Undiagnosed T2DM Research Articles

Analysis of risk factors and clinical implications for diabetes in first-degree relatives in the northeastern region of China.

The prevalence of diabetes has risen fast with a considerable weighted prevalence of undiagnosed diabetes or uncontrolled diabetes. Then it becomes more necessary to timely screen out and monitor high-risk populations who are likely to be ignored during the COVID-19 pandemic. To classify and find the common risks of undiagnosed diabetes and uncontrolled diabetes, it's beneficial to put specific risk control measures into effect for comprehensive primary care. Especially, there is a need for accurate yet accessible prediction models. Based on a cross-sectional study and secondary analysis on the health examination held in Changchun City (2016), we aimed to evaluate the factors associated with hyperglycemia, analyze the management status of T2DM, and determine the best cutoff value of incidence of diabetes in the first-degree relatives to suggest the necessity of early diagnosis of diabetes after first screening. A total of 5658 volunteers were analyzed. Prevalence of T2DM and impaired fasting glucose were 8.4% (n=477) and 11.5% (n=648), respectively. There were 925 participants (16.3%) with a family history of T2DM in their first-degree relatives. Multivariable analysis demonstrated that family history was associated with hyperglycemia. Among the 477 patients with T2DM, 40.9% had not been previously diagnosed. The predictive equation was calculated with the following logistic regression parameters with 0.71 (95% CI: 0.67-0.76) of the area under the ROC curve, 64.0% of sensitivity and 29% of specificity (P < 0.001): P = \frac{1}{1 + e^{-z}}, where z = -3.08 + [0.89 (Family history-group) + 0.69 (age-group)+ 0.25 (BMI-group)]. Positive family history was associated with the diagnosis of T2DM, but not glucose level in the diagnosed patients. The best cutoff value of incidence of diabetes in the first-degree relatives was 9.55% (P < 0.001). Family history of diabetes was independently associated with glucose dysfunction. Classification by the first-degree relatives with diabetes is prominent for targeting high-risk population. Meanwhile, positive family history of diabetes was associated with diabetes being diagnosed rather than the glycemic control in patients who had been diagnosed. It's necessary to emphasize the linkage between early diagnosis and positive family history for high proportions of undiagnosed T2DM.

Vericiguat and Cardiovascular Outcomes in Heart Failure by Baseline Diabetes Status: Insights From the VICTORIA Trial

BackgroundType 2 diabetes mellitus (T2DM) significantly worsens heart failure (HF) prognosis. ObjectivesThis study sought to investigate the impact of T2DM on outcomes in patients enrolled in VICTORIA and assess the efficacy of vericiguat in patients with and without T2DM. MethodsPatients with HF with reduced ejection fraction were randomized to receive vericiguat or placebo in addition to standard therapy. The primary outcome was a composite of cardiovascular death or first heart failure hospitalization (HFH). A Cox proportional hazards model was used to calculate HRs and 95% CIs to assess if the effect of vericiguat differed by history of T2DM. ResultsOf 5,050 patients enrolled, 3,683 (72.9%) had glycosylated hemoglobin (HbA1c) measured at baseline. Of these, 2,270 (61.6%) had T2DM, 741 (20.1%) had pre-T2DM, 449 (12.2%) did not have T2DM, and 178 (4.8%) had undiagnosed T2DM. The risks of the primary outcome, HFH, and all-cause and cardiovascular mortality were high across all categories. The efficacy of vericiguat on the primary outcome did not differ in patients stratified by T2DM by history (HR: 0.92; 95% CI: 0.81-1.04), T2DM measured by HbA1c (HR: 0.77; 95% CI: 0.49-1.20), and pre-T2DM measured by HbA1c (HR: 0.88; 95% CI: 0.68-1.13) and in those with normoglycemia (HR: 1.02: 95% CI: 0.75-1.39; P for interaction = 0.752). No significant differences were observed in subgroups with respect to the efficacy of vericiguat on HFH and all-cause or cardiovascular death. ConclusionsIn this post hoc analysis of VICTORIA, vericiguat compared with placebo significantly reduced the risk of cardiovascular death or HFH in patients with worsening HF with reduced ejection fraction regardless of T2DM status. (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction [HFrEF] [Mk-1242-001] [VICTORIA]; NCT02861534)

To access the prevalence of undiagnosed type 2 diabetes mellitus in patients with acute coronary syndrome.

