Annals Journal Club: Yield of Opportunistic Targeted Screening for Type 2 Diabetes in Primary Care: The Diabscreen Study

PURPOSE In screening for type 2 diabetes, guidelines recommend targeting high-risk individuals. Our objectives were to assess the yield of opportunistic targeted screening for type 2 diabetes in primary care and to assess the diagnostic value of various risk factors.METHODS In 11 family practices (total practice population = 49,229) in The Netherlands, we conducted a stepwise opportunistic screening program among patients aged 45 to 75 years by (1) identifying high-risk individuals (=1 diabetes risk factor) and low-risk individuals using the electronic medical record, (2) obtaining a capillary fasting plasma glucose measurement, repeated on a separate day if the value was greater than 110 mg/dL, and (3) obtaining a venous sample if both capillary fasting plasma glucose values were greater than 110 mg/dL and at least 1 sample was 126 mg/dL or greater. We calculated the yield (percentage of invited patients with undiagnosed diabetes), number needed to screen (NNS), and diagnostic value of the risk factors (odds ratio and area under the receiver operating characteristic curve).RESULTS We invited for a first capillary measurement 3,724 high-risk patients seen during usual care and a random sample of 465 low-risk patients contacted by mail. The response rate was 90% and 86%, respectively. Ultimately, 101 high-risk patients (2.7%; 95% confidence interval [CI], 2.2%–3.3%; NNS = 37) and 2 low-risk patients (0.4%; 95% CI, 0.1%–1.6%; NNS = 233) had undiagnosed diabetes (P <.01). The prevalence of diabetes among patients 45 to 75 years old increased from 6.1% to 6.8% as a result. Among diagnostic models containing various risk factors, a model containing obesity alone was the best predictor of undiagnosed diabetes (odds ratio = 3.2; 95% CI, 2.0–5.2; area under the curve=0.63).CONCLUSIONS The yield of opportunistic targeted screening was fair; obesity alone was the best predictor of undiagnosed diabetes. Opportunistic screening for type 2 diabetes in primary care could target middle-aged and older adults with obesity.     

Evaluation of a new diabetes screening method at the Derbarl Yerrigan Health Service

BACKGROUND AND OBJECTIVES: Diabetes is a major health problem for the Aboriginal population of Australia. Early detection is a key strategy to reduce the burden of diabetes. The aim of this study was to assess the acceptability, sensitivity and specificity, effectiveness and cost of a new method of screening for diabetes at Derbarl Yerrigan, the Aboriginal health service in Perth. METHODS: Between January and May 1999, all clients over the age of 30 years and not known to have diabetes were approached for HbA1c testing using the DCA 2000 analyser. Those whose HbA1c results indicated the need for follow-up were asked to return for confirmatory testing using the gold standard oral glucose tolerance test (OGTT). A questionnaire was administered to participants who did not return. A file audit was conducted over 15 non-consecutive days to determine screening, follow-up and the number of new cases diagnosed using the previous ad hoc approach to screening with a glucometer. RESULT: 238 clients were approached and all agreed to participate and undertook the test. Of these, 37 were referred for follow-up diagnostic testing. Of these, only 14 had an OGTT. Among these 14, five were found to have diabetes and three were found to have impaired glucose tolerance. Of the remaining 23 participants, we were able to contact only six and administer the questionnaire to four. Poor follow-up meant that the sensitivity, specificity and cost-effectiveness of the test could not be assessed. CONCLUSIONS AND IMPLICATIONS: The reasons for poor follow-up need to be investigated if Aboriginal health services are to be more successful at screening for diabetes.     

