The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes in India study (PODIS)

This random multistage cross-sectional population survey was undertaken to determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in subjects aged 25 years and above in India. The study was carried out in 77 centers (40 urban and 37 rural). 18363 (9008 males and 9355 females) subjects were studied. 10617 (5379 males and 5238 females) were from urban areas and 7746 (3629 males and 4117 females) from rural areas. Blood samples were taken after a fast of 10-12 h and 2 h after 75 g of oral glucose. Subjects were categorized as having IGT or DM using the World Health Organisation (WHO) (1999) criteria. The standardized prevalence rate for DM in the total Indian, urban and rural populations was 4.3, 5.9 and 2.7%, respectively. The corresponding IGT rates in the three populations was 5.2, 6.3 and 3.7%, respectively. The urban prevalence of DM and IGT was significantly greater than in the rural population (P < 0.001 in both instances). The prevalence of DM was significantly, more than that of IGT (P < 0.001) within both the rural and urban populations. Type 2 diabetes is a major health problem is India.     

Glucose tolerance in a rural population of Bangladesh

CONTEXT:

The prevalence of type 2 diabetes is increasing in the Bangladeshi population. However, there is little information available on the prevalence of glucose intolerance, ie, type 2 diabetes, impaired glucose tolerance, and impaired fasting glucose.

AIMS:

The main aim of this study is to determine the prevalence of different categories of glucose intolerance and their relationship with different anthropometric and demographic characteristics.

SETTINGS AND DESIGN:

This cross-sectional study was performed in a rural area of Bangladesh.

MATERIALS AND METHODS:

A random sample of 5000 persons aged ≥ 20 years was included in this study. Fasting blood glucose was measured in 3981 individuals and 2-h post-glucose blood glucose was measured in 3954 subjects after the known cases of diabetes (n = 27) were excluded. Height, weight, waist and hip circumference, and blood pressure were measured.

STATISTICAL ANALYSIS:

Pearson Chi-squared test and correlation test were used for analysis as appropriate.

RESULTS:

The prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes (DM) were 1.3, 2.0, and 7.0%, respectively. IFG, IGT, and IFG + IGT were more prevalent in females. Age showed a significant positive relationship with increasing levels of glucose intolerance. Body mass index, waist circumference, and waist-to-hip ratio were higher in the glucose-intolerant group than in the normal glucose tolerance (NGT) group. There was a positive correlation between FBG and 2-h BG in NGT and DM subjects.

CONCLUSION:

The FBG value identified more people with glucose intolerance than the 2-h BG. These findings will help developing diabetes preventive strategy in rural populations.     

The abbreviated glucose tolerance test in screening for diabetes: the Islington Diabetes Survey

The World Health Organization has recommended a single 2-h post-glucose load blood glucose level as a screening test for diabetes mellitus in epidemiological surveys. We have assessed its characteristics, when compared with a full supervised glucose tolerance test (OGTT), in estimating prevalence, and in diagnosing diabetes in the individual patient. A stratified sample of 223 of 1040 subjects who had participated in a diabetic survey that utilized a single capillary 2-h blood glucose estimation as a screening test were recalled for formal glucose tolerance testing. The numbers of subjects with diabetes at screening and at recall were similar (14/212, 6.6%; 13/216, 6.0%) but only 9 subjects were so classified on both occasions. Thirty-five subjects (16.5%) were suspected of having impaired glucose tolerance (IGT) at screening, and 52 (24.1%) at recall. There was substantial reclassification from screening IGT, with 3/35 worsening to diabetes, and 10/35 returning to normal. Capillary 2-h glucose levels gave an accurate assessment of the prevalence of diabetes but underestimated that of IGT. On the full OGTT, little difference in classification was found when the values of fasting and 1-h blood glucose were used in addition to those of the 2-h blood glucose used alone. The 2-h glucose had a within-subject coefficient of variation of 32.4% which produced substantial reclassification of subjects with levels close to the diagnostic levels for diabetes, and this implies that such individuals should not be classified as having diabetes on the basis of a single glucose tolerance test.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans.

AIMS: This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. METHODS: This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist-hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (kappa statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. RESULTS: The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted kappa = 0.228 men, weighted kappa = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. CONCLUSIONS: Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.     

