Screening For Impaired Glucose Tolerance Research Articles

Screening of Impaired Glucose Tolerance among Children and Adolescents with Observed Obesity in Mosul/Iraq

Impaired glucose tolerance (IGT) is recognized as the precursor of Type 2 diabetes and is more frequent in obese children and adolescents. Objective: In this research, we examined the prevalence of impaired glucose tolerance among obese children and adolescents. It is crucial to diagnose aberrant glucose metabolism as early as possible to prevent T2DM progression. Methods: Hospital-based research examined 163 obese kids and teens. A 2-hour oral glucose tolerance test (1.75 g. of glucose/kilogram of body weight) was done on all individuals. Results: 19.0% of children and 17.0% of adolescents had impaired glucose tolerance. This research showed 16.5% (n=16) of males and 19.7% (n=13) of females had IGT. In this investigation, systolic blood pressure, physical activity, LDL, total cholesterol, and acanthosis nigricans were strongly linked to decreased glucose tolerance (p < 0.05). Conclusion: Impaired glucose tolerance is quite frequent among obese children and adolescents, and it represents a major risk of diabetes.

A new formula to improve the screening of impaired glucose tolerance in youths with overweight or obesity

AimTo assess a new formula to improve the screening of isolated impaired glucose tolerance (IGT) in youth with overweight/obesity (OW/OB). Methods and resultsA cross-sectional study was performed in 1189 Caucasian youths with OW/OB aged 5–17 years, in whom impaired fasting glucose and high glycosylated hemoglobin were excluded. The sample was divided into training set (TS) (n = 883) and validation set (VS) (n = 306). Fasting (FG) and post-load plasma glucose, alanine aminotransferase (ALT), lipids and familial history for type 2 diabetes (FD) were available in all individuals. In the TS youths with IGT (n = 58, 7.0%) showed higher prevalence of female sex (FS), FD, and higher levels of FG, post-load glucose, ALT and lower levels of HDL-cholesterol vs individuals without IGT. The linear formula was obtained by logistic regression analysis in the TS: 0.05∗ALT + 0.07∗FG + 0.87∗FD + (0.06∗HDL∗ − 1) + 1∗FS. The best cut-off was 5.84. The performance of the formula vs IGT was: sensitivity: 0.74 and specificity: 0.71. Similar results were obtained in the VS. ConclusionsUsing metabolic and anamnestic data we obtained a simple formula with a good performance for screening isolated IGT. This formula may support pediatricians to identify youths with OW/OB in whom the OGTT may be useful for detecting IGT.

Correlation between Glycated Hemoglobin Levels with Polycystic Ovary Syndrome Phenotypes and Metabolic Syndrome

Background: Polycystic Ovary Syndrome (PCOS) is one of the endocrine disorders that causes oligo-anovulation, clinical and biochemical signs hyperandrogenism and ovarian- specific morphological signs on ultrasound examination are common in women of reproductive age. Conditions of insulin resistance and hyperandrogenism accompanied by hypertension and obesity can lead to dyslipidemia that can meet the diagnostic criteria for the metabolic syndrome. The American Diabetes Association approved the examination of glycated hemoglobin (HbA1c) levels as a routine screening for impaired glucose tolerance and hyperglycemic conditions. Examination of HbA1c levels using the method Point of Care Test. Several studies have shown a direct correlation between elevated HbA1c levels and complications of PCOS, providing evidence that HbA1c plays a potential role in PCOS. This study aims to determine the correlation between HbA1c levels with PCOS phenotype and metabolic syndrome. Methods: The study used an analytical study with a cross sectional analytic study design, the number of samples was 52 respondents. The sample was using selected consecutive sampling and then analyzed for HbA1c levels using POCT, PCOS phenotype, and metabolic syndrome for univariate and bivariate. Results: The study with 52 respondents with PCOS patients, the results showed that the number of respondents with increased HbA1c levels was 17 (32.7%) respondents, most of the respondents with phenotype A were 30 (57.7%) respondents. The number of PCOS respondents with metabolic syndrome was 21 (40.4%) respondents. The results of statistical tests showed that correlation between the PCOS phenotype and HbA1c levels. The proportion of the incidence of metabolic syndrome was higher in respondents with phenotype A than phenotypes B, C, and D. The proportion of metabolic syndrome was higher in the category of elevated HbA1c levels compared to normal HbA1c levels, based on statistical tests there was a correlation between HbA1c levels and metabolic syndrome. Conclusion: There was an increase in HbA1c levels in PCOS patients in this study, which was 32.7% and most of the respondents were with phenotype A. Less than half of the respondents had metabolic syndrome. Statistically, there is a correlation between HbA1c levels and PCOS phenotype in PCOS patients and a correlation between HbA1c levels and metabolic syndrome in PCOS patients.

