Undetected Diabetes Research Articles

Type 2 diabetes prevalence among Canadian adults - dietary habits and sociodemographic risk factors.

Patients with diagnosed diabetes receive recommendations by their healthcare providers about lifestyle modification, particularly on diet. The aim of this study was to determine the prevalence of type 2 diagnosed diabetes, undetected (undiagnosed) type 2 diabetes, and prediabetes of Canadian adults, and to evaluate whether individuals with diagnosed diabetes have different dietary intakes compared with the other groups. We used nationally representative data from Canadian Health Measures Survey Cycles 1 and 2 (n = 6807, representing estimated population of 23 022 890). We evaluated prevalence of diagnosed diabetes, undetected diabetes, and prediabetes and their distribution across sociodemographic and lifestyle factors. The intake from different food/food groups was compared between those with diagnosed diabetes and the rest of the population. Among Canadians 20-79 years of age, 12.4% had prediabetes, and 7.5% had diabetes. Among all diabetes cases, 37.3% were undiagnosed. All 3 diabetic categories were more prevalent among older age groups (60-79 years) compared with younger age (20-39 years) groups. Diagnosed diabetes and prediabetes were more prevalent among less educated individuals compared with the higher educated ones. Diagnosed diabetes was more common among individuals with lower-middle income level compared with the highest income level. Diagnosed diabetes individuals had lower intake from juice and ice cream and higher intake from potatoes and diet soft drinks compared with other groups. More than 600 000 adults were unaware of their diabetes status; the aware ones had lower intakes of sugar-containing foods. In evaluating the association between dietary intake and risk of chronic diseases in populations, diagnosed diabetes cases should be evaluated separately.

Cathepsin D improves the prediction of undetected diabetes in patients with myocardial infarction

Background: Newer therapeutic agents for type 2 diabetes mellitus can improve cardiovascular outcomes, but diabetes remains underdiagnosed in patients with myocardial infarction (MI). We sought to identify proteomic markers of undetected dysglycaemia (impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) to improve the identification of patients at highest risk for diabetes.Materials and methods: In this prospective cohort, 626 patients without known diabetes underwent oral glucose tolerance testing (OGTT) during admission for MI. Proximity extension assay was used to measure 81 biomarkers. Multivariable logistic regression, adjusting for risk factors, was used to evaluate the association of biomarkers with dysglycaemia. Subsequently, lasso regression was performed in a 2/3 training set to identify proteomic biomarkers with prognostic value for dysglycaemia, when added to risk factors, fasting plasma glucose, and glycated haemoglobin A1c. Determination of discriminatory ability was performed in a 1/3 test set.Results: In total, 401/626 patients (64.1%) met the criteria for dysglycaemia. Using multivariable logistic regression, cathepsin D had the strongest association with dysglycaemia. Lasso regression selected seven markers, including cathepsin D, that improved prediction of dysglycaemia (area under the receiver operator curve [AUC] 0.848 increased to 0.863). In patients with normal fasting plasma glucose, only cathepsin D was selected (AUC 0.699 increased to 0.704).Conclusions: Newly detected dysglycaemia, including manifest diabetes, is common in patients with acute MI. Cathepsin D improved the prediction of dysglycaemia, which may be helpful in the a priori risk determination of diabetes as a motivation for confirmatory OGTT.Trial registration: ClinicalTrials.gov identifier: NCT01452178.

Undetected Dysglycemia Is an Important Risk Factor for Two Common Diseases, Myocardial Infarction and Periodontitis: A Report From the PAROKRANK Study.

