Prognostic Implications of Single-Sample Confirmatory Testing for Undiagnosed Diabetes

Selvin, Elizabeth; Wang, Dan; Matsushita, Kunihiro; Grams, Morgan E.; Coresh, Josef

doi:10.7326/m18-0091

Cited by 56 publications

(42 citation statements)

References 22 publications

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“…The Atherosclerosis Risk in Communities (ARIC) study (2018) also showed that the risk of CKD was higher in the DD patients than in the UD patients. The risk factor for each condition was in the sequence: No diabetes < unconfirmed UD < confirmed UD < DD [27]. The findings of the study by Herrington et al and the ARIC study are contradictory to our findings.…”

Section: Ud and The Risk Of Developing Dkdcontrasting

confidence: 99%

Burden of Undiagnosed Type 2 Diabetes in Diabetic Kidney Disease: A Japanese Retrospective Cohort Study

Tanabe

Saito

Machii

et al. 2020

JCM

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The risk of developing diabetic kidney disease (DKD) in patients with undiagnosed diabetes mellitus (UD) has never been evaluated. We studied the burden of UD on the risk of developing DKD in the Japanese population in a single-center retrospective cohort study. The patients with type 2 diabetes mellitus, but without DKD (estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or proteinuria), were recruited from January 2018 to January 2019; medical records were scrutinized retrospectively from January 2003 until May 2019. The individuals, with diabetes that could not be denied based on past and current records, comprised the undiagnosed diabetes (UD) group whereas those with confirmed diagnosis comprised the diagnosed diabetes (DD) group. The group differences were tested using a Kaplan–Meier curve and Cox proportional hazards model. Among the 408 participants, 164 (40.2%) and 244 (59.8%) comprised the DD and UD groups, respectively. The baseline parameters, including age, male gender, and BMI were comparable between the groups, but the plasma glucose, HbA1c levels, and diabetic retinopathy prevalence were higher in the UD group. The risk of developing DKD (log rank test, p < 0.001), an eGFR of < 60 mL/min/1.73 m2 (p = 0.001) and proteinuria (p = 0.007) were also higher in the UD group. The unadjusted and adjusted hazard ratios for DKD were 1.760 ((95% CI: 1.323–2.341), p < 0.001) and 1.566 ((95% CI: 1.159–2.115), p = 0.003), respectively, for the UD group. In conclusion, this is the first report showing that UD is a strong risk factor for DKD. The notion that a longer duration of untreated diabetes mellitus is involved strongly in the risk of developing DKD warrants the need for the identification and monitoring of UD patients.

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Section: Ud and The Risk Of Developing Dkdcontrasting

confidence: 99%

Burden of Undiagnosed Type 2 Diabetes in Diabetic Kidney Disease: A Japanese Retrospective Cohort Study

Tanabe

Saito

Machii

et al. 2020

JCM

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“…Unless there is a clear clinical diagnosis (e.g., patient in a hyperglycemic crisis or with classic symptoms of hyperglycemia and a random plasma glucose $200 mg/dL [11.1 mmol/L]), diagnosis requires two abnormal test results from the same sample (32)…”

Section: Confirming the Diagnosismentioning

confidence: 99%

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

2,290

987

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Background. Endothelial dysfunction, induced by some cardiovascular risk factors, is the early determinant of atherosclerotic cardiovascular disease. Moreover, it predicts incident type-2 diabetes that is associated with an increased risk of fatal and nonfatal cardiovascular events; however, no data demonstrating a possible interaction between them in predicting cardiovascular outcomes are available. Thus, we designed present study to evaluate the prognostic signi cance of the joint effect of endothelial dysfunction and new-onset type-2 diabetes in hypertensives. Methods. We enrolled 653 white never-treated hypertensive outpatients free of cardiovascular events from the CATanzaro Metabolic Risk factors (CATAMERI) study. All subjects were without type-2 diabetes, heart failure and chronic kidney disease. Endothelium-dependent vasodilation was investigated by intraarterial infusion of acetylcholine, and laboratory determinations were obtained by standard procedures. Follow-up included periodic control visits every six months in our outpatients Clinic and ranged from 26-206 months (median 113). Patients were treated to reduce blood pressure <140/90 mmHg using standard lifestyle and pharmacological treatment. Incident type-2 diabetes and following cardiovascular events were monitored: fatal and nonfatal myocardial infarction and stroke, TIA, unstable angina, coronary revascularization procedures and symptomatic aortoiliac occlusive disease. Results. We documented 191 new cardiovascular morbid events (3.1%) at the cardiac (n=134), cerebrovascular (n=50), or peripheral (n=7) level. Dividing the study population in progressors and nonprogressors, progressors were older and had a higher baseline heart rate, fasting insulin, HOMA, creatinine, and hs-CRP mean values, while e-GFR and acetylcholine-stimulated forearm blood ow (FBF) were lower. Similarly, incident type-2 diabetes was higher in the progressors group. In the multiple Cox regression analysis, incident diabetes (HR=2.015, 95%CI=1.416-2.868), hs-CRP (HR=1.306, 95%CI=1.213-1.407) and acetylcholine-stimulated FBF (HR=0.729, 95%CI=0.633-0.839) maintained an independent association with the outcomes. The interaction between new-onset diabetes and FBF demonstrated that patients with new diabetes and maximal FBF under the median show a higher risk for subsequent cardiovascular events (HR=7.411, 95%CI=4.875-11.265). Conclusions. Endothelial dysfunction and new-onset diabetes predict cardiovascular events and their joint effect greatly increases this risk. These results highlight the importance of interaction between hemodynamic and metabolic alterations in predicting cardiovascular events.

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“…The most recent guidelines state that 2 different tests can be obtained from the same blood sample. This new recommendation is based in large part on the results of the long‐term prospective Atherosclerosis Risk in Communities study that examined testing for diabetes using just one sampling of blood . The researchers found that using high values of both a fasting plasma glucose and HgbA1c obtained from the same specimen has a high positive predictive value (88.7%) for the diagnosis of diabetes at a 15 year follow‐up visit.…”

Section: Diagnosis Of Type 2 Diabetesmentioning

confidence: 99%

Person‐Centered Primary Care and Type 2 Diabetes: Beyond Blood Glucose Control

Trout

McCool

Homko

2019

J Midwife Womens Health

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With an estimated 9% of persons in the United States diagnosed with diabetes, primary care providers such as midwives and nurse practitioners are increasingly working with persons who have diabetes and are seeking primary care services. This article reviews the current literature with regard to the initial evaluation of individuals who are diagnosed with diabetes, and what is entailed in comprehensive continuing management of care. A person-centered interprofessional approach to care of the person with diabetes is presented. Recommendations are given that address dietary habits, activities of daily living, medication regimens, and potential alternative therapies. Social constructs related to effective care of individuals with diabetes also are addressed. Knowledge of current research that has identified effective care practices for individuals with diabetes is imperative to ensuring their well-being, and promoting a person-centered and interprofessional approach is best for offering optimal care to those diagnosed with diabetes.

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Prognostic Implications of Single-Sample Confirmatory Testing for Undiagnosed Diabetes

Abstract: National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute.

Cited by 56 publications

References 22 publications

Burden of Undiagnosed Type 2 Diabetes in Diabetic Kidney Disease: A Japanese Retrospective Cohort Study

Burden of Undiagnosed Type 2 Diabetes in Diabetic Kidney Disease: A Japanese Retrospective Cohort Study

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2019

Person‐Centered Primary Care and Type 2 Diabetes: Beyond Blood Glucose Control

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