Screening of Diabetes in Pregnancy at Nepalgunj Medical College Teaching Hospital Kohalpur

Introduction: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of variable severity or hyperglycemia occuring for the first time during pregnancy but the glucose intolerance reverting back to normal after the puerperium. According to American Diabetic Association, approximately 7% of all pregnancy are complicated by Gestational Diabetes Mellitus, resulting in more than two lakhs cases annually and the prevalence may range from 1-14% of all pregnancies. Gestational Diabetes Mellitus usually develop in the second trimester and carries grave prognosis both for mother and fetus. So screening of diabetes is necessary for early detection of diabetes and prevention of further progression. Aims: Screening of impaired glucose tolerance and gestational diabetes mellitus by glucose challenge test (GCT) and oral glucose tolerance test (OGTT) at 24-28 weeks of pregnancy. Methods: This study was conducted in Nepalgunj Medical College Teaching Hospital over one year period taking 98 pregnant women who came to ANC (Antenatal Check up) out patient department. Screening for diabetes was done giving 50 gm of oral glucose (glucose challenge test) to the pregnant women at 24-28 weeks of gestational age. Results: The incidence of Impaired glucose tolerance and gestational diabetes in this study population was 4.1% and 1% respectively. Conclusion: Screening of Diabetes mellitus in Second trimester of pregnancy is important investigation to be done to prevent the mother and the fetus from many upcoming complications of diabetes.

178-LB: Use of Random Glucose Followed by HbA1c Improves the Accuracy of Opportunistic Screening

The diagnostic accuracy of HbA1c to identify diabetes and dysglycemia as found in OGTTs is limited. Since opportunistic screening at health visits is cost-effective, and glucose is commonly included in metabolic panels obtained at such visits, we asked if use of glucose followed by HbA1c could improve the accuracy of screening. With the Screening for Impaired Glucose Tolerance (SIGT) study dataset of 1,573 adults without known diabetes, we used Receiver Operating Characteristic (ROC) analysis and OGTTs with ADA diagnostic criteria as a "standard" to evaluate screening; random plasma and capillary glucose (RPG and RCG) were measured on a separate day. Subjects were 58% female and 58% black, with mean age 47.9 year, BMI 30.3 kg/m2 and HbA1c 5.4%. Using OGTTs, 51.5% had normal glucose metabolism, 33.3% prediabetes (PreDM), 4.6% type 2 diabetes (DM), and 37.9% dysglycemia (PreDM or DM). For HbA1c to identify DM by ADA OGTT criteria, the ROC area under the curve (AUC) was 0.818 in all 1573 subjects. However, using an RPG cutoff of 100 mg/dl, the ROC was increased to 0.857 in the 576 with RPG >100 mg/dl but only 0.603 in the 997 with RPG <100 mg/dl (both p<0.001 vs. all subjects). There was similar improvement in identification of DM in the 756 subjects with RCG >100 mg/dl (ROC 0.841, p<0.001), and parallel improvement in identification of dysglycemia (ROC 0.671 for all subjects, vs. 0.740 and 0.741 for those with RPG or RCG >110 mg/dl, respectively, both p<0.001). Results were similar with RCG in a separate dataset (n=1,037). For identification of DM among those with RPG >100 mg/dl in the SIGT dataset, specificity and sensitivity were 79% and 74%, respectively, for HbA1c >5.7%, 84% and 69%, for HbA1c >5.8%, and 90% and 64% for HbA1c >5.9%. Conclusions: Use of random glucose followed by HbA1c improves the accuracy and efficiency of screening, identifying both individuals who should and should not have an OGTT. Such a strategy might improve recognition of diabetes and prediabetes, permitting initiation of preventive management. Disclosure B.T. Legvold: None. L.R. Staimez: None. D. Li: None. L.S. Phillips: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. Research Support; Self; AbbVie Inc., GlaxoSmithKline plc., Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc. Stock/Shareholder; Self; Diasyst Inc. Other Relationship; Self; Diasyst Inc., Janssen Pharmaceuticals, Inc. M.K. Rhee: None. Funding U.S. Department of Veterans Affairs; National Institutes of Health