Information on the relationship among dysglycemia (prediabetes or diabetes), myocardial infarction (MI), and periodontitis (PD) is limited. This study tests the hypothesis that undetected dysglycemia is associated with both conditions. The PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study included 805 patients with a first MI and 805 matched control subjects. All participants without diabetes (91%) were examined with an oral glucose tolerance test. Abnormal glucose tolerance (AGT) (impaired glucose tolerance or diabetes) was categorized according to the World Health Organization. Periodontal status was categorized from dental X-rays as healthy (≥80% remaining alveolar bone height), moderate (79-66%), or severe (<66%) PD. Odds ratios (ORs) and 95% CIs were calculated by logistic regression and were adjusted for age, sex, smoking, education, marital status, and explored associated risks of dysglycemia to PD and MI, respectively. AGT was more common in patients than in control subjects (32% vs. 19%; P < 0.001) and was associated with MI (OR 2.03; 95% CI 1.58-2.60). Undetected diabetes was associated with severe PD (2.50; 1.36-4.63) and more strongly in patients (2.35; 1.15-4.80) than in control subjects (1.80; 0.48-6.78), but not when categorized as AGT (total cohort: 1.07; 0.67-1.72). Severe PD was most frequent in subjects with undetected diabetes, and reversely undetected diabetes was most frequent in patients with severe PD. In this large case-control study previously undetected dysglycemia was independently associated to both MI and severe PD. In principal, it doubled the risk of a first MI and of severe PD. This supports the hypothesis that dysglycemia drives two common diseases, MI and PD.

Markedly Delayed Insulin Secretion and a High Rate of Undetected Overt Diabetes Characterize Glucose Metabolism in Adult Patients with Cystic Fibrosis After Lung Transplantation

Cystic fibrosis-related diabetes (CFRD) is associated with adverse clinical outcomes and should be screened for by an annual oral glucose tolerance test (OGTT). Since pathophysiologic studies have mainly been performed in a pediatric/adolescent, nontransplanted collective, we aimed to assess parameters of insulin secretion and sensitivity in adult cystic fibrosis (CF) patients after lung transplantation (LT). Twelve adult CF patients after LT without known diabetes (33.3 ± 11.5 years; body mass index [BMI] 21.5 ± 3.3 kg/m2) and 8 control subjects matched by age (36.0 ± 6.6 years; P>.05), BMI (22.3 ± 1.5 kg/m2; P>.05), and gender (CON group) underwent a 3-hour OGTT with glucose, insulin, and C-peptide measurements. Parameters of insulin secretion and sensitivity as well as lipid profiles were assessed. In the CF group, 4 patients were diagnosed with overt diabetes (CFRD) compared to CF patients without diabetes (CF-noDM), of whom 6 had indeterminate glycemia with 1-h glucose values >200 mg/dL. The insulin peak after glucose load occurred after 30 minutes in CON, after 90 minutes in CF-noDM, and was missing in CFRD. Insulin sensitivity was comparable between the groups. Beta-cell glucose sensitivity was markedly reduced in CFRD (10.7 ± 5.8 pmol/min*m2*mM), higher in CF-noDM (39.9 ± 23.4 pmol/min*m2*mM), but still significantly lower compared to CON (108.3 ± 53.9 pmol/min*m2*mM; P = .0008). CFRD patients exhibited increased triglyceride levels and decreased high-density lipoprotein levels. Adult CF patients after LT have profound disturbances in glucose metabolism, with a high rate of undetected diabetes and markedly delayed insulin secretion. Curbed beta-cell glucose sensitivity rather than insulin resistance explains postprandial hyperglycemia and is accompanied by abnormalities in lipid metabolism. AUC = area under the curve; BMI = body mass index; CF = cystic fibrosis; CFRD = cystic fibrosis-related diabetes; CFTR = cystic fibrosis transmembrane-conductance regulator; CF-TX = cystic fibrosis patients who underwent lung transplantation; CGM = continuous glucose monitoring; HbA1c = glycated hemoglobin; HDL = high-density lipoprotein; INDET = indeterminate glycemia; LDL = low-density lipoprotein; LT = lung transplantation; OGIS = oral glucose sensitivity index; OGTT = oral glucose tolerance test; QUICKI = quantitative insulin sensitivity check index.

