Undiagnosed Impaired Fasting Glucose Research Articles

Factors associated with undiagnosed type II diabetes mellitus, undiagnosed impaired fasting glucose and these patients' quality of life in Lebanon.

To assess the association between undiagnosed impaired fasting glucose (UIFG) and diabetes (UD), their risk factors and the patients' knowledge about diabetes and their quality of life (QOL). A cross-sectional study was conducted between May and September 2017 in four laboratories enrolling 495 patients. We used the Diabetes Knowledge and SF-12 questionnaires to assess the patients' knowledge about diabetes and QOL. This study meets the Wilson and Jungner criteria for disease screening. A higher knowledge score (ORa = 0.85) was significantly associated with the absence of diabetes compared to UPD, whereas an increased age (ORa = 1.2) and a positive family history of diabetes (ORa = 1.81) were significantly associated with higher odds of UPD. An increased knowledge score (ORa = 0.55) was significantly associated with an absence of diabetes compared to UD, whereas an increased BMI (ORa = 1.40) and an increased age (ORa = 1.07) were associated with increased odds of having UD.UD (Beta = -5.799) was significantly associated with decreased total physical component QOL score, whereas increased diabetes knowledge score (Beta = 0.415) was significantly associated with increased physical QOL. A higher diabetes knowledge score (Beta = 0.459) were associated with increased mental QOL. Seeing the relatively high percentage of UD and UIFG, we propose that screening should be considered and subject to proper assessment in the light of the findings of this study.

The development and validation of the Portuguese risk score for detecting type 2 diabetes and impaired fasting glucose

AimsTo develop and validate a non-invasive score for detecting undiagnosed impaired fasting glucose (IFG) and type 2 diabetes (T2DM) in a Portuguese population. MethodsWe used data from 3,374 individuals aged 18–94 years from a Portuguese cross-sectional study. We developed a logistic regression model for predicting IFG/T2DM (diagnosed using fasting glucose). We externally validated the score using data from two cohorts of the EPI-Porto study, cross-sectional (n=2,131) and data from the 5 year follow-up (n=1,304). ResultsThe final model included age, sex, BMI and hypertension with an area under the ROC curve of 70.1 (95%CI 68.4, 71.7). Using a cut-point which classifies 50% of the EPI-Porto cross-sectional data as high-risk gave sensitivity 73.2% (95%CI 68.5%, 77.6%), specificity 55.5% (53.1%, 57.8%), positive predictive value (PPV) 27.0% (24.3%, 29.8%) and negative predictive value (NPV) 90.2% (88.3%, 92.0%) for IFG/T2DM. Using the same cut-point on the prospective data classified 45% as high-risk; sensitivity 69.1% (63.4%, 74.4%), specificity 63.3% (60.0%, 66.5%), PPV 38.0% (33.9%, 42.4%), and NPV 86.2% (83.3%, 88.8%). ConclusionThe Portuguese risk score can be used to identify those at high risk of both prevalent undiagnosed and incident IFG/T2DM.

Prevalence of obesity and metabolic syndrome components in Mexican adults without type 2 diabetes or hypertension.

To describe the number of Mexican adults with undiagnosed diabetes and arterial hypertension and their association with obesity. The study included a sub-sample of 6 613 subjects aged 20 years or more who participated in the 2006 National Health and Nutrition Survey (ENSANUT 2006). Subjects with a previous diagnosis of diabetes or hypertension (n=1 861) were excluded. Prevalences and standard errors were estimated, taking into account the complex sample design. 6.4 million adults have obesity and undiagnosed impaired fasting glucose. Almost two million more have fasting glucose levels diagnostic for diabetes. As for arterial blood pressure, 5.4 million adults had prehypertension. Another 5.4 million adults had blood pressure levels suggestive of probable hypertension. A total of 21.4 million Mexican adults with obesity had at least one further component of the metabolic syndrome. A large proportion of adults with obesity-related metabolic comorbidities remains undiagnosed in Mexico.

