Screening For Glucose Intolerance Research Articles

Utilization of a Postpartum Fasting Blood Glucose to Predict Impaired Glucose Tolerance in Patients with Gestational Diabetes Mellitus.

The Endocrine Society recommends a postpartum fasting blood glucose (FBG) be performed for patients with gestational diabetes mellitus (GDM) prior to hospital discharge to screen for ongoing hyperglycemia. There are limited data, however, on whether an FBG can screen for glucose intolerance and if it correlates with the gold standard 4- to 12-week 2-hour oral glucose tolerance test (OGTT). Our objective was to evaluate if FBG correlates with the gold standard 2-hour OGTT. This retrospective cohort study of patients with GDM who delivered >20 weeks' gestation at two urban centers from January 2017 to December 2020 included those who completed both a postpartum FBG prior to discharge and a 2-hour 75-g OGTT within 1 year of delivery. Abnormal 2-hour OGTT was defined as fasting value ≥100 mg/dL and/or 2-hour value ≥140 mg/dL. We evaluated test characteristics (e.g., sensitivity, specificity) of postpartum FBG cut-offs to predict an abnormal 2-hour OGTT result. A total of 235 patients met inclusion criteria, of which 63% were diet-controlled and 37% required medical management. FBG ranged from 64 to 134 mg/dL, with 6/235 (2.6%) with values ≥126 mg/dL. A total of 39/235 (16.6%) of patients had an abnormal 2-hour OGTT. Overall, area under the curve for FBG predicting abnormal 2-hour OGTT was 0.65. Traditionally considered high cut-offs (≥126 mg/dL) for predicting persistent impaired glucose intolerance demonstrated poor positive predictive value (PPV; <20%). In contrast, low cut-offs demonstrated excellent NPV (>90%). A postpartum FBG of 88 mg/dL was determined to be the optimal cut-off for FBG with NPV = 92.4% (Youden index = 0.34). In this dataset, if FBG ≥ 88 mg/dL was used to determine if 2-hour OGTT was required, almost half of GDM patients could avoid further glucose tolerance testing. While previously thought of as best utilized for its PPV, the FBG may be best used for its NPV. In our study, clinical application of an FBG < 88 mg/dL was highly correlative with a normal 2-hour OGTT. · Screening for postpartum glucose intolerance is essential for gestational diabetes.. · A promising initiative includes offering screening tests while in the hospital, including an FBG.. · Application of a postpartum FBG < 88 mg/dL is highly correlative with a normal 2-hour OGTT..

Frequency and predictors of hyperglycemia in patients with various thyroid disorders attending a tertiary hospital of Bangladesh

Thyroid diseases and diabetes mellitus are the two most common endocrine disorders encountered in clinical practice having a mutual influence on each other, and an association between both conditions has long been reported. This cross-sectional study aimed to explore the frequency of hyperglycemia among newly detected patients with thyroid disorders. 400 subjects newly diagnosed with different forms of thyroid disorders previously not known to have diabetes or prediabetes underwent a standard oral glucose tolerance test (OGTT). Plasma glucose values were assessed by the glucose-oxidase method. Out of them, 211 (52.7%) subjects were found to have glucose intolerance (33.5% prediabetes and 19.3% diabetes). Subjects with glucose intolerance had higher mean age, body mass index (BMI), waist circumference, systolic BP, free T4, and lower TSH than euglycemic ones. No statistical difference in glycemic status was observed among the hypothyroid, hyperthyroid, and euthyroid groups. Having a family history of HTN and abdominal obesity was associated with significantly higher odds of glucose intolerance in the study subjects. Glucose intolerance is frequently found in patients with thyroid disorders. This study emphasizes the importance of screening for glucose intolerance among patients with thyroid disorder.

Maternal Serum Biomarkers for the Early Prediction of Gestational Diabetes Mellitus

The prevalence of gestational diabetes mellitus (GDM) is increasing because of the worldwide obesity/diabetes epidemic. The complications of untreated GDM affect both the mother and baby and include complications during pregnancy as well as increased risk of subsequent type-2 Diabetes in mother and offspring. Screening for glucose intolerance during pregnancy provides an opportunity to offer management to those women diagnosed with gestational diabetes mellitus (GDM). Standard tests for hyperglycemia in diabetes, such as fasting glucose and glycosylated hemoglobin (HbA1c) are not currently recommended for GDM screening. Instead, an oral glucose tolerance test (OGTT) is specified, which is invasive, time-consuming, and not easily accessible to many at-risk populations. In this article, we describe a multianalyte maternal serum profile test that incorporates novel glycoprotein biomarkers include endocrine and metabolic hormones like Myokines &amp; cytokines (Adiponectin, Irisin, HCG, Insulin, Ferritin, PAPP-A, Resistin, CRP, Fibronectin, Leptin and SHBG). Further studies are warranted to determine the Reliability of these markers.