Screening for diabetes in France: data from the 2000-2001 cohort of the national medical insurance system

BACKGROUND: Type 2 diabetes mellitus may go undiagnosed for several Years while complications are silently developing. In France, from 2 to 3.7% of adults aged 35-65 are unaware they have diabetes. Nevertheless fasting serum glucose is a simple diagnostic test. METHODS: We described people who underwent opportunist diabetes screening (serum glucose) within 2 Years (2000-2001). We used the administrative EPAS cohort from the employee National Health Insurance System which covers 70% of the total population in France. The data are based on reimbursements of glucose testing and hospitalization among people who did not received reimbursements of treatment for diabetes but used medical services during the 2 Years. RESULTS: The opportunistic screening rate within 2 Years was 48.6% overall and increased with age. Among those 45 Years old or older, it was 71.2%. The screening rate was higher among women than men. CONCLUSION: Opportunistic screening for diabetes is commonly practised in France, despite the lack of official guidelines. Several hypotheses may explain the discrepancy between common opportunist screening and high prevalence of undiagnosed diabetes: 1). undiagnosed diabetes is mostly present in people who do not use medical services; 2). opportunistic screening is not performed among the most at-risk population; 3). testing is not performed on fasting samples or results are neglected; 4). results of testing are overlooked by doctors/patients; 5). epidemiological studies based on self-report of diagnosis and only one testing overestimate undiagnosed diabetes.     

社区糖调节受损人群的筛查与危险因素调查

目的：了解社区人群中糖调节受损（IGR）患病情况,并对相关的危险因素进行分析。方法：通过整群随机抽样方法,抽取年龄≥45岁以上常住居民进行问卷调查,对筛查出的1313例高危人群进行体格检查、空腹血糖及口服75g无水葡萄糖耐量试验和血压、血脂检测,采集调查人群中糖调节受损患病情况和危险因素。结果：血糖升高（IFG）、糖耐量减低（IGT）和糖调节受损（IGR）的患病率分别为1．07％、8．15％、1．66％,且年龄、血压、血脂、肥胖、家族史、心血管病史等危险因素明显高于正常血糖人群。讨论：早期发现糖调节受损人群,并及早针对危险因素实施干预措施对预防糖尿病和并发症的发生具有重大意义。     

上海市青浦某村社区居民糖尿病患病率调查

[目的]了解青浦区某村35～74岁常住居民糖尿病患病率及其影响发病因素。[方法]按分层随机抽样原则,抽取青浦区某镇一个行政村1000名35～74岁本地常住居民进行横断面调查,采用口服75g葡萄糖耐量实验（OGTT）进行筛查。[结果]糖尿病、糖耐量受损、空腹血糖受损和糖调节受损的标化患病率分别为7．17％、1．14％、10．6％、11．8％。女性患病率高于男性（11．3％,6．7％,P〈0．05）。随着年龄的增加,糖尿病的患病率增加。年龄大、女性、肥胖、高血压、高脂血症、有糖尿病家族史是糖尿病患病的危险因素。[结论]青浦区该村糖尿病患病率明显高于1997年全国流行病学调查的患病率水平,且随着地区的城市化和人口老龄化进程加快,糖尿病患病率将升高。     

Test agreement for classifying diabetes in indigenous Australians

OBJECTIVE: To evaluate for Indigenous Australians the agreement between a fasting plasma glucose (FPG) criterion of 7.0 mmol/L and diabetes test results using a two-hour oral glucose tolerance test (OGTT), comparing relationships between test agreement and prevalence to similar studies. METHODS: Screening was undertaken in 25 remote settlements. Agreement between FPG and OGTT results was evaluated using the kappa coefficient (chance-corrected agreement). RESULTS: Participants (n=3,249) ranged from 15-94 years. Kappa ranged from 0.70-0.77 for diabetes prevalence of 5-30%, with overall agreement of 0.76. In comparison studies, the relationship between kappa and diabetes prevalence was similar, but with kappa 0.21-0.48. CONCLUSIONS AND IMPLICATIONS: A FPG test with a 7.0 mmol/L cut-off is a reliable screening method, relative to the OGTT, for remote Indigenous settlements. The level of agreement between the FPG test and the OGTT for the Indigenous population surveyed is superior by far to agreement reported for non-Indigenous samples.     