Metabolic Screening in Patients With Polycystic Ovary Syndrome Is Largely Underutilized Among Obstetrician-Gynecologists

(Abstracted from Am J Obstet Gynecol 2016;215:579.e1–579.e5) Women with polycystic ovary syndrome (PCOS) are at significantly increased risk of several metabolic abnormalities (insulin resistance, impaired glucose tolerance, type 2 diabetes, dyslipidemia, and metabolic syndrome) and have substantially higher rates of these abnormalities compared with women without PCOS. Published guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) and Endocrine Society recommend that all women with PCOS undergo screening for impaired glucose tolerance and dyslipidemia (with a 2-hour, 75-g oral glucose tolerance test [OGTT] and fasting lipid profile upon diagnosis) and undergo repeat screening every 2 to 5 years and every 2 years, respectively.

Metabolic screening in patients with polycystic ovary syndrome is largely underutilized among obstetrician-gynecologists

Women with polycystic ovary syndrome have substantially higher rates of insulin resistance, impaired glucose tolerance, type 2 diabetes, dyslipidemia, and metabolic syndrome when compared with women without the disease. Given the high prevalence of these comorbidities, guidelines issued by the American College of Obstetricians and Gynecologists and the Endocrine Society recommend that all women with polycystic ovary syndrome undergo screening for impaired glucose tolerance and dyslipidemia with a 2 hour 75 g oral glucose tolerance test and fasting lipid profile upon diagnosis and also undergo repeat screening every 2-5 years and every 2 years, respectively. Although a hemoglobin A1C and/or fasting glucose are widely used screening tests for diabetes, both the American College of Obstetricians and Gynecologists and the Endocrine Society preferentially recommend the 2 hour oral glucose tolerance test in women with polycystic ovary syndrome as a superior indicator of impaired glucose tolerance/diabetes mellitus. However, we found that gynecologists underutilize current recommendations for metabolic screening in women with polycystic ovary syndrome. In an online survey study targeting American College of Obstetricians and Gynecologists fellows and junior fellows, 22.3% of respondents would not order any screening test at the initial visit for at least 50% of their patients with polycystic ovary syndrome. The most common tests used to screen for impaired glucose tolerance in women with polycystic ovary syndrome were hemoglobin A1C (51.0%) and fasting glucose (42.7%). Whereas 54.1% would order a fasting lipid profile in at least 50% of their polycystic ovary syndrome patients, only 7% of respondents order a 2 hour oral glucose tolerance test. We therefore call for increased efforts to encourage obstetrician-gynecologists to address metabolic abnormalities in their patients with polycystic ovary syndrome. Such efforts should include education of physicians early in their careers, at the medical student and resident level. Efforts should also include implementation of continuing medical education activities, both locally and at the national level, to improve understanding of the metabolic implications of polycystic ovary syndrome. Electronic medical record systems should be utilized to generate prompts for appropriate screening tests in patients with a diagnosis of polycystic ovary syndrome. Because obstetrician-gynecologists may be the only physicians seen by many polycystic ovary syndrome patients, particularly those in their young reproductive years, such interventions could effectively promote optimal preventative health care and early diagnosis of metabolic comorbidities in these at-risk women.

