Predicting Impaired Glucose Tolerance Using Common Clinical Information

Nelson, Karin M.

doi:10.2337/diacare.26.7.2058

Cited by 37 publications

(20 citation statements)

References 23 publications

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“…While our results validated the previous findings with respect to the value of HbA1c as a sensitive marker of IGT [17,18,19,20,21,22], QUICKI and HOMA-IR were not found to correlate with abnormal glucose tolerance in all ages and across all pubertal statuses. This may be due to the fact that these indices are calculated based on fasting insulin and glucose, which may not necessarily be abnormal in prepubertal obese children with early-stage insulin resistance and peripheral insulin that is only intermittently elevated [28].…”

Section: Discussionsupporting

confidence: 90%

“…In adults, several studies have shown the utility of hemoglobin A1c (HbA1c) or a combination of multiple clinical parameters as a simple screening tool to assess the risk of IGT [17,18,19,20,21]. In children, only one study has suggested that HbA1c alone or in combination with other clinical measures can predict 2-hour post-OGTT abnormal glucose tolerance [22].…”

Section: Introductionmentioning

confidence: 99%

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Screening Markers of Impaired Glucose Tolerance in the Obese Pediatric Population

et al. 2010

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Background: With the epidemic of childhood obesity, it is crucial to devise a simple screening protocol to predict impaired glucose tolerance (IGT) or pre-diabetes. The oral glucose tolerance test (OGTT), which is the gold standard for the diagnosis of IGT, is impractical for screening purposes. This pilot study was designed to formulate a simple, sensitive algorithm to predict IGT using clinical and laboratory parameters. Methods: Ethnicity, family history of diabetes, pubertal status, BMI z-score, blood pressure, lipids, hemoglobin A1c (HbA1c) and OGTT data were retrospectively collected from 209 overweight multi-ethnic subjects aged 3–21 years. Multivariate logistic regression was used to determine independent predictors of IGT. Results: HbA1c was the only significant predictor of IGT (p = 0.001), whereas fasting glucose was not. A cut-off of 5.5% had the best combined sensitivity (85.7%) and specificity (56.9%) with an odds ratio of 7.9 of having IGT when HbA1c is ≧5.5%. The remaining clinical parameters were not significant predictors of IGT. Conclusion: While fasting blood glucose does not seem to be a predictor of IGT, we propose that HbA1c ≧5.5% can be used as a screening test to assess the risk of IGT and to determine who should undergo diagnostic OGTT. Large prospective studies validating our findings are warranted.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Screening Markers of Impaired Glucose Tolerance in the Obese Pediatric Population

et al. 2010

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“…Among the Ϸ21% of mothers who underwent the glucose tolerance test, the prevalence of glucose intolerance was similar to that in women of comparable age and ethnicity in NHANES III cohort (29). This finding is in contrast to earlier studies from other investigators, who had reported an increase in the prevalence of glucose intolerance in parents of women with PCOS (13,14).…”

Section: Discussioncontrasting

confidence: 49%

Evidence for metabolic and reproductive phenotypes in mothers of women with polycystic ovary syndrome