Fasting blood glucose in determining the prevalence of diabetes in a large,homogeneous population of Caucasian middle-aged women

Abstract. Objectives. To determine the usefulness of a single, fasting blood glucose (FBG) value in measuring the prevalence of diabetes mellitus in a large, homogeneous population. Design. Fasting blood glucose and 2-h oral glucose tolerance test (OGTT) values were determined. Based on the results of the OGTT, the sensitivity and specificity of different cut-off levels of FBG for the diagnosis of diabetes were assessed. ROC (receiver operating characteristic) analysis was performed on the data. Setting. A health screening unit at the University Hospital in Malmö, Sweden. Subjects. A total of 1843 Caucasian women without known diabetes aged 55–57 years. Results. The prevalence of previously undiagnosed diabetes was 3.9% and the prevalence of impaired glucose tolerance (IGT) was 27.9% using the WHO cut-off values for 2-h blood glucose values after an OGTT. With an FBG cut-off value of 6.7 mmol IT^?1, the sensitivity of a single FBG value was 36.6%. Reducing the cut-off value to 6.0 mmol L^?1 increased the sensitivity to 53.4%. At a cut-off level of 4.8 mmol L^?1, the sensitivity reached the high value of 85.9%, but the specificity was only 45% and the predictive value of a positive test as low as 5.9%. ROC analysis showed that the optimal cut-off value for FBG in this population was 5.3 mmol L^?1, giving a sensitivity and specificity of 77% but a positive predictive value of only 11.9%. Conclusions. This study has shown that in a large and homogeneous Caucasian population of women aged 55–57 years with a high prevalence of IGT, a single FBG value is not useful as a screening tool for diabetes mellitus.     

2007年北京市居民糖尿病与代谢综合征患病状况调查

目的 了解2007年北京市居民糖尿病与代谢综合征的患病情况.方法 采用整群随机抽样方法,于2007年9月至11月抽取本市3个地区,分别代表城市、城镇和农村地区进行调查.共有20岁以上常住居民3 484名参与调查.通过询问病史、体格检查、检测空腹血糖、血脂及口服糖耐量试验,并依据1999年WHO糖尿病诊断标准和2005年IDF代谢综合征全球共识定义进行诊断.使用EPI data 3.02软件建立数据库,SPSS 13.0软件进行统计分析.计量资料采用(-x)±s表示,两组间比较采用t检验,多组阳比较采用方差分析,计数资料比较采用卡方检验.结果 北京市居民糖尿病患病率为10.16%(城市10.97%、城镇11.95%、农村6.86%):其中已知糖尿病患病率为5.02%(城市6.14%、城镇6.62%、农村1.71%)(x2=54.06,P＜0.01);新诊断糖尿病患病率为5.14%(城市4.83%、城镇5.33%、农村5.15%)(x2=2.35,P＞0.05);空腹血糖受损患病率为1.35%(城市0.58%、城镇2.26%、农村1.43%)(x2=12.97,P＜0.01);糖耐量异常患病率为9.84%(城市10.52%、城镇9.68%、农村9.27%)(x2=3.99,P＞0.05);代谢综合征患病率为20.39%(城市17.34%、城镇23.30%、农村20.78%)(x2=35.38,P＜0.01).糖尿病患者平均知晓率为49.85%.结论 北京市糖尿病及代谢综合征患病率高,城镇和农村地区患病率呈现加速升高趋势.     

