High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius

OBJECTIVE: To describe the incidence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. RESEARCH DESIGN, METHODS AND SUBJECTS: Population-based surveys were undertaken in the multi-ethnic nation of Mauritius in 1987, 1992 and 1998 with 5083, 6616 and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Three cohorts aged between 25 and 79 years with classifiable glucose tolerance data were identified; 3680 between 1987 and 1992, 4178 between 1992 and 1998, and 2631 between 1987 and 1998. Glucose tolerance was classified according to WHO 1999 criteria. RESULTS: The incidence rate of type 2 diabetes was higher between 1992 and 1998 than between 1987 and 1992. In men, the incidence was similar between cohorts (24.5 and 25.4 per 1000 person-years) whereas the incidence increased in women (23.3 and 16.4 per 1000 person-years). The incidence of diabetes peaked in the 45-54 year age group and then plateaued or fell. The incidences of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) decreased in both men and women. Of normoglycaemic subjects at baseline, more women than men developed IGT and more men than women developed IFG. Of those labelled as IFG in 1987, 38% developed diabetes after 11 years. The corresponding figure for IGT was 46%. CONCLUSIONS: In this study, we report changes in incidence rates of glucose intolerance over a 11-year period. In particular, differences between men and women were observed. The increased incidence of IGT in women compared with men, and increased incidence of IFG in men compared with women was consistent with, and explains the sex biases seen in the prevalences of these states.     

Impaired fasting glucose and impaired glucose tolerance in urban population in India.

AIMS: To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics. METHODS: Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged > or = 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2-h blood glucose (2hBG; 75-g glucose load) values. Subjects with known diabetes were excluded. RESULTS: Age-standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (chi2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose-intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated. CONCLUSIONS: Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.     

The utility of fasting glucose for detection of prediabetes

Treatment of prediabetes attenuates progression to type 2 diabetes mellitus. The American Diabetes Association (ADA) previously defined prediabetes as either impaired fasting glucose (IFG) = 6.1 to 6.9 mmol/L (110-125 mg/dL) and/or impaired glucose tolerance (IGT) (2-hour postload glucose of 7.8-11.0 mmol/L [140-199 mg/dL]). For practical reasons, fasting plasma glucose (FPG) is commonly used for diabetes screening. Recently, the ADA lowered the fasting glucose threshold value for IFG from 110 to 100 mg/dL. Our objective was to determine the utility of FPG alone for detecting prediabetes in African Americans. Oral glucose tolerance test (OGTT) data from a cohort of 304 young adult African American men and women were examined. We calculated prediabetes prevalence using the previous ADA criteria and examined the effect of lowering the IFG threshold value for IFG to 100 mg/dL. The prediabetes prevalence in this cohort using the previous ADA criteria was 20.4% (n = 62). Of the 62 cases, 8 had IFG, 45 had IGT, and 9 had IFG together with IGT. Fasting plasma glucose testing alone detected 17 (27.4%) prediabetic cases, whereas a complete OGTT detected 54 (87.1%). Lowering the IFG threshold value to FPG = 100 mg/dL identified 13 of the 45 IGT-only cases. However, this lower IFG threshold increased prediabetes prevalence in the overall cohort from 20.4% to 31.9%. In conclusion, in young adult African Americans, an ethnic group at high risk for developing diabetes, FPG testing alone may be inadequate for diagnosing prediabetes. Until alternative strategies are identified, an OGTT is presently the best method for detecting the prediabetic condition in these high-risk patients.     

Impaired fasting glucose is not a risk factor for atherosclerosis.

