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Fasting Glucose (fasting + glucose)
Kinds of Fasting Glucose Terms modified by Fasting Glucose Selected AbstractsImpaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patientsDIABETIC MEDICINE, Issue 3 2008H. H. H. Feringa Abstract Aims Cardiac morbidity and mortality is high in patients undergoing high-risk surgery. This study investigated whether impaired glucose regulation and elevated glycated haemoglobin (HbA1c) levels are associated with increased cardiac ischaemic events in vascular surgery patients. Methods Baseline glucose and HbA1c were measured in 401 vascular surgery patients. Glucose < 5.6 mmol/l was defined as normal. Fasting glucose 5.6,7.0 mmol/l or random glucose 5.6,11.1 mmol/l was defined as impaired glucose regulation. Fasting glucose , 7.0 or random glucose , 11.1 mmol/l was defined as diabetes. Perioperative ischaemia was identified by 72-h Holter monitoring. Troponin T was measured on days 1, 3 and 7 and before discharge. Cardiac death or Q-wave myocardial infarction was noted at 30-day and longer-term follow-up (mean 2.5 years). Results Mean (± sd) level for glucose was 6.3 ± 2.3 mmol/l and for HbA1c 6.2 ± 1.3%. Ischaemia, troponin release, 30-day and long-term cardiac events occurred in 27, 22, 6 and 17%, respectively. Using subjects with normal glucose levels as the reference category, multivariate analysis revealed that patients with impaired glucose regulation and diabetes were at 2.2- and 2.6-fold increased risk of ischaemia, 3.8- and 3.9-fold for troponin release, 4.3- and 4.8-fold for 30-day cardiac events and 1.9- and 3.1-fold for long-term cardiac events. Patients with HbA1c > 7.0% (n = 63, 16%) were at 2.8-fold, 2.1-fold, 5.3-fold and 5.6-fold increased risk for ischaemia, troponin release, 30-day and long-term cardiac events, respectively. Conclusions Impaired glucose regulation and elevated HbA1c are risk factors for cardiac ischaemic events in vascular surgery patients. [source] Screening for gestational diabetes; past, present and futureDIABETIC MEDICINE, Issue 5 2002F. W. F. Hanna Abstract Gestational diabetes is carbohydrate intolerance, with onset or first recognition of hyperglycaemia during pregnancy. Several studies have suggested that gestational hyperglycaemia is associated with adverse maternal and fetal outcomes, promoting the case for screening. Conversely, others argue that screening for gestational diabetes may colour the clinical judgement, influencing further management, e.g. more ,unjustified' caesarean sections. Additionally, the lack of definitive data either on a clear-cut glycaemic threshold for the development of adverse outcomes or on the impact of intervention is emphasized by opponents of screening. This review attempts to evaluate the available data on screening for gestational diabetes. Oral glucose tolerance test is promoted on the basis that the diabetogenic stress of pregnancy is encountered during late gestation and is best recognized in the fed state. There are different tests, including the 1 h/50-g, 2 h/75-g and 3 h/100-g tests, with practical limitations, including the time and cost involved and the unpleasant supra-physiological glucose load that is unrelated to body weight, and issues of reproducibility and sensitivity/specificity profiles. Despite its convenience, the poor sensitivity of random glucose has precluded its routine use for screening. Fasting glucose appears to be promising but further testing is required to ensure satisfactory sensitivity/specificity in different populations. Despite its limitations, the oral glucose tolerance test has become established as the ,most acceptable' diagnostic test for gestational diabetes. More convenient methods, e.g. fasting or random or post-load glucose, have to be validated therefore against the oral glucose tolerance test to gain acceptance for routine screening. Diabet. Med 19, 351,358 (2002) [source] Prevalence of obesity and metabolic syndrome in Indigenous Australian youthsOBESITY REVIEWS, Issue 3 2009P. C. Valery Summary We conducted a cross-sectional study of Indigenous youths residing in the Torres Strait region of Australia to assess the prevalence of obesity and the metabolic syndrome. Data on body mass index (BMI), waist circumference, blood pressure, presence of acanthosis nigricans and blood glucose were collected. Fasting glucose, insulin, C-Peptide, HbA1c and lipids were measured, and an oral glucose tolerance test was performed in those with a BMI greater than 25 (childhood-equivalent cut-points) or fasting glucometer reading >5.5 mmol/L. Of 158 youths, 31% were overweight and 15% were obese, 38% had enlarged waist circumference consistent with central obesity, 43% had acanthosis nigricans and 27% were hypertensive. More females than males had enlarged waist circumferences (59% vs. 13%, P < 0.001). Among overweight or obese youth, 56% had significantly elevated insulin (P = 0.021); they also had higher HOMA-IR (P = 0.002). The metabolic syndrome was present in 17% of all youths (mostly females) and in 33% of the overweight or obese subgroup. Type 2 diabetes was diagnosed in two youths. These very high proportions of overweight or obese Torres Strait youth with metabolic risk factors have major public health implications. [source] Initial short-term intensive insulin therapy as a strategy for evaluating the preservation of beta-cell function with oral antidiabetic medications: a pilot study with sitagliptinDIABETES OBESITY & METABOLISM, Issue 10 2010R. Retnakaran Aim: Studies evaluating the effects of oral antidiabetic drugs (OADs) on beta-cell function in type 2 diabetes mellitus (T2DM) are confounded by an inability to establish the actual baseline degree of beta-cell dysfunction, independent of the deleterious effects of hyperglycaemia (glucotoxicity). Because intensive insulin therapy (IIT) can induce normoglycaemia, we reasoned that short-term IIT could enable evaluation of the beta-cell protective capacity of OADs, free from confounding hyperglycaemia. We applied this strategy to assess the effect of sitagliptin on beta-cell function. Methods: In this pilot study, 37 patients with T2DM of 6.0 + 6.4 years duration and A1c 7.0 + 0.8% on 0,2 OADs were switched to 4,8 weeks of IIT consisting of basal detemir and premeal insulin aspart. Subjects achieving fasting glucose <7.0 mmol/l 1 day after completing IIT (n = 21) were then randomized to metformin with either sitagliptin (n = 10) or placebo (n = 11). Subjects were followed for 48 weeks, with