Detection of Undiagnosed Diabetes and Other Hyperglycemia States

Schmidt, María Inês; Duncan, Bruce Bartholow; Vigo, Álvaro; Pankow, James S.; Ballantyne, Christie M.; Couper, David J.; Brancati, Frederick L.; Folsom, Aaron R.

doi:10.2337/diacare.26.5.1338

Cited by 33 publications

(21 citation statements)

References 24 publications

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“…Whether our results generalize to other populations is an important area for future research. The Atherosclerosis Risk in Communities Study (18) concluded that twothirds of those classified at the lower (100 -109 mg/dl) IFG cut point had either diabetes or IGT. Thus, because many patients with IFG also have IGT, interventions proven effective in IGT populations (19 -22) would likely also apply to the majority of patients with IFG.…”

Section: Figure 1-progression From Normal Fasting Plasma Glucose To Smentioning

confidence: 99%

Progression From Newly Acquired Impaired Fasting Glusose to Type 2 Diabetes

2007

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OBJECTIVE -We sought to estimate the rate of progression from newly acquired (incident) impaired fasting glucose (IFG) to diabetes under the old and new IFG criteria and to identify predictors of progression to diabetes.RESEARCH DESIGN AND METHODS -We identified 5,452 members of an HMO with no prior history of diabetes, with at least two elevated fasting glucose tests (100 -125 mg/dl) measured between 1 January 1994 and 31 December 2003, and with a normal fasting glucose test before the two elevated tests. All data were obtained from electronic records of routine clinical care. Subjects were followed until they developed diabetes, died, left the health plan, or until 31 December 2005.RESULTS -Overall, 8.1% of subjects whose initial abnormal fasting glucose was 100 -109 mg/dl (added IFG subjects) and 24.3% of subjects whose initial abnormal fasting glucose was 110 -125 mg/dl (original IFG subjects) developed diabetes (P Ͻ 0.0001). Added IFG subjects who progressed to diabetes did so within a mean of 41.4 months, a rate of 1.34% per year. Original IFG subjects converted at a rate of 5.56% per year after an average of 29.0 months. A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycerides; and lower HDL cholesterol predicted diabetes development.CONCLUSIONS -To our knowledge, these are the first estimates of diabetes incidence from a clinical care setting when the date of IFG onset is approximately known under the new criterion for IFG. The older criterion was more predictive of diabetes development. Many newly identified IFG patients progress to diabetes in Ͻ3 years, which is the currently recommended screening interval. Diabetes Care 30:228 -233, 2007T he American Diabetes Association (ADA) defines impaired fasting glucose (IFG) as an intermediate state of hyperglycemia in which glucose levels do not meet criteria for diabetes but are too high to be considered normal (1). Although the ADA calls IFG "pre-diabetes" (1), reported estimates of diabetes development in IFG patients vary widely (2). The Hoorn Study (3) found that 33% of patients with IFG but not impaired glucose tolerance (IGT) and 64.5% of patients with IFG and IGT developed diabetes over a follow-up of 5.8 -6.5 years. The Paris Prospective Study (4) reported much lower proportions: 2.7% among patients with normal glucose tolerance or isolated IFG and 14.9% among patients with IFG and IGT over 30 months of follow-up. An Italian study (5) spanning 11.5 years found that 9.1% of patients with isolated IFG and 44.4% of subjects with IFG and IGT developed diabetes. Studies of nonwhite populations have reported diabetes development proportions ranging from 21.6% over 5 years among Mauritians with isolated IFG (6) to 41.2% over 5 years among Pima Indians with IFG and IGT (7). The highest proportion of diabetes development, 72.7% over 7 years among subjects with IGT and IFG, was found in a Brazilian-Japanese population (8).Most of this wide variation in reported rates of diabetes development among IFG patients probably arises f...