AIM: To determine a new category of dysfunctional glucose homeostasis - impaired fasting glucose (IFG) - introduced by the American Diabetes Association (ADA) and the World Health Organization (WHO) defining those with abnormal but nondiabetic fasting glucose values and with a possible risk for developing diabetes. It is not known whether IFG is a risk factor for atherosclerosis, as is impaired glucose tolerance (IGT). METHODS: In this case-control cross-sectional study in which the oral glucose tolerance (75-g OGTT) and the carotid intima-media thickness (IMT) with B mode ultrasound, as a marker of atherosclerosis, were measured, together with HbA1c, lipids, plasminogen activator (PAI), insulin and proinsulin concentrations in blood plasma. Out of 788 subjects of the risk factors in IGT for Atherosclerosis and Diabetes (RIAD) study we found 104 IFG cases that were compared to 104 controls with fasting plasma glucose (FPG)<6.1 mmol/l, matched for age, sex and body mass index. Subjects with 2h postprandial (pp) plasma glucose > or = 11.1 mmol/l were excluded. The rest were subdivided into those with 2h plasma glucose < 7.8 mmol/l (63 pairs, NGT) and those with plasma glucose > 7.8 mmol/l and < 11.1 mmol/l (41 pairs, IGT). RESULTS: The case and control groups showed no significant differences in the major risk factors except for waist-to-hip ratio (WHR) which was higher in the IFG with NGT. IFG with NGT exhibited significantly higher levels of HbA1c, true insulin and proinsulin. In IFG with IGT, only HbA1c and proinsulin were significantly increased vs. controls. IMT was in the same range for cases and controls in both subgroups. However, IMT mean and IMTmax were significantly increased in IFG with IGT vs. IFG with NGT (0.95 mm vs. 0.80 mm and 1.10 mm vs. 0.90 mm). Cumulative distribution analysis of IMT illustrates that IMT in IFG with IGT is more shifted to higher artery wall thickness than in IFG with NGT. CONCLUSIONS: In our case-control study IFG alone was not related to increased IMT. Only IFG in a combination with IGT exhibited atherosclerotic changes of the carotid arteries. IFG is not analogous to IGT as a risk factor for atherosclerosis.     

Incidence of Type 2 diabetes in England and its association with baseline impaired fasting glucose: the Ely study 1990-2000.

AIM: To determine the incidence of Type 2 diabetes and to examine the effect of different cut-points for impaired fasting glucose (IFG) on diabetes incidence. METHODS: Population-based longitudinal study (1990-2000) with clinical, anthropometric and biochemical measurements, including an oral glucose tolerance test (OGTT), in 1040 non-diabetic adults aged 40-69 years at baseline. Baseline glucose status was defined as normoglycaemia < 5.6, IFG-lower 5.6-6.0 and IFG-original 6.1-6.9 mmol/l. The all-IFG group included fasting glucose values of 5.6-6.9 mmol/l. RESULTS: The 10-year cumulative incidence of diabetes was 7.3 per 1000 person-years. Diabetes incidence was 2.4 [95% confidence interval (CI) 1.2, 4.8], 6.2 (4.0, 9.8) and 17.5 (12.5, 24.5) per 1000 person-years in those with normoglycaemia, IFG-lower and IFG-original, respectively. Compared with normoglycaemia, the age/sex-adjusted risk [hazard ratio (HR) and 95% CI] for incident diabetes was greatest in the IFG-original category (HR 6.9; 3.1, 15.2) and increased to a lesser degree in the IFG-lower (HR 2.5; 1.1, 5.7) and all-IFG categories (HR 4.1; 1.9, 8.7). When adjusted for confounding factors, the magnitude and direction of associations persisted, with HR 1.9, 4.4 and 2.9, for the categories IFG-lower, IFG-original and all-IFG, respectively. CONCLUSIONS: Diabetes incidence is more strongly related to IFG defined as fasting glucose between 6.1 and 6.9 mmol/l than to the lower category of 5.6-6.0 mmol/l, or entire range of 5.6-6.9 mmol/l. Future studies should examine the association of IFG with cardiovascular outcomes, but for diabetes risk our study supports the use of the IFG cut-point at 6.1 mmol/l.     

Early insulin secretion failure leads to diabetes in Chinese subjects with impaired glucose regulation