Breast complaints during the Dutch nationwide breast cancer screening program: increased risk of referral and of breast cancer]

OBJECTIVE: To determine the prevalence of breast complaints reported on a questionnaire among participants in the first round of the national breast cancer screening programme in the Netherlands, and to assess the relationship between these complaints and referral and diagnosis of breast cancer. DESIGN: Retrospective controlled study. METHOD: Women in the South screening region of the Dutch nation-wide breast cancer screening programme (Stichting Bevolkingsonderzoek Borstkander Zuid (BoBZ)) received a medical questionnaire together with the invitation for participation in the screening programme. This questionnaire was only reviewed by the radiologist if there were doubts concerning referral. The study assessed whether participants with these complaints had higher risks of referral and screen-detected breast cancer than those without these complaints. In this study two random and independent samples were drawn from the screening files: 1116 women who attended the first screening round and 1113 women who were referred for medical checkup in the same screening round. RESULTS: The prevalence of breast complaints reported in the first screening round was 5.1% (95% CI = 3.9-6.6). More than half of the complaints included pain not related to menses; nipple secretion; changes in skin (retraction or discolouration) or tumours. The referral risk for women with these complaints was more than twice that for women without complaints (adjusted odds ratio (OR) = 2.3; 95% CI = 1.4-3.8) and their risk of screen-detected breast cancer was more than three times as high (adjusted OR = 3.3; 95% CI = 1.4-3.8). Up to 5.8% of the screen-detected breast cancers could be attributed to the breast complaints. CONCLUSION: Breast complaints at the time of breast cancer screening increased the risk of breast cancer being detected, but it is not clear as yet whether the screening will benefit from the explicit incorporation of questions regarding complaints.     

Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults

There is concern about an emerging diabetes epidemic in Turkey. We aimed to determine the prevalence of diagnosed and undiagnosed diabetes, prediabetes and their 12-year trends and to identify risk factors for diabetes in the adult Turkish population. A cross-sectional, population-based survey, ‘TURDEP-II’ included 26,499 randomly sampled adults aged ≥ 20 years (response rate: 87 %). Fasting glucose and biochemical parameters were measured in all; then a OGTT was performed to identify diabetes and prediabetes in eligible participants. The prevalence of diabetes was 16.5 % (new 7.5 %), translating to 6.5 million adults with diabetes in Turkey. It was higher in women than men (p = 0.008). The age-standardized prevalence to the TURDEP-I population (performed in 1997–98) was 13.7 % (if same diagnostic definition was applied diabetes prevalence is calculated 11.4 %). The prevalence of isolated-IFG and impaired glucose tolerance (IGT), and combined prediabetes was 14.7, 7.9, and 8.2 %, respectively; and that of obesity 36 % and hypertension 31.4 %. Compared to TURDEP-I; the rate of increase for diabetes: 90 %, IGT: 106 %, obesity: 40 % and central obesity: 35 %, but hypertension decreased by 11 % during the last 12 years. In women age, waist, body mass index (BMI), hypertension, low education, and living environment; in men age, BMI, and hypertension were independently associated with an increased prevalence of diabetes. In women current smoking, and in men being single were associated with a reduced risk. These results from one of the largest nationally representative surveys carried out so far show that diabetes has rapidly become a major public health challenge in Turkey. The figures are alarming and underscore the urgent need for national programs to prevent diabetes, to manage the illness and thus prevent complications.     