serial assessment of beta-cell function [ratio of AUCCpep to AUCgluc over Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (AUCCpep/gluc/HOMA-IR)] on 4-h meal tests. Results: During the study, fasting glucagon-like-peptide-1 was higher (p = 0.003) and A1c lower in the sitagliptin arm (p = 0.016). Nevertheless, although beta-cell function improved during the IIT phase, it declined similarly in both arms over time (p = 0.61). By study end, AUCCpep/gluc/HOMA-IR was not significantly different between the placebo and sitagliptin arms (median 71.2 vs 80.4; p = 0.36). Conclusions: Pretreatment IIT can provide a useful strategy for evaluating the beta-cell protective capacity of diabetes interventions. In this pilot study, improved A1c with sitagliptin could not be attributed to a significant effect on preservation of beta-cell function. [source] Effects of physical exercise versus rosiglitazone on endothelial function in coronary artery disease patients with prediabetesDIABETES OBESITY & METABOLISM, Issue 9 2010S. Desch We conducted a three-arm, parallel-group, randomized, controlled trial to compare the effects of rosiglitazone and physical exercise on endothelial function in patients with coronary artery disease and impaired fasting glucose or impaired glucose tolerance over a 6-month period. Group A received rosiglitazone tablets 8 mg daily (n = 16), group B underwent a structured physical exercise programme (n = 15) and group C served as a control group (n = 12). At baseline and after 6 months, brachial artery ultrasound imaging was performed to assess reactive flow-mediated dilation (FMD). Rosiglitazone treatment and exercise both led to significant improvements in insulin resistance at 6 months, whereas no change was observed in control patients. FMD improved significantly in physical exercise patients, whereas no change could be observed in patients receiving rosiglitazone or in the control group. Between-group comparisons also showed a significant relative improvement in FMD in exercise patients compared with rosiglitazone. [source] Reflecting on Type 2 Diabetes Prevention: More Questions than Answers!DIABETES OBESITY & METABOLISM, Issue 2007J. Rosenstock Given the enormous public health and economic burden posed by the global epidemic of type 2 diabetes mellitus (T2DM), intervention in the prediabetes stage of disease to prevent progression to T2DM and its vascular complications seems the most sensible approach. Precisely how best to intervene remains the subject of much debate. Prudent lifestyle changes have been shown to significantly reduce the risk of progression in individuals with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Although lifestyle modifications are notoriously difficult to maintain, there is evidence that intensive intervention results in continued preventive benefit after the stopping of structured counselling. A number of drug therapies, including metformin, acarbose, orlistat and rosiglitazone, have also been proven effective in preventing progression from IFG/IGT, but unresolved issues still remain. Specifically, whether large numbers of individuals with glucose dysregulation who may never progress to T2DM should be exposed to the risk of pharmacological adverse effects is a topic of discussion and debate. Furthermore, there are limited data on the effectiveness of implementing interventions during the prediabetic state to prevent cardiovascular complications that may be hyperglycaemia related. A recent American Diabetes Association (ADA) consensus statement on IFG/IGT recommends lifestyle modification for individuals with IFG or IGT. Of note, the ADA consensus statement introduces the option of adding metformin treatment to lifestyle changes in those individuals who have combined IFG/IGT plus an additional risk factor for progression and who also have some features that increase the likelihood of benefiting from metformin treatment. The dipeptidyl peptidase-4 inhibitors are a new class of oral antidiabetic agents that, in addition to being effective in improving glycaemic control, may exert beneficial effects in preserving ,-cell function. These characteristics, combined with a low risk of hypoglycaemia, weight neutrality and what appears , so far , to be a relatively benign tolerability profile, make these agents intriguing candidates for preventive treatment. [source] Degradation in insulin sensitivity with increasing severity of the metabolic syndrome in obese postmenopausal womenDIABETES OBESITY & METABOLISM, Issue 3 2006A. D. Karelis Aim:, We investigated the relationship between insulin sensitivity and the graded increase in the number of features of the metabolic syndrome in a cross-sectional sample of obese postmenopausal women. We hypothesized that insulin sensitivity would deteriorate with an increased number of metabolic syndrome phenotypes. Methods:, Insulin sensitivity was measured in 75 obese postmenopausal women (age: 57.3 ± 5.3 years; BMI: 32.8 ± 4.5 kg/m2) by using both the hyperinsulinaemic,euglycaemic clamp and the homeostasis model assessment (HOMA-IR). Features of the metabolic syndrome included visceral fat (>130 cm2), HDL-cholesterol (<1.29 mmol/l), fasting triglycerides (,1.7 mmol/l), blood pressure (,130/,85 mmHg) and fasting glucose (,6.1 mmol/l). Participants were classified into three categories based on the presence of metabolic syndrome phenotypes: 0,1 vs. 2 vs. ,3 features of the metabolic syndrome. Results:, We found that insulin sensitivity decreased in a graded fashion (12.19 ± 3.2 vs. 11.80 ± 2.3 vs. 9.29 ± 2.6 mg/min/FFM) and HOMA-IR increased in a similar manner (2.95 ± 1.1 vs. 3.28 ± 1.3 vs. 4.65 ± 2.2), as the number of features of the metabolic syndrome increased from 0,1 to ,3. When insulin sensitivity was statistically adjusted for visceral fat (as measured by computed tomography) and plasma triglycerides, the differences among groups were abolished. Conclusions:, These findings suggest that a decreased insulin sensitivity is associated with increased features of the metabolic syndrome in obese postmenopausal women and that visceral fat as well as plasma triglyceride accumulation might be potential mediators of this relationship. [source] Lipids and lipoprotein(a) concentrations in Pakistani patients with type 2 diabetes mellitusDIABETES OBESITY & METABOLISM, Issue 5 2004S. S. Habib Aim:, The aim of the present study was to analyze serum lipoprotein(a) [Lp(a)] levels in Pakistani patients with type 2 diabetes mellitus (DM) and to find correlations between clinical