Thyroid abscess: a rare condition in immunocompetent patient

&lt;p class="abstract"&gt;Thyroid abscess is rare due to certain anatomical and physiological characteristics of the thyroid gland. Thyroid abscess can occur due to spread of flora in the upper respiratory tract to perithyroid space and thyroid gland through fistula. We are reporting case of thyroid abscess where the infecting pathogen was &lt;em&gt;E. coli&lt;/em&gt;. USG and guided FNAC are simple and first line investigations. However there can be abscess formation following FNAC in immune compromised patients. A 50 years old man presented to us with complaints of fever and swelling over the left anterior aspect of neck of 10 days duration. It was associated with pain during swallowing. Ultrasound is investigation of choice as it does not have ionizing radiation, gives a good exposure of thyroid gland, show heterogeneous echo texture and superimposition of abscess is present. It can also show vascularity and internal haemorrhage. Patient was a case of undetected and uncontrolled diabetes mellitus which might have predisposed him to suppurative thyroiditis. Timely detection and surgical debridement of necrosed tissue and specific antibiotic treatment with management of diabetes helped him recover from this life threatening condition.&lt;/p&gt;

Long-term mortality is increased in patients with undetected prediabetes and type-2 diabetes hospitalized for worsening heart failure and reduced ejection fraction.

We assessed the prevalence of newly diagnosed prediabetes and type-2 diabetes mellitus (T2DM), and their impact on long-term mortality in patients hospitalized for worsening heart failure with reduced ejection fraction (HFrEF). We included patients hospitalized with HFrEF and New York Heart Association (NYHA) functional class II-III. Baseline two-hour oral glucose tolerance test was used to classify patients as normoglycaemic or having newly diagnosed prediabetes or T2DM. Outcomes included post-discharge all-cause and cardiovascular mortality during the median follow-up of 2.1 years. At baseline, out of 150 patients (mean-age 57 ± 12 years; 88% male), prediabetes was diagnosed in 65 (43%) patients, and T2DM in 29 (19%) patients. These patients were older and more often with NYHA class III symptoms, but distribution of comorbidities was similar to normoglycaemic patients. Taking normoglycaemic patients as a reference, adjusted risk of all-cause mortality was significantly increased both in patients with prediabetes (hazard ratio, 2.6; 95% confidence interval (CI), 1.1-6.3; p = 0.040) and in patients with T2DM (hazard ratio, 5.3; 95% CI, 1.7-15.3; p = 0.023). Likewise, both prediabetes (hazard ratio, 2.9; 95% CI, 1.1-7.9; p = 0.041) and T2DM (hazard ratio, 9.7; 95% CI 2.9-36.7; p = 0.018) independently increased the risk of cardiovascular mortality compared with normoglycaemic individuals. There was no interaction between either prediabetes or T2DM and heart failure aetiology or gender on study outcomes (all interaction p-values > 0.05). Newly diagnosed prediabetes and T2DM are highly prevalent in patients hospitalized for worsening HFrEF and NYHA functional class II-III. Importantly, they impose independently increased long-term risk of higher all-cause and cardiovascular mortality.

Screening for Diabetic Retinopathy in African Immigrants—The Africans in America Study

