: Glucose normalisation is associated with better survival

Background Hyperglycemia on admission increases the risk of death in patients with acute stroke. It remains unclear whether glucose normalisation after admission is associated with improved survival. The goal of the study was to determine the relationship between postadmission glucose levels and mortality in stroke patients with and without admission hyperglycemia. Methods 302 patients with first-ever ischemic stroke and without prior diagnosis of diabetes mellitus were enrolled. Random plasma glucose level was measured on admission and fasting glucose on day 1, 2, 3, 5 and 7. Hyperglycemia on admission was defined as glucose level ≥7.8 mmol/L. Postadmission hyperglycemia was diagnosed if mean postadmission fasting glucose level was ≥6.1 mmol/L. Results After multivariable adjustment, postadmission hyperglycemia was associated with higher risk of death regardless of admission glucose levels (HR: 1.80, 95%CI: 1.39–2.86, P < 0.01). Postadmission hyperglycemia increases risk of death in both patients with admission hyperglycemia (HR: 4.83, 95%CI: 1.93–12.06, P < 0.01) and those with admission normoglycemia (HR: 1.64, 95%CI: 1.06–2.54, P = 0.03). In patients with admission hyperglycemia glucose normalisation after admission was associated with reduced risk of death compared to those with persistent hyperglycemia (HR: 0.21, 95%CI: 0.08–0.52). The patients who were normoglycemic on day 1 and developed hyperglycemia on next days had increased risk of death compared to persistent normoglycemic patients (HR: 1.55, 95%CI: 1.01–2.39, P = 0.04). Conclusions Postadmission, but not admission, hyperglycemia is associated with increased risk of death. Glucose normalisation after admission is associated with better survival.

Glucose as a prognostic factor in non-diabetic women with locally advanced cervical cancer (IIB–IVA)

Objective The aim of this study was to evaluate the association between pretreatment random plasma glucose levels and cancer prognosis in non-diabetic women with locally advanced cervical cancer treated with CCRT (concurrent chemoradiation) or RT (radiation therapy) only. Methods We investigated the non-fasting plasma glucose levels checked during the initial work up before treatment in 134 non-diabetic patients with locally advanced cervical cancer. Based on the survival time and the progression-free interval (PFI) recorded in the electronic medical records Cox proportional hazard regression models were used to estimate the hazard ratio (HR) for overall survival and PFI according to the various level of glucose and a cut-off level (< 102 mg/dL and ≥ 102 mg/dL), adjusting for clinical covariates. Results A shorter overall survival and PFI was observed in the group with higher glucose levels (HR, 1.03; p = 0.002, HR, 1.02; p = 0.001, respectively) and more than 102 mg/dL, by univariate analyses (HR, 3.21; p = 0.012, HR, 2.20; p = 0.006, respectively). Multivariate analysis, adjusting for clinical FIGO stage, performance status, treatment type (CCRT vs. RT) and chemotherapeutic regimen types showed that patients with higher glucose levels or more than ≥ 102 mg/dL had shorter overall survival times (HR, 1.02; p = 0.015, HR, 2.54; p = 0.049, respectively) and PFI (HR, 1.02; p = 0.003, HR, 1.88; p = 0.031, respectively). Conclusion This investigation provides evidence supporting the prognostic value of glucose levels in non-diabetic women with locally advanced cervical cancer treated with radiation therapy and/or concurrent chemotherapy; high glucose levels were associated with a greater risk for recurrence and mortality in these patients.

Environmental rather than genetic fetal overgrowth: defining the difference and hints for diagnosis and management

Environmental rather than genetic fetal overgrowth: defining the difference and hints for diagnosis and management

Polymorphisms at newly identified lipid-associated loci are associated with blood lipids and cardiovascular disease in an Asian Malay population