characteristics and dyslipidaemias in these patients. Methods:, Fasting blood samples were analyzed for Lp(a), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), glucose and glycosylated haemoglobin (HbA1c) in 68 Pakistani patients with type 2 DM and 40 non-diabetic healthy control subjects. Results:, Lp(a) levels were significantly raised in diabetics as compared to the control group. No correlation of Lp(a) was seen with age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting glucose. There was a positive correlation of BMI to SBP and DBP. There was a significant positive correlation between Lp(a) and total cholesterol and LDL-c. No correlation of Lp(a) was observed with HDL-c, triglycerides and glycosylated haemoglobin (HbA1c). Conclusion:, The present study led us to conclude that serum Lp(a) levels are significantly raised in type 2 DM and have a positive correlation with serum total and LDL-c levels. [source] Integrating glycaemic variability in the glycaemic disorders of type 2 diabetes: a move towards a unified glucose tetrad conceptDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2009Louis Monnier Abstract The high incidence of atherosclerosis and cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes. Evidence is accumulating that postprandial hyperglycaemia is an independent risk factor for diabetes-associated complications and mortality, and that worsening diabetes control is characterized by postprandial glucose (PPG) deterioration preceding an impairment in fasting glucose levels. Postprandial and general glucose fluctuations play a major role in activating oxidative stress, leading to the endothelial dysfunction, one of the mechanisms responsible for vascular complications. Therefore, the management of PPG is key for any strategy used in the monitoring and treatment of diabetes. We recommend that any strategy aimed at controlling the glycaemic disorders associated with type 2 diabetes, and limiting the risk of complications, should target the ,glucose tetrad', which comprises the following components: HbA1c, fasting and postprandial plasma glucose, and markers of glycaemic variability, such as the mean amplitude of glycaemic excursions (MAGE) index. This brings together, in a simple, unified concept, the conventional markers (HbA1c and fasting glucose) and the more recently recognized markers of glycaemic control (PPG excursions and acute glycaemic variability). Copyright © 2009 John Wiley & Sons, Ltd. [source] Glucometabolic state of in-hospital primary hypertension patients with normal fasting blood glucose in a sub-population of ChinaDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2009Yang-Xin Chen Abstract Background There is a high prevalence of abnormal glucometabolism (AGM) in patients with coronary heart disease (CHD) and primary hypertension (PH). However, little is known about the glucometabolic state of PH patients with normal fasting blood glucose (FBG). Methods Oral glucose tolerance test (OGTT) was performed for 445 in-hospital PH patients with normal FBG and re-performed for those patients with impaired glucose tolerance (IGT) during the follow-up period. Results Diabetes mellitus (DM), IGT, and AGM (including IGT and DM) accounted for 4.4, 24.5, and 28.9% of patients, respectively. Prevalence of AGM in patients with higher haemoglobin A1c (HbA1c) (,6.0%), risk factors (CHD, overweight, hyperlipidaemia, proteinuria) was significantly higher than that in patients without these factors. Regression analysis showed that age, overweight, proteinuria, HbA1c, and CRP were the independent risk factors of AGM. Follow-up data in 98 IGT patients showed that no improvement of glucometabolism was found, but contrarily, a significant increase of new onset of impaired fasting glucose (IFG) and DM was found after 9 months (P < 0.05), even if diet control and moderate exercise were adopted. Conclusions AGM is prevalent and underestimated in PH patients with normal FBG, and it will develop even if therapeutic life-style changes are adopted. Except for FBG, more attention should be paid to postprandial blood glucose. OGTT should be a routine procedure for PH patients, especially in-hospital PH patients, regardless of normal FBG, and active drug intervention for IGT patients with PH may be recommended. Copyright © 2009 John Wiley & Sons, Ltd. [source] The role of insulin-like growth factor-I and its binding proteins in glucose homeostasis and type 2 diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2009Swapnil N. Rajpathak Abstract This review addresses the possible role of the insulin-like growth factor (IGF)-axis in normal glucose homoeostasis and in the etiopathogenesis of type 2 diabetes. IGF-I, a peptide hormone, shares amino acid sequence homology with insulin and has insulin-like activity; most notably, the promotion of glucose uptake by peripheral tissues. Type 2 diabetes as well as pre-diabetic states, including impaired fasting glucose and impaired glucose tolerance, are associated cross-sectionally with altered circulating levels of IGF-I and its binding proteins (IGFBPs). Administration of recombinant human IGF-I has been reported to improve insulin sensitivity in healthy individuals as well as in patients with insulin resistance and type 2 diabetes. Further, IGF-I may have beneficial effects on systemic inflammation, a risk factor for type 2 diabetes, and on pancreatic ,-cell mass and function. There is considerable inter-individual heterogeneity in endogenous levels of IGF-I and its binding proteins; however, the relationship between these variations and the risk of developing type 2 diabetes has not been extensively investigated. Large prospective studies are required to evaluate this association. Copyright © 2009 John Wiley & Sons, Ltd. [source] The different mechanisms of insulin sensitizers to prevent type 2 diabetes in OLETF ratsDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2007Sung Hee Choi Abstract Objective To investigate the effects of pioglitazone and metformin treatment during pre-diabetic period for the prevention of diabetes in a rat model. Methods OLETF rats aged 18-weeks, were treated with pioglitazone (10 mg/kg/day) and metformin (300 mg/kg/day) for 10 weeks from their pre-diabetic period. We measured weight, lipid profiles, fat distribution, glucose tolerance, and pancreatic insulin content. Results Prominent weight gain (mostly subcutaneous fat area) was observed in the pioglitazone-treated OLETF (O-P) rats versus significant weight loss was observed in the