The degree to which retinopathy occurs in Africans with abnormal glucose tolerance is unknown. Therefore, the objective of this study was to screen for diabetic retinopathy in self-identified healthy African immigrants. A total of 167 Africans now living in the Washington DC area underwent a medical workup and eye exam at the NIH. Visual acuity, intraocular pressure, slit lamp biomicroscopy and dilated fundus biomicroscopy were performed. Diagnostic testing included color fundus photography, fundus autofluorescence, and optical coherence tomography of the macula and optic nerve. The participants were 41 ± 10 years old (mean ±SD) and duration of stay in the U.S.A was 12 ± 10y. BMI was 28 ± 4 kg/m2, and 17 (10%) participants were being treated for hypertension. OGTT revealed diabetes in 15 (9%) participants, and prediabetes in 58 (35%) participants. Retinopathy was detected in 7 (4.2%) participants, 5 of whom had findings consistent with mild non-proliferative diabetic retinopathy in the setting of diabetes (n=3) or prediabetes (n=2) on OGTT. One participant had a flame shaped hemorrhage due to untreated Stage 2 hypertension, and one participant without vascular risk factors had peripheral dot-blot hemorrhages. Participants with retinopathy were older (49 ± 10 vs. 40 ± 10 years old, p=0.02), had higher systolic BP (140 ± 25 vs. 119 ± 14 mmHg, p&amp;lt;0.001) and higher A1C (6.4 ± 2.2% vs. 5.4 ± 0.6%, p&amp;lt;0.001) than participants without retinopathy. There was no difference in retinopathy rates based on sex, African region, BMI, education level, income, drinking/smoking status, physical activity, or sickle cell/HbC trait status. In short, OGTT testing reveals that African immigrants who self-identify as healthy have high rates of undetected diabetes and prediabetes. Some (4.2%) already have retinopathy, and require annual follow-up to monitor for progression. Vascular risk factors including hypertension and prediabetes were associated with retinopathy, and we would recommend screening at-risk individuals. Disclosure P.G. Christakis: None. J. Kabakambira: None. S.M. Briker: None. C. DuBose: None. A.E. Sumner: None. E. Chew: None.

Emphysematous Pyelonephritis Complicating an Undetected Diabetic Female: A Case Report

A case of emphysematous pyelonephritis is reported here. A middle aged Bangladeshi lady presented with fever and left loin pain. She had tachycardia, dehydration and left renal angle tenderness. Investigations revealed diabetes mellitus, left renal stone and left sided emphysematous pyelonephritis complicated by acute kidney injury. She required nephrectomy along with antibiotics. Emphysematous pyelonephritis almost exclusively occurs in diabetic patients and rarely emphysematous pyelonephritis may unmask undetected diabetes as in the present case. Renal stone is also recognized risk factor for emphysematous pyelonephritis.J Bangladesh Coll Phys Surg 2018; 36(2): 80-81

A study on the altered glycemic and lipid parameters and prevalence of insulin resistance in nonalcoholic fatty liver disease.

Introduction:Nonalcoholic fatty liver disease (NAFLD) is a hepatic disorder that develops in the absence of alcohol intake. Obesity and diabetes are considered risk factors for the development of fatty liver; however, whether fatty liver is the cause or consequence of these conditions is not yet clear. Insulin resistance (IR) is found to be a common risk factor for the development of diabetes, obesity and fatty liver.Aims and Objectives:The aim and objective of this study is to determine the prevalence of undetected diabetes, dyslipidemia, and IR in subjects with NAFLD.Materials and Methods:In apparently healthy 100 subjects, with ultrasound diagnosis of fatty liver, fasting and postprandial blood sugar levels, fasting insulin levels, and fasting lipid profile were checked. IR value was estimated using homeostatic model assessment-IR formula. Appropriate statistical methods were adopted to analyze the data.Results:A total of 66 subjects out of the 100 had IR. It was noted that IR significantly correlated with raised fasting blood sugar and fasting plasma insulin values. There was no significant correlation between IR and lipid profile values.Conclusion:The chance of developing NAFLD was high if the subjects are having IR, or vice versa. There was an increased prevalence of prediabetes and diabetes in the subjects with NAFLD. Waist circumference, rather than body mass index, was found to be a strong predictor of central adiposity and IR.

Differential associations between diet and prediabetes or diabetes in the KORA FF4 study.