We conducted a cross-sectional study of Malay participants aged 40-80 years (n = 2,932) to examine the associations between polymorphisms at newly identified, lipid-associated loci with blood lipid levels and prevalent cardiovascular disease (CVD) in a Malay population in Asia. A polymorphism adjacent to the TRIB1 locus (rs17321515) was associated with elevated total cholesterol and LDL-cholesterol (LDL-C) after adjustment for age and sex (both P values <0.007) and with increased risk of coronary heart disease and CVD [odds ratio (OR) 1.23, 95% confidence interval (95% CI) 1.03-1.46; and OR 1.2, 95% CI 1.02-1.42, respectively] under an additive model of inheritance. In addition, using recessive models of inheritance, polymorphisms on chromosome 19 adjacent to the CILP2 and PBX4 loci (rs16996148) and on chromosome 1 at the GALNT2 locus (rs4846914) were associated with elevated HDL-C (P = 0.005) and lower LDL-C (P = 0.048), respectively. Although novel, the former is consistent with the association between this polymorphism and lower blood triglycerides observed in the initial studies conducted in populations of European ancestry. Neither showed statistically significant association with CVD. These observations should form the basis of further investigation to identify the causative polymorphisms at this locus, and also to understand the mechanistic roles that this protein may play in lipoprotein metabolism in Asians and other populations.

Rare hemoglobin variant Hb I Philadelphia in North Indian family

Dear Editor, Hemoglobinopathies are important inherited disorders that are highly prevalent in India constituting a significant public heath problem. The three most predominant clinically relevant abnormal hemoglobins are Hb S, Hb E, and Hb D with the cumulative gene frequency 5.35% in India [1]. Apart from these, Hb H, J, K, L, M, Q, Koya-Dora, Chandigarh are other variants detected so far in India [2]. This paper reports a rare variant of alpha globin chain Hb I Philadelphia present in a Hindu family. Hb I Philadelphia [α 16 (A14) Lys-Glu] is a fast alpha globin chain variant resulting from point mutation in codon 16 of α1 globin gene AAG-GAG that leads to a substitution of lysine by glutamic acid. It has considerably lower isoelectric point than normal hemoglobin (Hb A) and moves ahead of Hb A at alkaline pH similar to the Hb H migration, while at acidic pH, it migrates with Hb A [3]. The concentration of mutant protein is 24–28% in heterozygotes with normal stability. It is clinically asymptomatic in carriers [4]. Rucknagel et al. described Hb I Philadelphia for the first time in 1955 in an Afro-American family [3]. After that, it was identified in different ethnic groups with low frequency viz Africans, American, Caucasians, and Asians. This is the first report from India, which indicates the presence of Hb I Philadelphia in an Indian subject and its association with β thalassemia. Several fast hemoglobin variants can produce varied interference in cation exchange chromatography of Hb A1c, which require careful interpretation [5]. Krauss and Khankhanian demonstrated the effectiveness of highperformance liquid chromatography (HPLC) in distinguishing Hb A1c and Hb I Philadelphia [6]. A 48-year-old male patient visited the Department of Endocrinology with some specific problems. Co-morbids include cholelithiasis. Here, he was prediagnosed with diabetes mellitus type II and his initial Hb A1c (performed on Bio-Rad D10, Hemoglobin A1c Program. Bio-Rad Laboratories, Hercules, CA, USA) was evaluated as 12.2% (reference range for non-diabetic normal population 4–6%). The pre-breakfast glucose levels and random glucose levels were 129 and 235 mg/dl, respectively (reference range for fasting and random plasma glucose levels defined by WHO are 126 and 200 mg/dl, respectively). The measurement of Hb A1c and blood glucose levels were done at 5–6 months interval. As his HbA1c chromatogram showed abnormal unexplained peak (Fig. 1), he was referred to the Department of Genetics for the possible exclusion of hemoglobinopathy. Here, his complete blood counts were analyzed on an automated cell counter (Sysmex Kx-21, Japan). His Hb, MCV, and MCH were 12.8 g/dL, 80.0 fL, and 28.0 pg, respectively. Peripheral smear was not reviewed. Hemoglobin electrophoresis on cellulose acetate at pH 8.6 showed an abnormal fast-moving hemoglobin band. The sample was reanalyzed on HPLC (Bio-Rad Variant β Thalassemia short program-Bio-Rad Laboratories, Hercules, CA,USA) Ann Hematol (2009) 88:927–929 DOI 10.1007/s00277-009-0710-1