metformin-treated OLETF (O-M) rats. Pioglitazone reversed the serum triglyceride (TG) and FFAs levels to normal (TG 0.46 ± 0.04 vs 0.88 ± 0.05 mmol/l in LETO). At the age of 28 weeks, the O-P rats showed completely normal glucose tolerance, and the glucose disposal rate (GDR) was markedly improved (25.6 ± 0.4 vs 20.6 ± 0.5 mg/min/kg in O-C, p < 0.05). The O-M rats also showed an improved fasting glucose and GDR level, but not as much as those with O-P rats. The pancreas insulin contents were much improved in the O-P rats (22.9 ± 1.2 vs 18.8 ± 1.3 nmol/pancreas in O-M rats, p < 0.05) with histological improvement. Conclusion The pre-diabetic treatment with pioglitazone, despite significant weight gain, completely prevents to develop diabetes and enhances beta cell function with preservation of islet cell changes. Metformin treatment was also effective, but mainly by ameliorating the insulin resistance with marked reduction in body weight. The reversal of dyslipidaemia and the fat redistribution might contribute to the greater improvement of pioglitazone treatment compared to metformin in OLETF rats. Copyright © 2007 John Wiley & Sons, Ltd. [source] Validation of an algorithm combining haemoglobin A1c and fasting plasma glucose for diagnosis of diabetes mellitus in UK and Australian populationsDIABETIC MEDICINE, Issue 2 2009S. E. Manley Abstract Aim, To determine whether glycated haemoglobin (HbA1c) can be used in combination with fasting plasma glucose (FPG) for the diagnosis of diabetes in patients with impaired fasting glucose (IFG) and in a broader spectrum of patients. Methods, An algorithm was derived from oral glucose tolerance test (OGTT) capillary samples in 500 consecutive UK patients with IFG by World Health Organization criteria. It was validated in a further 500 UK patients and, with venous specimens, in 1175 unselected Australian patients. Results, The derivation cohort was aged 61 years (50,69 years) (median IQ range) with 52% male and 12% South Asian. Diabetes Control and Complications Trial-aligned HbA1c was 6.2% (5.8,6.6%) (reference interval < 6.0%) and FPG 6.7 mmol/l (6.3,7.2 mmol/l). FPG was in the diabetes range in 36% of patients, with an OGTT identifying a further 12% with diabetes. The derived algorithm, (HbA1c , 6.0% with FPG < 7.0 mmol/l) identified those patients requiring an OGTT to diagnose diabetes. When applied to the UK validation cohort, sensitivity was 97% and specificity 100%. The algorithm was equally effective in the unselected group, aged 59 years (49,68 years) and 54% male, with sensitivity 93% and specificity 100%. HbA1c was 6.0% (5.6,6.6%) and FPG 6.0 mmol/l (5.3,6.8 mmol/l), with 26% having IFG. Use of the algorithm would reduce the number of OGTTs performed in the UK validation cohort by 33% and by 66% in the Australian patients studied. Conclusions, Use of this algorithm would simplify procedures for diagnosis of diabetes and could also be used for monitoring pre-diabetes. Validation is now required in other populations and patient groups. [source] Psychosocial factors are independent risk factors for the development of Type 2 diabetes in Japanese workers with impaired fasting glucose and/or impaired glucose tolerance,DIABETIC MEDICINE, Issue 10 2008M. Toshihiro Abstract Aims, We prospectively studied Japanese workers with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and analysed possible risk factors for diabetes, including psychosocial factors such as stress. Methods, The participants were 128 male Japanese company employees (mean age, 49.3 ± 5.9 years) with IFG and/or IGT diagnosed by oral glucose tolerance test (OGTT). Participants were prospectively studied for 5 years with annual OGTTs. The Kaplan,Meier method and Cox's proportional hazard model were used to analyse the incidence of diabetes and the factors affecting glucose tolerance, including anthropometric, biochemical and social,psychological factors. Results, Of 128 participants, 36 (28.1%) developed diabetes and 39 (30.5%) returned to normal glucose tolerance (NGT) during a mean follow-up of 3.2 years. Independent risk factors for diabetes were night duty [hazard ratio (HR) = 5.48, P = 0.002], higher fasting plasma glucose (FPG) levels within 6.1,6.9 mmol/l (HR = 1.05, P = 0.031), stress (HR = 3.81, P = 0.037) and administrative position (HR = 12.70, P = 0.045), while independent factors associated with recovery were lower FPG levels (HR = 0.94, P = 0.017), being a white-collar worker (HR = 0.34, P = 0.033), non-smoking (HR = 0.31, P = 0.040) and lower serum alanine aminotransferase (ALT) levels (HR = 0.97, P = 0.042). Conclusions, In addition to FPG levels at baseline, psychosocial factors (night duty, stress and administrative position) are risk factors for Type 2 diabetes, while being a white-collar worker, a non-smoker and lower serum ALT levels are factors associated with return to NGT in Japanese workers with IFG and/or IGT. [source] Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka,Sri Lanka Diabetes, Cardiovascular Study (SLDCS)DIABETIC MEDICINE, Issue 9 2008P. Katulanda Abstract Aims To determine the prevalence of diabetes mellitus and pre-diabetes (impaired fasting glucose and impaired glucose tolerance) in adults in Sri Lanka. Projections for the year 2030 and factors associated with diabetes and pre-diabetes are also presented. Methods This cross-sectional study was conducted between 2005 and 2006. A nationally representative sample of 5000 adults aged , 18 years was selected by a multi-stage random cluster sampling technique. Fasting plasma glucose was tested in all participants and a 75-g oral glucose tolerance test was performed in non-diabetic subjects. Prevalence was estimated for those > 20 years of age. Results Response rate was 91% (n = 4532), males 40%, age 46.1 ± 15.1 years (mean ± standard deviation). The age,sex standardized prevalence (95% confidence interval) of diabetes for Sri Lankans aged , 20 years was 10.3% (9.4,11.2%) [males 9.8% (8.4,11.2%), females 10.9% (9.7,12.1%), P = 0.129). Thirty-six per cent (31.9,40.1%) of all diabetic subjects were previously undiagnosed. Diabetes prevalence was higher in the urban population compared with rural [16.4% (13.8,19.0%) vs. 8.7% (7.8,9.6%); P < 0.001]. The prevalence of overall, urban and rural pre-diabetes was 11.5% (10.5,12.5%), 13.6% (11.2,16.0%) and 11.0% (10.0,12.0%), respectively. Overall, 21.8% (20.5,23.1%) had some form of dysglycaemia. The projected diabetes prevalence for the year 2030 is 13.9%. Those with diabetes and pre-diabetes compared