Rising prevalence of NIDDM in an urban population in India

Summary A survey conducted in 1988–1989, in the city of Madras, South India, showed that the prevalence of diabetes mellitus in adults was 8.2 % and prevalence of impaired glucose tolerance (IGT) was 8.7 %. The present survey was another cross-sectional study conducted 5 years later in the same urban area to study the temporal changes in the prevalence of diabetes and IGT. The two sample populations surveyed were similar in age structure and socioeconomic factors. In the second survey in 1994–1995, a total of 2183 subjects, 1081 men and 1102 women, with a mean age of 40 ± 12 years were tested by an oral glucose tolerance test; fasting and 2-h post-glucose plasma glucose were measured. Anthropometric measurements, details of physical activity and clinical history of diabetes were recorded. Age-standardised prevalence of diabetes had increased to 11.6 % from 8.2 % in 1989 and IGT was 9.1 %, similar to 8.7 % in 1989. Multiple regression analysis showed age, waist : hip ratio, body mass index (BMI) and female sex were correlated to diabetes. Family history of diabetes showed interaction with age and BMI. Prevalence of IGT correlated to age, BMI and waist : hip ratio. This study highlights the rising trend in the prevalence of non-insulin-dependent diabetes (NIDDM) in urban Indians. The persistent high prevalence of IGT may also be a predictor of a further increase in NIDDM in the future. No significant differences in the anthropometric data were noted in this compared to the previous study. [Diabetologia (1997) 40: 232–237] Received: 24 April 1996 and in final revised form: 31 October 1996     

Insulin secretion and insulin sensitivity in Japanese subjects with impaired fasting glucose and isolated fasting hyperglycemia

Impaired fasting glucose (IFG) is a subgroup of impaired glucose regulation exhibiting an elevated fasting glucose levels without elevated 2-h glucose levels on oral glucose tolerance test (OGTT). Diabetes mellitus with isolated fasting hyperglycemia (DM/IFH) is a similar subgroup of diabetes having higher fasting glucose levels with 2-h glucose levels within the non-diabetic range. The aim of this study is to profile the characteristics of these subgroups to estimate the factors involved in the development from normal glucose tolerance (NGT) via IFG to DM/IFH. Five hundred and sixty seven Japanese males were classified on the basis of 75 g OGTT into four groups, NGT, IFG, DM/IFH, and isolated impaired glucose tolerance (isolated IGT). Insulin secretion was evaluated by insulinogenic index, insulin sensitivity was evaluated by ISI composite, and insulin secretory patterns were compared additionally. IFG and DM/IFH subjects exhibited both lower insulin secretion and lower insulin sensitivity than NGT subjects. There was an insulin peak in NGT, IFG, and DM/IFH at 60 min, which did not occur in isolated IGT. Impaired early-phase and basal insulin secretion and decreased insulin sensitivity both are estimated as factors in progression from NGT via IFG to DM/IFH in these subjects. IFG and DM/IFH subjects have definite fasting hyperglycemia in contrast to isolated IGT subjects, 2-h glucose levels being maintained within the non-diabetic range partly by the insulin peak at 60 min.     

Rising prevalence of type 2 diabetes in rural Bangladesh: a population based study

The aim of the study was to determine the temporal changes in the prevalence of type 2 diabetes mellitus and its associated risk factors in a rural population of Bangladesh. A total of 4757 subjects age >/=20 years both male and female were enrolled randomly in a cross-sectional study in 1999. The same area and population was reinvestigated in 2004 following the same selection procedure, on a sample of 3981 individuals. Structural and economical changes were noted for the last 5 years in the locality. An increased prevalence of diabetes was found with 6.8% in the present survey compared with 2.3% in the earlier survey (p<0.05). Age, BMI and systolic blood pressure were found to be significant risk factors following both for FBG and for OGTT. WHR was found to be a significant risk factor for men only. A substantial agreement was observed between FBG and OGTT (kappa 0.63) compared to the previous investigation in 1999 (kappa 0.40). Differences in the indices of obesity, that is BMI, WHR and waist girth, may in part explain the increased prevalence, which in turn may explain due to fast-expanded urbanization. The state of affairs warrants immediate measures necessary to prevent the epidemic particularly in the localities that are in the transition phase from rural to semi-urban facilities.     

Changes and relations of circulating visfatin, apelin, and resistin levels in normal, impaired glucose tolerance, and type 2 diabetic subjects.