A preliminary investigation of EZSCAN™ screening for impaired glucose tolerance and diabetes in a patient population.

EZSCAN™ is a non-invasive technology that evaluates sweat gland dysfunction using electrochemical skin conductance measurements, providing an opportunity to determine the risk of impaired glucose tolerance (IGT) and diabetes mellitus (DM). This study was conducted with the aims of detecting IGT and DM and investigating the efficacy and cut-off points of the EZSCAN test in a patient population. The traditional serum and plasma glucose tests were used as comparators. In this cross-sectional study, 270 previously undiagnosed patients (180 women and 90 men) with a high risk of glucose metabolism disorders (≥45 years old) were enrolled. All patients underwent an oral glucose tolerance test (OGTT) and hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and EZSCAN tests. Forty (14.8%) patients had newly diagnosed DM (NDM), 79 (29.3%) had IGT and 151 (55.9%) had normal glucose tolerance. The EZSCAN values of these groups were 48±11, 47±11 and 34±13%, respectively. For all patients, the correlation coefficient of EZSCAN was 0.462 with the OGTT (P<0.001), 0.182 with the FPG test (P<0.001) and 0.379 with the HbA1c test (P<0.001). The EZSCAN cut-off point for the detection of IGT was 37% [sensitivity, 82%; specificity, 62%; area under the curve (AUC), 0.778], and the cut-off point for NDM was 50% (sensitivity, 53%; specificity, 59%; AUC, 0.528). This study demonstrated that the non-invasive EZSCAN system is an effective screening tool for the detection of glucose dysfunction in the population tested, and that its performance in detecting previously undiagnosed IGT is superior to its performance in detecting DM.

PCOS in adolescence and type 2 diabetes.

Polycystic ovary syndrome is a frequent disorder in women of reproductive age that consists of a heterogeneous combination of hyperandrogenism, chronic anovulation, and polycystic ovaries. Hyperandrogenism and anovulation are clearly linked to insulin resistance and compensatory hyperinsulinism, with an ovarian androgenic hyperresponsiveness to circulating insulin. Evidence is increasing that suggests that lipotoxicity, which is a key mechanism in the development of insulin resistance and type 2 diabetes, could also explain the androgen overproduction. During adolescence, diagnosis of polycystic ovarian syndrome (PCOS) may be difficult but is of importance because PCOS increases future risk of type 2 diabetes and metabolic complications. Metabolic perturbations begin early in adolescence and also exist in adolescent relatives of women with PCOS, even before clinical signs of PCOS. Screening for impaired glucose tolerance or type 2 diabetes is also important in this population, and treatment should focus on PCOS clinical manifestations as well as long-term metabolic risk.

Aging is associated with increased HbA1c levels, independently of glucose levels and insulin resistance, and also with decreased HbA1c diagnostic specificity

