社区自然人群糖调节受损者5年转归及其影响因素

目的 探讨糖调节受损人群发生糖尿病的危险性及其影响因素.方法 2002年6月至8月,采用抽样分层横断面现场调查方法于上海市浦东新区社区中检出192例糖调节受损者.2007年同期进行随访,观察单纯糖耐量受损、单纯空腹血糖受损、糖耐量受损合并空腹血糖受损、糖尿病人群比例,变化.使用t检验、方差分析、卡方检验进行统计学分析.结果 5年中死亡5例,存活的187例中79例发生糖尿病,糖尿病年转化率为8.4%(79/187/5年).基线单纯糖耐量受损者糖尿病年转化率为8.2%(47/114/5年),基线单纯空腹血糖受损者精尿病年转化率为6.3%(12/38/5年),基线糖耐量受损合并空腹血糖受损者糖尿病年转化率为11.4%(20/35/5年).正常糖耐量年转化率为6.3%(59/187/5年).单纯糖耐量受损者和糖耐量受损合并空腹血糖受损者发生糖尿病的风险分别是单纯空腹血糖受损者的1.4倍(95%可信区间为0.753～2.508,P=0.29)和107倍(95%可信区间为1.021～2.80,P=0.028).转化为糖尿病者较未转化为精尿病者高血压、肥胖的比例增高,基线年龄、体重指数、腰围、腰臀比和2 h血精明显升高,随访结束时体重指数和收缩压较基线时增高.结论 上海市浦东新区糖耐量受损合并空腹血糖受损者糖尿病转化率最高.多种代谢异常可促进糖调节受损人群向糖球病转化.     

糖代谢异常患者冠状动脉病变分析

目的:探讨冠心病合并糖调节受损患者的冠状动脉病变特点。方法:回顾分析2000年5月~2007年11月冠状动脉造影阳性患者720例,分为糖尿病组(208例)、糖耐量减低组(96例)、空腹血糖受损组(30例)和非糖代谢异常组(386例)。所有患者均测定空腹血糖、空腹胰岛素、餐后2 h血糖、血胆固醇、三酸甘油、低密度脂蛋白、高密度脂蛋白、C反应蛋白及糖化血红蛋白,观察其年龄、冠心病危险因素(包括高血压、高胆固醇血症及体质量指数BMI及吸烟)和冠状动脉病变情况。结果:1.4组在年龄、性别、危险因素等方面差异无统计学意义(P>0.05)。2.冠心病合并糖尿病组、糖耐量减低组、空腹血糖受损组双支病变率分别为38%、27%、和30%,与非糖代谢异常组18%比较差异有统计学意义(P<0.01);3支病变率分别为43%、40%、和37%,与非糖代谢异常组20%比较差异有统计学意义(P<0.01);糖耐量减低组、空腹血糖受损组与糖尿病组相比,3支病变率、病变程度差异无统计学意义(P>0.05)。3.Logistic回归分析表明空腹胰岛素、C反应蛋白、糖化血红蛋白及低密度脂蛋白是多支冠状动脉病变的独立危险因子。结论:糖调节受损与2型糖尿病有类似血管损害,糖耐量试验对及时发现血糖异常非常重要。     

成都地区社区居民高血压前期与糖脂代谢关系的研究

目的探讨成都地区社区居民高血压前期和糖脂代谢紊乱之间的关系。方法利用成都地区慢性病防治项目的现况调查资料,分析年龄40岁及40岁以上中老年人群的数据,比较高血压前期与正常血压人群的糖脂代谢情况,并进一步分析高血压前期与相关危险因素的关系。结果高血压前期组空腹血糖受损、单纯性糖耐量异常、空腹血糖受损合并糖耐量异常以及糖尿病的患病率均明显高于正常血压组(P<0.05);高血压前期组高胆固醇血症、高甘油三酯血症、高LDL-C和低HDL-C的患病率明显高于正常血压组(P<0.05);Logistic回归分析显示,男性、老龄、肥胖、餐后血糖、胆固醇和甘油三酯升高都是高血压前期的危险因素(P<0.05),女性和HDL-C升高是高血压前期的保护因素,其中年龄和性别是不可控制的因素。结论高血压前期与糖脂代谢关系密切,是糖尿病和高脂血症发生发展的重要危险因素。成都地区社区中老年人群高血压前期的患病率高且更易发生糖尿病和血脂紊乱。尽早对社区人群进行高血压前期和糖脂代谢干预,对降低心血管疾病事件的发生和疾病负担具有重要意义。     

