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van Wilpe R, van Zuylen ML, Hermanides J, DeVries JH, Preckel B, Hulst AH. Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus-A Retrospective Cohort Study. J Pers Med 2024; 14:219. [PMID: 38392652 PMCID: PMC10890067 DOI: 10.3390/jpm14020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
More than 25% of older adults in Europe have diabetes mellitus. It is estimated that 45% of patients with diabetes are currently undiagnosed, which is a known risk factor for perioperative morbidity. We investigated whether routine HbA1c screening in older adult patients undergoing surgery would identify patients with undiagnosed diabetes. We included patients aged ≥65 years without a diagnosis of diabetes who visited the preoperative assessment clinic at the Amsterdam University Medical Center and underwent HbA1c screening within three months before surgery. Patients undergoing cardiac surgery were excluded. We assessed the prevalence of undiagnosed diabetes (defined as HbA1c ≥ 48 mmol·mol-1) and prediabetes (HbA1c 39-47 mmol·mol-1). Using a multivariate regression model, we analysed the ability of HbA1c to predict days alive and at home within 30 days after surgery. From January to December 2019, we screened 2015 patients ≥65 years at our clinic. Of these, 697 patients without a diagnosis of diabetes underwent HbA1c screening. The prevalence of undiagnosed diabetes and prediabetes was 3.7% (95%CI 2.5-5.4%) and 42.9% (95%CI 39.2-46.7%), respectively. Preoperative HbA1c was not associated with days alive and at home within 30 days after surgery. In conclusion, we identified a small number of patients with undiagnosed diabetes and a high prevalence of prediabetes based on preoperative HbA1c screening in a cohort of older adults undergoing non-cardiac surgery. The relevance of prediabetes in the perioperative setting is unclear. Screening for HbA1c in older adult patients undergoing non-cardiac surgery does not appear to help predict postoperative outcome.
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Affiliation(s)
- Robert van Wilpe
- Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The Netherlands
| | - Mark L van Zuylen
- Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The Netherlands
- Department of Paediatric Intensive Care, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The Netherlands
| | - Abraham H Hulst
- Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The Netherlands
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Ajayi IO, Balogun WO, Olopade OB, Ajani GO, Soyoye DO, Bolarinwa OA, Olamoyegun MA, Alatishe-Muhammad BW, Odeniyi IA, Odukoya O, Fasanmade OA, Diyaolu FP, Otrofanowei E, Akase I, Agabi PO, Adejimi A, Ajetunmobi OA, Durowade KA, Gabriel-Alayode EO, Ibrahim AO, Ezekpo OO, Elegbede TO, Lamidi AO, Owolabi FA, Yusuf AO, Adetunji TA, Ogunmodede AJ, Ameen AH, Biliaminu AS, Nasiru S. Prevalence of haemoglobin A1c based dysglycaemia among adult community dwellers in selected states in Nigeria: a descriptive cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1192491. [PMID: 37547317 PMCID: PMC10399573 DOI: 10.3389/fendo.2023.1192491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Pre-diabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c. Methodology A cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an interviewer-administered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16. Results The mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45-54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes. Conclusion Over half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia.
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Affiliation(s)
| | - William O. Balogun
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital Ibadan, Ibadan, Nigeria
| | | | - Gbadebo O. Ajani
- College of Medicine and Health Sciences, Afe Babalola University, Ekiti, Nigeria
| | - David O. Soyoye
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Michael A. Olamoyegun
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | | | | | | | | | | | | | - Iorhen Akase
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Paul O. Agabi
- College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Kabir A. Durowade
- College of Medicine and Health Sciences, Afe Babalola University, Ekiti, Nigeria
| | | | - Azeez O. Ibrahim
- Department of Medicine, Federal Teaching Hospital Ido-Ekiti, Ido-Ekiti, Nigeria
| | - Okechukwu O. Ezekpo
- College of Medicine and Health Sciences, Afe Babalola University, Ekiti, Nigeria
| | - Toyin O. Elegbede
- College of Medicine and Health Sciences, Afe Babalola University, Ekiti, Nigeria
| | - Ayodeji O. Lamidi
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Adebimpe O. Yusuf
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Abolore H. Ameen
- College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | | | - Sanni Nasiru
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Deepa M, Elangovan N, Venkatesan U, Das HK, Jampa L, Adhikari P, Joshi PP, Budnah RO, Suokhrie V, John M, Tobgay KJ, Subashini R, Pradeepa R, Anjana RM, Mohan V, Kaur T, Dhaliwal RS. Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15). Indian J Med Res 2023; 157:239-249. [PMID: 37282387 PMCID: PMC10438401 DOI: 10.4103/ijmr.ijmr_2615_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 06/08/2023] Open
Abstract
Background & objectives Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods Data were acquired from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under high-, moderate- and low-risk categories of IDRS. The ROC-AUC for the identification of diabetes was 0.697 (95% confidence interval: 0.684-0.709) for urban population and 0.694 (0.684-0.704) for rural, as well as 0.693 (0.682-0.705) for males and 0.707 (0.697-0.718) for females. MDRF-IDRS performed well when the population were sub-categorized by state or by regions. Interpretation & conclusions Performance of MDRF-IDRS is evaluated across the nation and is found to be suitable for easy and effective screening of diabetes in Asian Indians.