Type 2 diabetes mellitus (T2DM) is a global public health epidemic. Diet and lifestyle changes have been demonstrated as effective measures in managing T2DM and preventing or delaying the progression from prediabetes to diabetes, yet the relationship between diet, prediabetes and diabetes is still not entirely clear. The present study aimed to further elucidate the relationship between diet, diabetes and especially prediabetes. A total of 1542 participants of the cross-sectional, population-based Cooperative Health Research in the Region of Augsburg (KORA) FF4 study (2013/2014) were included in this analysis. Dietary intake was derived using a method combining information from a FFQ and repeated 24-h food lists. Glucose tolerance status was assessed via oral glucose tolerance tests in all participants without a previous physician-confirmed diagnosis of T2DM, and was classified according to the 2003 American Diabetes Association criteria. Crude and fully adjusted multinomial logistic regression models were fitted to examine associations between diet and prediabetes, undetected diabetes mellitus (UDM) and prevalent T2DM. After adjusting for major covariates, fruit was significantly inversely and total meat, processed meat, sugar-sweetened beverages and moderate alcohol significantly associated with UDM and/or prevalent diabetes. Sex-specific analyses showed that in men, coffee was significantly inversely (OR 0·80; 95% CI 0·67, 0·96) and heavy alcohol significantly (OR 1·84; 95% CI 1·14, 2·95) associated with prediabetes. Our findings on diet and T2DM are consistent with current literature, while our results regarding coffee, heavy alcohol consumption and prediabetes highlight new possible targets for primary prevention of the derangement of glucose homeostasis.

Detection And Management Of Diabetes In England: Results From The Health Survey For England

As part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of South-east Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings. Data were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socio-economic gradient in disease detection and control among and between ethnic groups. In regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis. In the UK current guidance recommends practitioners consider testing for diabetes among South-east Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.

Corneal Endotheleal Cells Changes after Phacoemulsification in Type II Diabetes Mellitus

Background: Corneal endothelial cells are responsible for the clarity of the cornea; however, endothelial cells have limited cell division ability. Studies have proven that cornea is more vulnerable to chronic changes affecting endothelial cells in diabetic patients. Cataract extraction by phacoemulsification is one of the most ophthalmic surgeries having a negative effect on the corneal endothelial cells especially in elders. Age of the patient and diabetes mellitus have a negative effect on the outcome of phacoemulsification. The aim of the study is to compare the changes occur in corneal endothelium pre and post cataract extraction by phacoemulsification in diabetic patients in aspects of BCVA, CCT, CD, CV and HEX. Aim of the work: To assess endothelial cells changes following cataract extraction by phacoemulsification and posterior chamber IOL implantation in type II diabetic patients. Methods: The study included 20 eyes of 20 patients scheduled for cataract surgery by phacoemulsification at Al Azhar university hospitals. The patients were assigned to 2 groups. Group 1: Ten patients without diabetes were used as a control group, and a casual blood glucose test and glucose tolerance test were undertaken in accordance with the recommendations of the American Diabetes Association to disclose undetected diabetes. Group 2: Ten patients diagnosed with type II diabetes based on medical history and all were on oral anti-diabetic medication or subcutaneous treatment with insulin. Serum glycosylated hemoglobin (HbA1c) was obtained in all patients with diabetes to evaluate their glycemic status.In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy ( Topcon SP- 1P,Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, in group 1 the CCT mean ±SD in preoperative is 510.7 ±35.13, in 1 month postoperative is 522.1 ±35.91 and in 6 months postoperative is 512 ±34.91, the difference between preoperative CCT and 6 months postoperative is 1.3 ±0.95. In group 2 the CCT mean ±SD in preoperative is 497.45 ±25.82, in 1 month postoperative 515.64 ±26.59 and in 6 months postoperative is 500.18 ±25.5, the difference between preoperative CCT and 6 months postoperative is 2.73 ±1.64. In term of CD, in group 1 the CD mean ±SD in preoperative is 2678 ±390, in 1 month postoperative is 2599 ±378 and in 6 months postoperative is 2571 ±355, the difference between preoperative CD and 6 months postoperative is -107.17 ±15.53. In group 2 the CD mean ±SD in preoperative is 2872 ±335, in 1 month postoperative is 2703 ±326 and in 6 months postoperative is 2441 ±284, the difference between preoperative CD and 6 months postoperative is -430.8 ±50.31. In term of CV, in group 1 the CV mean ±SD in preoperative CV is 34.4 ±2.95, in 1 month postoperative is 35.2 ±3.05 and in 6 months postoperative is 35 ±2.6, the difference between preoperative CV and 6 months postoperative is 0.7 ± 1.34 which is statistically insignificant. In group 2 the CV mean ±SD in preoperative CV is 36 ±3, in 1 month postoperative is 37 ±3.16 and in months postoperative is 36 ±3.2, the difference between preoperative CV and 6 months postoperative is -0.3 ±1.64 which is statistically insignificant. In term of HEX, in group 1 the HEX mean ±SD in preoperative is 34 ±8, in 1 month postoperative 29 ±7 and in 6 months postoperative 28 ±7, the difference between preoperative and 6 months postoperative is -6.2 ±1.55 which is statistically significant. In group 2 the mean HEX mean ±SD in preoperative is 33 ±10, in 1 month postoperative is 25 ±7 and in 6 months postoperative is 24 ±7, the difference between preoperative HEX and 6 months postoperative is -8.7 ±2.58 which is statistically significant. In term of BCVA, in group 1 the BCVA mean ±SD in preoperative is 0.15 ±0.05, in 1 month postoperative is 0.38 ±0.11 and in 6 months postoperative is 0.5 ±0.07, the difference between preoperative BCVA and 6 months postoperatively is statistically significant. In group 2 the BCVA mean ±SD in preoperative is 0.128 ±0.034, in 1 month postoperative is 0.285 ±0.0369 and in 6 months postoperative is 0.392 ±0.093, the difference between preoperative BCVA and 6 months postoperatively is statistically significant. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical trauma and has a lower capability in the process of repair.

