Screening for impaired glucose tolerance. Results from a population-based study in 21,057 individuals.

Lindahl, Bernt; Weinehall, Lars; Asplund, Karin M.; Hallmans, Göran

doi:10.2337/diacare.22.12.1988

Cited by 62 publications

(36 citation statements)

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“…Overall, these studies found that the sensitivity of fasting glucose to identify individuals with impaired glucose tolerance was fairly low (15,16) and that HbA 1c was fairly specific but not very sensitive (17)(18)(19). However, only one of these studies focused specifically on screening for impaired glucose tolerance (15) and none were representative of the general U.S. population.…”

Section: Impact Of the Results Of The Diabetes Prevention Program In mentioning

confidence: 99%

Projected Impact of Implementing the Results of the Diabetes Prevention Program in the U.S. Population

2002

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OBJECTIVE -To determine the feasibility of using either fasting plasma glucose or HbA 1c to identify individuals in the U.S. population who meet the Diabetes Prevention Program (DPP) criteria for intervention, defined as BMI Ն24 kg/m 2 , fasting plasma glucose level 96 -125 mg/dl, and 2-h glucose level 140 -199 mg/dl in an oral glucose tolerance test (OGTT).RESEARCH DESIGN AND METHODS -Analysis of a representative sample of U.S. adults aged 40 -74 years with no medical history of diabetes for whom data on height, weight, fasting plasma glucose, HbA 1c , and 2-h plasma glucose during an OGTT were obtained. Sensitivity, specificity, positive predictive value (PPV), and receiver operator characteristic (ROC) curves for fasting glucose and HbA 1c were determined.RESULTS -Using BMI Ͻ24 kg/m 2 as an initial criterion eliminated 27.2% of U.S. adults from further testing. Of the remaining group, 41.1% did not have to be considered for an OGTT because their fasting glucose level was below or above 96 -125 mg/dl. Overall, 10.6% of adults aged 40 -74 years without medical history of diabetes met the DPP eligibility criteria for intervention. Among individuals with BMI Ն24 kg/m 2 and fasting glucose level 96 -125 mg/dl, applying a fasting plasma glucose cutoff of Ն105 mg/dl excluded 62.5% of this group and resulted in 56.0% of those with 2-h glucose level 140 -199 mg/dl in this group being identified, with a specificity of 72.0% and a PPV of 17.1%. Similar values were obtained for an HbA 1c cutoff value of Ն5.5%.CONCLUSIONS -Using data on BMI and setting cutoff values for fasting glucose and HbA 1c would greatly reduce the number of individuals who would need to undergo an OGTT while achieving adequate sensitivity, specificity, and PPV.

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Section: Impact Of the Results Of The Diabetes Prevention Program In mentioning

confidence: 99%

Projected Impact of Implementing the Results of the Diabetes Prevention Program in the U.S. Population

2002

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“…The independent variables in the multivariate models included clinical characteristics associated with IGT in bivariate analysis or from previously published literature (8,11). The first model will be referred to as the "clinical model" and includes those data most likely to be available at a routine clinical encounter, including sex, age, race/ ethnicity, family history of diabetes, BMI, fasting glucose, and blood pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Our results add important evidence for screening individuals at high risk of IGT based on commonly available clinical data. Previous authors have not advocated using clinical data to predict IGT (11). In a population-based study conducted in Sweden, a high-risk screening strategy based on obesity and family history did not detect the majority of individuals with IGT (11).…”

Section: Discussionmentioning

confidence: 99%

Predicting Impaired Glucose Tolerance Using Common Clinical Information

Nelson

2003

Diabetes Care

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OBJECTIVE -To develop a score to predict impaired glucose tolerance (IGT) using common clinical data.RESEARCH DESIGN AND METHODS -We analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III) for 2,746 individuals aged 40 -74 years who completed an oral glucose tolerance test. IGT was defined as a 2-h postchallenge glucose Ն140 mg/dl (7.7 mmol/l). We performed bivariate and multivariate analyses to describe the association of IGT with commonly available clinical information. A numerical score to predict IGT was derived from the results of the multivariate logistic regression models.RESULTS -Fasting glucose levels between 101 and 109 mg/dl (5.6 and 6.0 mmol/l) or between 110 and 125 mg/dl (6.1 and 6.9 mmol/l) were associated with IGT (odds ratio 1.8 and 6.2, respectively; P Ͻ 0.05). BMI Ն25 kg/m 2 , Mexican-American ethnicity, age between 60 and 74 years, hypertension, and triglyceride level Ն150 mg/dl (1.69 mmol/l) were also associated with IGT. The area under the receiver operating characteristic curve for an 8-point scale derived from the multivariate analysis was 0.74 (95% CI 0.72-0.76). Setting a low cut point of 2 on this scale resulted in high sensitivity (86%), whereas a high cut point of 6 yielded high specificity (97%) for the detection of IGT.CONCLUSIONS -A numerical score based on common clinical data can identify individuals with a low or high likelihood of having IGT.

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“…The most comparable data come from previous Swedish studies based on thorough registries in health centres and hospital clinics where data from 1977 to 1995 are remarkably similar to ours in all age and gender groups (see Table I) (23 -25). Also, in 1992 -95, the Vä sterbotten Intervention Project (VIP) examined 22,000 subjects aged between 30 and 60 years in one of the two counties included in the present paper, and found the same prevalence of known diabetes (26,27). From mid-Norway a very similar prevalence was reported (7).…”

Section: Discussionmentioning

confidence: 99%

Diabetes and obesity in Northern Sweden: occurrence and risk factors for stroke and myocardial infarction

Eliasson

Lindahl

Lundberg³

et al. 2003

Scand J Public Health

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Aims: The authors describe the occurrence of diabetes and obesity in the population of Northern Sweden and the role of diabetes in cardiovascular disease. Methods: Four surveys of the population aged 25 to 64 years were undertaken during a 14-year time span. Stroke events in subjects 35 -74 years during 1985 -92 and myocardial infarction in subjects 25 -64 years 1989 -93 were registered. Results: The prevalence of diagnosed diabetes was 3.1 and 2.0% in men and women, respectively, and 2.6 and 2.7% for previously undiagnosed diabetes. During the 13-year observation period, BMI increased 0.96 kg/m 2 in men and 0.87 in women. The proportion of subjects with obesity (BMI¢30) increased from 10.3% to 14.6% in men and from 12.5% to 15.7% in women. Hip circumference increased substantially more than waist circumference, leading to a decreasing waits-to-hip ratio (WHR). The relative risk for stroke or myocardial infarction was four to six times higher in a person with diabetes than in those without diabetes. The 28-day case fatality for myocardial infarction, but not for stroke, was significantly higher in both men and women with diabetes. Population-attributable risk for diabetes and stroke was 18% in men and 22% in women and for myocardial infarction it was 11% in men and 17% in women. Conclusion: Obesity is becoming more common, although of a more distal than central distribution. The burden of diabetes in cardiovascular diseases in Northern Sweden is high.

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Screening for impaired glucose tolerance. Results from a population-based study in 21,057 individuals.

Cited by 62 publications

References 0 publications

Projected Impact of Implementing the Results of the Diabetes Prevention Program in the U.S. Population

Projected Impact of Implementing the Results of the Diabetes Prevention Program in the U.S. Population

Predicting Impaired Glucose Tolerance Using Common Clinical Information

Diabetes and obesity in Northern Sweden: occurrence and risk factors for stroke and myocardial infarction

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