Bimodality in Blood Glucose Distribution

Lim, Teck Onn; Bakri, Rugayah; Morad, Zaki; Hamid, Maimunah

doi:10.2337/diacare.25.12.2212

Cited by 25 publications

(29 citation statements)

References 19 publications

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“…According to these criteria, values above the nadir are indicative of diabetes, whereas values below the nadir are not. In the present study, the nadir of postchallenge glucose (the cut point that separates the two components) was in the range of 11.1-13.6 mmol/l, which was slightly higher than the diabetes diagnostic criteria recommended by the World Health Organization in 1985 (9), but similar to the 2-h glucose nadirs found in a recent Malaysian study of four ethnic groups (17) and in Egyptians (18).…”

Section: Methodssupporting

confidence: 71%

“…Other biases that could obscure bimodality of type 1 and type 2 diabetes or admixture in white cohorts include the exclusion of persons with known diabetes who refuse or are not offered a glucose tolerance test (17).…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, some very high-risk groups may require little overall obesity, only central adiposity. For example, none of the participants in the four ethnic groups in the Malaysian study showing bimodal postchallenge hyperglycemia were obese by Western standards (17). Increasing obesity in the U.S. suggests that the predicted epidemic of diabetes will affect all ethnic groups (25).…”

Section: Methodsmentioning

confidence: 99%

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Bimodality of 2-h Plasma Glucose Distributions in Whites

et al. 2005

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OBJECTIVE -Several studies have shown a bimodal curve in the distribution of glucose in populations with a high prevalence of type 2 diabetes, but bimodality has not been reported among whites of Northern European ancestry. It is not clear whether this difference reflects the lower prevalence of diabetes, obscuring a second mode, or implies a more fundamental difference between whites and nonwhites. We investigate this issue by studying glucose distributions in older white patients. RESEARCH DESIGN AND METHODS-A study of diabetes was conducted among older community-dwelling white residents of a suburban Southern California community between 1984 and 1987. Two-hour plasma glucose data were collected from 2,326 older white men and women aged 23-92. To investigate bimodality of glucose distributions, we fit unimodal and bimodal normal models to 2-h plasma glucose concentrations transformed by the Box-Cox family of transformations.RESULTS -We found that the bimodal normal mixture model fit the data significantly better than the unimodal skewed distribution model for both sexes and all age-groups except those Ն80 years. The cut points separating the two modes were generally within the 11.1-to 13.6-mmol/l range.CONCLUSIONS -The bimodality of glucose distributions among whites, combined with previous findings, indicates that this phenomenon may be universal. A smaller second mode in our study compared with other studies suggests that whites have diabetes susceptibility but may require more obesity to demonstrate it. With increasing obesity in the U.S., the predicted epidemic of diabetes may affect all ethnic groups including whites. Diabetes Care 28:1451-1456, 2005A bimodal distribution of plasma glucose concentrations in a population was first described in a 1971 study on Pima Indians, who have the highest prevalence of type 2 diabetes in the world (1). A bimodal curve showing two distinct distributions of plasma glucose concentrations, instead of a single skewed distribution, is compatible with a genetic condition (diabetes) manifest by hyperglycemia and a second population without diabetes (without hyperglycemia). Subsequently, bimodality was reported in other populations with a high prevalence of diabetes, including Nauruans from Micronesia (2), Samoans (3), Asian Indians who had migrated to South Africa (4), and Mexican Americans who were ϳ50% white (5). The diversity of populations with glucose bimodality suggests that this may be a universal phenomenon, readily detected in populations with a high prevalence of diabetes. To our knowledge, no studies have reported a bimodal glucose distribution among whites of Northern European ancestry, suggesting either genetic/environmental differences or a prevalence of diabetes too low to detect a second mode (6,7).We hypothesized that statistically significant bimodality might be detectable in older white patients because the prevalence of diabetes increases to nearly 20% in old age (8) and because most genetically susceptible people might be expected to develop diabetes if ...