妊娠期糖尿病3种筛查方法的探讨

目的:对孕妇糖尿病3种筛查方法进行对比分析,以简化传统的筛查方法,使之更加适应孕妇普查需要。方法:对孕妇作空腹静脉血糖、末梢血糖、血清糖化蛋白测定,并作50 g OGTT测静脉及末梢血糖。阳性者再作75 g OGTT。统计资料时将75 g OGTT异常及GDM者列为异常组,其他为正常组,两者进行对比分析。结果:筛查206例,50 g OGTT异常者30例,75 g OGTT异常者13例(GDM 2例占0.97%,G IGT 11例占5.39%),孕妇空腹时末梢血糖高于静脉血糖,服糖后无此现象。血清糖化蛋白检测GDM敏感度为92.31%,有61.65%孕妇在正常值之下。50 g OGTT静脉血糖异常者67例(37.72%),末梢血糖异常者153例(79.21%)。结论:测定孕妇血清糖化蛋白可作为孕妇糖尿病的初筛。更加适宜筛查的需要。异常者再作50 g OGTT比做50 g末梢血糖筛查更经济、合理,若阳性再做75 g OGTT以确诊。     

Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus

OBJECTIVES: To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus. DESIGN: Cross-sectional. SETTING: Population-based study. SUBJECTS: A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects. INTERVENTION: A questionnaire and measurements of weight, height, waist and hip. MAIN OUTCOME MEASUREMENT: Central obesity indicator (WC > or =102 cm men, > or =88 cm women). RESULTS: WC was positively associated with age (65-74 y vs 18-24 y) in men (OR=7.7, 95% CI 3.4-17.4) and women (OR=6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR=0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR=1.7, 95% CI=1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR=1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR=1.6, 95% CI 1.3-1.9). CONCLUSIONS: The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus. SPONSORSHIP: Island Governments of Saba, St Eustatius and Bonaire, the Federal Government of the Netherlands Antilles, Dutch Directorate for Kingdom relationships.     

上海城郊中老年人群糖尿病前期影响因素分析

目的 了解上海市浦东新区城郊结合社区中年人群糖尿病前期（IGR）影响因素,为社区筛查和预防提供科学依据。方法 采用多阶段分层随机抽样抽取上海浦东新区周浦社区45-64岁1148名中老年人进行问卷调查、测量血压、身高、体重,检测空腹血糖(FPG)、三酰甘油(TG)、胆固醇(TC),并进行口服75g葡萄糖耐量实验（OGTT）。计算IGR患病率,采用多因素Logistic回归分析IGR发生的危险因素。结果 1148名中老年人中,发现IGR 238例,患病率20.7%。多因素Logistic回归分析显示,年龄、BMI、高血压和血脂异常是上海城郊社区中年人群IGR的危险因素（P<0.05）。结论 上海浦东新区城郊结合社区中年人群IGR患病与年龄、BMI、高血压和血脂异常密切相关,应针对危险因素开展社区高危筛查和预防干预,形成预防糖尿病的有效的医院-社区-患者一级预防模式。     

Screening for pre-diabetes and diabetes in the workplace

BACKGROUND: Diabetes is an increasingly prevalent and burdensome disease in working populations. In settings with established occupational medical programmes, there may be opportunities to intervene in a positive way to reduce the burden of this disease. AIM: To integrate diabetes screening and prevention into an existing occupational medical programme. METHODS: Screening to detect potential cases of pre-diabetes and diabetes was conducted in a large working population using differing criteria to define risk groups over a 2-year period. Classification of new cases was based on fasting plasma glucose, random plasma glucose or oral glucose tolerance test (OGTT). RESULTS: Among 13,086 employees screened via fasting or random glucose, there were 96 diabetes and 650 pre-diabetes cases detected. Among high-risk employees, 20 new cases of pre-diabetes and 8 cases of diabetes were detected in 84 employees assessed by OGTT. The percentage of employees with new findings increased with increasing age (2.3%, under age 40 compared to 11.4% for age 50 years and above) and body mass index (2.6, 6.1 and 11.4% among normal weight, overweight and obese employees, respectively). CONCLUSIONS: Given the likely magnitude of unrecognized diabetes and pre-diabetes cases, further interventions are being implemented targeting all employees and not just those who require routine occupational medical examinations.     