Microalbuminuria is a negative correlate for cognitive function in older adults with peripheral arterial disease: results from the U.S. National Health and Nutrition Examination Survey 1999–2002

Microalbuminuria (MA) has been increasingly identified as a marker of cardiovascular risk. Although poor cognitive function has been implicated as a sequelae of increased cardiovascular burden, little is known about the association between MA and cognitive function. Population-based cross-sectional study. National Health and Nutrition Examination Survey 1999-2002 in the USA. 2049 noninstitutionalized adults (>/=60 years) with nonmissing values in cognitive test, urinary albumin-to-creatinine ratio (UACR) and ankle-brachial blood pressure index (ABPI) was analysed. Participants with UACR >300 microg mg(-1) were excluded. The UACR, in the unit of microg mg(-1), was calculated by dividing the urinary albumin value by the urinary creatinine concentration. MA was defined as UACR between 30 and 300 microg mg(-1). Cognitive function was measured by a 2-min Digit Symbol Substitution Test (DSST). Peripheral artery disease (PAD) was defined as an ABPI <0.9 in either leg. Overall speaking, MA was inversely associated with DSST score after controlling for age, sex, race, body mass index and educational level (regression coefficient = -2.8, P = 0.002). There was an effect modification of PAD on the association between MA and the DSST score. Amongst participants with PAD, the DSST score for those with MA was lower than those without MA (beta = -6.3, P = 0.003) after multivariate adjustment. Moreover, participants with PAD in the highest quartile of UACR had significantly lower DSST score compared to those in the lowest quartile (beta = -8.7, P = 0.001). There was no association between MA and cognitive function amongst participants without PAD. We observed an additive effect of MA and PAD on DSST score. Participants with both MA and PAD had a lower mean DSST score compared to those without both conditions (beta = -6.2, P = 0.003). The presence of MA or a higher level of urinary albumin excretion was inversely associated with cognitive function in participants with PAD.

Acute hyperglycemic emergencies in children with type 2 diabetes

Acute hyperglycemic emergencies in children with type 2 diabetes

The Effect of Borderline Diabetes on the Risk of Dementia and Alzheimer’s Disease

To verify the hypothesis that borderline diabetes may increase the risk of dementia and Alzheimer's disease, a community-based cohort of 1,173 dementia- and diabetes-free individuals aged >or=75 years was longitudinally examined three times to detect patients with dementia and Alzheimer's disease (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria). Borderline diabetes was defined as a random plasma glucose level of 7.8-11.0 mmol/l. Data were analyzed using Cox proportional hazards models. During the 9-year follow-up, 397 subjects developed dementia, including 307 Alzheimer's cases. At baseline, 47 subjects were identified with borderline diabetes. Borderline diabetes was associated with adjusted hazard ratios (95% CIs) of 1.67 (1.04-2.67) for dementia and 1.77 (1.06-2.97) for Alzheimer's disease; the significant associations were present after additional adjustment for future development of diabetes. Stratified analysis suggested a significant association between borderline diabetes and Alzheimer's disease only among noncarriers of APOE epsilon4 allele. There was an interaction between borderline diabetes and severe systolic hypertension on the risk of Alzheimer's disease (P = 0.04). We conclude that borderline diabetes is associated with increased risks of dementia and Alzheimer's disease; the risk effect is independent of the future development of diabetes. Borderline diabetes may interact with severe systolic hypertension to multiply the risk of Alzheimer's disease.

Normal but increasing hemoglobin A1c levels predict progression from islet autoimmunity to overt type 1 diabetes: Diabetes Autoimmunity Study in the Young (DAISY)