Visfatin and apelin are two novel adipocyte- secreted hormone proposed to link obesity with insulin resistance. In this study we investigated whether plasma visfatin and apelin levels were altered in normal, impaired glucose tolerance, and type 2 diabetic subjects. We also assessed the association between plasma visfatin, or apelin and body composition, metabolic parameters, and resistin concentrations in these subjects. The visfatin levels of fasting and 2-h post-glucose load were found to be significantly decreased in diabetics compared with the controls ( P<0.05). In contrast, basal apelin levels were significantly increased in the IGT and diabetic subjects compared with the controls ( P<0.05 and P<0.01). The apelin levels of 2-h post-glucose load were significantly higher than the basal levels in every group (all P<0.05). Fasting plasma visfatin was found to correlate positively and significantly with BMI, WHR, and fasting plasma resistin, but negatively with HbA1c and 2 h OGTT glucose. Multiple regression analysis showed that WHR, HbA1c, 2 h OGTT glucose were independent related factors influencing plasma visfatin levels. Fasting plasma apelin levels correlated positively with HOMA-IR, BMI, TC, LDL-C, FBG and Fasting plasma insulin. Multiple regression analysis also showed that HOMA-IR, BMI, and TC were independent related factors influencing plasma apelin levels. The present work indicates the potential link of visfatin and apelin with the pathogenesis of insulin resistance and T2DM.     

空腹血糖正常的住院高血压患者的糖耐量调查分析

目的 检测住院原发性高血压伴有糖代谢异常患者的数据,为全面干预危险因素提供科学依据.方法 选择既往无糖代谢异常病史,空腹血糖<5.6 mmol/L确诊为原发件高血压的586例住院患者行口服葡萄糖耐量试验(OGYT)后2 h的血糖测定.观察年龄、性别、体质指数、入院时血压、血尿酸、血脂、动脉硬化等参数与OGTT后2 h血糖的关系.结果 (1)586例患者中检出糖耐量减低患者159例(27.1%);2型糖尿病患者41例(7.0%).(2)糖代谢异常的患者动脉硬化的比例高达67.5%,高于血糖正常组的59.6%,年龄标化后比较差异无统计学意义.结论 原发性高血压患者合并糖耐量异常的比例高,对于合并代谢综合征的原发性高血压患者,应积极行OGTT测定,以早期发现和干预糖代谢紊乱,减少动脉硬化的发生.     

Concordance between fasting and 2-h post-glucose challenge criteria for the diagnosis of diabetes mellitus and glucose intolerance in high risk individuals.

AIMS: To compare the new fasting with the 2-h post glucose challenge diagnostic criteria for diabetes mellitus in a high-risk Central European population. METHODS: The results of the 75-g oral glucose tolerance tests (OGTT) performed between 1st January 1990 and 31st December 1998 in patients at high risk of glucose metabolism disturbance were analysed. RESULTS: From 1554 patients with OGTT results available for the study, 1360 (759 women and 601 men, aged 65.5+/-6.9 years, body mass index 28.2 +/- 4.5 kg/m2) were included into the study. With the use of the post-challenge criteria, 41.3% of the analysed population had diabetes or impaired diabetes tolerance (IGT), whereas with the new fasting system only 16.6% would have been diagnosed with any type of glucose intolerance. Diabetes was significantly more often diagnosed with the post-challenge criteria than with the fasting ones: 16.2 vs. 5.3% (P < 0.0001). The subjects with diabetes diagnosed upon fasting glucose value were significantly younger than the subjects with diabetes diagnosed according to the 2-h glucose challenge: 65.7 +/- 6.2 vs. 68.8 +/- 7.0 years, respectively (P < 0.01). The sensitivity of the new criteria for the diagnosis of diabetes was 18.2%, and specificity 97.2%. A total of 77.8% of IGT cases would have been diagnosed as having normal glucose metabolism according to the fasting glucose. The sensitivity of the new criteria for the diagnosis of impaired glucose tolerance (IGT or impaired fasting glucose) was 14.6%, and specificity 89.8%. The overall kappa statistic (k) was low; 0.211 (95% confidence interval 0.149-0.27). CONCLUSIONS: The new lower fasting criteria might be too insensitive to identify a large proportion of individuals with diabetes or impaired glucose intolerance, particularly in a high-risk population.     

Screening for diabetes mellitus--a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications.