Objective: To access the prevalence of undiagnosed type 2 Diabetes Mellitus in patients with Acute Coronary Syndrome. Study Design: Cross-sectional study. Setting: Department of Medicine, of Tertiary Care Hospital of Islamabad. Period: 17th July 2023 to 17th October 2023. Material &amp; Methods: WHO calculator was used to calculate the sample size and 100 subjects were selected fulfilling the inclusion criteria (Both male and female of age 18 to 65 years retained in ER or admitted with the diagnosis of ACS). Blood samples were obtained for baseline investigations including blood sugar and HBA1C. Results were entered on EXCEL Sheets and analyzed using SPSS V.20. Results: The data showed 47% males, 70% of the participants belonging to the age group 41-65 years ACS presenting with STEMI in 37%, 40% patients with NSTEMI and unstable angina was found in 23%. The Mean BMI was 27±3.2SD mean HBA1C level was 4.3±1.7SD and the mean FBG was 129±17.9SD. Among all the male patients, there were (27.65%) patients with undiagnosed T2DM while among all the female patients, (18.8%) were reported with undiagnosed T2DM. Conclusion: A high prevalence of undiagnosed DM was observed in ACS patients admitted to tertiary care hospital. Research work done in developing countries showed data which was consistent with our study, however, research data from developed world was in contrast to our study.

Abstract MP60: Prediabetes and Undiagnosed Diabetes Predisposing Women to Excess Risk of Cardiovascular Disease

Objective: Women with type 2 diabetes (T2DM) have a 25-50% higher risk of cardiovascular disease (CVD) than their men counterparts. The reasons for this sex disparity are incompletely understood. We sought to examine if pre-diabetes (preDM) and undiagnosed T2DM are associated with a greater magnitude of CVD risk in women than in men. Methods: We pooled CVD-free individuals (N=18,745) from the Atherosclerosis Risk in Communities, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. CVD outcomes included incident coronary heart disease (CHD) (myocardial infarction, CHD death, or cardiac procedures including percutaneous coronary interventions, bypass surgery, or coronary revascularization), stroke (ischemic or hemorrhagic stroke), and a composite atherosclerotic CVD (ASCVD) (any CHD condition or stroke). Multivariable Cox models examined the outcomes associated with preDM (fasting glucose [FG] 100-125 mg/dL or HbA1c 5.7-6.4%) or undiagnosed T2DM (FG ≥126 mg/dL or HbA1c ≥6.5% and without a DM diagnosis or anti-diabetes medication use) adjusted for age, race/ethnicity, education, BMI, blood pressure, total cholesterols, smoking, anti-hypertensive and lipid-lowering medications, and cohort indicator. An interaction term sex x preDM or undiagnosed DM was added to models to test the sex modifying effect. We consider p-interaction&lt;0.2 as significant. Results: During a median follow-up of 17 years, the adjusted model showed that preDM was significantly associated with a higher risk of CHD (Hazard ratio 1.09, 95%CI 1.04-1.14), stroke (1.08, 1.04-1.13), and ASCVD (1.09, 1.04-1.14) in women, but not in men (1.04, 0.99-1.1 for CHD, 1.03, 0.98-1.08 for stroke, and 1.03, 0.98-1.09 for ASCVD, respectively). Undiagnosed T2DM was significantly associated with the risk of CHD (1.27, 1.16-1.4 in women and 1.17, 1.05-1.3 in men), stroke (1.32, 1.21-1.45 in women and 1.2, 1.09-1.32 in men), and ASCVD (1.27, 1.16-1.4 in women and 1.15, 1.03-1.29 in men) in both sexes but with more pronounced effect in women (P-interactions ≤0.11). In racial-stratified analysis, a higher magnitude of CVD risk associated with preDM or undiagnosed DM was also found in non-Hispanic (NH) white women and NH-black women than in their men counterparts. Conclusions: PreDM and undiagnosed DM predispose women to excess CVD risk, possibly due to women’s higher susceptibility to metabolic dysfunction at a lower glucose level and the prolonged unmanaged time for risk factors relative to men. T2DM screening and risk factor control should be enhanced in both sexes to reduce future CVD risk, particularly in women.

