Receiver Operating Characteristic Analysis on Fasting Plasma Glucose, HbA1c, and Fructosamine on Diabetes Screening

Tsuji, Ichiro; Nakamoto, K.; Hasegawa, Toshihiko; Hisashige, Akinori; Inawashiro, Hiroshi; Fukao, Akira; Hisamichi, Shigeru

doi:10.2337/diacare.14.11.1075

Cited by 55 publications

(24 citation statements)

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“…We also used a 2 test for trend ( 2 trend) to assess the proportion of patients with increased plantar pressures who presented with one, two, and three forefoot deformities. For selecting the optimal diagnostic cutoff points on the scale of pressure measurement, ROC curves were used (16,20). This is a graphical method of representing sensitivity and specificity for a given test.…”

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confidence: 99%

Predictive Value of Foot Pressure Assessment as Part of a Population-Based Diabetes Disease Management Program

Lavery

Armstrong

Wunderlich³

et al. 2003

Diabetes Care

271

191

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OBJECTIVE -To evaluate the effectiveness of dynamic plantar pressure assessment to determine patients at high risk for neuropathic ulceration. In choosing the cut point, we looked for an optimum combination of sensitivity and specificity of plantar pressure to screen for neuropathic ulceration.RESEARCH DESIGN AND METHODS -A total of 1,666 consecutive individuals with diabetes (50.3% male) presenting to a large urban managed care-based outpatient clinic were enrolled in this longitudinal 2-year outcome study. Patients received a standardized medical and musculoskeletal assessment at the time of enrollment, including evaluation in an onsite gait laboratory.RESULTS -Of the entire population, 263 patients (15.8%) either presented with or developed an ulcer during the 24-month follow-up period. As expected, baseline peak plantar pressure was significantly higher in the ulcerated group than in the group who did not ulcerate (95.5 Ϯ 26.4 vs. 85.1 Ϯ 27.3 N/cm 2 , P Ͻ 0.001). There was also a trend toward increased pressure with increasing numbers of foot deformities, as well as with increasing foot risk classification (P ϭ 0.0001). Peak pressure was not a suitable diagnostic tool by itself to identify high-risk patients. After eliminating patients without loss of protective sensation, using receiver operating characteristic (ROC) analysis, the optimal cut point, as determined by a balance of sensitivity and specificity, was 87.5 N/cm 2 , yielding a sensitivity of 63.5% and a specificity of 46.3%.CONCLUSIONS -The data from this evaluation continue to support the notion that elevated foot pressure is an important risk factor for foot complications. However, the ROC analysis suggests that foot pressure is a poor tool by itself to predict foot ulcers. Diabetes Care 26:1069 -1073, 2003N europathic foot ulcers in individuals with diabetes are precipitated by a combination of pressure and cycles of repetitive stress (1,2). Identification, quantification, and mitigation of pressure and cycles of stress (activity) are thought to be important components in risk assessment and management of patients both before and after ulceration (3-8).Several investigators have evaluated populations of high-risk patients to identify strata of foot pressures that might assist in assessment. Boulton et al. (9) reported that pressures were Ͼ110 N/cm 2 for every subject with a foot ulcer, suggesting a threshold pressure below which individuals would not ulcerate. Only 31% of individuals with diabetes without a history of ulceration demonstrated abnormal peak foot pressures based on the criteria of Boulton et al. However, it is not clear if a threshold pressure level exists because other reports have identified lower peak foot pressures at sites of neuropathic ulceration than those identified by . For instance, diabetic subjects with peak plantar pressures Ͼ65 N/cm 2 have been shown to be at a six times greater risk for ulceration than subjects with pressures below this value (3). In a previous case-control study, our group was unable to identify...