To determine whether using HbA1c for screening and management could be confounded by age differences, whether age effects can be explained by unrecognized diabetes and prediabetes, insulin resistance or postprandial hyperglycaemia, and whether the effects of aging have an impact on diagnostic accuracy. We conducted a cross-sectional analysis in adults without known diabetes in the Screening for Impaired Glucose Tolerance (SIGT) study 2005-2008 (n=1573) and the National Health and Nutrition Examination Survey (NHANES) 2005-2006 (n=1184). Both glucose intolerance and HbA(1c) levels increased with age. In univariate analyses including all subjects, HbA(1c) levels increased by 0.93 mmol/mol (0.085%) per 10 years of age in the SIGT study and by 1.03 mmol/mol (0.094%) per 10 years in the NHANES; in both datasets, the HbA(1c) increase was 0.87 mmol/mol (0.08%) per 10 years in subjects without diabetes, and 0.76 mmol/mol (0.07%) per 10 years in subjects with normal glucose tolerance, all P<0.001. In multivariate analyses of subjects with normal glucose tolerance, the relationship between age and HbA(1c) remained significant (P<0.001) after adjustment for covariates including race, BMI, waist circumference, sagittal abdominal diameter, triglyceride/HDL ratio, and fasting and 2-h plasma glucose and other glucose levels, as assessed by an oral glucose tolerance test. In both datasets, the HbA(1c) of an 80-year-old individual with normal glucose tolerance would be 3.82 mmol/mol (0.35%) greater than that of a 30-year-old with normal glucose tolerance, a difference that is clinically significant. Moreover, the specificity of HbA(1c) -based diagnostic criteria for prediabetes decreased substantially with increasing age (P<0.0001). In two large datasets, using different methods to measure HbA(1c), the association of age with higher HbA(1c) levels: was consistent and similar; was both statistically and clinically significant; was unexplained by features of aging; and reduced diagnostic specificity. Age should be taken into consideration when using HbA(1c) for the diagnosis and management of diabetes and prediabetes.

Screening for impaired glucose tolerance in obese children and adolescents. A validation and implementation study.

Impaired glucose tolerance (IGT) is a strong risk factor for Type 2 diabetes and cardiovascular disease. The aim of this study was to validate and implement a previously published fasting predictive tool for IGT in obese children: TG > 1.17 mmol /L, which showed a 71.4[57.8–85.1]% sensitivity and a 64.1[57.7–70.4]% specificity in 259 obese Canadian children. The possible contribution of other metabolic variables was evaluated by assessing the net reclassification improvement (NRI). 817 Italian obese children (8–18.4 years) were recruited and underwent fasting blood analysis and oral glucose tolerance test (OGTT). Thirty-nine children (4.7%) had IGT. The 1.17 mmol/L TG threshold showed 66.6 [51.8–81.4]% sensitivity and 68.2 [64.9–71.5]% specificity, thus successfully validated. Fasting plasma glucose (FPG) was independently associated with IGT (OR = 3.86 [2.09–7.14], P 1.13 mmol/L plus FPG > 4.44 mmol/L had a 69.2[54.7–83.7]% sensitivity and a 78.2[76.8–79.6]% specificity, thus displaying a 12.6% NRI ( P 1.17 mmol/L. TG > 1.17 mmol/L is a useful criterion to detect roughly 66% of obese children with IGT through OGTT performed in about 33% of all obese children. However, the ‘TG > 1.13 mmol/L plus FPG > 4.44 mmol/L’ criterion allows for detecting even more than 66% of obese children with IGT, though limiting OGTT to just 25% of all obese children.

Diagnosing Dysglycemia in Adolescents With Polycystic Ovary Syndrome

Screening for impaired glucose tolerance (IGT) is recommended for adolescents with polycystic ovary syndrome (PCOS) with oral glucose tolerance test (OGTT). Whether glycated hemoglobin (HbA1c) can be used for screening in this patient population is unknown. We sought to determine the utility of HbA1c and 2-hour OGTT for diagnosing dysglycemia in adolescents with PCOS. This was a retrospective cohort study of 68 adolescents with PCOS seen in the Boston Children's Hospital Division of Adolescent Medicine between 2008 and 2011 and not known to have diabetes. Prevalence of dysglycemia (impaired fasting glucose, IGT, increased risk for diabetes, or diabetes mellitus as diagnosed by fasting plasma glucose, 2-hour OGTT, and/or HbA1c) and sensitivity and specificity of HbA1c for diagnosing dysglycemia compared with OGTT were assessed. Twenty-four participants had abnormal glucose testing, including one participant (1.5%) who met criteria for diabetes mellitus and 23 participants (34%) who met criteria for impaired fasting glucose/IGT/prediabetes. More patients were identified as having dysglycemia by HbA1c than OGTT. Compared with OGTT, HbA1c had a sensitivity of 60% and a specificity of 69% for diagnosing dysglycemia. In adolescents with PCOS, HbA1c had moderate sensitivity and specificity for detecting dysglycemia compared with OGTT. Clinicians should be aware that both tests have benefits and limitations, and the optimal test for follow-up requires further study.