Pharmacy diabetes screening trial (PDST): Outcomes of a national clustered RCT comparing three screening methods for undiagnosed type 2 diabetes (T2DM) in community pharmacy

AimsTo compare the effectiveness of three pharmacy-based screening methods for type 2 diabetes (T2DM): (1) risk assessment (AUSDRISK) alone (Group A); AUSDRISK followed by a point of care test if AUSDRISK ≥12; either (2) HbA1c (Group B); or (3) small capillary blood glucose test (Group C). MethodsA cluster RCT with a nationally representative sample of Australian pharmacies was implemented with random allocation of eligible pharmacies to Groups A, B or C. GP referral was based on prespecified cut offs. Diagnoses were considered positive if confirmed by a GP, pathology laboratory, or national diabetes register. ResultsOf the 14,093 people screened in 339 pharmacies, 3059 participants met group-specific referral criteria: 1775 (45%) (Group A); 893 (17%) (Group B); and 391 (8%) (Group C). For the total screened population rates of T2DM diagnoses were significantly higher in Group B (1.5%), compared with Groups A (< 0.8%) and C (< 0.6%) with the odds of detection in Group B compared with Group A (1.8 [1.0;3.0]), and no difference between Groups A and C. ConclusionsIn community pharmacy, the most effective method to uncover undiagnosed T2DM was a stepwise approach; initial risk assessment; and if appropriate an HbA1C POC test and referral.

Development and External Validation of a Multivariable Prediction Model to Identify Nondiabetic Hyperglycemia and Undiagnosed Type 2 Diabetes: Diabetes Risk Assessment in Dentistry Score (DDS)

The aim of this study was to develop and externally validate a score for use in dental settings to identify those at risk of undiagnosed nondiabetic hyperglycemia (NDH) or type 2 diabetes (T2D). The Studies of Health in Pomerania (SHIP) project comprises 2 representative population-based cohort studies conducted in northeast Germany. SHIP-TREND-0, 2008 to 2012 (the development data set) had 3,339 eligible participants, with 329 having undiagnosed NDH or T2D. Missing data were replaced using multiple imputation. Potential covariates were selected for inclusion in the model using backward elimination. Heuristic shrinkage was used to reduce overfitting, and the final model was adjusted for optimism. We report the full model and a simplified paper-based point-score system. External validation of the model and score employed an independent data set comprising 2,359 participants with 357 events. Predictive performance, discrimination, calibration, and clinical utility were assessed. The final model included age, sex, body mass index, smoking status, first-degree relative with diabetes, presence of a dental prosthesis, presence of mobile teeth, history of periodontal treatment, and probing pocket depths ≥5 mm as well as prespecified interaction terms. In SHIP-TREND-0, the model area under the curve (AUC) was 0.72 (95% confidence interval [CI] 0.69, 0.75), calibration in the large was −0.025. The point score AUC was 0.69 (95% CI 0.65, 0.72), with sensitivity of 77.0 (95% CI 76.8, 77.2), specificity of 51.5 (95% CI 51.4, 51.7), negative predictive value of 94.5 (95% CI 94.5, 94.6), and positive predictive value of 17.0 (95% CI 17.0, 17.1). External validation of the point score gave an AUC of 0.69 (95% CI 0.66, 0.71), sensitivity of 79.2 (95% CI 79.0, 79.4), specificity of 49.9 (95% CI 49.8, 50.00), negative predictive value 91.5 (95% CI 91.5, 91.6), and positive predictive value of 25.9 (95% CI 25.8, 26.0). A validated prediction model involving dental variables can identify NDH or undiagnosed T2DM. Further studies are required to validate the model for different European populations.

Prevalence of hyperglycemia in masters athletes.