AIMS: To compare the new American Diabetes Association (ADA) fasting plasma glucose (FPG) criteria to the 1985 World Health Organization (WHO) 2-h post glucose (2hPG) criteria when used for screening of those with no prior history of diabetes mellitus. METHODS: The study included 3,407 subjects without a history of diabetes in whom both FPG and 2hPG were available from the 1992 Singapore National Health Survey. The agreement (kappa) between FPG and 2hPG for the diagnosis of DM was assessed. The optimal cut-off of FPG for the detection of individuals with 2hPG > or = 11.1 mmol/l was determined by receiver-operating characteristics analysis. RESULTS: The prevalence of diabetes diagnosed by FPG alone was 7.3% compared to 8.4% diagnosed by 2hPG. The prevalence of impaired fasting glucose was 8.0%. FPG and 2hPG showed moderate agreement (kappa = 0.646, 95% confidence interval 0.584-0.708). Age, ethnic group and obesity did not affect the degree of agreement. Of those with 2hPG > or = 11.1 mmol/l, 40.8% had FPG in the non-diabetic range while 24.8% of those with FG > or = 7.0 mmol/l had 2hPG in the non-diabetic range. The optimal FPG for the detection of 2hPG > or =11.1 mmol/l was 6.1 mmol/l. Oral glucose tolerance tests (OGTT) in those with 6.0 mmol/ < FPG < 7.0 mmol/l resulted in the diagnosis of diabetes in 90.7% of individuals at risk of microvascular complications. CONCLUSIONS: FPG provides a simple screening test for diabetes, which shows moderate agreement with the 2hPG. A two-step strategy of OGTT in those with impaired fasting glucose improves the detection of at-risk individuals. However, diabetes should not be diagnosed on a single test. The test should be repeated on another day if an individual tests positive for diabetes.     

Prevalence of Glucose Intolerance in Urban and Rural Communities in Saudi Arabia

The prevalence and associated factors for glucose intolerance among Saudi populations in urban and rural communities were investigated among 13177 subjects, 15 years and over, from different regions of Saudi Arabia. The data were standardized using the known age structure of the Saudi population. The sample was randomly selected from subjects who participated in the National Epidemiological Household Study for Chronic Metabolic Diseases. Medical and social history was ascertained from all the study population during house visits. All subjects were then requested to attend a local primary care centre for physical examination and phlebotomy for measurement of random plasma glucose (RPG). A 75 g oral glucose tolerance test was employed for subjects with borderline values. WHO criteria for diagnosis of diabetes mellitus (DM) and impaired glucose tolerance (IGT) were applied. Mean RPG from the urban population was significantly higher than in the rural population. Age adjusted prevalence of DM was significantly higher in the urban population (males 12 %, 95 % CI 11–13 and females 14 %, 95 % CI 13–15) than in the rural population (males 7 %, 95 % CI 7–8 and females 7.7 %, 95 % CI 7–9) and is among the highest in the world. The prevalence of DM increased with age. The lowest and highest prevalences of DM in the urban population were 2 % for subjects aged 15–20 years and 49 % for female subjects aged 51–60 years. The lowest and highest prevalences of DM among rural population were 1 % for subjects aged 15–20 years and 29 % for female subjects over the age of 60 years. Fifty-six per cent of diabetic patients were newly diagnosed at the time of the study. Age adjusted prevalence of IGT was not significantly higher in the urban population. The highest prevalence of obesity, BMI>30, was among urban female subjects. Age, obesity, and family history of DM were associated with DM. Considering the young nature of Saudi population, the prevalence is expected to increase in the near future. There is a need to develop a multi-disciplinary approach for the general population with special attention to female subjects for prevention through controlling modifiable risk factors such as obesity and sedentary life style, improving glycemic control of the diabetic population, and early identification and treatment of diabetic complications. © 1997 John Wiley & Sons, Ltd.     

The burden of diabetes and impaired fasting glucose in India using the ADA 1997 criteria: prevalence of diabetes in India study (PODIS)