Detection and Management of Diabetes in England: Results from the Health Survey for England.

IntroductionAs part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of South-east Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings.MethodsData were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socio-economic gradient in disease detection and control among and between ethnic groups.ResultsIn regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis.ConclusionIn the UK current guidance recommends practitioners consider testing for diabetes among South-east Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.

Perceived risk of diabetes seriously underestimates actual diabetes risk: The KORA FF4 study.

ObjectiveEarly detection of diabetes and prediabetic states is beneficial for patients, but may be delayed by patients´ being overly optimistic about their own health. Therefore, we assessed how persons without known diabetes perceive their risk of having or developing diabetes, and we identified factors associated with perception of diabetes risk.Research design and methods1,953 participants without previously known diabetes from the population-based, German KORA FF4 Study (59.1 years, 47.8% men) had an oral glucose tolerance test. They estimated their probability of having undiagnosed diabetes mellitus (UDM) on a six category scale, and assessed whether they were at risk of developing diabetes in the future. We cross-tabulated glycemic status with risk perception, and fitted robust Poisson regression models to identify determinants of diabetes risk perception.Results74% (95% CI: 65–82) of persons with UDM believed that their probability of having undetected diabetes was low or very low. 72% (95% CI: 69–75) of persons with prediabetes believed that they were not at risk of developing diabetes. In people with prediabetes, seeing oneself at risk of diabetes was associated with self-rated poor general health (prevalence ratio (PR) = 3.1 (95% CI: 1.4–6.8), parental diabetes (PR = 2.6, 1.9–3.4), high educational level (PR = 1.9 (1.4–2.5)), lower age (PR = 0.7, 0.6–0.8, per 1 standard deviation increase), female sex (PR = 1.2, 0.9–1.5) and obesity (PR = 1.5, 1.2–2.0).ConclusionsPeople with undiagnosed diabetes or prediabetes considerably underestimate their probability of having or developing diabetes. Contrary to associations with actual diabetes risk, perceived diabetes risk was lower in men, lower educated and older persons.