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Affiliation(s)
- Mohan Deepa
- Department of Epidemiology, Diabetes Complications, Chennai, Tamil Nadu, India
| | - Nirmal Elangovan
- Department of Research Operations & Diabetes Complications, Chennai, Tamil Nadu, India
| | | | - Hiranya Kumar Das
- Regional Medical Research Centre, ICMR NE Region, Dibrugarh, Assam, India
| | - Lobsang Jampa
- Directorate of Health Services, Naharlagun, Arunachal Pradesh, India
| | - Prabha Adhikari
- Department of Epidemiology, Yenepoya Medical College, Yenepoya University Campus, Deralakatte, Karnataka, India
| | - Prashant P. Joshi
- Department of General Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | | | - Vizolie Suokhrie
- Directorate of Health & Family Welfare, Government of Nagaland, Kohima, Nagaland, India
| | - Mary John
- Deparment of Internal Medicine, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Karma Jigme Tobgay
- Department of Health Care, Human Services & Family Welfare, Government of Sikkim, Gangtok, Sikkim, India
| | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Division of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Fukushima T, Chubachi S, Namkoong H, Asakura T, Tanaka H, Lee H, Azekawa S, Okada Y, Koike R, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Clinical significance of prediabetes, undiagnosed diabetes and diagnosed diabetes on critical outcomes in COVID-19: Integrative analysis from the Japan COVID-19 task force. Diabetes Obes Metab 2023; 25:144-155. [PMID: 36056760 PMCID: PMC9538969 DOI: 10.1111/dom.14857] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 01/08/2023]
Abstract
AIM Diabetes mellitus (DM) is a known risk factor for severe coronavirus disease 2019 (COVID-19), but the clinical impact of undiagnosed diabetes and prediabetes in COVID-19 are unclear particularly in Japan. We clarify the difference in clinical characteristics, including age, sex, body mass index and co-morbidities, laboratory findings and critical outcomes, in a large Japanese COVID-19 cohort without diabetes, with prediabetes, undiagnosed diabetes and diagnosed diabetes, and to identify associated risk factors. MATERIALS AND METHODS This multicentre, retrospective cohort study used the Japan COVID-19 Task Force database, which included data on 2430 hospitalized COVID-19 patients from over 70 hospitals from February 2020 to October 2021. The prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes were estimated based on HbA1c levels or a clinical diabetes history. Critical outcomes were defined as the use of high-flow oxygen, invasive positive-pressure ventilation or extracorporeal membrane oxygenation, or death during hospitalization. RESULTS Prediabetes, undiagnosed diabetes and diagnosed diabetes were observed in 40.9%, 10.0% and 23.0%, respectively. Similar to diagnosed diabetes, prediabetes and undiagnosed diabetes were risk factors for critical COVID-19 outcomes (adjusted odds ratio [aOR] [95% CI]: 2.13 [1.31-3.48] and 4.00 [2.19-7.28], respectively). HbA1c was associated with COVID-19 severity in prediabetes patients (aOR [95% CI]: 11.2 [3.49-36.3]), but not other groups. CONCLUSIONS We documented the clinical characteristics and outcomes of Japanese COVID-19 patients according to HbA1c levels or diabetes co-morbidity. As well as undiagnosed and diagnosed diabetes, physicians should be aware of prediabetes related to COVID-19 severity.
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Affiliation(s)
- Takahiro Fukushima
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
- Department of Infectious DiseasesKeio University School of MedicineTokyoJapan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine)Kitasato University School of PharmacyTokyoJapan
- Department of Respiratory MedicineKitasato University Kitasato Institute HospitalTokyoJapan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
| | - Yukinori Okada
- Department of Statistical GeneticsOsaka University Graduate School of MedicineSuitaJapan
- Department of Genome InformaticsGraduate School of Medicine, The University of TokyoTokyoJapan
- Laboratory for Systems GeneticsRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Ryuji Koike
- Medical Innovation Promotion CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Akinori Kimura
- Institute of ResearchTokyo Medical and Dental UniversityTokyoJapan
| | - Seiya Imoto
- Division of Health Medical IntelligenceHuman Genome Center, The Institute of Medical Science, The University of TokyoTokyoJapan
| | - Satoru Miyano
- M&D Data Science CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Seishi Ogawa
- Department of Pathology and Tumor BiologyInstitute for the Advanced Study of Human Biology (WPI‐ASHBi), Kyoto UniversityKyotoJapan
- Department of Medicine, Center for Hematology and Regenerative MedicineKarolinska InstituteStockholmSweden
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of MedicineKeio University School of MedicineTokyoJapan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of MedicineKeio University School of MedicineTokyoJapan
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Abstract
We investigated disparities in diabetes between the US-born and foreign-born populations using three diabetes measures: diagnosed diabetes, undiagnosed diabetes, and total diabetes, either diagnosed or undiagnosed diabetes. We analyzed adults aged 30-84 years drawn from the National Health and Nutrition Examination Survey 2009-2018 (n = 21,390). Of cohorts in 2009-2018, foreign-born adults had significantly higher age-standardized prevalence of diagnosed (12.6% vs. 10.6%) and undiagnosed diabetes (4.5% vs. 2.6%), and total diabetes (17.1% vs. 13.2%) than US-born adults. Results from logistic and multinomial regressions adjusting for age, sex, race/ethnicity, limited access to healthcare and BMI showed that the foreign-born had significantly higher odds of total diabetes (OR: 1.25, 95% CI: 1.04-1.50) and undiagnosed diabetes (OR: 1.83, 95% CI: 1.44-2.32) compared to the US-born. There was no significant difference in diagnosed diabetes by nativity (OR: 1.12, 95% CI: 0.96-1.53). Our results show that foreign-born adults were at higher risk of diabetes than US-born adults, and the difference by nativity was largely attributable to BMI and racial/ethnic composition. In addition, we demonstrated the importance of choosing measures of diabetes in studying diabetes mainly due to the foreign-born group's high prevalence of undiagnosed diabetes, which biases the prevalence of diabetes downward when diagnosed diabetes is used.
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Affiliation(s)
- Daesung Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Najafipour H, Farjami M, Sanjari M, Amirzadeh R, Shadkam Farokhi M, Mirzazadeh A. Prevalence and Incidence Rate of Diabetes, Pre-diabetes, Uncontrolled Diabetes, and Their Predictors in the Adult Population in Southeastern Iran: Findings From KERCADR Study. Front Public Health 2021; 9:611652. [PMID: 34790639 PMCID: PMC8591105 DOI: 10.3389/fpubh.2021.611652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Diabetes mellitus is among the most serious health challenges worldwide. We assessed the prevalence of pre-diabetes (pre-DM) and diabetes (DM), the effectiveness of diabetes management, the 5-year incidence rate, and associated variables in the adult population in southeastern Iran. Methods: In a random cluster household survey (2014-2018), 9,959 adult individuals aged 15-80 years were assessed for coronary artery disease risk factors, including diabetes mellitus in Kerman (KERCADRS, phase 2). Among these people, 2,820 persons had also participated in phase 1 of the study 5 years earlier (2009-2011). Univariable and multivariable survey logistic regression models were used to identify the potential predictors of diabetes and pre-diabetes. Results: The prevalence of pre-DM was 12% (males 13.2% vs. females 11.1%), steadily increasing from 7.1% in the 15-24 years group to 18.4% in the 55-64 years group. The prevalence of DM was 10.2% (male and female, 7.9 and 10.8%, respectively), of which 1.9% were undiagnosed. DM was diagnosed in 10.6% of educated and 15.1% of illiterate people. The prevalence of diagnosed DM was lower in smokers (5.2 vs. 8.7%) and dependent opium users (5.4 vs. 8.8%). The prevalence of uncontrolled DM (HbA1c > 7%) was 48.8%, increasing with age. The frequency of uncontrolled DM among people without and with treatment was 32 and 55.9%, respectively. Illiterate people had worse uncontrolled DM (55.6 vs. 39.6%). The 5-year incidence rate (persons/100 person-years) was 1.5 for pre-DM and 1.2 for DM, respectively. The lowest and the highest incidence rate of DM belonged to the 15-34 years old group (0.5) and dependent opium users (2.4). The incidence rate was found to have a direct relationship with BMI and a reverse relationship with physical activity. Conclusion: Pre-DM and DM affected 22.2% of the population. One-third of patients with diabetes had undiagnosed DM, and in 55.9% of people with diagnosed DM, treatment had been ineffective. Appropriate health interventions are needed to reduce the prevalence and health consequences of diabetes in the region.