This random multistage cross sectional population survey was undertaken to determine the prevalence of diabetes mellitus (DM) and impaired fasting glycemia/glucose (IFG) in subjects aged 25 years and above in India. The study was carried out in 108 centers (49 urban and 59 rural) to reflect the size and heterogeneity of the Indian population. 41,270 (20,534 males and 20,736 females) subjects were studied. 21,516 (10,865 males and 10,651 females) were from urban areas and 19,754 (9669 males and 10,085 females) from rural areas. Blood samples were taken after a fast of 10-12h and the subjects were categorized as having IFG or DM using the 1997 American Diabetes Association criteria. The age and gender standardized prevalence rate for DM and IFG in the total Indian population was 3.3 and 3.6% respectively (P < 0.001). The standardized prevalence of DM and IFG in urban areas was significantly higher than that for the rural population (urban DM prevalence 4.6% versus rural DM prevalence 1.9%, P < 0.001; urban IFG prevalence 4.8% versus rural IFG prevalence 2.5%, P < 0.001). There was no statistically significant difference in the prevalence between DM (4.6%) and IFG (4.8%) in the urban population. The rural prevalence of IFG (2.5%) was significantly (P <0.001) more than the rural prevalence of DM (1.9%). Type 2 diabetes is a major health problem is India.     

Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon

Summary The adoption of Western lifestyles is known to lead to increasing prevalence of non-insulin-dependent diabetes mellitus in Africa, yet epidemiological studies using standardised methods are rare. The prevalence of diabetes and impaired glucose tolerance was determined in a rural and an urban community in Cameroon using the 75-g oral glucose tolerance test and the World Health Organization diagnostic criteria in 719 rural (292 men, 427 women) and 1048 urban (458 men, 590 women) subjects aged 24–74 years. The response rate was 95 and 91 % for the rural and urban population, respectively. The age-standardized prevalence of diabetes in the rural and urban population was respectively 0.9 % (95 % confidence interval (0.2–2.7)) and 0.8 % (0.2–1.8) for men and 0.5 % (0.1–1.6) and 1.6 % (0.7–3.1) for women, and that of impaired glucose tolerance was 5.8 % (3.3–9.4) and 1.8 % (0.9–3.2) for men, and for women, 2.2 % (1.0–4.0) and 2.0 % (0.6–4.5). Although for both men and women the body mass index was higher at all ages in the urban than in the rural area, the 2-h plasma glucose, even after adjustment for age and body mass index, was significantly higher in the rural than in the urban area (p < 0.005, p < 0.002 for men and women, respectively). There was a female excess of diabetes in the urban area and an equal sex distribution in the rural area. In the rural area 67 % (4 of 6) of diabetic subjects were unknown before the survey, compared with 57 % (8 of 14) in the urban area. These data indicate a low prevalence of diabetes in Cameroon; however, the prevalence of impaired glucose tolerance suggests an early stage of a diabetes epidemic. [Diabetologia (1997) 40: 824–829] Received: 19 November 1996 and in revised form: 10 March 1997     

Comparison of ADA 1997 and WHO 1985 criteria for diabetes in south Indians--the Chennai Urban Population Study. American Diabetes Association.

AIMS: To compare the American Diabetes Association (ADA) fasting criteria and World Health Organization (WHO) 2-h criteria for diabetes in an urban south Indian population. METHODS: Subjects were drawn from the Chennai Urban Population Study. Of the 1001 subjects studied, 52 (5.2%) were diagnosed as having diabetes according to WHO 2-h criteria and 32 (3.2%) according to the ADA fasting criteria. RESULTS: Twenty-five (48%) of the subjects diagnosed with diabetes by the WHO 2-h criteria were not classified as having diabetes by the ADA fasting criteria. Similarly, of the 78 subjects (7.8%) classified as having impaired glucose tolerance (IGT), only eight (10.3%) had impaired fasting glucose (IFG) according to the ADA fasting criteria. The overall agreement between the WHO 2-h criteria and ADA fasting criteria was poor (kappa = 0.40). CONCLUSIONS: Use of the ADA fasting criteria results in a lower prevalence rates of diabetes in this lean urban south Indian population.     