How to improve opportunistic screening by using EMRs and other data. The prevalence of undetected diabetes mellitus in target population in Croatia

ObjectivesOpportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record. Study designWe conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45–70 years. MethodsFirst, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase. Second, those with data about normoglycemia in past three years were excluded. Remaining patients started the consultation phase during their usual visit, when they were offered capillary fasting plasma glucose testing in the next consultation. ResultsPrevalence of T2D was 10.9% (new 1.4%). A total of 5568 (46.1%) patients had risks and 2849 (51.2%) had data about normoglycemia in the last three years. Using those data, number needed to invite to screening (NNI) was reduced to half: from 46.1% to 22.5%. One hundred eighty-four patients were screened positive for T2D in two capillary fasting plasma glucose tests (yield 9.8%). Number needed to screen (NNS) in order to detect one T2D was 10.3 patients. Among risks for T2D, overweight was the best predictive factor for undiagnosed T2D (odds ratio [OR]: 2.11, confidence interval [CI]:1.41–3.15, P < .001). Logistic regression showed that in targeted population, overweight patients with a family history in fold were 2.5 times more likely to have T2D (OR: 2.54, CI 1.78–.61, P < .001). ConclusionsTotal yield in targeted population was 1,4%. By using data about normoglycemia from EMRs, NNI was reduced by half and NNS was 10.3 patients. Our findings suggest the model for improvement in opportunistic screening.

Hearing Impairment and Undiagnosed Disease: The Potential Role of Clinical Recommendations.

The objective of this study was to use cross-sectional, nationally representative data to examine the relationship between self-reported hearing impairment and undetected diabetes, hypertension, hypercholesterolemia, and chronic kidney disease. We analyzed the National Health and Nutrition Examination Survey for the years 2007-2012 for individuals 40 years of age and older without previously diagnosed cardiovascular disease. Analyses were conducted examining hearing impairment and undiagnosed disease. The unweighted sample size was 9,786, representing 123,444,066 Americans. Hearing impairment was reported in 10.2% of the individuals. In unadjusted analyses, there was no significant difference between adults with hearing impairment and adults with typical hearing for undiagnosed diabetes, hypertension, or hypercholesterolemia. A higher proportion of adults with hearing impairment than adults with typical hearing had undiagnosed chronic kidney disease (20.1% vs. 10.7%; p = .0001). In models adjusting for demographics and health care utilization, hearing impairment was associated with a higher likelihood of having undiagnosed chronic kidney disease (odds ratio = 1.53, 95% CI [1.23, 1.91]). Individuals with hearing impairment are more likely to have undiagnosed chronic kidney disease. Hearing impairment may affect disclosure of important signs and symptoms as well as the comprehension of medical conversations for chronic disease management. General practitioners can play a critical role in improving medical communication by responding with sensitivity to the signs of hearing impairment in their patients.

Prevalence of hypertension and diabetes and their determinants among commercial drivers in Ibadan metropolis, South-Western Nigeria

Introduction: Undetected hypertension and diabetes could result in cardiovascular and cerebrovascular complications and may result in fatal road accidents if they occur while driving. Commercial drivers are prone to risk factors for these diseases. This study determined the prevalence of hypertension and diabetes among commercial drivers in Ibadan metropolis, South-western Nigeria. Methodology: A cross-sectional study was conducted among 305 commercial drivers selected using multistage sampling technique from motor parks across Ibadan metropolis. The WHO stepwise interviewer-administered questionnaire was used for data collection on respondents' sociodemographic characteristics, work-related characteristics, knowledge about hypertension and diabetes, physical activity, alcohol consumption, and tobacco use. Blood pressure, anthropometry, and blood sugar level measurements were carried out. Hypertension was defined as systolic blood pressure of ≥140 mmHg and diastolic blood pressure of ≥90 mmHg and diabetes was defined as ≥126 mg/dl fasting blood sugar. Data were analyzed using descriptive statistics, Chi-square test. and logistic regression at α = 5%. Results: Mean age of respondents was 45.3 ± 10.5 years. About 47.5% and 37.8% demonstrated good knowledge about hypertension and diabetes, respectively. About 49% reported to have ever smoked, 78.0% had consumed alcohol, 45.5% ever had traffic accident, and 44.6% reported physical inactivity. The prevalence of hypertension was 27.7% and diabetes was 3.4% while 42.9% had comorbidity. Hypertension was found among 26.2% of those who had ever smoked and 47.2% of those obese (body mass index ≥30 kg/m2). Age ≥41 years (adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] = 0.99–5.88) and abdominal obesity (aOR = 2.41, 95% CI = 0.99–5.83) were predictors of hypertension, and frequent fruit consumption was predictor of diabetes (aOR = 2.71, 95% CI = 0.23–32) although not significant. Conclusions: High prevalence of hypertension and relatively low prevalence of diabetes among commercial drivers in Ibadan metropolis call for health awareness campaign and free health screening in motor parks for early detection and prevention of the diseases.