with normal glucose tolerance were older, physically inactive, frequently lived in urban areas and had a family history of diabetes. They had higher body mass index, waist circumference, waist,hip ratio, systolic/diastolic blood pressure, low-density lipoprotein cholesterol and triglycerides. Insulin was prescribed to 4.4% (2.7,6.1%) of all diabetic subjects. Conclusions One in five adults in Sri Lanka has either diabetes or pre-diabetes and one-third of those with diabetes are undiagnosed. [source] Reduced insulin secretion in normoglycaemic patients with ,-thalassaemia majorDIABETIC MEDICINE, Issue 12 2006N. G. Angelopoulos Abstract Aims To assess insulin sensitivity and secretion in the fasting state in regularly transfused patients with ,-thalassaemia major with normal glucose response during an oral glucose tolerance test and to estimate its possible relation to iron overload. Methods We measured fasting glucose, insulin and C-peptide levels in 24 patients with ,-thalassaemia major and 18 control subjects matched for age and body mass index. Insulin sensitivity and insulin release index were calculated according to the homeostasis model assessment (HOMA). Correlations with age, body mass index and serum ferritin were also calculated. Results Fasting glucose levels in patients were increased compared with control subjects (5.5 ± 0.12 vs. 4.7 ± 0.13 mmol/l, mean ± sem, P < 0.001). Pancreatic B-cell insulin secretion in the fasting state (estimated by SCHOMA) was lower in thalassaemic patients (SCHOMA 88.5 ± 11.11 vs. 184.3 ± 23.72 in control subjects, P < 0.001). Patients were then divided into those with impaired (IFG) and normal (NFG) fasting glucose. SCHOMA was higher in the patients with NFG compared with those with IFG patients (110.6 ± 17.63 vs. 66.3 ± 10.88, respectively, P < 0.05) but estimated insulin sensitivity (ISIHOMA) was similar. Plasma values of C-peptide correlated positively with ferritin (r = 0.42, P = 0.04) and SCHOMA (r = 0.45, P = 0.02) and negatively with ISIHOMA (r = ,0.43, P = 0.03). Conclusions These results support the concept that impaired B-cell function, as reflected by a reduction in the insulin secretion index, is present in ,-thalassaemic patients with normoglycaemia before changes in oral glucose tolerance tests are apparent. [source] Metabolic consequences of pancreatic systemic or portal venous drainage in simultaneous pancreas-kidney transplant recipientsDIABETIC MEDICINE, Issue 6 2006P. Petruzzo Abstract Aims The aim was to investigate pancreatic B-cell function and insulin sensitivity in simultaneous pancreas-kidney (SPK) recipients with systemic or portal venous drained pancreas allograft using simple and easy tests. Methods The study included 44 patients with Type 1 diabetes and end-stage renal disease who had undergone SPK transplantation: 20 recipients received a pancreas allograft with systemic venous drainage (S-SPK) and 24 with portal venous drainage (P-SPK). We studied only recipients with functioning grafts, with normal serum glucose, HbA1c and serum creatinine values, on a stable drug regimen. The subjects were studied at 6, 12, 24, 36, 48 and 60 months after transplantation. Insulin sensitivity and B-cell function indices were derived from blood samples and oral glucose tolerance tests. Results All patients from both groups had normal fasting glucose, body mass index and HbA1c values by selection. The homeostatic model (HOMA) ,-cell index was significantly lower in P-SPK recipients at several points of the follow-up. HOMA-IR was significantly higher in S-SPK recipients at 6 and 24 months after transplantation and was positively correlated with fasting insulin values, but never exceeded 3.2. There was no significant difference in QUICKI index values between the two groups. Although all patients from both groups always had normal glucose tolerance, the area under the insulin curve was higher in the S-SPK group. Cholesterol, low-density lipoprotein-cholesterol and triglycerides were higher in the P-SPK group. Conclusions The results suggest sustained long-term endocrine function in both groups and show that portal venous drainage does not offer major metabolic advantages. [source] Prevalence of the metabolic syndrome in the island of Gran Canaria: comparison of three major diagnostic proposalsDIABETIC MEDICINE, Issue 12 2005M. Boronat Abstract Aims The present study was conducted to estimate the prevalence of the metabolic syndrome in a Canarian population, and to compare its frequency as defined by the most commonly used working definitions. Methods Cross-sectional population-based study. One thousand and thirty adult subjects were randomly selected from the local census of Telde, a city located on the island of Gran Canaria. Participants completed a survey questionnaire and underwent physical examination, fasting blood analyses, and a 75-g standardized oral glucose tolerance test. The prevalence of the metabolic syndrome was estimated according to the definitions proposed by the World Health Organization (WHO), the European Group for the Study of Insulin Resistance (EGIR) and the National Cholesterol Education Program (NCEP), the latter with the original (6.1 mmol/l) and the revised criterion (5.6 mmol/l) for abnormal fasting glucose. Results The adjusted prevalence of the metabolic syndrome was 28.0, 15.9, 23.0 and 28.2%, using the WHO, EGIR, NCEP and revised NCEP criteria, respectively. The measure of agreement (, statistic) was 0.57 between the WHO and the original NCEP definitions, and 0.61 between the WHO and the revised NCEP definitions. After excluding diabetic subjects, the agreement between the EGIR and WHO proposals was fairly good (, = 0.70), whereas concordance of the EGIR with the original and the revised NCEP definitions was moderate (, = 0.47 and 0.46, respectively). Conclusions Whichever the considered diagnostic criteria, the prevalence of the metabolic syndrome in this area of the Canary Islands is greater than that observed in most other European populations. [source] Serum ,-glutamyltransferase within its normal concentration range is related to the presence of diabetes and cardiovascular risk factorsDIABETIC MEDICINE, Issue 9 2005D.