Background Both beta‐cell dysfunction and decreased insulin sensitivity are involved in the pathogenesis of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), while their relative contribution in the progression to type 2 diabetes still remains controversial. The aim of the present study is to clarify this process in Chinese subjects by using cross‐sectional method. Methods 2975 Chinese subjects were classified into: normal glucose tolerance (NGT), impaired glucose regulations (IGR), and diabetes mellitus (DM) based on oral glucose tolerance test (OGTT). The IGR group was sub‐classified as isolated IFG, isolated IGT and combined glucose intolerance (CGI). The DM group was sub‐classified as normal fasting plasma glucose and 2‐hour hyperglycemia (N0D2), fasting hyperglycemia and normal 2‐hour plasma glucose (D0N2), and both fasting and 2‐hour hyperglycemia (D0D2). Results As far as insulinogenic index (IGI) was concerned, there was no difference between IFG and IGT in either gender, however, HOMA2‐B% (homeostasis model assessment for beta‐cell function) of IGT was higher than that of IFG and CGI in both male and female (P < 0.05). In the diabetic sub‐groups, IGI of N0D2 was higher than that of D0N2, and both deteriorated compared with those of IGT and IFG, respectively. HOMA2‐B% of N0D2 was still higher than that of D0N2 and D0D2. No significant difference was detected in OGIS and HOMA2‐S% (homeostasis model assessment for insulin sensitivity) between IFG and IGT, and this was the case between N0D2 and D0N2. OGIS and HOMA‐IR of IGR sub‐groups were not different from those of their diabetic counterparts. Conclusion Failure of beta‐cell function might be the main reason for both IGT and IFG developing into diabetes instead of aggravated insulin resistance. Copyright © 2008 John Wiley & Sons, Ltd.     

Comparison of Fasting Glucose with Post-Load Glucose Values and Glycated Hemoglobin for Prediction of Type 2 Diabetes: The Isfahan Diabetes Prevention Study

OBJECTIVES: The aim of this study was to compare the ability of fasting plasma glucose (FPG), post-load plasma glucose values and glycated hemoglobin (HbA1c) to predict progression to diabetes in non-diabetic first-degree relatives (FDR) of patients with type 2 diabetes. METHODS: A total of 701 non-diabetic FDR of diabetic patients aged 20-70 years surveyed in 2003 to 2005 were followed until 2008 for the onset of type 2 diabetes mellitus. At baseline and at follow-ups, participants underwent a standard 75 g 2-hour oral glucose tolerance test (OGTT). Prediction of progression to type 2 diabetes was assessed by using area under the receiver-operating characteristic (ROC) curves based upon measurement of FPG, post-load glucose values and HbA1c. RESULTS: The incidence of type 2 diabetes was 33.9 per 1000 person-years in men and 48.6 in women. The incidence rates were 4.6, 50.7, and 99.7 per 1000 person-years in FDR with normal glucose tolerance, impaired fasting glucose and impaired glucose tolerance respectively. FPG value was a better predictor of progression to diabetes than any post-load glucose values or HbA1c. The areas under the ROC curves were 0.811 for fasting, 0.752 for 1/2-hour, 0.782 for 1-hour and 0.756 for 2-hour glucose vs. 0.634 for HbA1c (p < 0.001). CONCLUSIONS: FPG had more discriminatory power to distinguish between individuals at risk for diabetes and those who were not at risk than post-load glucose values during OGTT or HbA1c. Our findings support the American Diabetes Association recommendation of using FPG concentration to diagnose diabetes.     

Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemia.

AIMS: To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance. METHODS: Men (1223) and women (1370) aged 45-64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register. RESULTS: During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72-0.82) than for fasting glucose (0.65, 0.58-0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4-6.2) than for isolated IFG (2.3, 0.9-5.7) as compared with subjects with neither IFG nor IGT. CONCLUSION: Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention.     

Diabetes and impaired glucose regulation in first-degree relatives of patients with type 2 diabetes in isfahan, iran: prevalence and risk factors

OBJECTIVES: The aim of this study was to estimate the prevalence of diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in first-degree relatives (FDR) of people with type 2 diabetes mellitus. METHODS: A cross-sectional study of FDR of type 2 diabetes patients was conducted between 2003 and 2005. A total of 2,368 FDR of type 2 diabetes outpatients aged 30-60 years (614 men and 1754 women) from Isfahan Endocrine and Metabolism Research Center (Iran) were examined. All subjects underwent a standard 75 g 2-h oral glucose tolerance test (OGTT). IGT, IFG and type 2 diabetes were diagnosed according to the criteria of the American Diabetes Association (ADA). The mean (SD) age of participants was 43.1 (6.9) years. RESULTS: The prevalence of type 2 diabetes, IGT and IFG were 10.3% (95% CI: 9.1-11.5), 19.5% (17.9-21.1) and 17.3% (15.8-18.8) respectively. The prevalence rates were significantly higher than those reported for a control population of the same age (type 2 diabetes, 6.0% (95% CI: 5.7-6.2) and IGT 9.6 (95% CI: 9.3-9.9)). IGT was more frequent among women (OR: 0.66; 95% CI: 0.51-0.87), whereas diabetes (OR: 1.31; 95% CI: 0.96-1.78) and IFG (OR: 1.41; 95% CI: 1.10-1.80) were higher in men. Multivariate analysis revealed that age and obesity or abdominal obesity were significantly associated with diabetes, IGT and IFG. CONCLUSIONS: FDR of people with type 2 diabetes in Iran are at higher risk of IGT and type 2 diabetes than the population at large. Risk increases with age and obesity. These findings may be useful for the identification of persons at risk of developing type 2 diabetes and strongly support the regular screening of FDR of type 2 diabetes patients.     

Progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screening programme in general practice: the ADDITION Study,Denmark

AIMS/HYPOTHESIS: To estimate the 1-year progression rates from both IFG and IGT to diabetes in individuals identified in a pragmatic diabetes screening programme in general practice (the ADDITION Study, Denmark [Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care]). METHODS: Persons aged 40-69 years were screened for type 2 diabetes based on a high-risk, stepwise strategy. At baseline, anthropometric measurements, blood samples and questionnaire data were collected. A total of 1,160 persons had IFG or IGT at baseline: 811 (70%) accepted re-examination after 1 year. Glucose tolerance classification was based on the 1999 WHO definition. At follow-up, diabetes was based on one diabetic glucose value of fasting blood glucose or 2-h blood glucose. RESULTS: At baseline, 308 persons had IFG and 503 had IGT. The incidence of diabetes was 17.6 and 18.8 per 100 person-years in the two groups, respectively. CONCLUSIONS/INTERPRETATION: IFG and IGT identified in general practice during a stepwise, high-risk screening programme for type 2 diabetes have high 1-year progression rates to diabetes. Consequently, intensive follow-up and intervention strategies are recommended for these high-risk individuals.     

Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter?

OBJECTIVE: To examine gender differences in the characteristics and prevalence of various categories of glucose tolerance in a population study in Mauritius. RESEARCH DESIGN AND METHODS: In 1998, a community-based cross-sectional survey was conducted in Mauritius. Categories of glucose metabolism were determined in 5388 adults, with an oral glucose tolerance test given to those who did not have previously diagnosed diabetes (n=4036). Other cardiovascular risk factors were assessed among those without known diabetes. RESULTS: For men and women the prevalence of diabetes (22.0 vs. 21.8%, respectively) and the prevalence of coexisting impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (3.2 vs. 2.9%) were similar. However, men were twice as likely as women to have isolated IFG [5.1% (4.2-6.0) vs. 2.9% (2.3-3.5)], despite being younger, thinner and with lower plasma insulin but higher lipids. Conversely, the prevalence of isolated IGT was lower in men [9.0% (7.9-10.2) vs. 13.9% (12.6-15.1)]. Among non-diabetic individuals, fasting glucose was higher in men than women, whereas 2-h glucose was higher in women. In people without diabetes, women had significantly higher body mass index, beta cell function (HOMA-B), fasting and 2-h insulin than men and significantly lower waist-hip ratios, waist circumference, insulin sensitivity (HOMA-S) and triglycerides. CONCLUSION: In Mauritius, the distribution of impaired glucose metabolism differs by sex. The observation that IFG is more prevalent in men and IGT more prevalent in women raises important questions about their underlying aetiology and the ability of the current glucose thresholds to equally identify men and women at high-risk of developing diabetes. IFG should be seen as a complimentary category of abnormal glucose tolerance, rather than a replacement for IGT.     