糖化血红蛋白与糖调节受损血糖水平相关性的研究

目的 探讨研究糖化血红蛋白(HbAlc)与糖调节受损血糖水平的相关性.方法 2009年2-3月在兰州大学附属白银医院在岗职工中开展口服75 g葡萄糖耐量试验(OGTT)和HbAlc普查,测定空腹血糖、服糖后2 h血糖及HbAlc,采用葡萄糖氧化酶法测定静脉血浆血糖,采用高效液相色谱分析法测定HbAlc.研究资料纳入标准:空腹血糖<7.0 mmol/L且服糖后2 h血糖<11.1mmol/L者,无糖尿病、血红蛋白病、肝、肾疾患等.进入结果分析的对象共726例,男197例,女529例,平均年龄(39±10)岁.其中正常糖耐量636例(87.6%),糖调节受损90例(12.4%),糖调节受损诊断采用1999年世界卫生组织糖尿病诊断标准.率间比较采用χ~2检验,双变量分析采用Pearson相关分析.结果 (1)糖调节受损占HbAlc≤5.7%人群的2.3%,占HbAlc≥5.8%的人群中89.3%.HbAlc≥5.8%时预测OGTT诊断的糖调节受损状态的敏感度、特异度、阳性预测值、阴性预测值分别为83%、99%、0.89和0.98;(2)OGTT诊断的空腹血糖受损、糖耐量减低及糖调节受损状态的患病率,在HbAlc为5.8%组与5.7%组比较差异具有统计学意义(χ~2值分别为10.077、22.219和27.780,P<0.01或P<0.001);(3)HbAlc水平与空腹血糖受损、糖耐量减低、糖调节受损的患病率之间呈显著性正相关(r值分别为0.957、0.928和0.936,均P<0.01).结论 (1)HbAlc预测糖调节受损与OGTT具有一致性,与OGTT诊断的糖调节受损状态相关的HbAlc最佳临界值为5.8%;(2)HbAlc与OGTT诊断空腹血糖受损、糖耐量减低、糖调节受损状态的血糖水平呈显著性正相关,且HbAlc为5.8%与其相关性极其密切.建议当HbAlc≥5.8%时均应行OGTY检查,以明确有无糖调节受损.     

糖调节受损与冠状动脉粥样硬化性心脏病

葡萄糖调节受损(impaired glucose regulation,IGR)包括糖耐量低减(impaired glucose tolerate,IGT)和空腹糖调节受损(impaired fasting glucose,IFG),是正常糖代谢与糖尿病之间的中间代谢状态,许多研究表明,糖调节受损不仅仅是糖代谢正常与糖尿病之间的过渡阶段,也是直接导致心血管事件发生和死亡的重要阶段,是冠心病发生的重要危险因素。1糖调节受损的定义葡萄糖耐量低减(IGT)的定义是空腹血浆血糖<7·0mmol/L(126mg/dL),75g口服葡萄糖耐量试验(OGTT),2h血浆葡萄糖介于7·8~11·0mmol/L(140~199mg/dL)之间。空腹糖调节受损(IFG)…     

空腹血糖未达糖尿病诊断标准患者直接进行口服葡萄糖耐量试验的异常率及安全性

目的探讨既往1年内空腹血糖检查未达糖尿病诊断标准(7 mmol/L)患者直接进行口服葡萄糖耐量试验(OGTT)糖代谢异常发生率及安全性等。方法年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病症状的患者301例直接进行OGTT,收集患者一般情况及血糖、血脂等。根据OGTT结果分为:血糖正常、糖调节受损组、糖尿病3组。分析糖调节受损、糖尿病发生率,分析3组年龄、血压、血糖、血脂等差异。结果血糖正常比例为47.18%,糖调节受损比例为34.88%,糖尿病比例为17.94%。血糖正常组年龄最小,糖尿病组高血压比例最高,糖调节受损组总胆固醇及低密度脂蛋白显著比血糖正常组高(均P0.05)。空腹血糖、餐后2 h血糖、糖化血红蛋白3组比较:血糖正常组糖尿病前期组糖尿病组(均P0.05)。空腹血糖5.6 mmol/L患者OGTT筛查餐后2 h血糖204例,其中糖耐量异常21.57%,糖尿病6.37%。3组直接行OGTT均未出现糖尿病酮症、糖尿病高渗状态等需紧急降糖处理病例,也未发现恶心、反酸、胃灼痛等消化道症状。结论年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病三多一少症状的患者直接进行OGTT检查具有很强的必要性及良好的安全性。     