A Synopsis of Current Practice in the Diagnosis and Management of Patients with Turner Syndrome in Turkey: A Survey of 18 Pediatric Endocrinology Centers

Objective:A comprehensive survey was conducted to evaluate the shortcomings of clinical care in patients with Turner syndrome (TS) in Turkey.Methods:A structured questionnaire prepared by the Turner study group in Turkey, which covered relevant aspects of patient care in TS was sent to 44 pediatric endocrinology centers.Results:Eighteen centers (41%) responded to the questionnaire. In the majority of the centers, diagnostic genetic testing, screening for Y chromosomal material, protocols regarding the timing and posology of growth hormone (GH) and estrogen, thrombophilia screening, fertility information and screening for glucose intolerance, thyroid, and coeliac diseases in patients with TS were in line with the current consensus. Thirteen centers (72.2%) performed GH stimulation tests. Only four centers (22.2%) used oxandrolone in patients with TS with very short stature. The majority of the centers relied on bone age and breast development to assess estrogen adequacy, though together with variable combinations of oestrogen surrogates. Two centers (11.1%) reported performing serum estradiol measurements. Eight centers (44.4%) routinely conducted cardiac/thoracic aorta magnetic resonance imaging. Screening for hearing, dental and ophthalmologic problems were performed by thirteen (72.2%), six (33.3%) and ten (55.6%) centers, respectively. Psychiatric assessments were made by four centers (22.2%) at diagnosis, with only one center (5.6%) requiring annual reassessments.Conclusion:Although we found some conformity between the current consensus and practice of the participating centers in Turkey regarding TS, further improvements are mandatory in the multi-disciplinary approach to address co-morbidities, which if unrecognized, may be associated with reduced quality of life and even mortality.

Simple Screening for Glucose Intolerance Based on Myoinositol Levels in Self-Collected Urine Samples at Home

Background: Urinary myoinositol (UMI) is a molecule with a structure similar to D-glucose. In the presence of hyperglycemia, reabsorption of MI in the renal tubules is inhibited by urinary glucose (UG), resulting in high concentrations of MI excreted into the urine. Unlike UG, UMI is highly stable at room temperature (RT) for over a week. Therefore, we conducted a study to establish a simple screening method for glucose intolerance (GI) based on UMI levels in self-collected pre- and postprandial urine samples at home. Methods: First, to diagnose GI, we performed a 75gOGTT at the hospital in 115 volunteers without a past history of diabetes (DM). Within a week, each volunteer collected urine samples before and 2h after consuming the test meal (500kcal, energy bar) at home, and these samples were shipped to a single laboratory at RT. UMI was measured using an enzymatic method. Results: To assess the usefulness of UMI for screening GI (IGT+DM), we performed statistical analyses using receiver-operating characteristic (ROC) curve. It revealed that the area under the curve of ROC (AUCROC) for 2h-postprandial UMI/creatinine (Cr) was 0.74 for diagnostic accuracy of GI (IGT+DM). The optimal cut-off was 27 mg/gCr with a sensitivity of 60%, and a specificity of 81%. For diagnostic accuracy of DM, AUCROC for 2h-postprandial UMI/Cr was 0.83, with a sensitivity of 80%, and a specificity of 74% at the cut-off value of 27 mg/gCr. Conclusions: UMI measurement of urine samples self-collected at home may be a non-invasive, inexpensive, and valuable screening method for GI. This strategy may be suitable for subjects in area with limited access to medical care including developing countries, and could be the first step towards further medical examinations such as blood glucose (OGTT when required), and HbA1c. Disclosure M. Takakado: None. Y. Takata: None. R. Kawamura: None. H. Osawa: None.

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

Effect of Hemoglobin Levels and Sex on HbA1c Levels among Japanese Population

HbA1c levels decreased with increasing Hb levels, independent of age, sex, BMI, FPG, and smoking and alcohol habits in Japanese men and women without diabetes or anemia. There was an interaction between sex and hemoglobin in the effects on HbA1c. The interpretation of HbA1c values should be cautious in the screening of glucose intolerance.

