Utility of equivocal glucose tolerances

Age-related glucose metabolism alterations in nondiabetic and potentially diabetic women

The incidence of pathological glucose tolerance was investigated in women of three age groups: 20--39, 40--59 and over 60 yr, by means of oral glucose tolerance tests and the Danowski Index. The incidence was found to be significantly higher in older women: thus an age-related deterioration of glucose metabolism was confirmed. The women in each are group were further divided into "healthy" nondiabetic and "potentially diabetic" women. The parameter of "potential diabetes" was found to be associated to a greater extent with age-related glucose tolerance deterioration than advancing age alone. The existing theories for the etiology of carbohydrate metabolism alteration in older women are reviewed. it is suggested that in view of the age-related deterioration of glucose metabolism, a new normal range of glucose tolerance should be established in an ageing population.

Glycosylated haemoglobin in renal failure

The level of the glycosylated haemoglobin hbA1c was measured in (1) subjects with normal renal function, (2) patients with renal failure and (3) patients on intermittent haemodialysis. In 60 subjects with normal renal function but with a varying degree of glucose tolerance, there was a significant correlation between HbA1c and fasting blood-glucose. In 20 patients with renal failure the mean value of HbA1c was 6.6 +/- 1.3% (mean +/- SD) whereas in 17 subjects with normal renal function, but with the same degree of glucose tolerance, this value was 4.7 +/- 0.9%. In 30 patients on intermittent dialysis the mean level of HbA1c was 6.3 +/- 1.5%. This level did not fall after 3 months of dialysis with a glucose-free fluid. In both groups of patients with renal failure there was no correlation between HbA1c and fasting blood-glucose. -- It is concluded that renal failure itself causes an increase in HbA1c.

The diagnosis of diabetes: how to determine which patients to treat

The diagnosis of diabetes depends on identifying a compatible clinical picture with confirmation by demonstrable abnormalities in blood glucose levels. In florid diabetes, classical symptoms of diabetes and high glucose in blood and urine make the diagnosis easy. For asymptomatic diabetes; if confirmed fasting blood glucose measures over 125 mg per 100 ml, the diagnosis is accepted. When the fasting blood glucose measures under 125 mg per 100 ml, I recommend an oral glucose tolerance test and apply suitable criteria for interpretation. The United States Public Health Service criteria represent a reasonable, moderate approach when one modifies the interpretation by cognizance of environmental factors in the patient and by identifying interfering influences as drugs, physical inactivity, fever or starvation. Indeed, one should postpone a glucose tolerance test until these interfering factors abate. Management of the patient with an abnormal glucose tolerance test includes sharing the prognostic dilemma with the patient regarding the likelihood of deterioration in glucose tolerance to florid diabetes. In this situation the term, abnormal glucose tolerance test, is preferred over chemical diabetes. The physician and the patient must develop some degree of comfort with a clinical state that often remains nebulous. Though the writings of authorities occasionally sound dogmatic, rigid, and conflicting, they reflect a viewpoint which opines that no clear answers are available; that the clinician and his patient must accept this posture; and that together they must develop the best therapeutic program for the individual in question.

Endocrine abnormalities and myopathy in Bloom's syndrome

Abnormal endocrine indices and myopathy have been variably present in two brothers with Bloom's syndrome (congenital teleangiectatic erythema, hypersensitivity to light, and growth retardation). These consisted of: (1) growth retardation with height and weight below the third centiles; in the younger one at age 14, hypoglycaemia failed to elicit a rise in growth hormone but did so in the older one at age 17; (2) serum TSH was raised in the older one in whom serum FSH and LH were also above the normal range; and (3) myopathy characterised by pronounced dilatation of the sarcoplasmic reticulum was present in the younger one; distinct reduction of muscle strength was shown in his older brother with ultrastructural alteration of skeletal muscle of unknown significance.

Follow-up of "non-diabetic" relatives of diabetics by retesting oral glucose tolerance after 5 years

Of 743 first degree relatives of diabetics in whom oral glucose tolerance tests had been performed in 1967 488 were re-tested in 1972. Among the original "normals" (n = 353) 17.6% had developed a "subclinical" and 1.3% an "overt diabetes" within 5 years. The original "subclinical diabetes" (n = 118) showed a remission to "normal" in 35.6% and a progression to "overt diabetes" in 13.6%. 3 out of the 17 formerly "overt diabetes" were found to be "normal" after 5 years and 3 were "subclinical diabetics". Thus the performance of an oral glucose tolerance test is of limited prognostic value in the individual case. In both studies a higher prevalence of abnormal test results occurred in the older age groups and in overweight subjects. Remission or deterioration did not depend, however, on age or on weight changes. The frequency of abnormal tests was higher in males than in females, but the tendency towards the development of diabetes was more pronounced in females, in accordance with a previous observation of a higher age dependance of glucose tolerance in females.

Five-hour oral glucose tolerance test in obese children

Concentrations of blood glucose, plasma free fatty acids, and plasma glycerol during a 5-hour oral glucose tolerance test on 46 obese children are reported. Seven children had unequivocally impaired glucose tolerance. However in the group as a whole, there was a delay in return of blood glucose to baseline levels after oral glucose, 27 children (60%) having a blood glucose concentration greater than 110 mg/100 ml at 2 hours. It was concluded that some degree of glucose intolerance is common in childhood obesity. No relation was seen among the following: impairment of glucose tolerance and age, degree or duration of obesity, or family history of diabetes. Fasting plasma free fatty acids and glycerol concentrations were high (mean ± 1SD, 1030 ± 221 μEq/litre FFA and 121 ± 44 μmol/l. glycerol). For all children, concentrations of FFA and glycerol decreased during the first hour after glucose, though minimal levels were not reached until 90-120 minutes (mean ± 1SD, 395 ± 170 μEq/litre FFA, 77 ± 24 μmol/l. glycerol). For those children (27) who had raised blood glucose at 2 hours, there was a positive correlation between fasting plasma glycerol concentration and glucose tolerance sum, suggesting that impaired glucose tolerance was associated with increased basal lipolysis.