The aim of this study was to assess the utility of hemoglobin A1c (HbA1c) measurements in the early detection of clinical type 1 diabetes during prospective follow-up of children with islet autoimmunity. The Diabetes Autoimmunity Study in the Young (DAISY) has followed for development of islet autoimmunity and diabetes general population newborns carrying human leukocyte antigen (HLA) genotypes conferring risk for type 1 diabetes and young siblings or offspring of people with type 1 diabetes. Testing for autoantibodies was performed at least once in 2234 and twice or more in 1887 children. Among the latter, 100 children tested positive on at least two consecutive visits. To date, 92 children have developed persistent islet autoantibodies to glutamic acid decarboxylase 65 (GAD65), insulin, or insulinoma associated antigen-2 (IA-2) and had at least two subsequent clinic visits. These children had study visits with point-of-care testing for HbA1c and random glucose every 3-6 months and those with random plasma glucose above 11.1 mmol/L or HbA1c above 6.3% were evaluated by a pediatric endocrinologist for clinical diabetes. During a mean follow-up of 3.4 yr from onset of autoimmunity, 28 children developed type 1 diabetes, at mean age of 6.5 yr. Mean prediagnostic HbA1c was 5.1% [standard deviation (SD) = 0.4%]. In a Cox regression model accounting for changes in values in individuals over time, increase in HbA1c predicted increased risk of progression to type 1 diabetes, hazard ratio = 4.8 (95% confidence interval 3.0-7.7) for each SD of 0.4%, independent of random glucose and number of autoantibodies. Increase in random plasma glucose levels only marginally predicted risk of progression (hazard ratio = 1.4, 95% confidence interval 1.02-1.8, per SD of 1.1 mmol/L). Normal but increasing Hb1Ac may be useful in early detection of type 1 diabetes, whereas random plasma glucose levels were less predictive.

Medication-Induced Weight Gain and Dyslipidemia in Patients With Schizophrenia

Our friend and colleague Wayne Fenton asked to write this article for the Journal because of his desire to educate other psychiatrists about the treatment of schizophrenia, including what he recognized to be a growing problem with the metabolic syndrome. This lifelong passion, which he pursued from his psychiatry residency at Yale, through his directorship of Chestnut Lodge, to his position at NIMH as Director of the Division of Adult Translational Research and Associate Director for Clinical Affairs, ended tragically with his killing during an evaluation of a psychotic young man. Wayne had worked tirelessly to secure support for new drug discovery in the NIMH programs that he directed. The Journal will be initiating in 2007 a series of articles on the discovery of new mental illness treatments. We will dedicate this series to Wayne's memory and include with it a memorial of his life and contributions to the treatment of mental illness.

Frequency of chronic complications of type II diabetes.

To assess the frequency of chronic complications of type II diabetes in subjects attending a tertiary care unit in Karachi, Pakistan. A cross-sectional analytical study. First visit of all type II diabetic subjects attending the outpatient department of Baqai Institute of Diabetology and Endocrinology from September 1996 to December 2001. Computerized clinical records of 2199 type II diabetic subjects were analyzed for this study. The clinical and laboratory variables were statistically evaluated with significance at p. Means of glycosylated hemoglobin HbA1c, fasting and random plasma glucose levels, systolic blood pressure, triglycerides and high density lipoproteins (HDL) were higher than the risk indicator value for both genders (p <0.005). Mean body mass index and total blood cholesterol was higher for females only. Hyperglycemia was present in 88%, high HbA1c in 81%, low HDL in 81%, obesity in 66% and hypertriglyceridemia in 54%, neuropathy in 36%, proteinuria in 28% and hypertension in 50% of the subjects. Frequency of obesity, low HDL and hypertension was higher among females (p < 0.001 in each case). Retinopathy (p<0.05), nephropathy (p<0.005), neuropathy (p<0.005) and foot ulcers (p<0.001) were higher among males. Frequency of obesity was significantly higher among those with shorter duration and in younger group while frequency of other complications was higher among those with longer duration and in the older groups. Higher rates of complications were observed compared to previous studies. Certain variables showed significant association with gender and age as described above.