Changes in Insulin Sensitivity and Glucose and Bone Metabolism over Time in Patients with Asymptomatic Primary Hyperparathyroidism

The clinical profile of asymptomatic primary hyperparathyroidism (PHPT) has shifted from a symptomatic disorder toward a more subtle, asymptomatic state. The lack of knowledge about the natural course of asymptomatic PHPT contributes to the controversy regarding the optimal management of these patients. The aim of this study is to evaluate the natural course of calcium and glucose metabolism abnormalities, insulin sensitivity, and bone mineral density (BMD) in subjects with asymptomatic PHPT over 18 months. The study was designed as a prospective observational examination of asymptomatic PHPT patients at baseline and at 6-month intervals for 18 months. Our study examined 61 patients with asymptomatic PHPT and 80 healthy control subjects matched for age, sex, and body mass index. We evaluated calcium metabolism, glucose metabolism by oral glucose tolerance test, insulin sensitivity by homeostasis model assessment index, and BMD by dual-energy x-ray absorptiometry at distal radius, lumbar spine, and femur. Although in asymptomatic PHPT patients, homeostasis model assessment index at baseline was slightly higher than in controls (3.0 +/- 2.2 vs. 2.2 +/- 1.3; P = 0.035), the prevalence of preexisting diabetes mellitus (13.1 vs. 11.3%), undiagnosed impaired fasting glucose (34.4 vs. 30%), impaired glucose tolerance (13.1 vs. 18.8%), and newly diagnosed diabetes mellitus (4.9% vs. 2.5%) was similar. Baseline BMDs (g/cm2) at all three sites were not different between two groups. Six-month interval measurements showed no change in calcium metabolism parameters including serum calcium, phosphorus, 25-hydroxyvitamin D, and 24-h calcium excretion. No significant longitudinal adverse changes were noted in glucose metabolism, insulin sensitivity, or BMD at any site over the 18-month observation period. Our follow-up of patients with asymptomatic PHPT revealed no progression of calcium and glucose metabolism abnormalities, insulin sensitivity, and loss of BMD during the 18-month study period.

Frequency of undiagnosed and untreated diabetes mellitus in patients with acute coronary syndromes

The current epidemic of obesity warrants aggressive screening for associated comorbid conditions; namely, the metabolic syndrome and diabetes mellitus. Approximately 25–30% of patients with acute coronary syndrome have diabetes. Of the remaining patients, most have a spectrum of abnormal glucose metabolism, including previously undiagnosed impaired fasting glucose and diabetes mellitus. This article reviews the current literature and the author’s own experience of this subject, as well as highlighting effective new agents in treating diabetes.

Value of the Oral Glucose Tolerance Test in the Evaluation of Chronic Idiopathic Axonal Polyneuropathy

An underlying cause is found in only 7% to 30% of patients with chronic idiopathic axonal polyneuropathy (CIAP). Diabetes mellitus, inherited disorders, toxin exposure, and primary amyloidosis are the most common identified causes of sensory neuropathies affecting both large and small myelinated fibers. Undiagnosed impaired fasting glucose metabolism has been associated with CIAP at a higher frequency rate than in the general population. This increased prevalence rate was identified using the 2-hour oral glucose tolerance test (2h-OGTT) and a previous version of the American Diabetes Association (ADA) guidelines. To determine the prevalence of abnormal fasting glucose metabolism in patients with CIAP and to compare the value of determining fasting plasma glucose levels using revised (2003) ADA criteria with the 2h-OGTT for predicting abnormal fasting glucose metabolism. In this 24-month retrospective study, 100 consecutive patients were identified with no known cause for CIAP, including diabetes mellitus, between January 2003 and January 2005. All had both a fasting plasma glucose test and a 2h-OGTT in addition to a complete neurological examination. Neurophysiological studies, computer-assisted sensory examination, and quantitative sudomotor axonal reflex testing were used to classify CIAP into subtypes according to nerve fiber involvement. The prevalence of undiagnosed abnormal fasting glucose metabolism was found to be nearly 2-fold higher (62%) in patients with CIAP than in similar age-matched general population groups (33%). Using the 2003 revised ADA criteria, 39 patients (39%) had abnormal fasting plasma glucose metabolism (36 with impaired fasting glucose, 3 with diabetes mellitus), while the 2h-OGTT provided an even higher diagnostic rate of 62% (62 patients; P<.001) of impaired fasting glucose metabolism (38 with impaired glucose tolerance, 24 with diabetes mellitus). The abnormal glucose metabolism rates were found to be similar across the 3 subtypes (sensorimotor, pure sensory, and small-fiber neuropathy) of CIAP (P = .60, .72, and .61). This study adds to emerging evidence that abnormal glucose metabolism may be a risk factor for CIAP. Even with revised (2003) ADA criteria, the 2h-OGTT provides additional diagnostic information to the health care professional in the evaluation of CIAP. Subtypes of CIAP are equally likely to have abnormal glucose metabolism.