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Section: Figure 1-progression From Normal Fasting Plasma Glucose To Smentioning

confidence: 99%

Progression From Newly Acquired Impaired Fasting Glusose to Type 2 Diabetes

2007

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“…The use of the DRS as an initial screening instrument, followed by the measurement of FBG in individuals with a score Ն9 and by the OGTT in individuals with an FBG between 5.6 and 6.9 mmol/l, would lead to the identification of 83% of the cases of unknown diabetes and 57% of IGT cases, at a cost of an OGTT in 38% of the sample and an FBG in 64%. Therefore, the yield of this strategy would be almost identical to that obtained in the ARIC study (21), but with a much simpler and less expensive approach, considering that only two-thirds of the patients needed the FBG measurement with our strategy. It is important to note that the same detection rate would be obtained with a strategy using an FBG measurement as the initial step, followed by an OGTT in individuals with an FBG of 6.1-6.9 mmol/l.…”

Section: Igloo Study Groupmentioning

confidence: 80%

“…The yield of the different screening strategies is summarized in Table 3, where we report the results obtained in the IGLOO population as well as those deriving from the simulations based on different scenarios, with a prevalence of glucose abnormalities ranging between 5 and 20%. From the table it emerges that the best compromise between number of cases detected and cost per case detected is represented by the screening strategy using the DRS as initial instrument, with an FBG performed in individuals with a (15)(16)(17)(18)(19)(20), only a few studies have addressed the problem of also identifying those with asymptomatic hyperglycemia requiring clinical intervention (21,22). In particular, in the Atherosclerosis Risk in Communities (ARIC) study, a clinical detection rule was developed that, associated with FPG and/or OGTT, led to the detection of 86.3% of the cases of diabetes and 52.4% of the cases of IGT, with 39.6% of the patients needing an OGTT (assuming that patients with IFG needed to be reclassified) (21).…”

Section: Igloo Study Groupmentioning

confidence: 99%

Use of the Diabetes Risk Score for Opportunistic Screening of Undiagnosed Diabetes and Impaired Glucose Tolerance

et al. 2005

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OBJECTIVE -To evaluate an opportunistic screening strategy addressed to individuals with one or more cardiovascular risk factor, based on the Diabetes Risk Score (DRS) as the initial instrument, for the identification of individuals with type 2 diabetes or impaired glucose tolerance (IGT).RESEARCH DESIGN AND METHODS -The DRS, a simple self-administered questionnaire, was completed by individuals identified by general practitioners and presenting with one or more cardiovascular risk factor. All patients underwent a 2-h oral glucose tolerance test (OGTT). The optimal DRS cutoff was calculated by applying the receiver-operating characteristic curve.RESULTS -Overall, 1,377 individuals aged between 55 and 75 years received an OGTT and completed the DRS. Mean DRS values showed a marked variation according to glucose metabolism categories, as follows: 8.7 Ϯ 3.0 in normoglycemic individuals, 9.5 Ϯ 3.1 in individuals with impaired fasting glucose, 9.9 Ϯ 3.3 in individuals with IGT, and 12.0 Ϯ 3.5 in individuals with type 2 diabetes. The receiver-operating characteristic curve showed that, with a cutoff of 9, the sensitivity of DRS in detecting individuals with glucose abnormalities (type 2 diabetes or IGT) was 77% and the specificity 45%. The use of the DRS as an initial screening instrument, followed by the measurement of fasting blood glucose in individuals with a score Ն9 and by the OGTT in individuals with a fasting blood glucose between 5.6 and 6.9 mmol/l, would lead to the identification of 83% of the case subjects with type 2 diabetes and 57% of the case subjects with IGT, at a cost of an OGTT in 38% of the sample and a fasting blood glucose in 64%.CONCLUSIONS -The DRS can represent a valid inexpensive instrument for opportunistic screening and a useful alternative to indiscriminate fasting blood glucose measurement, not readily available in general practice. Diabetes Care 28:1187-1194, 2005T he prevalence of type 2 diabetes is rapidly growing worldwide (1,2). This condition exerts a pernicious effect on patient health and health care budgets, and early detection of subjects with undiagnosed diabetes might be important in reducing the burden of diabetic complications. This is of particular importance considering that diabetes is frequently not diagnosed until complications appear, and approximately onethird of all people with diabetes may be undiagnosed (3).Recent experimental evidence has shown that type 2 diabetes can be prevented or delayed by implementing lifestyle modifications (e.g., diet and exercise) or using pharmacological treatment (metformin or acarbose) in individuals with impaired glucose tolerance (IGT) (4 -7). These findings have provided the rationale for screening IGT. This condition is defined using a 2-h oral glucose tolerance test (OGTT), a kind of test that is often considered to entail enough discomfort to discourage its indiscriminate use. Identifying people at increased risk for undiagnosed diabetes or glucose intolerance, followed by blood glucose testing to establish diagnosis, is consid...