299: Screening for glucose intolerance during the immediate postpartum period in women with gestational diabetes

299: Screening for glucose intolerance during the immediate postpartum period in women with gestational diabetes

Iron Biomarker in Gestational Diabetes Pathogenesis

Gestational diabetes mellitus (GDM) is observed to be associated with increased perinatal morbidity and mortality. Screening for glucose intolerance during pregnancy provides an opportunity to offer management to those women diagnosed with gestational diabetes mellitus after first trimester. Elevated iron stores may induce diabetes through a variety of mechanisms, including oxidative damage to pancreatic beta cells, impairment of hepatic insulin extraction by the liver, and interference with insulin's ability to suppress hepatic glucose production. Raised Serum Ferritin could be related to the occurrence of long term complications of diabetes, both micro vascular and macro vascular. Iron affects glucose metabolism and glucose metabolism impinges on several iron metabolic processes. Iron overload decreases insulin sensitivity and cause earlier complications in diabetes mellitus. Iron plays a direct and causal role in diabetes pathogenesis mediated both by cell failure and insulin resistance. Iron also regulates metabolism in most tissues involved in fuel homeostasis, with the adipocyte in particular serving an iron-sensing role.

Usefulness of a novel system for measuring glucose area under the curve while screening for glucose intolerance in outpatients.

To realize the effectiveness of a novel system for measuring glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET), outpatients undergoing oral glucose tolerance tests (OGTT) were investigated for the efficacy of screening for glucose intolerance using this system. Fifty outpatients scheduled to undergo a 75-g OGTT for medical reasons were recruited to the study. An area of skin on the forearm was pretreated with microneedle arrays before the application of hydrogels for interstitial fluid extraction. Plasma glucose (PG) levels were measured every 30min for 2h to calculate reference (actual) AUC. The AUC was predicted by MIET on the basis of glucose extracted by the hydrogel using sodium ion levels as the internal standard. Good correlation between MIET-predicted and reference AUCs obtained using PG levels was confirmed for a wide AUC range. By introducing a threshold level for AUC to separate glucose intolerance with peak glucose ≥180mg/dL from normal glucose tolerance, the system was demonstrated to provide better screening accuracy compared with conventional methods that use HbA1c and fasting PG levels. The results of a questionnaire-based survey administered to the subjects suggested that this system was readily accepted by the majority as a painless monitoring method. The findings suggest that our glucose AUC measurement system using MIET would be useful for screening of glucose intolerance. In the future, this system may prove to be a useful aid as a screen for glucose intolerance before performing an OGTT for diagnosis.

Screening for Glucose Intolerance Using Minimally Invasive Glucose Monitoring System after Test Meal Loading

Screening for Glucose Intolerance Using Minimally Invasive Glucose Monitoring System after Test Meal Loading

Screening for biomarkers predictive of gestational diabetes mellitus

Screening for glucose intolerance during pregnancy provides an opportunity to offer management to those women diagnosed with gestational diabetes mellitus. However, there is a need to diagnose gestational diabetes early to minimize exposure of the developing fetus to suboptimal conditions and prevent perinatal complications and their sequelae. The purpose of this study was to identify potential biomarkers for impending gestational diabetes that appear in the plasma before impaired glucose tolerance. Pregnant women were prospectively recruited to the study and blood was collected at the first antenatal visit and at the time of routine oral glucose tolerance test. Women diagnosed with gestational diabetes were matched with an equal number of normal pregnant (control) women. Biomarkers under investigation included endocrine and metabolic hormones, cytokines and chemokines, and surrogate markers of oxidative stress. Compared to controls, women with gestational diabetes exhibited elevated plasma insulin and reduced plasma adiponectin concentrations at 28 weeks gestation. Significant differences in insulin and adiponectin concentrations were also observed in plasma at 11 weeks gestation. Bivariate logistic regression analysis showed that both insulin and adiponectin are associated with subsequent development of gestational diabetes. Plasma insulin and adiponectin concentrations, when measured at 11 weeks, may be predictive of impending gestational diabetes. Further studies are warranted to determine the reliability of these biomarkers.

The significance of impaired fasting glucose versus impaired glucose tolerance: importance of insulin secretion and resistance.