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Affiliation(s)
- Hamid Najafipour
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, and Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Farjami
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojgan Sanjari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, and Department of Endocrinology, Kerman University of Medical Sciences, Kerman, Iran
| | - Raheleh Amirzadeh
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Shadkam Farokhi
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, and Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Cho E, Min D, Lee HS. Development and Validation of an Undiagnosed Diabetes Screening Tool: Based on the Korean National Health and Nutrition Examination Survey (2010-2016). Healthcare (Basel) 2021; 9:1138. [PMID: 34574911 DOI: 10.3390/healthcare9091138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Approximately half of the population worldwide suffers from under/undiagnosed diabetes. In South Korea, 27.7% of people aged over 30 years have type 2 diabetes and are unaware of their condition because they have not been diagnosed. Optimal tools for identifying risk factors of undiagnosed diabetes, which is associated with multiple complications, are currently lacking. Secondary data analysis was conducted using the 2010-2016 Korean National Health and Nutrition Examination Survey. This study aimed to identify the risk factors in individuals not diagnosed with type 2 diabetes, using glycated hemoglobin as the diagnostic standard. Furthermore, we aimed to develop an accurate screening tool for diabetes using HbA1c values by analyzing the data of 12,843 adults (aged ≥20 years) not diagnosed with type 2 diabetes. Age, gender, family history of diabetes, hypertension diagnosis, waist-to-height ratio, smoking, and health check-ups were identified as significant risk factors for undiagnosed type 2 diabetes. A screening tool with total and cutoff scores of 13 and 7 points was developed, and it had a sensitivity of 82.7% and specificity of 58.2%. The developed screening tool appears to be a simple and cost-effective method for detecting undiagnosed type 2 diabetes.
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Puzianowska-Kuźnicka M, Januszkiewicz-Caulier J, Kurylowicz A, Mossakowska M, Zdrojewski T, Szybalska A, Skalska A, Chudek J, Franek E. Prevalence and socioeconomic predictors of diagnosed and undiagnosed diabetes in oldest-old and younger Caucasian seniors: results from the PolSenior study. Endokrynol Pol 2021; 72:249-255. [PMID: 33749811 DOI: 10.5603/ep.a2021.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Type 2 diabetes is one of the most common diseases in the aging population; however, data concerning correlates of diabetes in age-advanced individuals are limited. The study aimed to identify the socioeconomic correlates of diabetes in representative groups of oldest-old (≥ 85 years) and younger (65 to 84 years) Polish Caucasian seniors. MATERIAL AND METHODS PolSenior is a multicentre, population-based study conducted in Poland. Fasting plasma glucose levels and data from detailed medical questionnaires were obtained from 2128 male and 1961 female study participants aged ≥ 65 years. Multivariate logistic regression was used to identify significant socioeconomic risk factors for diabetes and undiagnosed diabetes. RESULTS The overall prevalence of diabetes in the study group was 21.9% (24.0% in women vs. 19.9% in men, p = 0.002), with an estimated weighted prevalence for all older Poles of 23.1%. Nearly one-fifth of cases were previously undiagnosed. Diabetes was more common in the younger elderly (65-84 years) than in the oldest-old (≥ 85 years) (23.4% vs. 18.6%, p < 0.001). The frequency of diabetes was higher in women than in men (24.0% vs. 19.9%, p < 0.002); however, men remained undiagnosed more commonly than women (4.7% vs. 3.3%, p = 0.029). The frequency of diabetes was higher among urban than rural dwellers (23% vs. 20.4%, p = 0.048). It was also related to marital status in women (p = 0.036) and occupation in men (p = 0.015). Multivariate logistic regression analysis revealed that the independent risk factors for diabetes were body mass index (BMI) and marital status in women, while in men it was solely BMI. Undiagnosed diabetes was more frequent among rural than city dwellers (4.8% vs. 3.5%, p = 0.03). In multivariate logistic regression analysis, only BMI and place of residence remained significant risk factors for being undiagnosed. CONCLUSIONS The prevalence of diabetes in the ≥ 65-year-old population exceeds 20% but is lower in the oldest-old than in the younger elderly and is modified by socioeconomic factors. Many elderly individuals remain undiagnosed and do not benefit from the currently available therapy.
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Affiliation(s)
- Monika Puzianowska-Kuźnicka
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland. .,Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, Warsaw, Poland.