The prevalence of diabetes mellitus in the Netherlands: A quantitative review

The prevalence of diabetes above the age of 30 years in TheNetherlands was estimated and the influence of methodologicalvariables on the reported prevalence rates was quantified. FifteenDutch studies performed since 1970 were entered in logisticregression models with the presence or absence of known diabetesabove the age of 30 years as a dependent variable. In orderto quantify the variability among studies, the study methodologyand population characteristics were chosen as independent variables.The age-standardized prevalence of known diabetes varied betweenthe studies. The total prevalence of known diabetes above theage of 30 years in 1993 can be estimated at 2.7% on the basisof the cases reported by general practitioners and at 3.2% basedon self-reported cases in surveys. The prevalence accordingto age increased by 7.1% per life year for men and by 7.7% forwomen. These associations were essentially similar in all studies.Systematic screening, performed with an oral glucose tolerancetest, revealed a prevalence which was 1.5–2 times higher.Dependingon the method used, the number of subjects with known diabetesin the Netherlands in 1993 varied between 235,000 and 285,000.After systematic screening, this prevalence will be 1.5–2times higher. These estimates may serve various goals. The prevalencerates based on self-reports or reports by general practitionersare important for estimating health care use. Prevalence ratesbased on screening are relevant for preventive strategies andlatent health care needs.     

苏州地区妊娠期糖尿病筛查的多中心临床研究

目的:通过苏州地区妊娠期糖尿病(GDM)的筛查,了解妊娠期糖代谢异常的发病率及对妊娠的不良影响。方法:采用前瞻性的研究方法,2004年8月～2006年12月对苏州市各大医院及太仓市建卡的大部分孕妇采用50g葡萄糖负荷试验,共筛查孕妇4166例,阳性者再做75g葡萄糖耐量试验(OGTT)。设糖尿病组(GDM)及糖耐量异常组(IGT),以糖筛查正常的孕妇作对照组,对临床资料进行分析。结果:筛查4166例孕妇中GCT阳性者1394例(33.46%),总糖代谢异常率为6.29%,其中GDM150例(3.60%)、糖耐量异常(IGT)者为112例(2.69%)。GDM及IGT的发生率随孕妇年龄增大而显著升高(P0.01)。新生儿出生体重GDM组和IGT组与对照组相比,有显著性差异(P0.05),GDM孕妇巨大儿占19.33%。GDM孕妇中剖宫产76.67%,子痫前期9.33%、羊水过多7.33%,均明显高于对照组,早产4例,1例新生儿死亡。结论:妊娠期糖筛查有利于早期检出妊娠期糖代谢异常的孕妇,以便加强管理,减少对母儿的不良影响。     

Evaluating the reported prevalence of type 2 diabetes mellitus by the Oguni diabetes registry using a two-sample method of capture-recapture.

BACKGROUND: Capture-recapture methods have been widely employed in the study of wildlife populations and have recently been applied to count various human diseases and conditions. We have estimated the prevalence of type 2 diabetes mellitus by adjusting for the degree of undercount using a two-sample model of capture-recapture among men and women aged 50-69 in Oguni town, Japan. METHODS: Oguni town diabetes registry data were utilized as the first source. In the registry, only those who had experienced fasting plasma glucose of > or = 7.8 mmol/l (140 mg/dl) or 2 h plasma glucose after a 75 g oral glucose tolerance test (OGTT) of > or = 11.1 mmol/l (200 mg/dl) were counted as having diabetes. A second source was a sample study selecting 200 men and 200 women aged 50-69 randomly, which was conducted in August 1991. A 75 g OGTT was done in the morning. The 1985 World Health Organization criteria were used to classify the diabetes status of the participants. A two-sample model of capture-recapture methods was employed to estimate the total number of cases of diabetes and determine the ascertainment rates of the registry. RESULTS: The prevalence estimated by the diabetes registry was 7.1%. The prevalence from the sample study was 8.8% with a participation rate of 74%. Estimated prevalence employing the capture-recapture method was 13.1%. The ascertainment rate of the registry was 53.8%. CONCLUSIONS: Little is known about the prevalence of type 2 diabetes in local areas in Japan, the US and the world. Capture-recapture methods are likely to provide a means to accurately assess the prevalence of diabetes.     