-J. Kim Abstract Aims Although many studies have reported an association between serum ,-glutamyltransferase (GGT) and cardiovascular risk factors, the mechanism of this relationship has not been clarified. Methods The medical records of 29 959 subjects (age, median 48, range 14,90 years; 16 706 men, 13 253 women) who visited the Center for Health Promotion at Samsung Medical Center for a medical check-up between January 2001 and December 2003, were investigated. Subjects with hepatic enzyme/GGT concentrations higher than three times the upper limit of the reference range, a positive test for hepatitis C virus antibody, a positive test for hepatitis B virus surface antigen, currently taking anti-diabetic/anti-hypertensive/anti-lipid medication, or a white blood cell (WBC) count higher than 10 000 cells/ml, were excluded. The subjects of each gender were classified into five groups according to their serum GGT concentrations, into quartiles of the normal range of GGT (groups 1, 2, 3 and 4) and into a group with elevated GGT (group 5). Results As the group number increased (group 1 , 5), the frequencies of all of the following increased: (i) diabetes and impaired fasting glucose (IFG); (ii) hypertension, obesity (body mass index , 27 kg/m2), dyslipidaemia (LDL-cholesterol , 4.1 mmol/l and/or triglyceride , 2.46 mmol/l, or HDL-cholesterol < 1.16 mmol/l); (iii) metabolic syndrome. Moreover, these significant relationships between GGT concentrations within its normal range and the presence of diabetes/IFG, hypertension, obesity, dyslipidaemia, and metabolic syndrome persisted after adjusting for several clinical and biochemical variables and for the presence of fatty liver based on ultrasonographic findings. Odds ratios (95% CI) for group 4 (highest quartile of normal range of GGT) vs. group 1 (lowest quartile of normal range of GGT); the referent group, were 3.16 (2.15,4.65) for diabetes, 2.24 (1.73,2.90) for IFG, 1.93 (1.59,2.33) for obesity, 1.38 (1.23,1.55) for dyslipidaemia and 2.88 (2.28,3.65) for metabolic syndrome in men. In women, the odds ratios were 2.72 (1.34,5.52), 3.67 (2.26,5.97), 2.10 (1.61,2.74), 1.80 (1.58,2.04) and 3.57 (2.52,5.07), respectively. Conclusions Our data show that, even within its normal range, serum GGT concentrations are closely associated with the presence of diabetes and cardiovascular risk factors, and that these associations are independent of a fatty liver by ultrasonography. [source] Plasma nitrotyrosine levels, antioxidant vitamins and hyperglycaemiaDIABETIC MEDICINE, Issue 9 2005S. Bo Abstract Aims Studies on plasma nitrotyrosine (NT) levels, a measure of oxidative injury, in diabetes are limited and discordant; the amount of antioxidants might represent a possible explanation for the discordant results. The aim of this paper is to evaluate the association between plasma NT levels and glucose tolerance status, according to antioxidant vitamin intakes. Methods In three hundred men randomly selected from a population-based cohort, NT levels were measured and dietary intake assessed by a food-frequency questionnaire. Results NT values were similar in patients with diabetes (n = 34), impaired fasting glucose (n = 77) and normoglycaemic subjects (n = 189). However, in subjects with lower than recommended daily intakes of antioxidant vitamins C and A, NT levels were significantly higher in the diabetic patients. In a multiple regression model, after adjustments for age, body mass index (BMI) and smoking habits, NT levels were significantly associated with fasting glucose in patients with lower intakes of vitamin C (, = 11.4; 95% CI 1.3 21.5) and vitamin A (, = 14.9; 95% CI 3.9 25.9), but not in subjects with lower intake of vitamin E. Conclusion A significant positive correlation between NT levels and fasting glucose is evident only in the presence of a reduced intake of some antioxidant vitamins. These findings might explain, at least in part, the discrepant results of previous studies and, if confirmed by further studies, suggest a simple measure (a balanced diet) to alleviate the increased oxidative stress of diabetes. [source] Screening for diabetes in Indigenous populations using glycated haemoglobin: sensitivity, specificity, post-test likelihood and risk of diseaseDIABETIC MEDICINE, Issue 7 2005K. G. Rowley Abstract Aims Screening for diabetes using glycated haemoglobin (HbA1c) offers potential advantages over fasting glucose or oral glucose tolerance testing. Current recommendations advise against the use of HbA1c for screening but test properties may vary systematically across populations, according to the diabetes prevalence and risk. We aimed to: (i) characterize the properties of test cut-offs of HbA1c for diagnosis of diabetes relative to a diagnosis based on a fasting plasma glucose concentration of 7.0 mmol/l for high-risk Indigenous populations; and (ii) examine test properties across a range of diabetes prevalence from 5 to 30%. Methods Data were collected from Aboriginal and Torres Strait Islander communities in Australia and a Canadian First Nations community (diabetes prevalence 12,22%) in the course of diabetes diagnostic and risk factor screening programmes (n = 431). Screening test properties were analyzed for the range of HbA1c observed (3,12.9%). Results In separate and pooled analyses, a HbA1c cut point of 7.0% proved the optimal limit for classifying diabetes, with summary analysis results of sensitivity = 73 (56,86)%, specificity = 98 (96,99)%, overall agreement (Youden's index) = 0.71, and positive predictive value (for an overall prevalence of 18%) = 88%. For diabetes prevalence from 5 to 30% the post-test likelihood of having diabetes given HbA1c = 7.0% (positive predictive value) ranged from 62.7 to 93.2%; for HbA1c < 7.0%, the post-test likelihood of having diabetes ranged from 4.5 to 27.7%. Conclusions The results converge with research on the likelihood of diabetes complications in supporting a HbA1c cut-off of 7.0% in screening for diabetes in epidemiological research. Glycated haemoglobin has potential utility in screening for diabetes in high-risk populations. [source] Prevalence of undiagnosed Type 2 diabetes and impaired fasting glucose in older B ritish men and womenDIABETIC MEDICINE, Issue 6 2005M. C. Thomas Abstract Aim To estimate the prevalence of undiagnosed diabetes and impaired fasting glucose in older British men and women, using the 1999 World Health Organization (WHO) thresholds based on fasting glucose measurements. Methods Participants in the British Regional Heart Study and the British Women's Heart and Health Study were selected from one socially representative general practice in 24 British towns. Included in this analysis were 3736 men and 3642 women aged 60,79 years (predominantly white), who provided a single fasting blood sample at a clinical examination between 1998 and 2001, and who