Undiagnosed impaired fasting glucose and diabetes mellitus amongst inpatients receiving antipsychotic drugs

The associations between psychosis, antipsychotic drugs and diabetes mellitus have not been precisely defined but it has been repeatedly suggested that atypical antipsychotics are more likely to give rise to diabetes than are conventional drugs. This belief is largely based on healthcare database analyses which, in part, rely on the assumption that all cases of diabetes are identified in practice. We examined records of 606 hospitalized patients receiving antipsychotic treatment and found an apparent prevalence of diabetes and impaired fasting glucose of 6.4%. From this sample of patients, we investigated 166 patients (fasting blood samples) who were not known to have any disorder of glucose homeostasis and identified 10 cases of impaired fasting glucose and nine cases of diabetes mellitus (11.4% of those tested). Nine of these cases had documented evidence of previous testing for diabetes. Apparent prevalence of diabetes and impaired fasting glucose was 16.9% in those tested in practice or the study. Diagnosis was significantly associated with age [odds ratio (OR) 1.02] and treatment duration with current drug (OR 1.01). Adjusted ORs of diagnosis were not significantly different for any atypical antipsychotic compared with conventional drugs. It is concluded that there was a clinically significant prevalence of undiagnosed diabetes and impaired fasting glucose in those individuals receiving antipsychotics. Importantly, database analyses may underestimate the true prevalence of diabetes in similar populations and erroneously ascribe increased risk to certain drug treatments.

Impaired fasting glucose in hypertensive patients

To determine the prevalence of multiple risk factors for CAD, especially previously undetected IFG and diabetes mellitus, in a sample of treated hypertensive patients. We conducted this cross-sectional study on 108 patients, 50 years and older, with essential hypertension within an urban academic outpatient primary care practice. We obtained blood pressure measurements and laboratory data, including fasting glucose and lipid values from all subjects. We reviewed the outpatient medical record to determine CAD risk factors and current antihypertensive medications. We totaled the number of CAD risk factors to derive a CAD risk score. The mean result of RIA on two timed overnight urine specimens was used to determine the presence of microalbuminuria in patients. To analyze the data, we stratified the entire sample according to the presence or absence of impaired fasting glucose, then used two-tailed unpaired t-tests to compare parameters between the two groups. Pearson's correlation coefficient was calculated to examine the relationship between FBG, UAE, BMI, lipid values, and the CAD risk score. The analysis was adjusted for patient usage of antiproteinuric medications. We detected previously undiagnosed impaired fasting glucose in 13.9% of subjects. HDL score was significantly lower in subjects with IFG. The FBG value directly and strongly correlated with the degree of CAD risk. Impaired fasting glucose (prediabetes) and diabetes mellitus occur with increased frequency in hypertensive patients. IFG and diabetes in hypertension are associated with greater cardiovascular risk.