BackgroundAgeing is associated with decreased physical activity, obesity and subsequently an increased risk of developing type 2 diabetes mellitus (T2dm). Master athletes (MA) have initiated exercise or sport later in life or pursued a physically active lifestyle for an extended period. Subsequently, MAs have been proposed as a model of successful ageing as this active lifestyle is associated with health benefits including decreased health risk of chronic diseases and a reduction in premature mortality. Given long-term physical activity/exercise has previously been shown to be protective against hyperglycemia, a risk factor for T2dm, it is plausible that MA may have protective benefit against developing hyperglycemia. Therefore, the aim of this study was to investigate the prevalence of hyperglycemia via fasting plasma glucose (FPG) in MAs competing at the World Masters Games (WMG).MethodsThis cross-sectional, observational survey utilized an online survey using open-source web-based software was used to investigate MAs physiological and medical-related parameters. Over 28,000 MAs competed in the WMG, of which 8,072 MAs completed the survey. Of these MAs, a total of 486 (males 277, females 209; range 27 to 91 years, mean age 55.1 ± 10.2 years) attained recent pathology results which included FPG which was subsequently analyzed for this study. FPG and other outcome variables were compared between genders and to the Australian and United States general population.ResultsMean FPG for MAs was 5.03 mmol (±1.2, 95% CI [4.9–5.1] mmol) with majority (75.5%) of MAs reporting a normal (<5.5 mmol) FPG, followed by pre-diabetes (20.2%, >5.51 to <5.99 mmol) and abnormal (4.3%, >7.0 mmol). There was no significant difference (P = 0.333) in FPG between genders however, males had a slightly higher (+2.1%) FPG as compared to females (5.08 ± 1.2 mmol (95% CI [4.9–5.22] mmol) versus 4.98 ± 1.1 mmol (95% CI 4.8-5.1 mmol)). The majority of males (71.8%) and females (80.3%) were classified with a normal FPG. With regard to an abnormal FPG level, only 4.0% of males and 4.9% of females were classified abnormal which was suggestive of undiagnosed T2dm. With regard to age by decade, there was no significant difference (P = 0.06–1.00) between age groups and no relationship between the MAs’ age and FPG (r = .054, P = 0.24). As a group, MAs had a significantly lower FPG as compared to the Australian (−3.2%, P = 0.005) and United States general populations (−13.9%, P < 0.001).ConclusionsMost, however not all, MAs were found to have normal glycaemia, with only a small percentage indicating a risk of developing T2dm (i.e., impaired fasting glucose) and a smaller percentage identified with an abnormal FPG, suggestive of T2dm. These findings suggest MAs appear to be at low metabolic risk for developing T2dm based upon FPG and the physical activity/exercise they complete as MAs may indeed be protective against hyperglycemia whilst maintaining an active lifestyle.

Epidemiology of undiagnosed type 2 diabetes mellitus among hill tribe adults in Thailand

A community-based cross-sectional study was performed to estimate the prevalence of and determine factors associated with undiagnosed type 2 diabetes (T2DM) among hill tribe adults aged 30 years and over. Data were collected from the target hill tribe people living in the 30 selected villages in Chiang Rai Province in northern Thailand. A total of 2365 people were invited to participate in the study; 65.9% were female, 72.4% were aged 40–69 years, 0.9% regularly received preventive healthcare, and only 41.2% understood Thai. The overall prevalence of undiagnosed T2DM was 7.5%. After adjusting for age and sex, two factors were found to be associated with T2DM: triglycerides and high-density lipoprotein cholesterol (HDL-C). Those with high triglyceride levels were 2.80 (95% CI 1.99–3.94) times more likely to be suffering from T2DM than those with a normal triglyceride level. Those with low HDL-C levels were 1.65 (95% CI 1.16–2.34) times more likely to be suffering from T2DM than those with normal HDL-C. Appropriate public health interventions should be developed and implemented to reduce T2DM by providing regular preventive healthcare, educating patients on DM prevention and control, and encouraging regular exercise and reduced consumption of fatty food.

How common is undiagnosed prediabetes or type 2 diabetes mellitus in the cardiology ward?

Abstract Background Type 2 diabetes mellitus (T2DM) is one of the most important risk as well as prognostic factors in patients with cardiovascular disease. Thus, it is of crucial importance to identify the patients with T2DM or prediabetes and provide them the necessary treatment and follow up. Purpose To identify the prevalence of undiagnosed prediabetes or T2DM in the patients admitted to cardiology department of our hospital during one year. Methods We retrospectively analyzed the data from the patients admitted to the cardiology department of our hospital (general secondary hospital) for a period of 12 months. We recorded the reason of admission, whether they had been previously diagnosed with T2DM or prediabetes.For those without a known history of T2DM glycosylated hemoglobin (HbA1C) was measured during their hospital stay. If HbA1c was higher than 6.5% the patient was classified as diabetic and if HbA1c was 5.7–6.4% the patient was classified as pre-diabetic. Results 1524 patients were admitted in the cardiology department during 1 year (612 female, 912 male, mean age 76±12.4 years).Of them, 932 (61.15%) had no history of T2DM or prediabetes. 524 (34.38) were admitted due to acute decompensation of heart failure (ADHF), 206 (13.51%) due to acute coronary syndrome (ACS), 103 (6.75%) due to atrial fibrillation (AF), 87 (5.7%) due to other arrhythmias and 12 (0.78%) for other reasons (including pericarditis, endocarditis etc).229 patients (24.5%) were identified as prediabetics and 329 (35.3%) as diabetics. In terms of the reason of admission, as prediabetics were classified the following number of patients: 124 (23.66%) with ADHF, 42 (20.38%) with ACS, 26 (25.24%) with AF, 35 (40.22%) with other arrhythmias and 2 (16.66%) of those admitted for other reasons. Respetctively, as diabetics were classified 230 (44.8%) patients with ADHF, 74 (32.6% with ACS, 15 (12.7%) with AF, 7 (12.4%) with other arrhythmias) and 3 (9.2%) of those admitted for other reasons. Conclusions 59.8% of all patients admitted in the cardiology department with no previous history of T2DM was found to have either prediabetes or T2DM. Given the fact that T2DM plays pivotal role in the prognosis of cardiovascular disease as well as the well established benefits of the new antidiabetic drugs especially in patients with heart failure and coronary artery disease, screening of all patients for T2DM could be very helpful in order to identify these patients and offer them suitable and timely treatment. Funding Acknowledgement Type of funding sources: None.