Case Study: Diabetes in a Patient With Cirrhosis

J.T. is a 72-year-old man with chronic hepatitis C and Child-Pugh grade A (clinically well-compensated) cirrhosis. He takes propranolol for esophageal variceal bleeding prophylaxis. He had a blood transfusion 25 years ago. Hepatitis C was diagnosed 10 years ago, and cirrhosis was diagnosed by liver biopsy 2 years ago. He does not drink alcohol. He has never been overweight. He has no personal or family history of diabetes. Over the past year, random plasma glucose levels have ranged from 110 to 180 mg/dl. The most recent random glucose was 210 mg/dl. The patient denies polydipsia, polyuria, nocturia, or any other symptoms of hyperglycemia. He weighs 150 lb (BMI 22 kg/m2). Physical examination findings are normal except for mild palmar erythema, spider angiomata on the upper chest, and a palpable spleen tip. Fasting blood glucose was 136 mg/dl, and a hemoglobin A1c (A1C) was 6.3%. Another fasting glucose several weeks later was 128 mg/dl. 1. Does this patient have type 2 diabetes? 2. Should medication be started to treat hyperglycemia? 3. How does the diagnosis of diabetes affect this patient’s prognosis? At first glance, many clinicians might assume this patient has type 2 diabetes. The history is compatible with this diagnosis. However, the absence of classic risk factors for type 2 diabetes and the appearance of new hyperglycemia in the …

Impact of known and unknown diabetes on in-hospital mortality from ischemic stroke

The effect of known diabetes on in-hospital mortality from ischemic stroke is still debated whereas the role of unknown diabetes is virtually unexplored. This study evaluates the impact of known and unknown diabetes on in-hospital mortality from ischemic stroke. We have retrospectively evaluated the records of 286 consecutive cases of ischemic stroke hospitalized from January 1998 to December 2000 at the Department of Internal Medicine of the General Hospital located in the western area of Naples. Fasting plasma glucose level < 7 mmol/L identified non diabetic subjects. Known diabetes mellitus was diagnosed by history of diabetes and/or hypoglycemic therapy, unknown diabetes was defined as a random plasma glucose level > or = 11 mmol/L and/or in-hospital fasting glucose > or = 7 mmol/L on two or more occasions. Severity of stroke was defined using the Canadian Neurological Score (CNS). According to these criteria, 144 subjects were non diabetics, 99 had known diabetes and 43 had unknown diabetes. Subjects with known diabetes showed a higher prevalence of female sex, hypertension and increased triglyceride levels as compared with non diabetic subjects (p < 0.01). Subjects with unknown diabetes were older (p < 0.01) and showed a more severe CNS (3.4 +/- 2.7) than non diabetic and diabetic subjects (5.8 +/- 2.6 and 5.8 +/- 2.6, respectively; p < 0.01). In-hospital mortality was significantly higher in the unknown diabetic group (44%) as compared with known diabetic (15%) and non diabetic groups (12%) (p < 0.001). This finding was independent of neurological deficit, age, atrial fibrillation and history of previous stroke. Our study shows that unknown diabetes, more than known diabetes, is a strong risk factor for in-hospital mortality in subjects with acute ischemic stroke.

&lt;TITLE&gt;Type 2 Diabetes Mellitus in Children&lt;/TITLE&gt;

The prevalence of type 2 diabetes mellitus in children and adolescents has increased worldwide over the past three decades. This increase has coincided with the obesity epidemic, and minority groups are disproportionately affected. The American Diabetes Association recommends screening for type 2 diabetes beginning at 10 years of age or the onset of puberty in children who are overweight or obese and have two additional risk factors. Diagnostic criteria include a fasting blood glucose level of 126 mg per dL or greater, a two-hour plasma glucose level of 200 mg per dL or greater during an oral glucose tolerance test, an A1C level of 6.5% or more, or a random plasma glucose level of 200 mg per dL or greater plus symptoms of polyuria, polydipsia, or unintentional weight loss. Management should be focused on a multidisciplinary, family-centered approach. Nutrition and exercise counseling should be started at the time of diagnosis and as a part of ongoing management. Metformin is the first-line therapy in conjunction with lifestyle changes. Insulin therapy should be initiated if there are signs of ketosis or ketoacidosis, or if the patient has significant hyperglycemia (A1C greater than 9% or a random plasma glucose level of 250 mg per dL or greater).

Laboratory diagnosis and monitoring of diabetes mellitus.