成都地区社区居民高血压前期与糖脂代谢关系的研究

目的探讨成都地区社区居民高血压前期和糖脂代谢紊乱之间的关系。方法利用成都地区慢性病防治项目的现况调查资料,分析年龄40岁及40岁以上中老年人群的数据,比较高血压前期与正常血压人群的糖脂代谢情况,并进一步分析高血压前期与相关危险因素的关系。结果高血压前期组空腹血糖受损、单纯性糖耐量异常、空腹血糖受损合并糖耐量异常以及糖尿病的患病率均明显高于正常血压组(P<0.05);高血压前期组高胆固醇血症、高甘油三酯血症、高LDL-C和低HDL-C的患病率明显高于正常血压组(P<0.05);Logistic回归分析显示,男性、老龄、肥胖、餐后血糖、胆固醇和甘油三酯升高都是高血压前期的危险因素(P<0.05),女性和HDL-C升高是高血压前期的保护因素,其中年龄和性别是不可控制的因素。结论高血压前期与糖脂代谢关系密切,是糖尿病和高脂血症发生发展的重要危险因素。成都地区社区中老年人群高血压前期的患病率高且更易发生糖尿病和血脂紊乱。尽早对社区人群进行高血压前期和糖脂代谢干预,对降低心血管疾病事件的发生和疾病负担具有重要意义。     

成都地区中老年高血压人群糖代谢异常流行状况及其影响因素

目的 探讨成都地区中老年高血压人群糖代谢异常流行状况及影响因素.方法 于2008年采用分层整群抽样的方法,调查成都城乡地区40～79岁中老年人口4685例,进行血压、口服葡萄糖耐量试验(OGTT)等检测,已确诊糖尿病患者只测空腹血糖,开展问卷调查.比较高血压及非高血压人群糖代谢异常患病率,获取中老年高血压人群单纯性糖耐量异常及单纯性负荷后高血糖情况,分析中老年高血压人群糖代谢异常的影响因素.结果 成都地区中老年高血压人群糖代谢异常患病率(53.4%)显著高于非高血压人群(25.1%);若不行OGTT,仅依靠检测空腹血糖,将漏诊中老年高血压人群中72.9%的糖尿病前期患者和54.4%的新诊断糖尿病患者;年龄、一级亲属糖尿病史、超重或肥胖为成都地区中老年男性高血压人群发生糖代谢异常的独立危险因素,体育锻炼、文化程度高为保护因素;年龄、一级亲属糖尿病史、腹型肥胖、高TG血症为成都地区中老年女性高血压人群发生糖代谢异常的独立危险因素.结论 成都地区中老年高血压人群超过半数合并糖代谢异常,需要通过OGTT及时发现这些合并糖代谢异常的患者.适当运动,了解糖尿病相关的保健知识以采取合理的生活方式,干预超重或肥胖、腹型肥胖及高TG血症等代谢性因素,对于减少中老年高血压人群糖代谢异常的发生有着较为重要的作用.     

福建省三明社区糖尿病及糖调节受损患病率现况调查

目的 了解东南沿海省份城市三明社区成人糖尿病(DM)以及糖调节受损(IGR)的患病率.方法 采用分层随机整群抽样方法,在2007-10～2007-11期间,横断面调查三明市社区16岁以上居民551名.所有调查对象均接受问卷调查、体格测量以及口服葡萄糖耐量试验(OGTT).结果 三明市社区16岁以上居民糖尿病、糖调节受损患病率分别为10.5%和13.6%[单纯空腹血糖受损(I-IFG)1.5%,糖耐量减低(IGT)12.1%,以2000年中国总人口标化后患病率7.4%、11.3%(I-IFG:0.8%,IGT:10.5%).55.17%为新诊断糖尿病患者,lGR/DM患病率达1.53.高血压、肥胖和超重人群患病率标化后分别为27.8%、8.7%和29.5%.结论 三明市社区的糖尿病患病情况不容乐观,仍然有一大部分未及时诊断的糖尿病人群,随着地区的城市化加剧和人口的老龄化程度加剧,DM患病率将有更大幅度的升高.     