Sam

Legro²,

Essah

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

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Dyslipidemia is a feature of polycystic ovary syndrome (PCOS), but its pathogenesis remains controversial. We performed this study of mothers of women with PCOS to test the hypothesis that dyslipidemia is a heritable trait in families of women with PCOS and to investigate the impact of age on reproductive and metabolic phenotypes. Fasting blood was obtained in 215 non-Hispanic white mothers of women with PCOS and 62 control women. The prevalence of metabolic syndrome was compared with that in nonHispanic white women of comparable age from the National Health and Nutrition Examination Survey III. Mothers had higher total (P < 0.001) and low-density lipoprotein (LDL) cholesterol levels (P ‫؍‬ 0.007), whereas high-density lipoprotein and triglyceride levels did not differ compared with control women. The only predictors of LDL levels in mothers were their daughters' LDL levels (r 2 ‫؍‬ 0.11, P < 0.001) and their own unbound testosterone levels (r 2 ‫؍‬ 0.04, P ‫؍‬ 0.03). The prevalence of metabolic syndrome was increased in obese (body mass index > 30 kg͞m 2 ) mothers compared with obese non-Hispanic white women from the National Health and Nutrition Examination Survey III (P ‫؍‬ 0.04). Thirty-one percent of mothers reported a history of menstrual irregularity. These mothers had higher androgen levels, markers of insulin resistance, and LDL levels than mothers with regular menses. LDL levels are increased in mothers of women with PCOS, suggestive of a heritable trait. A history of menstrual irregularity identifies mothers with features of PCOS. Obese mothers have a very high prevalence of metabolic syndrome. These findings suggest that both the reproductive and metabolic abnormalities persist with age in PCOS.hyperandrogenemia ͉ hypertriglyceridemia ͉ insulin resistance ͉ low-density lipoprotein cholesterol ͉ menstrual irregularity P olycystic ovary syndrome (PCOS) is a common endocrine disorder in premenopausal women (1) characterized by disordered gonadotropin secretion and hyperandrogenism (2). Women with PCOS frequently have substantial insulin resistance (3) and are at increased risk for type 2 diabetes mellitus (DM2) (4, 5). Affected women also have other risk factors for cardiovascular disease, including obesity and dyslipidemia (6-8). Studies of women with PCOS, by definition, have been limited to women in their reproductive years, and little is known about the reproductive or metabolic phenotypes as these women age. Paradoxically, the only controlled study of older women with PCOS suggested that lipid abnormalities normalize in the fifth decade of life as the prevalence of these changes increases in the normal population (7). The long-term health consequences of PCOS are of considerable importance because of the well established increase in cardiovascular disease risk conferred by DM2 and the emerging data on risk conferred by other disorders associated with insulin resistance. Moreover, the full burden of these associated disorders may not become evident until affected women are in their sixth to eighth d...

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“…In addition, screening large numbers of individuals using OGTTs is likely to be timeconsuming and expensive [35]. An alternative approach is to use simple risk-prediction tools to identify individuals who are likely to have dysglycemia [36]. Those individuals determined to be at high risk can then be referred for an OGTT to confirm whether they have IGT, or even undiagnosed type 2 diabetes [35].…”

Section: Identifying Individuals With Igtmentioning

confidence: 99%

Reducing the Risk of Type 2 Diabetes - Early Identification of High-Risk Individuals and Treatment with Acarbose

Pan

2007

CDR

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The severity of the type 2 diabetes epidemic is widely acknowledged. Demographic, social, and cultural changes around the world are driving a dramatic increase in the prevalence of type 2 diabetes. Consequently, there is increasing interest in defining the target population and developing strategies for preventing or delaying the disease. Impaired glucose tolerance (IGT), an asymptomatic condition early in the disease continuum of dysglycemia, is the best target for intervention, as it is a strong predictor for the development of both type 2 diabetes and cardiovascular disease (CVD). Identifying individuals likely to have IGT using risk-prediction tools is simple and cost-effective; diagnosis can be confirmed with an oral glucose tolerance test. Numerous trials have examined the benefits of intervention in IGT populations. Lifestyle modification and some pharmacologic therapies, such as acarbose, have been shown to significantly reduce disease progression. Acarbose therapy has also been associated with significant reductions in cardiovascular events and new cases of hypertension. Trials assessing the potential preventive effects of various therapies are ongoing, but current evidence confirms that early intervention in individuals with IGT can reduce the risks of type 2 diabetes and CVD. Identification of high-risk individuals should therefore be standard in general practice and, if IGT is diagnosed, therapeutic intervention should be initiated promptly.

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Predicting Impaired Glucose Tolerance Using Common Clinical Information

Cited by 37 publications

References 23 publications

Screening Markers of Impaired Glucose Tolerance in the Obese Pediatric Population

Screening Markers of Impaired Glucose Tolerance in the Obese Pediatric Population

Evidence for metabolic and reproductive phenotypes in mothers of women with polycystic ovary syndrome

Reducing the Risk of Type 2 Diabetes - Early Identification of High-Risk Individuals and Treatment with Acarbose

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