| | - Joanna Januszkiewicz-Caulier
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the MSWiA in Warsaw, Warsaw, Poland
| | - Alina Kurylowicz
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Malgorzata Mossakowska
- PolSenior Project, International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - Tomasz Zdrojewski
- Department of Hypertension and Diabetology, Medical University in Gdansk, Gdansk, Poland
| | - Aleksandra Szybalska
- PolSenior Project, International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Faculty of Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the MSWiA in Warsaw, Warsaw, Poland.,Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
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Montero E, Matesanz P, Nobili A, Luis Herrera-Pombo J, Sanz M, Guerrero A, Bujaldón A, Herrera D. Screening of undiagnosed hyperglycaemia in the dental setting: The DiabetRisk study. A field trial. J Clin Periodontol 2020; 48:378-388. [PMID: 33263197 DOI: 10.1111/jcpe.13408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/05/2020] [Accepted: 11/22/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the efficacy of different screening protocols for undiagnosed hyperglycaemia in a Research Network of Dental Clinics coordinated by the Spanish Society of Periodontology (SEPA). MATERIAL AND METHODS A total of 1143 patients were included in the study. Participants filled a questionnaire considering diabetes risk factors (FINDRISC) and received a periodontal screening examination. Patients with a slightly elevated score according to the Findrisc (≥7), received a point-of-care HbA1c and were eventually referred to their physician for confirmatory diagnosis. Receiver Operating Characteristic (ROC) curves were used to assess the performance of various predictive models with confirmed hyperglycaemia as outcome. RESULTS From this population, 97 (8.5%) were finally diagnosed of diabetes (n = 28; 2.5%) or prediabetes (n = 69; 6.0%). When only including the results from the FINDRISC questionnaire, the model reported an area under the curve (AUC) of 0.866 (95% confidence interval - CI [0.833; 0.900]). This model significantly improved when a basic periodontal examination (EPB Code; AUC = 0.876; 95% CI [0.845: 0.906]; p = .042) or a point-of-care HbA1c were added (AUC = 0.961; 95% CI [0.941; 0.980]; p < .001). CONCLUSIONS The tested protocol, combining the FINDRISC questionnaire and a point-of-care HbA1c, showed to be feasible when carried out in a dental clinic setting and was efficient to identify subjects with undiagnosed diabetes or prediabetes.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.,Working Group "Diabetes and Periodontal Diseases" of the Spanish Society of Diabetes (SED) and the Spanish Society of Periodontology (SEPA), Madrid, Spain
| | - Paula Matesanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.,Fundación SEPA de Periodoncia e Implantes Dentales and Spanish Society of Periodontology (SEPA), Madrid, Spain
| | - Antonio Nobili
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - José Luis Herrera-Pombo
- Working Group "Diabetes and Periodontal Diseases" of the Spanish Society of Diabetes (SED) and the Spanish Society of Periodontology (SEPA), Madrid, Spain.,Endocrinology and Nutrition Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.,Fundación SEPA de Periodoncia e Implantes Dentales and Spanish Society of Periodontology (SEPA), Madrid, Spain
| | - Adrián Guerrero
- Fundación SEPA de Periodoncia e Implantes Dentales and Spanish Society of Periodontology (SEPA), Madrid, Spain
| | - Antonio Bujaldón
- Fundación SEPA de Periodoncia e Implantes Dentales and Spanish Society of Periodontology (SEPA), Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.,Working Group "Diabetes and Periodontal Diseases" of the Spanish Society of Diabetes (SED) and the Spanish Society of Periodontology (SEPA), Madrid, Spain.,Fundación SEPA de Periodoncia e Implantes Dentales and Spanish Society of Periodontology (SEPA), Madrid, Spain
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10
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Ayele BH, Roba HS, Beyene AS, Mengesha MM. Prevalent, uncontrolled, and undiagnosed diabetes mellitus among urban adults in Dire Dawa, Eastern Ethiopia: A population-based cross-sectional study. SAGE Open Med 2020; 8:2050312120975235. [PMID: 33282310 PMCID: PMC7686592 DOI: 10.1177/2050312120975235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Globally, 8.8% of adults were estimated to have diabetes mellitus, with the low-and middle-income countries sharing the largest burden. However, the research evidence for targeted interventions is lacking in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of diabetes mellitus, disaggregated by the epidemiology of diabetes mellitus morbidity and associated factors among adults in Dire Dawa town, Eastern Ethiopia. Methods: Data from a total of 872 randomly sampled adults aged 25–64 years were obtained for analysis using the World Health Organization STEPwise approach to non-communicable disease risk factors surveillance instruments. We estimated the prevalence of diabetes mellitus disaggregated by the previous diabetes mellitus diagnosis status and by the current blood sugar level control status. The bivariable and multivariable binary logistic regression model was used to identify correlates of diabetes mellitus, along with STATA version 14.2 for data management and analysis. All statistical tests were declared significant at p-value < 0.05. Results: 14.9% (95% confidence interval: 12.1, 17.4) of adults aged 25–64 years had diabetes mellitus in the study sample with 58.5% (95% confidence interval: 49.7, 66.7) on diabetes mellitus medication. Among adults currently taking diabetes mellitus medications, 30.3% (95% confidence interval: 19.8, 45.6) had uncontrolled diabetes mellitus. The magnitude of previously undiagnosed diabetes mellitus was 6.2% (95% confidence interval: 4.8, 8.0) in the study sample and 41.5% (95% confidence interval: 33.3, 50.3) among the diabetics. The odds of diabetes mellitus were higher among adults over the age of 55 years (adjusted odds ratio = 2.1, 95% confidence interval: 1.2, 3.6), currently married adults (adjusted odds ratio = 2.3, 95% confidence interval: 1.2, 4.4), and overweight adults (adjusted odds ratio = 1.6, 95% confidence interval: 1.1, 2.1). Adults with primary education (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) and no formal education (adjusted odds ratio = 0.5, 95% confidence interval: 0.2, 0.9) had lower odds of diabetes mellitus. Conclusion: The prevalence of diabetes mellitus among adults was high in Dire Dawa, with a third of the diabetics having poor control of their blood sugar levels and, nearly four in ten were previously undiagnosed. Adults who were overweight, currently married, and those over 55 years need to be targeted for regular diabetes health checkups and community-based screening. Also, a mechanism should be instituted to track a patient’s adherence to medications and promote diabetes self-care management.
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Affiliation(s)
- Behailu Hawulte Ayele
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore Roba
- Department of Epidemiology and Biostatistics Unit, College of Health and Medical Sciences, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Addisu Shunu Beyene
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Melkamu Merid Mengesha
- Department of Epidemiology and Biostatistics Unit, College of Health and Medical Sciences, School of Public Health, Haramaya University, Harar, Ethiopia
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11
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Philips KH, Zhang S, Moss K, Ciarrocca K, Beck JD. Periodontal disease, undiagnosed diabetes, and body mass index: Implications for diabetes screening by dentists. J Am Dent Assoc 2021; 152:25-35. [PMID: 33256949 DOI: 10.1016/j.adaj.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Periodontal disease and diabetes are widespread comorbid conditions that are detrimental to oral and overall health. Dentists' performing chairside screenings for undiagnosed diabetes mellitus (UDM) can be beneficial to both patients and providers. The authors determined UDM rates in a population-based study and whether UDM and periodontal disease were independently associated. METHODS Data from 7,343 participants in the Atherosclerosis Risk in Communities study visit 4 were used to determine rates of UDM by periodontal status, edentulism, and body mass index. The authors used a χ2 test or analysis of variance, along with a 2-stage logistic regression model, to determine relationships with UDM. UDM was defined as no self-reported diabetes and blood glucose levels (fasting glucose ≥ 126 milligrams/deciliter or nonfasting glucose > 200 mg/dL). Periodontal disease was defined using the Periodontal Profile Classes system adapted to stages and the Centers for Disease Control and Prevention and American Academy of Periodontology index. RESULTS UDM rates overall were 5.6%. The highest rates occurred in patients who were obese and edentulous (12.6%) and obese and had severe periodontal disease (12.2%). Significant associations were found for UDM and severe periodontal disease (Periodontal Profile Classes system stage IV) (odds ratio, 1.78; 95% confidence interval, 1.10 to 2.88). Edentulism was significantly associated with UDM in the Periodontal Profile Classes system model (odds ratio, 1.87; 95% confidence interval, 1.27 to 2.75) and Centers for Disease Control and Prevention and American Academy of Periodontology index (odds ratio, 1.70; 95% confidence interval, 1.08 to 2.67). Hyperglycemia was found in participants of all body mass index categories. CONCLUSIONS UDM is significantly associated with obesity, edentulism, and periodontitis. These characteristics could help dentists identify patients at higher risk of developing DM. Patients without these characteristics still have UDM, so dentists performing chairside diabetes screening for all patients would yield additional benefit. PRACTICAL IMPLICATIONS Dental offices are a major point of contact within the US health care system. Diabetes screening in this setting can provide important health information with direct relevance to patient care.