The American Diabetes Association recommended substituting 2hBS (glycemia at the second hour of an oral glucose tolerance test [OGTT]) for fasting blood glucose (FBS) in screening for glucose intolerance. It is debated whether these tests measure the same abnormality and relate to defective insulin secretion or resistance. This study examines the diagnostic effectiveness of FBS versus 2hBS and their relationship with insulin secretion and resistance. Based on history or physical findings suggesting glucose intolerance, we enrolled 398 unselected subjects admitted to a general Internal Medicine ward. After 5 days of a weight-maintaining diet, FBS, 2hBS, and insulin were measured during OGTT. The homeostatic model assessment was used to assess beta-cell function and insulin resistance. Excluding 19 patients with diabetes (5%), we identified 284 subjects with normal glucose tolerance (NGT), 22 with isolated impaired fasting glucose (IFG), 59 with isolated impaired glucose tolerance (IGT), and 14 with associated IFG/IGT. The sensitivity of FBS in predicting 2hBS was 19%, specificity 93%. Positive and negative predictive values were 39% and 83%, respectively. Insulin resistance was absent in NGT and IFG and markedly elevated in IGT and IFG/IGT, whereas defective insulin release was significant only in isolated IFG. In unselected patients, elevated FBS depends primarily on defective insulin secretion, and impaired 2hBS on insulin resistance. Because these tests measure different alterations, they are useful in combination.

Undiagnosed diabetes mellitus among patients with prior myocardial infarction.

To determine the prevalence of undiagnosed diabetic subjects in a group of long-term myocardial infarction (MI) survivors and to investigate their cardiovascular risk factors and medical care. Glucose tolerance (OGTT WHO 1985), cardiovascular risk factors (blood pressure, lipids, urinary albumin), and primary medical care during the previous year were assessed among 244 patients without previously known diabetes (mean age +/- SD: 70.5 +/- 6.9 yrs; 75% males; time since incident infarction: 6.5 years (median), inter-quartile range: 4-9 years) from the population-based MONICA myocardial infarction registry in Augsburg (Germany). Proportion of undiagnosed diabetes among MI registry patients was 29/244, 12% (95%CI: 8-17%); impaired glucose tolerance was found in 27% (22-34%). Using fasting glucose according to ADA 1997 criteria, 11% (7-16%) had diabetes and 17% (12-22%) impaired fasting glucose. MI registry patients with newly detected diabetes (WHO or ADA) showed a more adverse risk factor profile (higher triglycerides, lower HDL-cholesterol, increased urinary albumin) than subjects with normal glucose tolerance after controlling for possible confounders (age, sex, time since MI, antihypertensive and lipid-lowering medication). No significant differences were observed for self-reported medical care during the previous year among diabetic compared to non-diabetic subjects (number of physician visits and basic investigations). There was a high prevalence of undiagnosed diabetes mellitus among the selected elderly long-term MI survivors. Because mortality rate after MI has been previously shown to be increased in diabetic patients, screening for glucose intolerance appears to be as essential as for standard cardiovascular risk factors.

Which cutoff level should be used in screening for glucose intolerance in pregnancy?

OBJECTIVE: Our purpose was to examine the validity of 140 mg/dL cutoff value in oral glucose challenge test screening for gestational diabetes mellitus when including in the group to be identified women fulfilling more inclusive Carpenter and Coustan criteria for 100-g oral glucose tolerance testing interpretation and gravid women with borderline glucose intolerance. STUDY DESIGN: We reanalyzed data of a multicenter study performed on 704 pregnant women screened at the twenty-fourth to twenty-eighth week with a 50-g oral glucose challenge test followed by a universal 100-g oral glucose tolerance test. We used receiver-operator characteristic curve analysis, assembling positive and negative groups according to the different criteria adopted in oral glucose tolerance test interpretation (National Diabetes Data Group or Carpenter-Coustan) and in assignment of women with borderline glucose intolerance. Besides the statistical cutoff value, defined by the Youden index (Sensitivity + Specificity – 1), we also selected a “high-sensitivity” cutoff value, identified by the maximal sensitivity associated with >70% specificity. RESULTS: With use of National Diabetes Data Group criteria, the statistical and high-sensitivity cutoff values were set at 142 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance. With use of Carpenter-Coustan criteria, the statistical cutoff value was set at 141 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance; the high-sensitivity cutoff value was set at 140 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 136 mg/dL when it also included subjects with borderline glucose intolerance. CONCLUSIONS: We suggest maintaining the 140 mg/dL oral glucose challenge test threshold if the diagnostic target is to recognize only women with positive results of the oral glucose tolerance test. To prevent perinatal risks in pregnancies complicated by borderline glucose intolerance, with Carpenter-Coustan criteria a lower cutoff value (136 mg/dL) could be hypothesized to improve test sensitivity, allowing more extensive diagnosis of “borderline” subjects; however, the higher economic costs resulting from the increased false-positive rate and the limited improvement obtainable in sensitivity currently do not justify its generalized use. (Am J Obstet Gynecol 1998;179:179-85.)

