Elevated One-Hour Post-Load Glucose Is Independently Associated with Albuminuria: A Cross-Sectional Population Study

Reduced glomerular filtration rate in individuals with intermediate hyperglycemia and type 2 diabetes as defined by 1-hour post-load glucose levels according to the newly released IDF criteria

AIMS

Recently, the International Diabetes Federation (IDF) has recommended determination of 1 h-post-load glucose (PG) to diagnose intermediate hyperglycemia (IH) and type 2 diabetes (T2DM). Herein, we investigate the implication of IDF recommendation in identifying subjects with chronic kidney disease (CKD).

METHODS

Estimated glomerular filtration rate (eGFR) was assessed on 2161 subjects classified on the basis of their fasting, 1 h and 2 h-PG, according to the IDF criteria, as having normal glucose tolerance (NGT), isolated impaired fasting glucose (iIFG), IH and T2DM.

RESULTS

Prevalence of CKD (eGFR < 60 ml/min/1.73 m2) and mildly reduced kidney function (eGFR 90-60 ml/min/1.73 m2) progressively increased at worsening of glucose tolerance. In a logistic regression analysis adjusted for several cardio-metabolic confounders, individuals with iIFG and IH exhibited a 3.48- (95 %CI = 1.01-11.00, P = 0.05) and 3.69- (95 %CI = 1.42-9.60, P = 0.007) fold increased risk of having CKD compared to the NGT group. The risk for CKD was further increased in subjects with T2DM (OR = 3.93, 95 %CI = 1.36-10.66, P = 0.007). Additionally, participants with IH and T2DM had a 1.89-fold (95 %CI = 1.38-2.60, P < 0.0001) and 2.78-fold (95 %CI = 1.97-3.98, P < 0.0001) higher risk of mildly reduced GFR compared to the NGT group.

CONCLUSIONS

The 1 h-PG thresholds proposed by IDF as diagnostic for IH and T2DM are capable of identifying individuals at risk of kidney dysfunction.

Impact of signs and symptoms of dry eye disease on health-related quality of life: a cross-sectional population study among older adults

PURPOSE

To assess the relationship between quality of life (QoL) and ocular surface health within a Finnish population-based cohort.

METHODS

A cross-sectional study involved 601 individuals born between the years 1933-1956. Ocular surface health and dry eye disease (DED) were clinically evaluated using several diagnostic tests. Participants completed the Ocular Surface Disease Index (OSDI), QoL assessment with the 15D and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and the Beck's Depression Inventory (BDI-II) questionnaires. Various statistical methods were employed to explore the associations between QoL, ocular surface health, and sex disparities.

RESULTS

DED had negative impact on QoL in all participants, and especially in women. Adjusted for comorbidities, DED doubled the odds of worse health-related QoL (15D: OR = 2.31 [95% CI: 1.24-4.31, p < 0.01]) and mental health (SF-36 MCS and BDI-II: OR = 2.08 [95% CI: 1.04-4.16, p < 0.05]). Noninvasive tear break-up time (NIBUT) correlated with all QoL scores. In women, the most significant clinical signs correlating with low QoL were NIBUT (15D: r = 0.20, p = 0.002; SF-36 MCS: r = 0.18, p = 0.026), and conjunctival staining (15D: r=-0.19, p = 0.004; BDI-II: r = 0.27, p < 0.001), whereas in men, blepharitis correlated with depression score (BDI-II: r = 0.20, p = 0.036). High OSDI was associated with worse QoL in women, but not in men.

CONCLUSION

This first population-based study assessing general QoL data with objective clinical measures of DED indicated that among elderly population, both symptoms and signs of DED independently impacted different aspects of QoL. In addition, significant sex-differences in these associations were observed and should be considered both in research settings and when assessing and treating people with DED.

International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes

Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA1c) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death. Given the relentlessly rising prevalence of diabetes, a more sensitive, practical method is needed to detect people with IH and T2D for early prevention or treatment in the often lengthy trajectory to T2D and its complications. The International Diabetes Federation (IDF) Position Statement reviews findings that the 1-h post-load PG ≥ 155 mg/dL (8.6 mmol/L) in people with normal glucose tolerance (NGT) during an OGTT is highly predictive for detecting progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, and mortality in individuals with risk factors. The 1-h PG of 209 mg/dL (11.6 mmol/L) is also diagnostic of T2D. Importantly, the 1-h PG cut points for diagnosing IH and T2D can be detected earlier than the recommended 2-h PG thresholds. Taken together, the 1-h PG provides an opportunity to avoid misclassification of glycaemic status if FPG or HbA1c alone are used. The 1-h PG also allows early detection of high-risk people for intervention to prevent progression to T2D which will benefit the sizeable and growing population of individuals at increased risk of T2D. Using a 1-h OGTT, subsequent to screening with a non-laboratory diabetes risk tool, and intervening early will favourably impact the global diabetes epidemic. Health services should consider developing a policy for screening for IH based on local human and technical resources. People with a 1-h PG ≥ 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention program. People with a 1-h PG ≥ 209 mg/dL (11.6 mmol/L) are considered to have T2D and should have a repeat test to confirm the diagnosis of T2D and then referred for further evaluation and treatment. The substantive data presented in the Position Statement provides strong evidence for redefining current diagnostic criteria for IH and T2D by adding the 1-h PG.