Risk factors for hearing impairment among adults with diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

AimThe aim was to examine risk factors for hearing impairment among Hispanic/Latino adults with diabetes. MethodsFindings are based on 3384 participants aged 18–76 years with diagnosed or previously undetected diabetes who completed audiometric testing as part of the Hispanic Community Health Study/Study of Latinos. We defined hearing impairment as the pure-tone average (PTA) >25 decibels hearing level [dB HL] of pure-tone thresholds at high frequencies (3000, 4000, 6000, and 8000 Hz) in the worse ear and defined a second hearing impairment outcome with the additional requirement of PTA >25 dB HL of low/mid-frequency (500, 1000, and 2000 Hz) thresholds in the worse ear. We identified independent associations using logistic regression. ResultsControlling for age and Hispanic/Latino background, prevalence ratios for hearing impairment in the high plus low/mid frequencies were 1.35 (95% CI 1.07, 1.71) for current smoking, 1.64 (1.14, 2.38) for alcohol consumption (≥14 drinks/week for men or ≥ 7 drinks/week for women), and 1.29 (1.06, 1.56) for triglycerides ≥ 150 mg/dL. For high-frequency only hearing impairment, the prevalence ratio for estimated glomerular filtration rate 30–59 mL/min/1.73 m2 was 1.23 (1.03, 1.47) adjusted for age and sex. People with family income less than $20,000 had almost twice the prevalence of hearing impairment (PR = 1.93 (1.34, 2.78)) as people with income over $40,000. ConclusionsCurrent smoking, alcohol consumption, high triglycerides, and chronic kidney disease are potentially preventable correlates of hearing impairment for persons with diabetes. Low income is a marker of increased likelihood of hearing impairment.

Diabetes Mellitus and Its Association to the Occurrence of Medication-Related Osteonecrosis of the Jaw.

To date there is no consensus on the role of diabetes in the development of medication-related osteonecrosis of the jaws (MR-ONJ). Therefore, this study aimed to investigate the prevalence of diabetes and pathological glucose metabolism in patients with MR-ONJ compared to the general population. All maxillofacial surgery inpatients in one year at our department were investigated regarding diagnosis, anamnesis, medication, and blood glucose readings. 1374 records were analyzed. 35 patients with MR-ONJ were identified. Diabetics accounted for 14.3%. No significant difference in the prevalence of known diabetes was found, except for pathological glucose metabolism in patients with MR-ONJ (p < 0.001). Diabetes does not necessarily promote the onset of MR-ONJ. Therefore, diabetes should not be considered as a standalone risk factor. On the contrary, hyperglycemia as a possible indicator for poorly managed or yet undetected diabetes is associated with MR-ONJ.

Direct costs in impaired glucose regulation: results from the population-based Heinz Nixdorf Recall study

ObjectiveFor the first time, this population-based study sought to analyze healthcare utilization and associated costs in people with normal fasting glycemia (NFG), impaired fasting glycemia (IFG), as well as previously...