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12
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Abdulai T, Runqi T, Mao Z, Oppong TB, Amponsem-Boateng C, Wang Y, Liu X, Zhang H, Wang C. Preference for High Dietary Salt Intake Is Associated With Undiagnosed Type 2 Diabetes: The Henan Rural Cohort. Front Nutr 2020; 7:537049. [PMID: 33117839 PMCID: PMC7557361 DOI: 10.3389/fnut.2020.537049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Diabetes continues to be a serious disease burden globally. Nutrition plays a vital role in human life and health, and both inadequate and over nutrition have been implicated in cause the of disease. Objective: We explored the role of preference for high dietary salt intake and diabetes in a rural population. We also looked at possible mediating factors in the relationship between diabetes and preference for high dietary salt intake. Methods/Participants: Data from the Henan rural cohort in China were analyzed. Using multinomial regression models, the association between diabetes diagnosis type and reported preference for dietary salt was assessed. Adjusted odds ratios (aORs) with confidence interval (CI) at a 95% level are reported. Mediation analyses using structural equation models in Stata were performed. Results: Of the 39,183 participants included in the analyses, 4.07% were previously diagnosed with diabetes, and 5.80% with undiagnosed diabetes. Eighteen percent had a preference for salty meals, the mean age was 55.45 years, and 60% were women. Preference for salty meals was associated with undiagnosed diabetes (aOR = 1.17, 95% CI 1.03, 1.32), but not with previously diagnosed diabetes. Stratified analysis revealed that the association with undiagnosed diabetes was only significant in men (aOR = 1.36, 95% CI 1.13, 1.70) but not in women (aOR = 1.06, 95% CI 0.81, 1.38). BMI and central obesity fully mediated the association. Dietary salt intake was self-reported and therefore presents a limitation. Conclusion: Our study demonstrated that preference for high dietary salt intake is associated with undiagnosed diabetes but not prevalent diabetes.
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Affiliation(s)
- Tanko Abdulai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Community Health and Family Medicine, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Tu Runqi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Timothy Bonney Oppong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cecilia Amponsem-Boateng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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13
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Hallit S, Saade S, Zeidan RK, Iskandar K, Kheir N, Youssef L, Costantine R, Hallit R, Salameh P. Factors associated with undiagnosed type II diabetes mellitus, undiagnosed impaired fasting glucose and these patients' quality of life in Lebanon. J Public Health (Oxf) 2020; 42:550-560. [PMID: 31162589 DOI: 10.1093/pubmed/fdz051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the association between undiagnosed impaired fasting glucose (UIFG) and diabetes (UD), their risk factors and the patients' knowledge about diabetes and their quality of life (QOL). METHODS A cross-sectional study was conducted between May and September 2017 in four laboratories enrolling 495 patients. We used the Diabetes Knowledge and SF-12 questionnaires to assess the patients' knowledge about diabetes and QOL. This study meets the Wilson and Jungner criteria for disease screening. RESULTS A higher knowledge score (ORa = 0.85) was significantly associated with the absence of diabetes compared to UPD, whereas an increased age (ORa = 1.2) and a positive family history of diabetes (ORa = 1.81) were significantly associated with higher odds of UPD. An increased knowledge score (ORa = 0.55) was significantly associated with an absence of diabetes compared to UD, whereas an increased BMI (ORa = 1.40) and an increased age (ORa = 1.07) were associated with increased odds of having UD.UD (Beta = -5.799) was significantly associated with decreased total physical component QOL score, whereas increased diabetes knowledge score (Beta = 0.415) was significantly associated with increased physical QOL. A higher diabetes knowledge score (Beta = 0.459) were associated with increased mental QOL. CONCLUSION Seeing the relatively high percentage of UD and UIFG, we propose that screening should be considered and subject to proper assessment in the light of the findings of this study.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Sylvia Saade
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- Faculty of Health Sciences, American University of Science and Technology, Beirut, Lebanon
| | - Rouba Karen Zeidan
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Katia Iskandar
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- INSERM, Equipe 5, EQUITY, Toulouse, France
| | - Nelly Kheir
- Faculty of Pedagogy, Université de la Sainte Famille, Batroun, Lebanon
| | - Lara Youssef
- Department of Nursing and Health Sciences, Notre-Dame University, Zouk, Lebanon
| | - Rachelle Costantine
- Department of Agronomic Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
- Faculty of Medicine and Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
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14
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Ghosh S, Manley SE, Nightingale PG, Williams JA, Susarla R, Alonso‐Perez I, Stratton IM, Gkoutos GV, Webber J, Luzio SD, Hanif W, Roberts GA. Prevalence of admission plasma glucose in 'diabetes' or 'at risk' ranges in hospital emergencies with no prior diagnosis of diabetes by gender, age and ethnicity. Endocrinol Diabetes Metab 2020; 3:e00140. [PMID: 32704561 PMCID: PMC7375073 DOI: 10.1002/edm2.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/04/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS To establish the prevalence of admission plasma glucose in 'diabetes' and 'at risk' ranges in emergency hospital admissions with no prior diagnosis of diabetes; characteristics of people with hyperglycaemia; and factors influencing glucose measurement. METHODS Electronic patient records for 113 097 hospital admissions over 1 year from 2014 to 2015 included 43 201 emergencies with glucose available for 31 927 (74%) admissions, comprising 22 045 people. Data are presented for 18 965 people with no prior diagnosis of diabetes and glucose available on first attendance. RESULTS Three quarters (14 214) were White Europeans aged 62 (43-78) years, median (IQ range); 12% (2241) South Asians 46 (32-64) years; 9% (1726) Unknown/Other ethnicities 43 (29-61) years; and 4% (784) Afro-Caribbeans 49 (33-63) years, P < .001. Overall, 5% (1003) had glucose in the 'diabetes' range (≥11.1 mmol/L) higher at 8% (175) for South Asians; 16% (3042) were 'at risk' (7.8-11.0 mmol/L), that is 17% (2379) White Europeans, 15% (338) South Asians, 14% (236) Unknown/Others and 11% (89) Afro-Caribbeans, P < .001. The prevalence for South Asians aged <30 years was 2.1% and 5.2%, respectively, 2.6% and 8.6% for Afro-Caribbeans <30 years, and 2.0% and 8.4% for White Europeans <40 years. Glucose increased with age and was more often in the 'diabetes' range for South Asians than White Europeans with South Asian men particularly affected. One third of all emergency admissions were for <24 hours with 58% of these having glucose measured compared to 82% with duration >24 hours. CONCLUSIONS Hyperglycaemia was evident in 21% of adults admitted as an emergency; various aspects related to follow-up and initial testing, age and ethnicity need to be considered by professional bodies addressing undiagnosed diabetes in hospital admissions.