妊娠期糖尿病孕妇50g GCT和75g OGTT分布特征的研究

目的:探讨成都市妊娠期糖尿病(gestational d iabetes m ellitus,GDM)孕妇糖筛查(50 g GCT)和糖耐量(75g OGTT)的分布特征。方法:选取2008年9月～2009年6月在四川省妇幼保健院建卡产检的2 514例孕妇进行GCT检查,有妊娠期糖尿病高危因素的孕妇在24周以前进行检查;无高危因素者在24～28周检查;在妊娠中晚期出现体重增长过快、胎儿发育过大、羊水过多等情况的孕妇即使之前GCT试验阴性,也应及时重复GCT检查;GCT异常者3天后行75 g OGTT检查。结果:①成都市GDM发生率为4.97%;不同筛查孕周GCT异常率和GDM阳性率差异有统计学意义,24～28周检出率最高;②成都市GDM 50 g GCT 1 h血糖值呈正态分布,平均值为(9.53±1.47)mmol/L,且随着孕周的增加,50 g GCT 1 h血糖值呈逐渐增高的趋势;③75 g OGTT平均空腹血糖值为(5.03±1.08)mmol/L,1 h血糖值为(11.56±1.36)mmol/L,2 h血糖值为(10.12±1.29)mmol/L,3h血糖值为(7.33±1.15)mmol/L,空腹血糖偏低,而服糖后1 h、2 h、3 h血糖值偏高。结论:①对孕妇常规进行血糖筛查是有必要的,GCT检查最佳筛查孕周为24～28周,有高危因素的孕妇宜初诊时进行检查,对首次血糖筛查结果正常而有高危因素者应在以后的孕周复查以防漏诊。②根据成都市GDM 50 g GCT和75 g OGTT的分布特征,在制定适合我国的GDM标准时,有必要进行不同地域的多中心研究,对现有糖筛查和糖耐量的诊断标准进行确认和调整。     

2306例孕妇糖耐量筛查及影响因素分析

目的:了解妊娠期糖代谢异常的发生率,探讨其相关因素,为制定干预措施提供科学依据。方法:对2 306例孕妇进行50 g葡萄糖筛查试验(GCT),50 g GCT结果≥7.8 mmol/L再行口服葡萄糖耐量试验(OGTT)明确诊断,将临床资料进行统计分析。结果:妊娠期50 g GCT阳性率20.77%。其中葡萄耐量降低发生率4.16%,妊娠期糖尿病(GDM)检出率3.64%。高龄、孕前肥胖及糖尿病家族史为妊娠期糖代谢异常的相关因素。结论:GDM母儿并发症多,50 g GCT对GDM的及时发现和管理具有重要的意义。妊娠期糖耐量异常的发生率与孕妇的年龄、孕前体重指数及糖尿病家族史相关。做好孕前保健工作,按时对孕妇进行50 g GCT检测,特别是对GDM高危孕妇的筛查与管理有非常重要的临床意义。     

A screening procedure detecting high-yield candidates for OGTT. The Women's Health in the Lund Area (WHILA) study: a population based study of middle-aged Swedish women