OGTT正常、异常及糖尿病患者冠状动脉造影特征比较

目的观察口服葡萄糖耐量试验（oral glucose tolerance test,OGTT）异常对冠心病患者冠脉病变特征的影响。方法对35例糖耐量异常（IGT）及空腹血糖受损（IFG）的冠心病患者的造影结果进行分析,并分析17例OGTT正常的冠心病患者及44例确诊糖尿病患者的冠脉造影结果。结果3组患者的3支病变的构成比有显著差异（P<0.05,P<0.01）,远端小血管病变的发生率有显著差异（P<0.05,P<0.01）。结论IGT（或IFG）患者在冠脉病变特征方面与OGTT正常者存在显著差异,而与糖尿病患者存在相似病变特征。     

老年空腹血糖受损62例进展研究

目的分析老年空腹血糖受损者(IFG)8年间进展情况。方法于2002年5～6月对我区离退休老干部中IFG行口服75g葡萄糖试验(OGTT),选取单纯空腹血糖受损者(I-IFG)62例,依据2003年美国糖尿病学会IFG诊断标准,将空腹血糖(FPG)为5.6～6.09mmol/L的受损者分为新增IFG组(A组),空腹血糖为6.1～6.99mmol/L的受损者分为原IFG组(B组),定期随访8年。结果基线时2组IFG者的血压、血脂、体质量指数(BMI)等临床指标差异均无统计学意义(P>0.05)。至随访结束时,A组进展为糖尿病(DM)的比率为20.59%,B组IFG进展为DM的比率为46.43%,是A组的2.25倍,差异有统计学意义(P<0.05);2组IFG逆转为糖耐量正常(NGT)、仍保持I-IFG以及进展为空腹血糖受损合并糖耐量受损(IFG/IGT)者的比率差异均无统计学意义(P>0.05)。全部IFG进展为DM的比率是32.25%,逆转为NGT的比率是14.52%,仍维持在I-IFG或IFG/IGT状态的比率是53.23%。结论 IFG诊断标准下调后,IFG患病率明显上升,但新增IFG进展为DM的风险明显低于原IFG。     

Irish diabetes detection programme in general practice.

OBJECTIVES: To assess the prevalence of undiagnosed diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in patients over the age of 40 years attending their general practitioner (GP) in Ireland, through opportunistic screening, using a three-step screening tool involving self-determined high-risk groups, random venous plasma glucose (RVPG) measurement and oral glucose tolerance tests. DESIGN: In participating general practices, 100 consecutive patients > 40 years, completed a screening questionnaire relating to diabetes-related symptoms and risk factors. Patients with previously diagnosed diabetes were not excluded from the study and the screening instrument included a question about known diabetes. Patients without known diabetes mellitus (DM) and with at least two risk factors and/or symptoms underwent a RVPG test. Those with an RVPG above 5.5 mmol/l underwent an oral glucose tolerance test. RESULTS: Forty-one practices returned 3821 questionnaires. The prevalence of Type 2 diabetes mellitus in the study population was 9.2% (353), of whom 23.5% (83) were previously undiagnosed. DM was detected on the basis of an RVPG >11.1 mmol/l in 0.8% (32) of the studied population. DM was detected on the basis of the oral glucose tolerance test in 1.3% (51) of the population. One per cent (39) had a fasting plasma glucose (FPG) > or = 7.0 mmol/l, 0.6% (24) had a 2-h >11.0 mmol/l and 0.3% (12) had both. Diabetes would not have been detected in 12 people had the 2-h test been omitted. The prevalence rate for IFG and/or IGT was 3.9% (148). Of the 103 patients with IGT, 83 (81%) would have been missed had the GTT been omitted. CONCLUSION: Opportunistic diabetes screening in general practice using a screening questionnaire followed by RVPG testing and GTT for those above 5.5 mmol/l is feasible, with a high participation rate. The use of GTTs rather than fasting glucose testing alone improves patient identification, in particular those with IGT who are at higher cardiovascular risk.     

红细胞体积分布宽度与糖代谢异常/糖耐量异常和糖尿病相关

目的探讨红细胞体积分布宽度（RDW）与2型糖尿病（T2DM）、空腹血糖受损／葡萄糖耐量异常（IFG／IGT）的相互关系。方法对152例在我院定期进行健康体检或治疗的患者,依据血糖情况分为3组,其中T2DM组42例,IFG／IGT组38例,正常对照（NGT）组72例,采取空腹血,采用全自动血液分析仪测定RDW、血红蛋白,多功能血生化自动分析仪测定血总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、血尿素氮和空腹血糖,同时统计高血压、冠心病的发病率并分析其关系。结果RDW在T2DM组、IFG／IGT组和NGT组之间比较具有统计学差异,其中T2DM组和NGT组、IFG／IGT组比较,差异均有统计学意义（P〈0．05或P〈0．01）,IFG／IGT组与NGT组比较差异无统计学意义（P〉0．05）。多因素直线回归分析显示空腹血糖（P〈0．01）和高密度脂蛋白胆固醇（P〈0．05）是RDW的独立危险因子。结论T2DM患者RDW升高,RDW的变化与空腹血糖水平相关。     

The prevalence of hypertension and diabetes defined by fasting and 2-h plasma glucose criteria in urban Nepal.