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Affiliation(s)
- Sandip Ghosh
- Diabetes Translational Research GroupDiabetes CentreNuffield HouseQueen Elizabeth Hospital BirminghamBirminghamUK
- Institute of Translational MedicineHeritage Building (Queen Elizabeth Hospital)BirminghamUK
| | - Susan E. Manley
- Diabetes Translational Research GroupDiabetes CentreNuffield HouseQueen Elizabeth Hospital BirminghamBirminghamUK
- Institute of Translational MedicineHeritage Building (Queen Elizabeth Hospital)BirminghamUK
- Institute of Metabolism and Systems ResearchCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Peter G. Nightingale
- Institute of Translational MedicineHeritage Building (Queen Elizabeth Hospital)BirminghamUK
| | - John A. Williams
- Institute of Translational MedicineHeritage Building (Queen Elizabeth Hospital)BirminghamUK
- Institute of Cancer and Genomic SciencesCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Mammalian Genetics UnitMedical Research Council Harwell InstituteOxfordshireUK
| | - Radhika Susarla
- Diabetes Translational Research GroupDiabetes CentreNuffield HouseQueen Elizabeth Hospital BirminghamBirminghamUK
- Institute of Translational MedicineHeritage Building (Queen Elizabeth Hospital)BirminghamUK
| | - Irene Alonso‐Perez
- Health Informatics DepartmentQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Irene M. Stratton
- Gloucestershire Retinal Research GroupCheltenham General HospitalCheltenhamUK
| | - Georgios V. Gkoutos
- Institute of Translational MedicineHeritage Building (Queen Elizabeth Hospital)BirminghamUK
- Institute of Cancer and Genomic SciencesCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- MRC Health Data Research UK (Central Office)Gibbs BuildingLondonUK
- NIHR Biomedical Research CentreBirminghamUK
| | - Jonathan Webber
- Diabetes Translational Research GroupDiabetes CentreNuffield HouseQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Stephen D. Luzio
- Diabetes Translational Research GroupDiabetes CentreNuffield HouseQueen Elizabeth Hospital BirminghamBirminghamUK
- Diabetes Research Unit (Cymru)Grove BuildingSwansea UniversitySwanseaUK
| | - Wasim Hanif
- Diabetes Translational Research GroupDiabetes CentreNuffield HouseQueen Elizabeth Hospital BirminghamBirminghamUK
- Institute of Translational MedicineHeritage Building (Queen Elizabeth Hospital)BirminghamUK
| | - Graham A. Roberts
- Diabetes Translational Research GroupDiabetes CentreNuffield HouseQueen Elizabeth Hospital BirminghamBirminghamUK
- Diabetes Research Unit (Cymru)Grove BuildingSwansea UniversitySwanseaUK
- HRB‐Clinical Research Facility – CorkMercy University HospitalCorkIreland
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15
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Tanabe H, Saito H, Machii N, Kudo A, Tanaka K, Asahi K, Kazama JJ, Shimabukuro M. Burden of Undiagnosed Type 2 Diabetes in Diabetic Kidney Disease: A Japanese Retrospective Cohort Study. J Clin Med 2020; 9:jcm9072028. [PMID: 32605211 PMCID: PMC7409199 DOI: 10.3390/jcm9072028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022] Open
Abstract
The risk of developing diabetic kidney disease (DKD) in patients with undiagnosed diabetes mellitus (UD) has never been evaluated. We studied the burden of UD on the risk of developing DKD in the Japanese population in a single-center retrospective cohort study. The patients with type 2 diabetes mellitus, but without DKD (estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or proteinuria), were recruited from January 2018 to January 2019; medical records were scrutinized retrospectively from January 2003 until May 2019. The individuals, with diabetes that could not be denied based on past and current records, comprised the undiagnosed diabetes (UD) group whereas those with confirmed diagnosis comprised the diagnosed diabetes (DD) group. The group differences were tested using a Kaplan–Meier curve and Cox proportional hazards model. Among the 408 participants, 164 (40.2%) and 244 (59.8%) comprised the DD and UD groups, respectively. The baseline parameters, including age, male gender, and BMI were comparable between the groups, but the plasma glucose, HbA1c levels, and diabetic retinopathy prevalence were higher in the UD group. The risk of developing DKD (log rank test, p < 0.001), an eGFR of < 60 mL/min/1.73 m2 (p = 0.001) and proteinuria (p = 0.007) were also higher in the UD group. The unadjusted and adjusted hazard ratios for DKD were 1.760 ((95% CI: 1.323–2.341), p < 0.001) and 1.566 ((95% CI: 1.159–2.115), p = 0.003), respectively, for the UD group. In conclusion, this is the first report showing that UD is a strong risk factor for DKD. The notion that a longer duration of untreated diabetes mellitus is involved strongly in the risk of developing DKD warrants the need for the identification and monitoring of UD patients.