高血压患者糖代谢状况调查研究

目的调查和分析高血压人群中糖代谢的状况。方法在2015年1月—2016年1月该院治疗的500例高血压患者作为研究对象,调查其基本信息,患者均进行空腹血糖,餐后血糖,以及OGTT实验的测定,并将所有患者分为糖耐量正常组,糖耐量减低组,糖尿病组,空腹血糖异常组,测定各组患者的血中胆固醇,甘油三酯以及收缩压的水平。结果有325例(65.00%)患者出现糖代谢异常的情况,其中空腹血糖异常患者30例(6.00%),糖耐量减低患者90例(18.00%),已达糖尿病诊断标准的患者205例(41.00%)。空腹血糖受损组和糖尿病组患者的发病率均随着年龄的增加而增加,而糖耐量异常组患者的年龄多在60~70岁的年龄段。糖耐量减低组和糖尿病组的血清甘油三酯,胆固醇,年龄,体重指数明显高于血糖正常的患者,差异有统计学意义(P0.05)。而空腹血糖受损组患者仅年龄高于正常血糖患者,差异有统计学意义(P0.05)。结论高血压人群中糖代谢异常的发生率较高,在预防高血压和糖代谢异常的过程中应注重其危险因素的预防,可有效改善高血压患者的预后,预防相关并发症。     

黑龙江省部分地区不同年龄、性别组糖代谢异常患病率调查

目的 调查黑龙江部分地区20～74岁人群的糖代谢异常年龄和性别分布情况,为糖尿病的防治提供依据.方法 选取2007年9月至2008年3月期间黑龙江省糖尿病流行病学调查中20～74岁的人群共3058例(男1219例、女1839例)作为研究对象,其中空腹血糖受损(IFG)患者143例,糖耐量异常(IGT)患者333例,IFG+IGT患者113例,糖尿病患者265例,糖调节正常(NGR)个体2204名.测定受试者空腹血糖、口服葡萄糖耐量试验(OGTT)1 h血糖及OGTT 2 h血糖.依据WHO1999年糖尿病的诊疗标准进行诊断.采用M-H x2检验分析组间数据.结果 糖尿病女性患病的高峰在60～74岁组,患病率为15.57%(20～29岁组:4.35%;30～39岁组:4.68%;40～49岁组:6.87%;50～59岁组:12.20%);男性患病的高峰在50～59岁组,患病率为21.84%(20～29岁组:5.96%;30～39岁组:10.60%;40～49岁组:11.79%;60～74岁组:15.0%).糖调节受损(IGR)女性和男性患病的高峰均在60～74岁组,患病率分别为35.33%(20～29岁组:13.04%;30～39岁组:14.56%;40～49岁组:20.62%;60～74岁组:24.58%)和30.83%(20～29岁组:16.80%;30～39岁组:14.90%;40～49岁组:28.05%;50～59岁组:17.78%).结论 IGR、糖尿病和IFG+IGT组的男性、女性和男女合计患病率和IGT组的女性和男女合计患病率均随年龄增加有上升趋势,而IFG组的男性、女性和男女合计患病率以及IGT组男性患病率和年龄无关.性别和年龄是糖尿病患病的两个重要危险因素,要采取综合措施预防和控制老年人糖尿病,特别是老年男性.     

综合干预对老年糖调节异常患者的影响

目的分析综合干预对老年血糖调节异常(IGR)患者进展为糖尿病的情况。方法对177例老年IGR患者(干预组)的生活方式进行4年综合干预,同期选择55例不进行综合干预的IGR患者作为对照组,分析空腹血糖受损、糖耐量异常患者进展为糖尿病的情况。结果干预组患者空腹血糖受损、糖耐量异常、空腹血糖受损合并糖耐量异常进展为糖尿病的比率分别为17.14%、20.99%和42.31%,空腹血糖受损合并糖耐量异常进展为糖尿病的比率分别是空腹血糖受损、糖耐量异常的2.47、2.02倍。与对照组比较,干预组空腹血糖受损、糖耐量异常患者进展为糖尿病的比率分别减少了55.01%和52.77%(P0.05,P0.01)。结论综合干预能有效控制与消弱心血管疾病危险因素,阻止或延缓IGR患者进展为糖尿病。     