Performance of Risk Assessment Models for Prevalent or Undiagnosed Type 2 Diabetes Mellitus in a Multi-Ethnic Population-The Helius Study.

Background:Most risk assessment models for type 2 diabetes (T2DM) have been developed in Caucasians and Asians; little is known about their performance in other ethnic groups.Objective(s):We aimed to identify existing models for the risk of prevalent or undiagnosed T2DM and externally validate them in a multi-ethnic population currently living in the Netherlands.Methods:A literature search to identify risk assessment models for prevalent or undiagnosed T2DM was performed in PubMed until December 2017. We validated these models in 4,547 Dutch, 3,035 South Asian Surinamese, 4,119 African Surinamese, 2,326 Ghanaian, 3,598 Turkish, and 3,894 Moroccan origin participants from the HELIUS (Healthy LIfe in an Urban Setting) cohort study performed in Amsterdam. Model performance was assessed in terms of discrimination (C-statistic) and calibration (Hosmer-Lemeshow test). We identified 25 studies containing 29 models for prevalent or undiagnosed T2DM. C-statistics varied between 0.77–0.92 in Dutch, 0.66–0.83 in South Asian Surinamese, 0.70–0.82 in African Surinamese, 0.61–0.81 in Ghanaian, 0.69–0.86 in Turkish, and 0.69–0.87 in the Moroccan populations. The C-statistics were generally lower among the South Asian Surinamese, African Surinamese, and Ghanaian populations and highest among the Dutch. Calibration was poor (Hosmer-Lemeshow p < 0.05) for all models except one.Conclusions:Generally, risk models for prevalent or undiagnosed T2DM show moderate to good discriminatory ability in different ethnic populations living in the Netherlands, but poor calibration. Therefore, these models should be recalibrated before use in clinical practice and should be adapted to the situation of the population they are intended to be used in.

Review of sexual health issues linked with cardiovascular disease and type 2 diabetes mellitus in Aboriginal and Torres Strait Islander males

There are well established links between male sexual health conditions and chronic disease, particularly cardiovascular disease (CVD) and type 2 diabetes (T2DM). Erectile dysfunction (ED) and low testosterone are two sexual health conditions that are relatively common among the wider male population. However, there is a lack of data specifically about these sexual problems among Aboriginal and Torres Strait Islander males. One of the most important findings of research regarding the links between sexual health and chronic disease is that ED can be a risk marker for future CVD or undiagnosed T2DM. Understanding these links can lead to more holistic health care for Aboriginal and Torres Strait Islander males, including the benefits of earlier diagnosis and treatment. Raising awareness of these issues and creating safe spaces for Aboriginal and Torres Strait Islander males to talk about sexual health may also prevent some from suffering in silence with a sexual problem.

Early detection of type 2 diabetes mellitus using machine learning-based prediction models

Most screening tests for T2DM in use today were developed using multivariate regression methods that are often further simplified to allow transformation into a scoring formula. The increasing volume of electronically collected data opened the opportunity to develop more complex, accurate prediction models that can be continuously updated using machine learning approaches. This study compares machine learning-based prediction models (i.e. Glmnet, RF, XGBoost, LightGBM) to commonly used regression models for prediction of undiagnosed T2DM. The performance in prediction of fasting plasma glucose level was measured using 100 bootstrap iterations in different subsets of data simulating new incoming data in 6-month batches. With 6 months of data available, simple regression model performed with the lowest average RMSE of 0.838, followed by RF (0.842), LightGBM (0.846), Glmnet (0.859) and XGBoost (0.881). When more data were added, Glmnet improved with the highest rate (+ 3.4%). The highest level of variable selection stability over time was observed with LightGBM models. Our results show no clinically relevant improvement when more sophisticated prediction models were used. Since higher stability of selected variables over time contributes to simpler interpretation of the models, interpretability and model calibration should also be considered in development of clinical prediction models.