Screening for impaired glucose tolerance in obese children and adolescents: a validation and implementation study

What is already known about this subject Fasting triglycerides above 1.17 mmol/L have been shown to be useful to select obese children and adolescents who may present impaired glucose tolerance in a Canadian cohort. Fasting plasma glucose is associated with the risk to present impaired glucose tolerance in several cohorts of obese children and adolescents. What this study adds When applied to Italian cohorts of obese children and adolescents, the triglycerides cut-off of 1.17 mmol/L has similar validity as in the Canadian cohort to select patients who may present impaired glucose tolerance. Fasting plasma glucose and fasting triglycerides can be combined to obtain an accurate criterion to select obese children and adolescents who may present impaired glucose tolerance. We aimed to validate fasting triglycerides > 1.17 mmol L(-1) , a criterion recently proposed for selecting obese children at risk of impaired glucose tolerance (IGT), and to assess whether the accuracy of triglycerides (TG) can be improved by the use of other variables. We studied an Italian cohort of 817 obese children and adolescents (8-18.4 years) who underwent clinical examination, fasting blood analysis and the oral glucose tolerance test (OGTT). The discriminative properties of TG > 1.17 mmol L(-1) were assessed and compared with those observed in a Canadian cohort from which this criterion was derived: 71.4 [57.8-85.1]% sensitivity and 64.1 [57.7-70.4]% specificity. The possible contribution of other variables was evaluated by assessing the net reclassification improvement (NRI), i.e., the net increase in the percentage of subjects correctly classified. Thirty-nine children (4.7%) had IGT. The 1.17 mmol L(-1) TG threshold showed 66.6 [51.8-81.4]% sensitivity and 68.2 [64.9-71.5]% specificity, thus successfully validated. Fasting plasma glucose (FPG) was independently associated with IGT (odds ratio = 3.86 [2.09-7.14], P < 0.001), besides TG. The bivariate criterion of TG ≥ 1.13 mmol L(-1) plus FPG ≥ 4.44 mmol L(-1) had a 69.2 [54.7-83.7]% sensitivity and a 78.2 [76.8-79.6]% specificity, thus displaying a 12.6% NRI (P < 0.001) compared with TG>1.17 mmol L(-1) . TG > 1.17 mmol L(-1) is a useful criterion to detect roughly 66% of obese children with IGT through OGTT performed in about 33% of all obese children. However, the 'TG≥1.13 mmol L(-1) plus FPG≥4.44 mmol L(-1) ' criterion improved discrimination accuracy, leading to the possibility of detecting even more than 66% of obese children with IGT though limiting OGTT to just 25% of all obese children.

Many Americans have pre-diabetes and should be considered for metformin therapy.

OBJECTIVETo determine the proportion of the American population who would merit metformin treatment, according to recent American Diabetes Association (ADA) consensus panel recommendations to prevent or delay the development of diabetes.RESEARCH DESIGN AND METHODSRisk factors were evaluated in 1,581 Screening for Impaired Glucose Tolerance (SIGT), 2,014 Third National Health and Nutrition Examination Survey (NHANES III), and 1,111 National Health and Nutrition Examination Survey 2005–2006 (NHANES 2005–2006) subjects, who were non-Hispanic white and black, without known diabetes. Criteria for consideration of metformin included the presence of both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), with ≥1 additional diabetes risk factor: age <60 years, BMI ≥35 kg/m2, family history of diabetes, elevated triglycerides, reduced HDL cholesterol, hypertension, or A1C >6.0%.RESULTSIsolated IFG, isolated IGT, and IFG and IGT were found in 18.0, 7.2, and 8.2% of SIGT; 22.3, 6.4, and 9.4% of NHANES III; and 21.8, 5.0, and 9.0% of NHANES 2005–2006 subjects, respectively. In SIGT, NHANES III, and NHANES 2005–2006, criteria for metformin consideration were met in 99, 96, and 96% of those with IFG and IGT; 31, 29, and 28% of all those with IFG; and 53, 57, and 62% of all those with IGT (8.1, 9.1, and 8.7% of all subjects), respectively.CONCLUSIONSMore than 96% of individuals with both IFG and IGT are likely to meet ADA consensus criteria for consideration of metformin. Because >28% of all those with IFG met the criteria, providers should perform oral glucose tolerance tests to find concomitant IGT in all patients with IFG. To the extent that our findings are representative of the U.S. population, ∼1 in 12 adults has a combination of pre-diabetes and risk factors that may justify consideration of metformin treatment for diabetes prevention.