AIMS: To determine the prevalence of diabetes, impaired fasting glucose and impaired glucose tolerance (IGT) in people aged >/= 40 years in urban communities of Nepal, comparing the fasting and 2-h plasma glucose (PG) criteria for diagnosis of diabetes and to relate the prevalence to age, gender and hypertension. METHODS: Field surveys of fasting and 2-h PG and blood pressure (BP) were done by cluster sampling in seven urban populations of Nepal. Of 1180 eligible individuals invited, 1012 (85.7%) aged >/= 40 years participated. RESULT: The age and sex standardized prevalence of diabetes (known and newly diagnosed), IGT and impaired fasting glycaemia (IFG) were 19.0%, 10.6% and 9.9%, respectively. Of the total population, 30.5% (37.8% of men and 25.3% of women) had some abnormality of glucose tolerance. Of all diabetic individuals, 54.4% (53.8% of men and 55.1% of women) were undiagnosed. The prevalence of diabetes increased with age until the age of 75 years. The prevalence of diabetes was higher in men than in women (P < 0.001). The sensitivity of the fasting plasma glucose (FPG) criterion compared with either FPG or 2-h PG or both criteria for the diagnosis of diabetes was 70.5%[95% confidence interval (CI) 60.7, 78.8] and the corresponding sensitivity of 2-h PG criterion was 79% (95% CI 69.8, 86.1). The age- and sex-standardized prevalence of hypertension (BP >/= 140/90 mmHg) was 22.7%. Hypertension was less common in subjects with normal plasma glucose than in those with diabetes (18.8% vs. 36.7%). Similarly, of all subjects with hypertension, 29.1% had diabetes (known or newly diagnosed) and 43.0% had glucose intolerance of some form. CONCLUSIONS: Our study shows that diabetes and hypertension are common and related problems in people aged >/= 40 years in urban Nepal. The overall sensitivity of the 2-h PG criteria was greater than that of the FPG criteria for diagnosing diabetes, except in subjects aged >/= 60 years.     

空腹血糖受损与糖耐量受损患者血管内皮功能的对比研究

目的:应用多普勒超声技术检测空腹血糖受损(IFG)与糖耐量受损(IGT)患者的血管内皮功能,探讨其对动脉粥样硬化的影响。方法:根据口服葡萄糖耐量试验(OGTT)结果,选择血糖正常(NGT)组25例,IFG组24例,IGT组22例,检测TC、TG、LDL-C、HDL-C、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1C)、高敏C反应蛋白(hs-CRP)及血管性血友病因子(vWF),OGTT后2h血糖(2hPG)及2h胰岛素(2hINS),以及肱动脉内皮依赖性舒张功能(EDD)。结果:IGT组vWF较IFG组、NGT组明显升高[(170.25±21.76)%∶(155.16±17.19)%、(135.46±15.52)%,P<0.05～0.01],肱动脉EDD较IFG组、NGT组明显降低[(4.86±0.94)%∶(5.47±0.90)%、(6.24±0.97)%,P<0.05～0.01];IFG组vWF较NGT组明显升高[(155.16±17.19)%∶(135.46±15.52)%,P<0.05],肱动脉EDD较NGT组明显降低[(5.47±0.90)%∶(6.24±0.97)%,P<0.05]。多因素逐步回归分析显示,EDD与2hPG、LDL-C明显负相关(r分别为-0.73、-0.59,P<0.05)。结论:IGT较IFG对血管内皮功能危害更大,加强IGT防治对延缓动脉粥样硬化更为重要。     

Association between C‐reactive protein and pre‐diabetic status in a Chinese Han clinical population