The American Diabetes Association emphasizes fasting plasma glucose (FPG) levels, rather than the oral glucose tolerance test (OGTT), to diagnose diabetes mellitus. The diagnostic cutoff for FPG is 126 mg/dL (7.0 mmol/L). A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or more during an OGTT or a random plasma glucose level of 200 mg/dL (11.1 mmol/L) or more also is diagnostic of diabetes. The 100-g, 3-hour OGTT remains the "gold standard" for gestational diabetes mellitus (GDM). Two of 4 samples exceeding cutoffs (fasting, > or = 105 mg/dL [5.8 mmol/L]; 1 hour, > or = 190 mg/dL [10.5 mmol/L]; 2 hours, > or = 165 mg/dL [9.2 mmol/L]; 3 hours, > or = 145 mg/dL [8.0 mmol/L]) indicate GDM. An effective GDM screening test is plasma glucose 1 hour after a 50-g oral glucose load. Tight control, which requires self-monitoring of blood glucose, reduces microvascular complications for patients with type 1 or type 2 diabetes. Patients with well-controlled diabetes have glycohemoglobin concentrations of 7% AIc (0.07 AIc/A) or less. Microalbuminuria indicates early, reversible, diabetic nephropathy. The random urine albumin-creatinine ratio is a convenient effective screening test. Albumin-creatinine ratios in the 0.03 to 0.30 (g/g) range indicate microalbuminuria.

Diabetes in urban African-Americans. XV. Identification of barriers to provider adherence to management protocols.

To determine whether health care providers appropriately identify patients with poor glycemic control and to investigate reasons why providers may fail to intensify therapy in these patients. Our management protocol calls for providers to advance diabetes therapy in patients with fasting plasma glucose levels > 7.8 mmol/l or random plasma glucose levels > 10.0 mmol/l. During a 3-month period, providers completed a questionnaire at the end of individual patient visits by asking whether the patient was well controlled and whether therapy was advanced. If therapy was not advanced in patients perceived to have poor control, providers were asked to provide a justification. Providers appropriately identified 88% of well-controlled patients and 94% of patients with poor glycemic control. Out of 1,144 patient visits, control was reported to be good in 508 and poor in 636. In these 636 visits, therapy was advanced in 490 but not in 146 visits. The dominant reasons for failure to intensify therapy were the perception by the provider that control was improving (34%) or the belief that the patient was not compliant with diet or medications (25%). Less common reasons included acute illness, patient refusal, and recurrent hypoglycemia. Based on fasting glucose levels, protocol adherence was 55% before the questionnaire, 64% during the questionnaire (P = 0.006), and 63% afterwards. Providers in a specialty diabetes clinic appropriately classified patients according to glycemic control and tended to intensify therapy when indicated in most poorly controlled patients. Provider self-survey of behavior and decision making may be an effective strategy to improve adherence to management protocols.

Improved Glycemic Control with use of oral Hypoglycemic Therapy with or Without Insulin

To determine whether combination oral hypoglycemic therapy in insulin-using patients with non-insulin-dependent diabetes mellitus (NIDDM) can improve glycemic control for a prolonged period. We expanded and extended an earlier study to include 130 patients with NIDDM for 10 to 30 years who had been using twice-daily mixed insulin for less than 10 years. Reduction and eventual elimination of the insulin therapy and substitution of metformin and a sulfonylurea were attempted. At follow-up visits, patients were weighed, random plasma glucose levels were determined, and glycosylated hemoglobin values were obtained. Of 130 C-peptide-positive patients with NIDDM receiving twice-daily mixed insulin, 100 were successfully transferred to combination oral hypoglycemic therapy with glyburide originally and later glimepiride and metformin--a primary failure rate of 23.1%. Secondary failure occurred in 20 patients after a mean duration of 6.4 months. Two patients with successful conversion to oral combination therapy resumed insulin treatment because of cost. Of the patients with primary failures, 6 had gastrointestinal side effects, 10 were successfully managed on combination oral therapy plus evening mixed insulin, and 14 ultimately received twice-daily insulin and metformin. Of the secondary failures, 13 were controlled on combination oral therapy plus evening insulin and 7 on twice-daily insulin in conjunction with metformin. No difference was found in the original C-peptide levels among these three groups. Glycosylated hemoglobin levels were significantly less on combined oral hypoglycemic therapy (9.8% versus 8.3%; P = 0.0001), on combination oral therapy plus evening insulin (11.2% versus 9.7%; P = 0.001), and on return to twice-daily mixed insulin with metformin (11.0% versus 9.9%; P = 0.04). Those eight patients who resumed twice-daily insulin therapy alone, however, had a nonsignificant increase in glycosylated hemoglobin (9.3% versus 9.9%). Improvement in glycosylated hemoglobin level in insulin-using patients with NIDDM can be obtained with combination oral therapy alone, combination oral therapy with once-daily evening insulin, or twice-daily mixed insulin with metformin in comparison with twice-daily insulin alone.