The objective was to evaluate a screening procedure for detecting high-yield candidates for an OGTT, in a population of middle-aged Swedish women. A two-step screening procedure was performed in 6917 subjects. Women with a positive screening outcome, i.e. increased non-fasting capillary blood glucose, serum triglycerides, BMI, WHR, blood pressure or a family history of diabetes, pharmacological treatment of hypertension or hyperlipidaemia at the primary screening underwent a 75-g OGTT. A control group of women with negative screening outcome (n = 221) also underwent an OGTT. In 2923 women with positive screening outcome, 517 (17.7%) had NFG/IGT (normal fasting venous blood glucose <5.6 mmol/l and 2h-glucose 6.7–9.9 mmol/l), 109 (3.7%) IFG/IGT (fasting 5.6–6.0 and 2h 6.7–9.9 mmol/l) and 223 (7.6%) diabetes (fasting 6.1 or 2h 10.0 mmol/l). These figures were three, five and four times higher, respectively, than in the control group with negative screening outcome (p < 0.001 for all); no differences were found for IFG/NGT (fasting 5.6–6.0 and normal 2h < 6.7 mmol/l) (4.6% vs. 7.2%). For predicting impaired glucose metabolism (IFG/NGT, NFG/IGT, IFG/IGT, diabetes), the screening instrument showed an estimated sensitivity of 70%, specificity of 55%, positive predictive value of 34% and negative predictive value of 85%, based on findings in the control sample. The odds ratio for NFG/IGT increased with the numbers of risk factors from 2.8 to 7.7, for IFG/IGT from 5.7 to 55.0 and for diabetes from 2.5 to 18.1. High B-glucose, WHR and BMI were the three most important factors associated with an increased risk for NFG/IGT, IFG/IGT and diabetes. In subjects with IFG/NGT, none of the screening variables was associated with an increased risk. In summary, the results show a population screening method focused on features of the metabolic syndrome that discloses high-yield candidates for OGTT. A high prevalence of unknown impaired glucose metabolism was found in middle-aged women with a positive screening profile.     

Impaired glucose regulation in adults in Jamaica: who should have the oral glucose tolerance test?

OBJECTIVE: To compare the 1999 World Health Organization (WHO) fasting plasma glucose (FPG) criteria and the WHO 2-hour post-challenge glucose (2hPG) criteria during an oral glucose tolerance test (OGTT) in identifying adults in Jamaica with hyperglycemia. As the OGTT is not commonly used in clinical practice, factors associated with the failure of the FPG criteria to detect persons with impaired 2hPG were investigated. METHODS: A random sample of 2 096 adults, 25-74 years old, living in the town of Spanish Town, Jamaica, was evaluated for diabetes. After excluding 215 individuals for reasons such as missing data, the remaining 1 881 persons were composed of 187 who were previously known to have diabetes and 1 694 who were screened for diabetes with both FPG and 2hPG. RESULTS: The FPG criteria detected 83 cases of diabetes, compared to 72 by the 2hPG criteria. The kappa statistic comparing the two criteria was 0.31 (95% confidence interval: 0.28-0.34), indicating fair agreement. There were 261 cases of impaired glucose tolerance (IGT) and 92 cases of impaired fasting glucose (IFG). In those 92 with IFG, an OGTT would identify 34 cases of IGT and 14 cases of diabetes. Of those classified as normoglycemic by FPG criteria, 14% of them had IGT or diabetes by 2hPG criteria. The factors predicting the likelihood of non-detection of impaired glucose tolerance or diabetes by FPG were age, body mass index, central obesity, systolic blood pressure, and female sex. By receiver operating characteristic curve analysis, an FPG of 5.1 mmol/L would predict a 2hPG >/= 7.8 mmol/L. CONCLUSIONS: A few individuals classified as normal on FPG will have IGT or diabetes, and an OGTT will be needed to identify them. The yield of IGT detected by screening in Jamaica can be improved by lowering the threshold for IFG or by using clinical information to identify high-risk individuals.     

上钢社区部分居民血糖异常情况的调查与分析

目的通过对社区482例社区居民的现况调查,了解上钢社区糖尿病患病情况,从而有针对性地开展预防和干预。方法随机选择上钢社区2个居委,按5％的比例随机抽取20岁以上的居民482人,通过糖尿病现况问卷调查,统计分析现在糖尿病患者的基本情况。结果上钢社区的糖尿病患病率为17．84％,IGT患病率为7．8％。40岁以上人群是体质指数超标和血糖异常的主要患者。结论应当加强社区40岁以上人群的糖尿病筛查工作,特别是餐后血糖的筛查。