Type 2 diabetes: Primary prevention, screening and health care approach for diagnosis in South Africa

AbstractWe have reviewed large studies that demonstrate different methods that have been adopted to prevent or delay the progression to Type 2 diabetes in high-risk individuals. The principal interventions include behavioural modifications in diet and physical activity, use of insulin sensitisers such as metformin and glitazones, and alpha-glucosidase inhibitors.Although there is no evidence of benefit in health outcomes from large-scale population screening for impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), screening of high-risk individuals has merit. During prolonged periods of dysglycaemia that precede diabetes, individuals remain largely asymptomatic. These periods can be from 8–10 years as extrapolated from the United Kingdom Prospective Diabetes Study data. This phase of pre-diabetes is not innocuous, and is often associated with the concurrent development of complications, which highlights the importance of early detection and treatment of this ‘silent killer’. Although differ...

Type 2 Diabetes: Primary Health Care Approach for Prevention, Screening and Diagnosis in South Africa

We have reviewed large studies that demonstrate different methods that have been adopted to prevent or delay the progression to Type 2 diabetes in high-risk individuals. The principal interventions include behavioural modifications in diet and physical activity, use of insulin sensitisers such as metformin and glitazones, and alpha-glucosidase inhibitors. Although there is no evidence of benefit in health outcomes from large-scale population screening for impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), screening of high-risk individuals has merit. During prolonged periods of dysglycaemia that precede diabetes, individuals remain largely asymptomatic. These periods can be from 8-10 years as extrapolated from the United Kingdom Prospective Diabetes Study data. This phase of pre-diabetes is not innocuous, and is often associated with the concurrent development of complications, which highlights the importance of early detection and treatment of this ‘silent killer'. Although different methods for screening of diabetes are available, preferred techniques include measurement of fasting plasma glucose and 2 hr post-load plasma glucose. People should be encouraged to eat correct diets, be active, and maintain a healthy weight - these behaviours have other benefits in addition to preventing or delaying the onset of Type 2 diabetes. There are various diagnostic criteria used for the diagnosis of diabetes. In this article we have presented two sets of criteria, one from the World Health Organization (WHO) and the other from the American Diabetes Association (ADA). South African Journal of Family Practice Vol. 50 (4) 2008: pp. 14-20

The Metabolic Syndrome in Polycystic Ovary Syndrome

Approximately one-third to one-half of all women and adolescent girls with polycystic ovary syndrome (PCOS) has the metabolic syndrome, associated with increased risk for cardiovascular disease and type 2 diabetes. Evidence suggests that insulin resistance is the likely link between PCOS and the metabolic syndrome. Early screening for impaired glucose tolerance, even in adolescents, is recommended. Lifestyle modification with increased physical activity and weight reduction remains first-line therapy. Insulin-sensitizing drugs may also ameliorate features of the metabolic syndrome in PCOS but long-term prospective studies are needed to determine the role of these drugs in the prevention of the metabolic syndrome.