空腹血糖受损、糖耐量受损人群3年自然转归及其影响因素的研究

目的 探讨空腹血糖受损(IFG)、糖耐量受损(IGT)人群发生糖尿病的危险性及其影响因素. 方法对2003年4～6月朝阳市市区居民1 062人糖尿病普查中IFG、IGT患者79人于2006年4～6月进行随访调查.测量身高、体重、腰围、血压,做过夜空腹75g葡萄糖耐量试验,同时测定血总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C).结果 随访的65人中22人发生糖尿病.其中孤立性IFG(I-IFG)糖尿病转变率为10.8%,孤立性IGT(I-IGT)为9.2%, IFG/IGT为10.4%.在不同的年龄组,随着年龄增长糖代谢异常、高血压、肥胖、脂代谢异常有增加趋势,在40岁以上人群糖代谢异常的患病率有明显增加趋势.进行单因素相关分析结果发现血糖升高可能与增龄、糖尿病(DM)家族史、劳动强度、腰围指数(WC)增加、收缩压(SBP)增加、血脂异常等相关.进行Logistic回归分析,高龄、血压升高、中心性肥胖、体力活动强度减弱均为糖尿病危险因素.结论 I-IGT、IGT/IFG人群糖尿病累计发病率明显高于I-IFG人群.增龄、向心性肥胖、高血压、体力活动减少是糖代谢异常的重要危险因素,因此控制血压、体重,增加体力活动,对糖尿病预防具有重要意义.     

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.     

Study on lifestyle-intervention and impaired glucose tolerance Maastricht (SLIM): design and screening results

The study on lifestyle-intervention and impaired glucose tolerance Maastricht (SLIM) is a 3 years randomised clinical trial designed to evaluate the effect of a combined diet and physical activity intervention program on glucose tolerance in a Dutch population at increased risk for developing type 2 diabetes. Here the design of the lifestyle-intervention study is described and results are presented from the preliminary population screening, conducted between March 1999 and June 2000. In total, 2,820 subjects with an increased risk of having disturbances in glucose homeostasis (i.e. age >40 years and BMI>25 kg/m(2) or a family history of diabetes) underwent a first oral glucose tolerance test (OGTT). Abnormal glucose homeostasis was detected in 826 subjects (30.4%): 226 type 2 diabetes (type 2DM, 8.3%), 215 impaired fasting glucose (IFG, 7.9%) and 385 impaired glucose tolerance (IGT, 14.2%). Both increasing age and BMI were strongly related to the prevalence of IGT and diabetes. After a second OGTT, 114 subjects with glucose intolerance and in otherwise good health were eligible for participation in the intervention study (SLIM). The high prevalence of disturbances in glucose homeostasis observed in the preliminary screening underscore the importance of early (lifestyle) interventions in those at risk for developing diabetes. SLIM will address this topic in the Dutch population.     

Diabesity in Australia: an affair of the heart

The objective of the Australian Diabetes and Lifestyle Study (AusDiab) was to determine the frequency of diabetes and other categories of glucose intolerance (impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)), as well as other cardiovascular risk factors in Australia and to compare the prevalence with previous Australia data. The study involved a national sample involving 11 247 participants aged 25 years from the six states and the Northern Territory. They were examined in a cross-sectional survey using the 75-g oral glucose tolerance test to assess fasting and 2-h plasma glucose levels. The World Health Organization diagnostic criteria were used to determine the prevalence of abnormal glucose tolerance. The prevalence of diabetes in Australia was 8.0% in men and 6.8% in women, and an additional 17.4% of men and 15.4% of women had IGT or IFG. The overall diabetes prevalence in Australia was 7.4%, and an additional 16.4% had IGT or IFG. Diabetes prevalence has more than doubled since 1981, and this is only partially explained by changes in age profile and obesity. Almost one in four Australians 25 years and over has either diabetes or a condition of impaired glucose metabolism. This condition is associated with substantially increased immediate risk of heart disease as well as increased risk of diabetes in the future. In addition, there were high prevalences of other key cardiovascular disease risk factors. Australia has a rapidly rising prevalence of diabetes and other categories of abnormal glucose tolerance. The prevalence of abnormal glucose tolerance in Australia is one of the highest yet reported from a developed nation with a predominantly European background.     

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.     

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.     

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.