Ten-year risk assessment for type 2 diabetes mellitus using the Finnish Diabetes Risk Score in family medicine.

Aim To assess ten-year risk of diabetes mellitus type 2 (T2DM) using the Finnish Diabetes Risk Score (FINDRISC) in respondents over 18, in Primary Health Centre in Banja Luka. Methods A prospective study was conducted using data from a population with undiagnosed T2DM in Primary Health Centre in Banja Luka. Eligible respondents were those aged 18 to 70 years. Sociodemographic, behavioural and anthropometric variables were those related to the risk models evaluated by FINDRISC. Results Data were collected from 520 individuals, 58.8% female and 41.2% male (p=0.005). A very high risk of developing T2DM in the next ten years was found in 5.6% females and 3.7% males. A high risk was found in 12.4% females and 15.9% males, 34.2% respondents ≥ 65 years, 28.8% with body mass index >30 kg/m2 , 26.6% who were not practicing physical activity (p=0.000), 24.0% who took antihypertensive drugs, 42.3% who were diagnosed with impaired glycaemia, 30.4% and 22.9% respondents whose parents and distant relatives, respectively, had T2DM. A moderate risk occurred in 31.4% females with waist circumference >88 cm. Half (50%) males with waist circumference >102 cm and 33.2% respondents who were not eating fruits and vegetables every day had a slightly increased risk of developing T2DM (p<0.05). Conclusion The FINDRISC may be used as a tool which would help general practitioners in everyday work, to detect patients with T2DM risk factors and to encourage them to change life style towards healthy habits.

The external validity and performance of the no-laboratory American Diabetes Association screening tool for identifying undiagnosed type 2 diabetes among the Iranian population

AimsThe aim of this study is to assess the American Diabetes Association (ADA) risk score as a self-assessment screening tool for undiagnosed type 2 diabetes (T2DM) in Iran. MethodsIn a national survey of risk factors for non-communicable diseases, we included 3458 Iranian adults. The discrimination and validity were assessed using the area under the curve (AUC), sensitivity, specificity, Youden's index, positive and negative predictive values (PPV and NPV). The frequency of high-risk Iranian population who need a glucose test and those who need intervention were also estimated. ResultsThe AUC was 73.7% and the suggested ADA score of ≥5 yielded a sensitivity of 51.6%, specificity 82.4%, NPV 98.3%, and PPV 7.9%. This threshold results in classifying 18.6% of the Iranians, equals to 8.5 million, as high-risk and 1.5% of the population, about 700,000, would need intervention. However, our study suggested score ≥4 that identified 34% of the population as high-risk and 2% of the population would need intervention. ConclusionOur findings support the ADA suggested threshold for identifying high-risk individuals for undiagnosed T2DM; however, a lower threshold is also recommended for higher sensitivity. The ADA screening tool could help the public health system for low-cost screening.

Refractory neutrophil activation in type 2 diabetics with chronic periodontitis.