had no previous diagnosis of diabetes. Results Two hundred and eleven men (5.7%) and 190 women (5.2%) had a fasting blood glucose level consistent with the WHO threshold for a diagnosis of diabetes (, 7.0 mmol/l), whilst a further 667 men (17.9%) and 642 women (17.6%) had impaired fasting glucose levels (6.1 , 7 mmol/l). When analyses were restricted to subjects who had fasted for at least 8 h, and whose blood sample was taken before 12.00 h, the predicted prevalence of undiagnosed diabetes (based on two separate measurements) was 6.7% in men and 6.0% in women. The predicted prevalence of impaired fasting glucose (based on two separate measurements) was approximately 20% in both sexes. Conclusions More than one-fifth of older white British men and women have either undiagnosed diabetes or impaired fasting glucose according to new WHO criteria. Strategies for the primary and secondary prevention of Type 2 diabetes among older individuals are urgently needed. [source] A multivariate logistic regression equation to screen for dysglycaemia: development and validationDIABETIC MEDICINE, Issue 5 2005B. P. Tabaei Abstract Aims To develop and validate an empirical equation to screen for dysglycaemia [impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and undiagnosed diabetes]. Methods A predictive equation was developed using multiple logistic regression analysis and data collected from 1032 Egyptian subjects with no history of diabetes. The equation incorporated age, sex, body mass index (BMI), post-prandial time (self-reported number of hours since last food or drink other than water), systolic blood pressure, high-density lipoprotein (HDL) cholesterol and random capillary plasma glucose as independent covariates for prediction of dysglycaemia based on fasting plasma glucose (FPG) , 6.1 mmol/l and/or plasma glucose 2 h after a 75-g oral glucose load (2-h PG) , 7.8 mmol/l. The equation was validated using a cross-validation procedure. Its performance was also compared with static plasma glucose cut-points for dysglycaemia screening. Results The predictive equation was calculated with the following logistic regression parameters: P = 1 + 1/(1 + e,X) = where X = ,8.3390 + 0.0214 (age in years) + 0.6764 (if female) + 0.0335 (BMI in kg/m2) + 0.0934 (post-prandial time in hours) + 0.0141 (systolic blood pressure in mmHg) , 0.0110 (HDL in mmol/l) + 0.0243 (random capillary plasma glucose in mmol/l). The cut-point for the prediction of dysglycaemia was defined as a probability , 0.38. The equation's sensitivity was 55%, specificity 90% and positive predictive value (PPV) 65%. When applied to a new sample, the equation's sensitivity was 53%, specificity 89% and PPV 63%. Conclusions This multivariate logistic equation improves on currently recommended methods of screening for dysglycaemia and can be easily implemented in a clinical setting using readily available clinical and non-fasting laboratory data and an inexpensive hand-held programmable calculator. [source] Increasing prevalence of Type 2 diabetes mellitus in all ethnic groups in MauritiusDIABETIC MEDICINE, Issue 1 2005S. Söderberg Abstract Aims To describe the prevalence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. Methods Population-based surveys were undertaken in the multiethnic nation of Mauritius in 1987, 1992 and 1998, with 5083, 6616, and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Subjects aged between 25 and 75 years with classifiable data were identified; 4991, 6463 and 5392 from 1987, 1992 and 1998, respectively. Glucose tolerance was classified according to WHO 1999 criteria. Results The prevalence of Type 2 diabetes increased significantly during the period studied, from 12.8% in 1987, to 15.2% in 1992, and 17.9% in 1998. The increasing prevalence was seen in both men and women, and in all age groups. The prevalence of known diabetes (KDM) increased progressively, and more markedly than the increase in newly diagnosed diabetes (NDM). A diagnosis of impaired glucose tolerance (IGT) was more prevalent amongst women whereas impaired fasting glucose (IFG) was more common amongst men. The prevalences of IGT and IFG did not change markedly during the period. The prevalence of diabetes and IGT was similar for participants of Indian, Creole and Chinese background in each survey, and the increasing prevalence of diabetes was seen in all ethnic groups. Conclusion In this study, we report an increasing prevalence of diabetes over an 11-year period in Mauritius. This increase was seen in both sexes, and in all age and ethnic groups, and was mainly due to an increase in the numbers of those with known diabetes. [source] Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemiaDIABETIC MEDICINE, Issue 12 2003Q. Qiao Abstract Aims To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance. Methods Men (1223) and women (1370) aged 45,64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register. Results During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72,0.82) than for fasting glucose (0.65, 0.58,0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4,6.2) than for isolated IFG (2.3, 0.9,5.7) as compared with subjects with neither IFG nor IGT. Conclusion Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention. [source] Alveolar bone loss associated with glucose tolerance in Japanese menDIABETIC MEDICINE, Issue 9 2003T. Marugame Abstract Aims Type 2 diabetes is known to affect alveolar bone loss (ABL). The purpose of this study was to examine whether impaired glucose tolerance (IGT) is associated with ABL, as is diabetes. Methods A case,control study was performed with 664 Japanese men aged 46,57 years. Panoramic radiographs revealed 513 severe ABL cases, 22 moderate ABL cases, and 129 controls with good alveolar bone. Diabetes status was classified into normal glucose tolerance (NGT), impaired fasting glucose (IFG), IGT, and newly diagnosed diabetes according to the fasting plasma glucose and 75-g oral glucose tolerance test (OGTT). Diabetes under treatment was excluded. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from ordinal logistic regression analysis. Statistical adjustment was made for total cholesterol, HDL-cholesterol, triglyceride, rank in the Self Defence Forces (SDF), cigarette-years, alcohol use, body mass index, previous 10 years' brushing habits and instrument use other than toothbrush, and history of periodontal treatment. Results A significant, approximately three-fold increase in the crude OR (crude OR = 3.28; 95% CI = 1.16,9.27) and non-significant 2.6-fold increase in the adjusted OR (adjusted OR = 2.55; 95% CI = 0.86, 7.54) of ABL was observed among men with newly diagnosed Type 2 diabetes compared with the reference group (NGT combined with IFG). However, there was no association between IGT and ABL (adjusted OR = 0.99; 95% CI = 0.59,1.64). Conclusions Type 2 diabetes, but not IGT, was positively associated with ABL. Preventive maintenance against periodontitis is important in middle-aged men with diabetes. [source] The vitamin D receptor gene variant and physical activity predicts fasting glucose levels in healthy young menDIABETIC MEDICINE, Issue 6 2003J. R. Ortlepp Abstract Aims Vitamin D can influence lipolysis and insulin secretion. A common genetic polymorphism of the vitamin D receptor (VDR), which has been found to be associated with bone mineral density, has been reported to be also associated with Type 2 diabetes mellitus (DM). To test the influence of the VDR polymorphism on fasting glucose in healthy young men before the onset of Type 2 DM, we studied a homogeneous population of aircrew members. Methods A total of 1539 individuals were recruited during routine medical qualification for flying duty. Physical activity was assessed in all individuals and categorized into low physical activity (, 3 h per week) and high physical activity (> 3 h per week). The BsmI VDR polymorphism was analysed by polymerase chain reaction. On the day of blood testing the individuals were fasting for at least 8 h overnight. Serum glucose was measured within 60 min after sampling venous blood. Results In young males with low physical activity (n = 752) gene carriers with the VDR genotype BB (n = 137) have significantly (P < 0.001) higher levels of fasting glucose (5.61 ± 0.49 mmol/l) than gene carriers with the genotype Bb (n = 370; 5.44 ± 0.44 mmol/l) or bb (n = 245; 5.38 ± 0.44 mmol/l). Of BB gene carriers, 47% had fasting glucose levels > 5.55 mmol/l compared with 36% of Bb gene carriers and 34% of bb gene carriers (P = 0.018). This effect is absent in gene carriers with high physical activity (n = 787). Conclusions The VDR genotype is associated with altered fasting glucose levels in young men with low physical activity. If this association is confirmed in other populations it might be worthwhile studying the particular benefits of an exercise programme in dependents of the VDR genotype. Diabet. Med. 20, 451,454 (2003) [source] Improvements in insulin sensitivity and ,-cell function (HOMA) with weight loss in the severely obeseDIABETIC MEDICINE, Issue 2 2003J. B. Dixon Abstract Aims To examine the effect of weight loss on insulin sensitivity and ,-cell function in severely obese subjects of varying glycaemic control. Patients and methods Subjects were 254 (F:M 209:45) patients having adjustable gastric banding for severe obesity, with paired biochemical data from before operation and at 1-year follow up. The homeostatic model assessment method was used to calculate insulin sensitivity (HOMA%S) and ,-cell function (HOMA%B). Subjects were grouped by diabetic status and by pre-weight loss HbA1c. Results Initial mean (sd) weight and body mass index were 128 (26) kg and 46.2 (7.7) kg/m2, respectively, and at 1-year were 101 (22) kg and 36.4 (6.7) kg/m2. The percentage of excess weight lost (%EWL) was 44.3 (14)%. HOMA%S improved from 37.5 (16)% presurgery to 62 (25)% (P < 0.001). %EWL was the only predictor of HOMA%S improvement (r = 0.28, P < 0.001). Subjects with normal fasting glucose, impaired fasting glucose and Type 2 diabetes had a fall, no change and increase in HOMA%B, respectively. The improvement in HOMA%B in subjects with diabetes (n = 39) was inversely related to the time with diabetes (r = ,0.36, P = 0.02). In non-diabetic subjects the HOMA%S,HOMA%B relationship was favourably altered with weight loss, so that for any given HOMA%S there was an increase in HOMA%B (f = 11.8, P = 0.001). This improvement in HOMA%B was positively related to %EWL (r = 0.25, P = 0.019). Discussion There are beneficial changes in both insulin sensitivity and ,-cell function with weight loss. Modern laparoscopic obesity surgery may have an important early role in the management of Type 2 diabetes in obese subjects. [source] Increasing prevalence of diabetes mellitus in OmanDIABETIC MEDICINE, Issue 11 2002J. A. Al-Lawati Abstract Aims To determine the prevalence of diabetes mellitus and impairedfasting glucose by age, gender, and by region and compare resultswith the 1991 survey; and estimate previously undiagnosed diabetesmellitus in the Omani population. Methods Cross-sectional survey containing a probability random sample of5838 Omani adults aged , 20 years. Diabetesand impaired fasting glucose (IFG) were assessed by fasting venous plasmaglucose using 1999 World Health Organization's diagnosticcriteria (normoglycaemia < 6.1 mmol/l, IFG , 6.1 but < 7 mmol/l,and diabetes , 7 mmol/l). The 1991 surveywas reanalysed using the same diagnostic criteria, and results werecompared. Results In 2000, the age-adjusted prevalence of diabetes among Omanis aged30,64 years reached 16.1% (95% confidenceinterval (CI) 14.7,17.4) compared with 12.2% (95% CI11.0,13.4) in 1991. IFG was found among 7.1% (95% CI6.2,8.1) of males and 5.1% (95% CI 4.4,6.0)of females. Generally, diabetes was more common in urban then ruralregions. Only one-third of diabetic subjects knew that they haddiabetes. Nearly half of the study population had a body mass index > 25 kg/m2. Conclusions The prevalence of diabetes is high in Oman and has increasedover the past decade. The high rate of abnormal fasting glucosetogether with high rates of overweight and obesity in the population makeit likely that diabetes will continue to be a major health problem inOman. Primary prevention programmes are urgently needed to counteract majorrisk factors that promote the development of diabetes. Diabet. Med. 19, 954,957 (2002) [source] Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly KoreansDIABETIC MEDICINE, Issue 10 2002K. M. Choi Abstract Aims This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. Methods This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist,hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (, statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. Results The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted , = 0.228 men, weighted , = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. Conclusions Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans. [source] | ||||||||||||||||||||||||||||||||||