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“…Use of glucose levels for screening has revealed that post-challenge glucose is a more uniform predictor of progression from IGT to diabetes as compared with fasting glucose [29]. Moreover, fasting glucose measurements often fail to recognise both IGT and diabetes [30,31], and poor sensitivity is obtained even with lower cut-off levels [32,33]. Previous studies of RPG and RCG have frequently not included AROC values [34,35], but RCG can be efficient when combined in an equation with postprandial time, age, sex and BMI [36].…”

Section: Discussionmentioning

confidence: 99%

Glucose challenge test screening for prediabetes and undiagnosed diabetes

et al. 2009

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Aims/hypothesis Diabetes prevention and care are limited by lack of screening. We hypothesised that screening could be done with a strategy similar to that used near-universally for gestational diabetes, i.e. a 50 g oral glucose challenge test (GCT) performed at any time of day, regardless of meal status, with one 1 h sample. Methods At a first visit, participants had random plasma and capillary glucose measured, followed by the GCT with plasma and capillary glucose (GCTplasma and GCTcap, respectively). At a second visit, participants had HbA 1c measured and a diagnostic 75 g OGTT. ResultsThe 1,573 participants had mean age of 48 years, BMI 30.3 kg/m 2 and 58% were women and 58% were black. Diabetes (defined by WHO) was present in 4.6% and prediabetes (defined as impaired glucose tolerance [2 h glucose 7.8-11.1 (140-199 mg/dl) with fasting glucose ≤6.9 (125 mg/dl)] and/or impaired fasting glucose with plasma glucose 6.1-6.9 mmol/l [110-125 mg/dl]) in 18.7%. The GCTplasma provided areas under the receiver-operatingcharacteristic curves of 0.90, 0.82 and 0.79 for detection of diabetes, diabetes or prediabetes, and prediabetes, respectively, all of which were higher than GCTcap, random and capillary glucose, and HbA 1c (p<0.02 for all). The perfor- mance of GCTplasma was unaffected by time after meals or time of day, and was better in blacks than whites, but otherwise comparable in men and women, and in groups with differing prevalence of glucose intolerance. GCTplasma screening would cost approximately US$84 to identify one person with previously unrecognised diabetes or prediabetes. Conclusions/interpretation GCT screening for prediabetes and previously unrecognised diabetes would be accurate, convenient and inexpensive. Widespread use of GCT screening could help improve disease management by permitting early initiation of therapy aimed at preventing or delaying the development of diabetes and its complications.

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Detection of Undiagnosed Diabetes and Other Hyperglycemia States

Cited by 33 publications

References 24 publications

Progression From Newly Acquired Impaired Fasting Glusose to Type 2 Diabetes

Progression From Newly Acquired Impaired Fasting Glusose to Type 2 Diabetes

Use of the Diabetes Risk Score for Opportunistic Screening of Undiagnosed Diabetes and Impaired Glucose Tolerance

Glucose challenge test screening for prediabetes and undiagnosed diabetes

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