Screening of glucose intolerance in human dry dock with 75gOGTT and glycemic control markers. -Is GTT necessary? -

Screening of glucose intolerance in human dry dock with 75gOGTT and glycemic control markers. -Is GTT necessary? -

Screening for glucose intolerance in pregnancy by random plasma glucose measurement

SummaryPlasma glucose was measured in a series of 646 subjects three times during pregnancy, at the same time as routine antenatal blood tests. The 95th centile levels calculated according to gestational age and time of last meal for this first group of subjects were applied to glucose values obtained for all pregnant women attending for antenatal care over 1 year. Patients with values exceeding these levels were selected for testing for glucose intolerance with a 75 g oral glucose tolerance test. The presence of glucose intolerance was established in 43 patients, representing 2.0 per cent of deliveries during the study. This approach is convenient, acceptable to patients and inexpensive. The proportion of women with glucose intolerance in pregnancy identified by such a programme is consistent with the anticipated incidence.

Glucose, insulin, gastric inhibitory polypeptide and pancreatic polypeptide responses to polycose during pregnancy

Polycose, a glucose polymer produced by controlled acid enzyme hydrolysis of starch, has been proposed as an effective substitute for glucose solution in antepartum screening for glucose intolerance. The purposes of this study were to examine the glucose and hormonal responses to 50 g of glucose polymer (polycose) solution in pregnant and nonpregnant women and to compare these with the standard 50-g oral glucose challenge test. In addition, the subject's acceptance of the glucose polymer solution was evaluated. Subjects were examined after an overnight fast following a 3-day dietary preparation. There was no difference in glucose or insulin responses to glucose or polycose in either pregnant or nonpregnant women. In contrast, the gastric inhibitory polypeptide response to polycose was significantly higher than to glucose. No differences were observed in plasma pancreatic polypeptide responses to glucose and polycose. In the pregnant subjects, even though the plasma insulin response to carbohydrate challenge was higher than in the nonpregnant subjects, gastric inhibitory polypeptide levels were significantly lower. Patient satisfaction was similar with both carbohydrate solutions. These data suggest that polycose can be used as a substitute for glucose in antepartum testing, although the differences in the hormonal responses should be recognized. Further studies in a subject population with carbohydrate intolerance will be required before polycose use can be recommended in abnormal states.

Screening for glucose intolerance in a pediatric multiphasic program

Venous serum glucose concentrations were obtained 1 hr after ingestion of 37.5 g of carbohydrate during multiphasic screening of 2396 children. Data were analyzed by age group (5–7 yr, 8–10 yr, and 11–13 yr), time of blood sampling (9–11 a.m., 12-2 p.m., and 3–5 p.m.), and duration of fast prior to glucose ingestion (0–3 hr, 4–6 hr, and 7+ hr). As expected with the use of a fixed glucose load, mean serum glucose levels decreased significantly with increasing age—at the <0.05 level between the younger age groups and at the <0.001 level between the early adolescent and the two younger groups. These variations in significance correspond to the more marked ponderal difference between the two preadolescent groups. Time of day of testing was also a significant variable ( p <0.001), independent of duration of fast prior to testing. There was no difference between the mean serum glucose following a short (0–3 hr) or a long (7+ hr) fast, but higher mean levels were attained with an intermediate (4–6 hr) fast ( p <0.001). The latter corresponds to the growth hormone phase of the postabsorptive period, known to be associated with glucose intolerance. Screening for glucose intolerance as part of a multiphasic program is of little or no value unless the testing variables are controlled or multiple criteria specific for varying testing conditions are applied.

Screening for glucose intolerance in siblings of children with diabetes

We have found one-third of siblings of children with overt diabetes mellitus to have an abnormal 2-hr glucose tolerance test by liberal criteria. On retesting and applying more strict criteria, nearly half of these abnormal siblings (26 of 55 retested) had a normal 4-hr glucose tolerance. Their mean insulin responses were significantly greater than those of a more normal group of children. One developed overt diabetes and now receives insulin, 16 have chemical diabetes, and 12 have borderline abnormality.