Prevalence of insulin resistance and prediction of glucose intolerance and type 2 diabetes mellitus in women with polycystic ovary syndrome

Diabetes mellitus type 2 (DM2) affects 10% of women with polycystic ovary syndrome (PCOS). We evaluated the sensitivity and specificity of clinical and fasting biochemical parameters in screening for impaired glucose tolerance (IGT) and DM2. Women with PCOS [n=244, age 27.4+/-7.5 years, body mass index (BMI) 27.5+/-6.9 kg/m(2)] and healthy women (n=57, age 26.8+/-5.8 years, BMI 21.3+/-2.1 kg/m(2)) underwent basal blood sampling and an oral glucose tolerance test (oGTT). Insulin resistance was identified in 40.2% of PCOS women. Impaired fasting glucose (5.6-6.9 mmol/L) was found in 30 subjects (12.3%), but the oGTT revealed IGT in only six of these cases and DM2 in one subject. IGT was found in 23 (9.4%) and DM2 in four (1.6%) of the women with PCOS. The conventional upper limits for total cholesterol, triglycerides, systolic and diastolic blood pressure and fasting glucose revealed low sensitivity for the identification of impaired glucose metabolism. No single parameter nor any combination of them showed an accuracy sufficient for screening of IGT or DM2 in PCOS patients. All PCOS patients should be screened using an oGTT to identify disturbances in glucose metabolism.

Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome

The aims of this study were to analyse the prevalence of impaired glucose tolerance (IGT) and diabetes mellitus (NIDDM) in Chinese polycystic ovary syndrome (PCOS) patients and to assess the ability of screening tests to predict these abnormalities within this population. A total of 102 PCOS patients were evaluated. All patients underwent oral glucose tolerance tests (OGTTs) with blood samples taken at 0, 1 and 2 h. The 2-h plasma glucose level was used to categorize subjects as having IGT or NIDDM. The prevalence of IGT was 20.5% and that of NIDDM was 1.9%. There was no significant relationship between BMI and 2-h plasma glucose levels. The areas under the receiver operating characteristic (ROC) curve for glucose to insulin ratio (G:I), homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were 0.702, 0.734 and 0.733 respectively. ROC analysis suggested a threshold value of 10.7 in G:I ratio (73.9% sensitivity and 59.5% specificity), a value of 2.14 in HOMA (73.9% sensitivity and 73.4% specificity) and a value of 0.34 in QUICKI (73.9% sensitivity and 73.4% specificity) for the prediction of abnormal glucose tolerance (IGT and NIDDM). Chinese women with PCOS are at increased risk of IGT and NIDDM. Even though G:I, HOMA and QUICKI are easier than OGTT, they could not replace the role of 2-h post-challenge plasma glucose level in the screening of IGT and NIDDM in PCOS women.

Prevalence of Diabetes and Impaired Glucose Tolerance in 64-Year-Old Swedish Women

The purpose of this study was to describe the prevalence of diabetes and impaired glucose tolerance (IGT) in middle-aged women and to examine the variability and practical use of the oral glucose tolerance test (OGTT) in the screening for IGT and diabetes. All 64-year-old women living in Göteborg, Sweden, were invited to take part in a screening examination (n = 4,856). Of these, 82% (n = 3,998) responded and 53% (n = 2,595) participated and underwent anthropometric measurements and a 75-g standardized OGTT that was repeated within 2 weeks in those not showing normal glucose tolerance (NGT). The prevalences of known and new diabetes, IGT at both OGTTs, and impaired fasting glucose were 4.7, 4.8, 14.4, and 6.4%, respectively. Half of the women with diabetes were previously undiagnosed, and 37% of the diagnoses were based on OGTT and diabetes 2-h values at both or one of the two examinations. Women with IGT at both OGTTs, in comparison with those with one impaired and one normal OGTT, had higher BMI, waist girth, and blood pressure. More than 40% of the women showed impaired glucose metabolism. Among these women, the prevalence of undetected diabetes was high and repeated OGTTs were needed to identify and not misclassify a considerable proportion of patients. The degree of glucose tolerance impairment and the number of abnormal OGTTs were directly associated with occurrence of components of the metabolic syndrome.