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Affiliation(s)
- Hayato Tanabe
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima 960-1295, Japan; (H.T.); (H.S.); (N.M.); (A.K.)
| | - Haruka Saito
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima 960-1295, Japan; (H.T.); (H.S.); (N.M.); (A.K.)
| | - Noritaka Machii
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima 960-1295, Japan; (H.T.); (H.S.); (N.M.); (A.K.)
| | - Akihiro Kudo
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima 960-1295, Japan; (H.T.); (H.S.); (N.M.); (A.K.)
- Department of Internal Medicine, Ohara General Hospital, Fukushima 960-8611, Japan
| | - Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima 960-1295, Japan; (K.T.); (J.J.K.)
| | - Koichi Asahi
- Devision of Nephrology and Hypertension, Iwate Medical University, Morioka 020-8505, Japan;
| | - Junichiro James Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima 960-1295, Japan; (K.T.); (J.J.K.)
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima 960-1295, Japan; (H.T.); (H.S.); (N.M.); (A.K.)
- Correspondence: ; Tel.: +81-24-547-1305
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16
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Casagrande SS, Cowie CC, Sosenko JM, Mizokami-Stout K, Boulton AJM, Pop-Busui R. The Association Between Heart Rate and Glycemic Status in the National Health and Nutrition Examination Surveys. J Clin Endocrinol Metab 2020; 105:5722003. [PMID: 32016389 PMCID: PMC7049265 DOI: 10.1210/clinem/dgaa055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/31/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT Evidence suggests that heart rate (HR) is a prognostic factor for cardiovascular disease (CVD), for which persons with diabetes are at increased risk. OBJECTIVE The objective of this article is to determine the association between HR and glycemic status in a nationally representative sample of US adults, and, among adults with diagnosed diabetes, the association between HR and hemoglobin A1c (HbA1c) level. DESIGN A cross-sectional study was conducted. SETTING The setting of this study is the National Health and Nutrition Examination Surveys, 2011 to 2016. PARTICIPANTS US general adult (age ≥ 20 years) population who had information on glycemic status based on self-report, HbA1c, and fasting plasma glucose (N = 8562). INTERVENTION There was no intervention. MAIN OUTCOME MEASURE The main outcome measure of this study was mean HR (beats per minute). RESULTS After adjustment for examination time, age, other demographic characteristics, health insurance, health behaviors, body mass index, CVD and kidney disease, and taking antihypertensive medications, mean HR was significantly higher for those with diagnosed (75 bpm), undiagnosed diabetes (75 bpm), and prediabetes (73 bpm) compared to those with normoglycemia (71 bpm, P < .05 for all); this association was robust both for men and women. Mean HR increased with increasing HbA1c level among individuals with diagnosed diabetes independent of other risk factors (HbA1c < 7.0% [< 53 mmol/mol], 73 bpm vs A1c ≥ 11.0% [≥ 97mmol/mol], 79 bpm, P < .001); this association was most pronounced for women. CONCLUSIONS Adjusted mean HR was higher among individuals with diabetes and increased glycemia, which may reflect underlying autonomic and/or myocardial dysfunction among those with diabetes.
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Affiliation(s)
- Sarah S Casagrande
- Social & Scientific Systems, Inc, Silver Spring, Maryland, US
- Correspondence and Reprint Requests: Sarah S. Casagrande, PhD, Social & Scientific Systems, Inc, Silver Spring, MD 20910. E-mail:
| | - Catherine C Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, US
| | - Jay M Sosenko
- University of Miami Miller School of Medicine, Miami, Florida, US
| | - Kara Mizokami-Stout
- University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, Michigan, US
| | - Andrew J M Boulton
- Division of Diabetes, Endocrinology, and Gastroenterology, University of Manchester, Manchester, UK
| | - Rodica Pop-Busui
- University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, Michigan, US
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Abstract
Subclavian artery thrombosis is a rare cause of upper limb ischemia resulting from occlusion of the upper extremity blood supply. Symptomatic presentation is quite rare and therefore remains underdiagnosed by physicians. Possible catastrophic clinical consequences necessitate prompt rectification of the underlying disease and risk factors. Treatment modalities are often selected depending on the severity of clinical presentation. Herein, we present a case of a 52-year-old man who presented to the outpatient department with a one-month history of pain and blackish discoloration of the right-hand digits, palm, and wrist. His social history also revealed a chronic 30-year history of smoking. At the time of consultation, his past medical history was insignificant for chronic medical disease and hospitalizations. However, inpatient investigations diagnosed him with diabetes. Physical examination revealed a bad odor emanating from the devitalized affected right hand. Neurological examination was significant for the loss of pain sensation in the right hand. Furthermore, the right radial and brachial pulses were also absent (grade 0). Right upper extremity angiography revealed the occlusion of the right subclavian artery and right brachial artery. Above elbow amputation was advised and performed based on angiogram scans and physical examination findings. We report a case of subclavian artery thrombosis in an undiagnosed diabetic with a chronic history of smoking. Our report details the common etiology, clinical presentation, and management options feasible for this clinical entity. Furthermore, it reiterates the importance of counseling patients to attend annual healthcare doctor visits.
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Affiliation(s)
| | - Ali Akhtar
- Internal Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi, PAK
| | - Noor Ul Falah
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Maham Khan
- Radiology, Armed Forces Institute of Radiology and Imaging, Rawalpindi, PAK
| | - Urooj Zahra
- Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK
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Falguera M, Vilanova MB, Alcubierre N, Granado-Casas M, Marsal JR, Miró N, Cebrian C, Molló À, Franch-Nadal J, Mata-Cases M, Castelblanco E, Mauricio D. Prevalence of pre-diabetes and undiagnosed diabetes in the Mollerussa prospective observational cohort study in a semi-rural area of Catalonia. BMJ Open 2020; 10:e033332. [PMID: 31964673 PMCID: PMC7044846 DOI: 10.1136/bmjopen-2019-033332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To assess the prevalence of undiagnosed diabetes and pre-diabetes in the healthy population in the Mollerussa cohort. As a secondary objective, to identify the variables associated with these conditions and to describe the changes in glycaemic status after 1 year of follow-up in subjects with pre-diabetes. DESIGN Prospective observational cohort study. SETTING General population from a semi-rural area. PARTICIPANTS The study included 583 participants without a diagnosis of diabetes recruited between March 2011 and July 2014. RESULTS The prevalence of undiagnosed diabetes was 20, 3.4% (95% CI 2.6 to 4.2) and that of pre-diabetes was 229, 39.3% (37.3 to 41.3). Among those with pre-diabetes, 18.3% had isolated impaired fasting plasma glucose (FPG) (FPG: 100 to <126 mg/dL), 58.1% had isolated impaired glycated haemoglobin (HbA1c) (HbA1c 5.7 to <6.5) and 23.6% fulfilled both criteria. Follow-up data were available for 166 subjects; 41.6%(37.8 to 45.4) returned to normoglycaemia, 57.6% (57.8 to 61.4) persisted in pre-diabetes and 0.6% (0 to 1.2) progressed to diabetes. Individuals with pre-diabetes had worse cardiometabolic risk profiles and sociodemographic features than normoglycaemic subjects. In the logistic regression model, variables significantly associated with pre-diabetes were older age (OR; 95% CI) (1.033; 1.011 to 1.056), higher physical activity (0.546; 0.360 to 0.827), body mass index (1.121; 1.029 to 1.222) and a family history of diabetes (1.543; 1.025 to 2.323). The variables significantly associated with glycaemic normalisation were older age (0.948; 0.916 to 0.982) and body mass index (0.779; 0.651 to 0.931). CONCLUSIONS Among adults in our region, the estimated prevalence of undiagnosed diabetes was 3.4% and that of pre-diabetes was 39.3%. After a 1-year follow-up, a small proportion of subjects (0.6%) with pre-diabetes progressed to diabetes, while a high proportion (41.6%) returned to normoglycaemia. Individuals with pre-diabetes who returned to normoglycaemia were younger and had a lower body mass index.