Background C‐reactive protein (CRP) has been showed to be associated with type 2 diabetes mellitus, but whether CRP underlies glucose disorders in Asian people is still unclear, for they have much lower body mass index (BMI) levels than these Westerns in previous studies. Method In this clinical‐based cross‐sectional study, the association between CRP and hyperglycaemia in different BMI levels and different gender was compared among 1730 Chinese Han men and women, including 1258 subjects with normal glucose tolerance (NGT), 126 subjects with impaired fasting glucose (IFG) and 346 subjects with impaired glucose tolerance (IGT). Subjects with isolated IFG or IGT were all newly diagnosed and did not use anti‐diabetic drugs. Results Compared with subjects with NGT, BMI, fasting blood glucose, homoeostatis model assessment insulin resistance (HOMA‐IR), blood pressure, dyslipidemia, and serum CRP levels were increased in subjects with IGT and IFG. In stratified analyses, increasing CRP levels were strongly associated with prevalence of IGT and IFG in different BMI strata. After adjustment for sex, age, BMI, education, alcohol consumption, smoking, hypertension status, recreational physical activity and occupational physical activity, the ORs across quartiles of CRP were 1.00, 1.43, 2.14 and 2.29 for IFG (P for trend: 0.025) and 1.00, 1.85, 2.32 and 2.79 for IGT (P for trend: 0.012). Conclusion These results support the hypothesis that chronic inflammation may be involved in the development of hyperglycaemia, even though in a thinner and healthy population. Copyright © 2008 John Wiley & Sons, Ltd.     

Comparison of ADA and WHO screening methods for diabetes mellitus in obese patients. American Diabetes Association.

AIMS: To compare the performance of fasting glycaemia (FG) and oral glucose tolerance testing (OGTT) in screening for diabetes mellitus in obese patients. METHODS: A consecutive series of 528 (445 female, 83 male) obese (body mass index > 30 kg/m2) outpatients, aged 45.2 +/- 14.3 years, was studied with FG and OGTT. The association of categories of glucose tolerance (diabetes and impaired glucose tolerance (IGT)) and fasting glycaemia (diabetes and impaired fasting glucose (IFG)) with hypertension and hyperlipidaemia were also assessed. RESULTS: Prevalence of diabetes and IGT were 20.1 and 22.9%, respectively. FG (> 7 mmol/l) had a sensitivity of 56.7%. Using FG > 6.1 mmol/l, and OGTT in those above the threshold, the sensitivity for diabetes would have been 89.6%, with a positive predictive value of 59.0%, but 68.8% of cases of IGT would not have been detected. Patients with impaired fasting glucose (FG of 6.1-7.0 mmol/l) showed lower insulin sensitivity and impaired beta cell function, and a weaker association to hypertriglyceridaemia, when compared to IGT. CONCLUSION: FG > 7.0 mmol/l does not show a sufficient sensitivity for the screening of diabetes in obese patients. FG > 6. mmol/l has a satisfactory sensitivity for diabetes, but not for IGT. IFG has different pathophysiological features than IGT and cannot be assumed to have the same prognostic value of IGT.     

Relative role of insulin resistance and beta-cell dysfunction in the progression to type 2 diabetes--The Kinmen Study

This study compared the relative role of insulin resistance and beta-cell dysfunction (both assessed using the HOMA method) with glucose intolerance conditions in the progression to type 2 diabetes among a high risk group of subjects with fasting plasma glucose (FPG) 5.6-7.0 mmol/l in Kinmen, Taiwan. Data were collected during a continuing prospective study (1998-99) of a group of Taiwanese subjects at high-risk of developing type 2 diabetes who had fasting hyperglycemia (5.6-7.0 mmol/l) and exhibited 2-h postload glucose concentrations <11.1 mmol/l from 1992-94 to 1995-96. Among 644 non-diabetic subjects at baseline, 79.8% (514/644) had at least one follow-up examination. There were 107 new cases of diabetes diagnosed by 1999 WHO criteria in 2918.7 person-years of follow-up. The incidence rate was 3.67%/year (107/2918.7). After adjustment for other possible associative variables, including gender, age, BMI, waist circumference, insulin resistance, and beta-cell dysfunction, Cox's hazard model showed that those individuals with isolated IFG (impaired fasting glucose) and those individuals with isolated IGT (2-h glucose impairment) exhibited similar risk of developing diabetes. Those individuals with isolated IFG and isolated IGT showed a comparable impairment of basal or hepatic insulin sensitivity, but those individuals with isolated IFG had a greater beta-cell dysfunction by the HOMA method.