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Section: Methodssupporting

confidence: 71%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Bimodality of 2-h Plasma Glucose Distributions in Whites

et al. 2005

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“…However, the estimated cut points were inconsistent between countries, especially for 2-h plasma glucose when participants with known diabetes were included. Comparing these results with those of earlier studies, we found that the overall cut point for FPG was somewhat lower (2,3,8,9), whereas the cut point for 2-h plasma glucose was well in line (1)(2)(3)5,8,10,11,13), except for the studies of South African Indians (9) and Western Samoans (12), which produced lower cut points for 2-h plasma glucose.…”

Section: -Distribution Of Fpg In Korea (A) and Nauru (B) And 2-h Plassupporting

confidence: 77%

“…This exclusion potentially makes the two components less distinct and thereby decreases the probability of a meaningful cut point separating them. However, as acknowledged in previous studies (3,10,13), including patients with known diabetes in the analyses will induce a treatment bias for the following reasons. In accordance with existing treatment guidelines, patients with diabetes are treated with the aim of lowering their glucose to a near-normal range.…”

Section: -Distribution Of Fpg In Korea (A) and Nauru (B) And 2-h Plasmentioning

confidence: 99%

Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Vistisen

Colagiuri²,

Borch‐Johnsen³

2009

Diabetes Care

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OBJECTIVE -Bimodality in the distribution of glucose has been used to define the cut point for the diagnosis of diabetes. Previous studies on bimodality have primarily been in populations with a high prevalence of type 2 diabetes, including one study in a white Caucasian population. All studies included participants with known diabetes. The aim of this study was to assess whether a bimodal structure is a general phenomenon in fasting plasma glucose (FPG) and 2-h plasma glucose that is useful for deriving a common cut point for diabetes in populations of different origin, both including and excluding known diabetes. RESEARCH DESIGN AND METHODS -The Evaluation of Screening and EarlyDetection Strategies for Type 2 Diabetes and Impaired Glucose Tolerance (DETECT-2) project is an international collaboration pooling surveys from all continents. These studies include surveys in which plasma glucose was measured during an oral glucose tolerance test; in total, 43 studies (135,383 participants) from 27 countries were included. A mixture of two normal distributions was fitted to plasma glucose levels, and a cut point for normal glycemia was estimated as their intersection. In populations with a biologically meaningful cut point, bimodality was tested for significance.RESULTS -Distributions of FPG and 2-h plasma glucose did not, in general, produce bimodal structures useful for deriving cut points for diabetes. When present, the cut points produced were inconsistent over geographical regions.CONCLUSIONS -Deriving cut points for normal glycemia from distributions of FPG and 2-h plasma glucose does not appear to be suitable for defining diagnostic cut points for diabetes. Diabetes Care 32:397-403, 2009

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Evaluation of the metastatic potential of malignant cells by image processing of digital holographic microscopy data

et al. 2017

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The cell refractive index has been proposed as a putative cancer biomarker of great potential, being correlated with cell content and morphology, cell division rate and membrane permeability. We used digital holographic microscopy to compare the refractive index and dry mass density of two B16 murine melanoma sublines of different metastatic potential. Using statistical methods, the distribution of phase shifts within the reconstructed quantitative phase images was analyzed by the method of bimodality coefficients. The observed correlation of refractive index, dry mass density and bimodality profile with the metastatic potential of the cells was validated by real time impedance‐based assay and clonogenic tests. We suggest that the refractive index and bimodality analysis of quantitative phase image histograms could be developed as optical biomarkers useful in label‐free detection and quantitative evaluation of cell metastatic potential.

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Bimodality in Blood Glucose Distribution

Cited by 25 publications

References 19 publications

Bimodality of 2-h Plasma Glucose Distributions in Whites

Bimodality of 2-h Plasma Glucose Distributions in Whites

Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Evaluation of the metastatic potential of malignant cells by image processing of digital holographic microscopy data

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