Inflammation increases diabetes mellitus type 2 (T2DM) progression and severity. T2DM patients are at high risk of the rapid development of chronic periodontitis (CP). Topical presence, high numbers, and bactericidal effects of immune cells are challenged by augmented antigen-induced inflammation, which promotes both diseases. To investigate gingival cellular inflammatory responses in individuals with previously undiagnosed T2DM with CP or CP alone and in systemically and periodontally healthy controls (H) in vivo and to establish an ex vivo technique permitting quantitative and qualitative assessments of gingival crevicular immune cells. T2DM+CP, CP, and H individuals (n=10, each) received a 2-week oral hygiene regimen (OHR). Afterwards, a noninvasive sampling technique was performed to evaluate gingival inflammation induced under standardized conditions in vivo, that is, in the absence of severe periodontal destruction and inflammation at clinically healthy sites. Stimuli (casein/test or phosphate-buffered saline w/o. Ca2+ or Mg2+ , PBS(-/-) /control) were randomly applied contralaterally in the gingival sulci of participants' upper dentes canini. One day after completion of the OHR, gingival crevicular fluid (GCF) was kinetically assayed between the time of the baseline (BL) measurement and 55minutes. Polymorphonuclear leukocyte (PMN) content (PMNGCF ) was quantitated at an optimum time of 35minutes. PMNGCF counts reflect local inflammation. Ex vivo samples were fluorimetrically labeled, gated according to the donor's peripheral blood polymorphonuclear neutrophils (PMNPB ), and then counted, employing flow cytometry. PMNGCF counts in unstimulated gingival crevices (at BL) in the T2DM+CP group were higher than those in the CP and H groups. PMNGCF counts were elevated in casein vs PBS(-/-) -stimulated gingival crevices in all groups. Patients with T2DM+CP showed increased PMNGCF counts compared to those with CP (P=.035) according to scatter plots. CD45+ counts in the stimulated sites in T2DM+CP patients were higher than those in CP and H patients (P=.041). Under stimulation conditions, the CD45+ counts differed from those under placebo conditions (P=.019), indicating augmented, inducible inflammatory leukocyte infiltrate in T2DM+CP patients. This noninvasive technique permits quantitative assessment of (experimental) gingival inflammation in vivo, revealing an influence of T2DM+CP on the number of primary immune cells in the gingival crevice. Patients who are challenged with (local) leukocytosis are likely at risk of collateral damage to the gingival crevice neighboring tissues, favoring the severity and progression of CP and consequently T2DM (www.clinicaltrials.gov NCT01848379).

Diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM in Peruvian population

AimsTo assess the diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM and to compare its performance with the Latin-American FINDRISC (LA-FINDRISC) and the Peruvian Risk Score. Materials and methodsA population-based study was conducted. T2DM and undiagnosed T2DM were defined using oral glucose tolerance test (OGTT). Risk scores assessed were FINDRISC, LA-FINDRISC and Peruvian Risk Score. Diagnostic accuracy of risk scores was estimated using the c-statistic and the area under the ROC curve (aROC). A simplified version of FINDRISC was also derived. ResultsData from 1609 individuals, mean age 48.2 (SD: 10.6), 810 (50.3%) women, were collected. A total of 176 (11.0%; 95%CI: 9.4%–12.5%) were classified as having T2DM, and 71 (4.7%; 95%CI: 3.7%–5.8%) were classified as having undiagnosed T2DM. Diagnostic accuracy of the FINDRISC (aROC=0.69), LA-FINDRISC (aROC=0.68), and Peruvian Risk Score (aROC=0.64) was similar (p=0.15). The simplified FINDRISC, with 4 variables, had a slightly better performance (aROC=0.71) than the other scores. ConclusionThe performance of FINDRISC, LA-FINDRISC and Peruvian Risk Score for undiagnosed T2DM was similar. A simplified FINDRISC can perform as well or better for undiagnosed T2DM. The FINDRISC may be useful to detect cases of undiagnosed T2DM in resource-constrained settings.

Prevalence of Undiagnosed Type 2 Diabetes Mellitus and Its Associated Factors Among the Malaysian Population: The 2015 National Health and Morbidity Survey, Malaysia

BACKGROUND: The prevalence of diabetes has increased dramatically in the last decade. Compounding the problem are undiagnosed cases of type 2 diabetes mellitus. These respondents are those who do not know that they have the disease. Undiagnosed cases have substantial implications as they are at more risk to develope fatal complications. This study aims to determine the prevalence of undiagnosed T2DM and to identify its associated factors in Malaysia.METHODS: A nationwide cross-sectional study was conducted involving 19,935 respondents. Two-stage stratified sampling design was used to select a representative sample of the Malaysian adult population. Face-to-face interviews using structured, validated questionnaires were used to obtain data from the respondents. Respondents who claimed that they were not diagnosed with diabetes before were asked to undergo a finger-prick test.RESULTS: The overall prevalence of T2DM was 17.5% while the prevalence of undiagnosed T2DM was 9.2% (n=2103). Respondents aged 60 years old &amp;amp; above had the highest percentage of undiagnosed T2DM at about 13.6 %, followed by those with no formal educational at 12.9%, among Indians were 11.9%, among female at 9.2%, among non-working citizen at 9.8%, widowed/divorced (12.0%), smokers (9.5%), obesity (13.6%) and hypertensive (12.8%). Multivariable analyses revealed that age group, ethnicity, education level, marital status, obesity and hypertensive were more likely to have undiagnosed T2DM.CONCLUSION: This study showed a high prevalence of undiagnosed T2DM in Malaysia. Factors associated with undiagnosed diabetes mellitus were obesity, age, ethnicity, educational level and hypertension. Screening is essential among adults aged 30 to 60 year old to enable early intervention and prevent development of serious complications of this disease.