The prevalence of type II diabetes mellitus in rural urban population over 35 years of age in Lublin region (Eastern Poland)

The prevalence of type 2 diabetes mellitus (DM 2) has increased dramatically in the last decade. Data relating to the number of undetected cases of diabetes are underestimated. The aim of the study was to evaluate the prevalence of DM 2, obesity, hypertension, and lipid disturbances in a representative group of urban and rural population in the Lublin region (Eastern Poland). The study was performed in 1998-2001. A two-layer draw was applied: two groups of 3000 people were drawn from the population of Lublin town and from the rural areas each comprising 100,000 inhabitants. In all subjects physical examination was performed and body weight, height, and blood pressure measurements were obtained. Blood samples were taken from the basilic vein to estimate: blood glucose, lipids and insulin concentration. Venous blood glucose concentration was measured using a Glucotrend glucometer. Oral glucose tolerance test (OGTT) after a 75 g-glucose load was performed in subjects without previously diagnosed diabetes mellitus and when the fasting blood glucose was < 8.0 mmol/l (144 mg/l). The LDL-cholesterol level was calculated according to Friedewald formula. DM 2 was identified according to the WHO criteria from 1985. Obesity and hypertension were diagnosed according to the new WHO criteria (Body Mass Index > or = 30 kg/m2, blood pressure > or = 140/90 mm Hg). 3782 subjects: 1809 in the rural area and 1973 in Lublin town were examined. The response rate among rural and urban population was 60.3% and 65.8% respectively. The prevalence of DM 2 was assessed in 17.6% of rural and in 14.1% of urban population. 75% of diabetics in the rural areas and 56% in the town were the newly diagnosed cases. We found impaired glucose tolerance in 30.3% of rural and in 21.6% of urban population, BMI > or = 30 kg/m2 in 30.8% and 30.1%, hypertension in 69.4% (29.2% newly diagnosed) and 68.6% (27.7% newly diagnosed), hypercholesterolaemia (total cholesterol > or = 5.2 mmol/l (200 mg/dl)) in 66.4% and 60%, hyper-LDL-cholesterolaemia (> or = 3.5 mmol/l (135 mg/dl)) in 57.3% and 52.6%, hypo-HDL--cholesterolaemia in 21.7% and 31.4%, hypertriglyceridemia (> or = 2.3 mmol/l (200 mg/dl)) in 15.1% and 22% respectively. This finding indicates the urgent need for introducing a national program for early diagnosis and prevention of DM 2 and concomitant metabolic disturbances.     

四川巴中地区老年人糖尿病及糖调节受损患病率的调查

目的了解四川巴中地区老年人糖尿病（DM）及糖调节受损的发病现状。方法采用多级抽样的方法,抽取2414名巴中地区60岁及以上人群进行问卷调查、体检、血糖检查和糖耐量试验。结果2414名对象中,有252例患DM,患病率为10．4％;女性DM患病率高于男性,城镇高于农村,大专及以上文化程度的发病率最低,从事脑力劳动的高于体力劳动的,随经济收入的增高,DM患病率增高。单纯IFG患病率为6．6％,单纯的IGT患病率为22．8％,IFG合并IGT的患病率为1．9％。结论巴中地区老年人糖尿病及糖调节受损的患病形势严峻,应重视和加强防治工作。     

Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome

Insulin resistance is common in adults with polycystic ovary syndrome (PCOS). Although recent data demonstrate that insulin resistance is present in the early stages of PCOS, the prevalence of insulin resistance in adolescents with PCOS has not been determined. Likewise, the prevalence of impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM) in adolescent cohorts has not been established. In this study we sought to obtain preliminary data regarding the prevalence of IGT and DM in adolescents with PCOS and to assess the ability of screening tests to predict these abnormalities within this population. Twenty-seven adolescents with PCOS underwent oral glucose tolerance tests. Plasma glucose and insulin levels were obtained at baseline, and glucose was measured 2 h after a 75-g glucose challenge. The 2-h plasma glucose level was used to categorize subjects as having IGT or the provisional diagnosis of DM. Eight of our 27 subjects had IGT, and 1 had previously undiagnosed DM. These abnormalities were seen among lean and obese subjects. Fasting plasma glucose levels and simple measures of insulin resistance were suboptimal predictors of IGT and DM within our cohort. As in adults, our results indicate that adolescents with PCOS are at increased risk for IGT and DM and that the 2-h plasma glucose level after an oral glucose challenge appears to be the most reliable screening test for these abnormalities. Our results need to be corroborated by future studies that determine the prevalence of abnormalities in glucose tolerance among large populations of adolescents, both with and without PCOS. However, as DM may be preventable by lifestyle modifications, we would recommend that adolescents with PCOS undergo periodic screening for abnormal glucose tolerance using 2-h postchallenge plasma glucose levels.