Australian diabetes screening study: Impaired glucose tolerance and non—insulin-dependent diabetes mellitus

In preventing non—insulin-dependent diabetes mellitus (NIDDM) and its complications, screening high-risk individuals complements public health measures. Our screening instrument for patients of general practitioners was a questionnaire for self-determined high-risk groups plus a laboratory measurement of a random venous plasma glucose level. Collaborating practitioners evaluated 100 consecutive outpatients aged 40 years or older. The questionnaire identified patients with two or more diabetic symptoms or with two or more risk factors, and they were recommended to have their blood tested. For those with a random plasma glucose greater than 5.5 mmol/L, oral glucose tolerance tests (OGTTs) were advised. Of 50,859 subjects completing the study, there were 1,013 cases (2.0%) of new diabetes, 1,704 cases (3.4%) of impaired glucose tolerance (IGT), and 5,508 cases (10.8%) of previously diagnosed diabetes. Symptoms alone were a relatively poor discriminant. Almost all newly identified NIDDM and IGT patients had two or more risk factors for NIDDM. The risk ratios for abnormal glucose tolerance were as follows: high blood pressure, 2.4; overweight, 2.0; and positive family history, 1.7. Selection of cutoff points higher than 5.5 mmol/L would have substantially reduced the rate of newly discovered NIDDM and IGT. Screening for NIDDM and IGT in general practice is feasible and can be achieved with little disruption of office procedures. In preventive programs of this nature, the low screening threshold of 5.5 mmol/L for random venous plasma glucose maximizes the case-finding rate.

Diabetes mellitus in Alaskan Yup'ik Eskimos and Athabascan Indians after 25 yr.

To estimate the prevalence of diabetes mellitus and overweight in two populations of Alaska Natives and to compare the results with previous data. Participants' heights, weights, and random plasma glucose levels were determined. Those with a glucose of greater than or equal to 6.72 mM received a follow-up glucose-tolerance test, interpreted by WHO criteria. Overweight was defined by National Center for Health Statistics criteria and also by criteria used in previous studies. The subjects were Eskimo and Athabascan residents greater than or equal to 40 yr of age in 15 villages in southwestern Alaska. Diabetes prevalence was 4.7% for Eskimos and 10.0% for Indians. Among Eskimo men and women, the prevalence of overweight was 34 and 56%, respectively, among Indian men and women, it was 29 and 55%, respectively. Comparisons with past data indicate that the prevalence of diabetes has increased from 1.7% in 1962 for Eskimos and 1.8% in 1969 for Indians. The prevalence of diabetes appears to have increased among Eskimos and Indians in Alaska. Overweight appears to be a significant problem in both groups.

Quantifying the extent to which random plasma glucose underestimates diabetes prevalence in the Nauruan population

The extent to which random plasma glucose levels underestimate the true prevalence of diabetes has been determined in Micronesian Nauruans. In 337 individuals who were screened on the basis of their random plasma glucose levels, the age-standardised prevalence based on a cut-off of 11.1 mmol/l underestimated the population prevalence based on a complete oral glucose tolerance test by 42% in males and 63% in females. At a cut-off level of 7.8 mmol/l the true age-standardised prevalence was underestimated by 16 and 38%, in males and females, respectively. The use of random plasma glucose concentrations to determine the prevalence of diabetes, as currently defined, seems inappropriate. Performing oral glucose tolerance tests on smaller representative population samples should provide more accurate data at less expense than through large-scale screening utilizing random glucose levels.