Effectiveness of a diabetes prevention program for rural women with prior gestational diabetes mellitus: study protocol of a multi-site randomized clinical trial

BackgroundIn China, about 53.4 million women (11%) have type 2 diabetes (T2DM). Women with prior 2 (GDM) are at a high risk for T2DM. Postpartum lifestyle interventions have been effective in reducing T2DM for this population, but the evidence is limited to interventions provided in urban areas, despite the fact that a higher prevalence of undiagnosed T2DM was found in rural areas in China. The primary purpose of this proposed study is to examine the effect of a postpartum intensive lifestyle modification (ILSM) program on physiological health outcomes (T2DM development, insulin resistance, and weight-related variables), weight-related health behaviors (dietary intake and physical activity), and psychosocial outcomes (self-efficacy, perceived stress, social support, and health-related quality of life) compared to usual care at 3, 6, and 18 months post baseline assessment. The secondary outcomes are to identify potential mediators and moderators on change of physiological health outcomes.Methods/designA multi-site randomized clinical trial (RCT) will be conducted to examine the efficacy of an evidence-based Intensive Lifestyle Modification (ILSM) program compared with usual care for women with prior GDM living in rural areas in China. A total sample of 256 participants will be recruited in the study. The intervention consists of six bi-weekly in-person group sessions, five bi-weekly telephone consultation sessions, and three monthly telephone consultations to encourage behavior change. The usual care provided to the control group will utilize current clinical guideline and recommendations for T2DM prevention. Outcome measures include physiological variables (OGTT-2 h, HbA1c, weight, and waist circumference); weight-related health behavioral (dietary intake and physical activities); and psychosocial variables (self-efficacy and social support) at 3-, 6- and 18- month after baseline. We will also assess the potential cost-effectiveness of ILSM (net cost per T2DM case and per DALY averted) compared with usual care.DiscussionIf successful, this ILSM program can be adapted and used in rural areas as a blueprint for clinical guidelines to decrease T2DM by improving postpartum GDM care in China. Findings of this study are expected to make a significant contribution to public health practice and health policy related to T2DM prevention in China.Trial registrationChinese Clinical Trial Registry, ChiCTR1800015023. Registered 1 March 2018 - Retrospectively registered, http://apps.who.int/trialsearch/default.aspx.

Colorectal adenomas and diabetes: implications for disease prevention.

AimThis study assessed the baseline type II diabetes mellitus (T2DM) risk status among overweight patients with screen‐detected colorectal adenomas and explored the implications of the findings for preventative practice.MethodParticipants aged between 50 and 74 years (73% of whom were men) were recruited from four Scottish health boards and assessed for diabetes risk. Participants were categorized as at ‘high’ diabetes risk if glycated haemoglobin (HbA1c) was between 6.0 and 6.4% or fasting plasma glucose (FPG) was between 5.5 and 6.9 mmol/l and as potentially undiagnosed T2DM when HbA1c ≥ 6.5% or FPG ≥ 7 mmol/l. Secondary outcome measures included anthropometric measurements, blood pressure and the plasma lipid profile. The tests were repeated at 12 months and diabetes risk categories were reassessed following intervention procedures.ResultsForty‐seven (14.3%) of the 329 participants had a preexisting diagnosis of T2DM. Of the remainder with complete biochemistry results (n = 250), 19 (7.6%) were classified as having potentially undiagnosed T2DM and 125 (50.0%) as being at high risk of developing diabetes. More than a quarter of participants in all categories had raised waist circumference, hypertension and plasma lipids, indicative of raised cardiovascular risk. At 12 months' follow‐up, the diabetes risk category diminished in 20% of the intervention group vs 11% in the controls [OR 2.26 (95% CI 1.03–4.96)].ConclusionOur results suggest that a diagnosis of adenoma in overweight patients provides a health service opportunity for diabetes assessment, prevention and management in a high‐risk population at a potentially teachable moment.

P2-391 HbA1c for diabetes mellitus diagnosis

AimsTo evaluate diagnostic strategy with OGTT and/or HbA1c for lowing number of people with undiagnosed T2DM.Materiales and MethodsPopulation-based screening for glucose metabolism impairments (GMI) among 661 adults in Moscow Country...