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mentioning

confidence: 99%

Predictive Value of Foot Pressure Assessment as Part of a Population-Based Diabetes Disease Management Program

Lavery

Armstrong

Wunderlich³

et al. 2003

Diabetes Care

271

191

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“…24 Hal lain yang menjadi kunci dalam pertimbangan perawatan gigi pada pasien DM meliputi tindakan mengurangi stres, setting perawatan, penggunaan antibiotik, modifikasi diet, membuat jadwal kunjungan, pemilihan obatobatan serta penanganan emergensi. [24][25][26][27] Epinefrin endogen dan kortisol dapat meningkatkan stres. Hormon ini akan meningkatkan kadar glukosa darah dan mempengaruhi kontrol glukosa.…”

Section: Penatalaksanaan Dental Pada Pasien Diabetesunclassified

“…Oleh karena itu penting bagi seorang dokter gigi mengetahui kadar gula darah pasien DM sebelum memulai tindakan pengobatan atau perawatan gigi. [24][25][26][27] Perawatan pasien GGK tergantung pada tahap penyakit ginjal dan status klinisnya. Pasien dengan penurunan fungsi ginjal, tetapi tanpa tanda dan gejala klinis dapat dirawat secara normal, dengan ketentuan semua obat yang dimetabolisme di ginjal tidak boleh diresepkan karena dapat menyebabkan intoksikasi/nefrotoksik dan memperburuk kondisi pasien, meskipun hanya dalam dosis biasa.…”

Section: Pembahasanunclassified

Evaluasi dan penatalaksanaan pasien medically-compromised di tempat praktek gigi Evaluation and management of medically compromised patient in dental practice

Vitria¹

2011

J Dentomaxillofac Sci

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ABSTRAKSebagai seorang dokter gigi, sebelum melakukan tindakan kedokteran gigi, khususnya yang menyangkut tindakan pembedahan, perlu mengetahui dengan pasti kesehatan umum pasien dan kondisi pasien apakah cukup aman untuk dilakukan prosedur tindakan. Untuk itu diperlukan evaluasi yang tepat dan akurat dalam menentukan kondisi sistemik pasien medically-compromised yang difokuskan pada patofisiologi penyakit, tanda dan gejala, hasil pemeriksaan laboratorium, terapi medis yang sedang dijalani pasien serta rekomendasi untuk mendapatkan perawatan gigi yang spesifik. Sehingga kita akan mengetahui kemungkinan prosedur perawatan terbaik yang dapat dilakukan dan menghindari komplikasi yang mungkin terjadi.

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“…Un estudio realizado por Rohlfing et al 26 en una población norteamericana obtuvo una sensibilidad del 63,2% y una especificidad del 97,4% con una cifra de corte de A 1C ≥ 6,1 (+2 DE). Otros autores 27 han obtenido resultados similares. La Sociedad Japonesa de Diabetes 28 recomienda utilizar como criterio diagnóstico de DM2 una A 1C ≥ 6,1% (+2 DE).…”

Section: Tablaunclassified

“…A pesar de las limitaciones del estudio, nos gustaría extraer algunas consideraciones prácticas acordes con las efectuadas por otros autores 5,10,16,17,22,[26][27][28][29] . Creemos que una combinación de los valores de la GB y la A 1C puede resultar de extraordinaria utilidad para establecer el diagnósti-co de la enfermedad diabética: -Si la GB es repetidamente superior a 125 mg/dl, debe establecerse el diagnóstico de DM2, y será necesaria una determinación de la A 1C para valorar su estado metabóli-co y orientar el tratamiento.…”

Section: Conclusionesunclassified

Comentario: Validez de las pruebas diagnósticas de la diabetes

Pons¹

2004

Aten Primaria

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Receiver Operating Characteristic Analysis on Fasting Plasma Glucose, HbA1c, and Fructosamine on Diabetes Screening

Abstract: The discriminating ability of HbA1c is almost the same as that of FPG, therefore HbA1c is a good alternative to FPG. Fructosamine is not suitable for diabetes screening.

Cited by 55 publications

References 0 publications

Predictive Value of Foot Pressure Assessment as Part of a Population-Based Diabetes Disease Management Program

Predictive Value of Foot Pressure Assessment as Part of a Population-Based Diabetes Disease Management Program

Evaluasi dan penatalaksanaan pasien medically-compromised di tempat praktek gigi Evaluation and management of medically compromised patient in dental practice

Comentario: Validez de las pruebas diagnósticas de la diabetes

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