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Affiliation(s)
- Mireia Falguera
- Primary Health Care Centre Cervera, Gerència d'Atenció Primaria, Institut Català de la Salut, Lleida, Spain
- Department of Medicine, University of Lleida & Biomedical Research Institute of Lleida, Lleida, Spain
| | - Maria Belén Vilanova
- Department of Medicine, University of Lleida & Biomedical Research Institute of Lleida, Lleida, Spain
- Primary Health Care Centre Igualada Nord, Gerència d'Atenció Primaria, Institut Català de la Salut, Lleida, Spain
| | - Nuria Alcubierre
- Department of Nutrition and Dietetics, Avantmedic, Lleida, Spain
| | - Minerva Granado-Casas
- Department of Medicine, University of Lleida & Biomedical Research Institute of Lleida, Lleida, Spain
- Department of Endocrinology & Nutrition, University Hospital Germans Trias I Pujol & Health Sciences Research Institute, Badalona, Spain
| | - Josep Ramón Marsal
- Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), & CIBER of Epidemiology and Public Health (CIBERESP), Lleida, Spain
- Department of Cardiovascular, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Neus Miró
- Primary Health Care Centre Tàrrega, Gerència d'Atenció Primaria, Institut Català de la Salut, Lleida, Spain
| | - Cristina Cebrian
- Primary Health Care Centre Mollerussa, Gerència d'Atenció Primaria, Institut Català de la Salut, Lleida, Spain
| | - Àngels Molló
- Primary Health Care Centre Guissona, Gerència d'Atenció Primaria, Institut Català de la Salut, Lleida, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), & CIBER on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
- Primary Health Care Centre Raval Sud, Gerència d'Atenció Primaria Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), & CIBER on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
- Primary Health Care Centre La Mina, Gerència d'Atenció Primària Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Esmeralda Castelblanco
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), & CIBER on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Didac Mauricio
- Department of Medicine, University of Lleida & Biomedical Research Institute of Lleida, Lleida, Spain
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), & CIBER on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
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Abdulai T, Li Y, Zhang H, Tu R, Liu X, Zhang L, Dong X, Li R, Wang Y, Wang C. Prevalence of impaired fasting glucose, type 2 diabetes and associated risk factors in undiagnosed Chinese rural population: the Henan Rural Cohort Study. BMJ Open 2019; 9:e029628. [PMID: 31383706 PMCID: PMC6686996 DOI: 10.1136/bmjopen-2019-029628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study estimated the burden and characterised the risk factors associated with diabetes and impaired fasting glucose (IFG) in an undiagnosed rural population. DESIGN Data for 36 960 participants from the Henan Rural Cohort baseline with undiagnosed diabetes were analysed. X2 test and multivariate logistic regression analyses were performed to test for association between risk factors and diabetes and IFG. RESULTS Women constituted 60.30% of the study participants, mean age of participants was 55.32±12.18 years, risk factors for diabetes and IFG were prevalent (75% dyslipidaemia, 57% overweight/obese, 50% central obesity and 18% metabolic syndrome). The prevalence of diabetes and IFG was 4.19% and 7.22%, respectively. Having a metabolic syndrome (adjusted OR (aOR) 4.7, 95% CI 4.27 to 5.33), dyslipidaemia (aOR 2.76, 95% CI 2.31 to 3.21), centrally obese (aOR 2.38, 95% CI 2.11 to 2.70), being overweight/obese (aOR 1.66, 95% CI 1.45 to 1.79) and a family history of diabetes (aOR 1.50, 95% CI 1.15 to 1.92) were associated with diabetes. These factors were also associated with IFG. Intake of high salt diet (aOR 1.16, 95% CI 1.02 to 1.32) and smoking (aOR 1.22, 95% CI 1.02 to 1.47; significant in men) were also associated with diabetes. Engaging in moderate physical activity (aOR 0.94, 95% CI 0.89 to 0.98) was noted to be negatively associated with diabetes. CONCLUSION Diabetes and IFG remain prevalent in Chinese population with obesity and dyslipidaemia being some of the most significant predictors. Regular physical activity and consumption of fruits and vegetables may be beneficial in keeping blood glucose level low. TRIAL REGISTRATION NUMBER ChiCTR-OOC-15006699.
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Affiliation(s)
- Tanko Abdulai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Community Health and Family Medicine, SMHS, University for Development Studies, Tamale, Ghana
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Liying Zhang
- School of Information Engineering, Zhengzhou University, Zhengzhou, China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuming Wang
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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Lyu YS, Kim SY, Bae HY, Kim JH. Prevalence and Risk Factors for Undiagnosed Glucose Intolerance Status in Apparently Healthy Young Adults Aged <40 Years: The Korean National Health and Nutrition Examination Survey 2014-2017. Int J Environ Res Public Health 2019; 16:ijerph16132393. [PMID: 31284480 PMCID: PMC6651181 DOI: 10.3390/ijerph16132393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/21/2023]
Abstract
Background: Early-onset diabetes results in longer lifetime hyperglycemic exposure that consequently leads to earlier chronic diabetes complications and premature death. The aim of this study was to quantify the prevalence and risk factors of undiagnosed diabetes and undiagnosed prediabetes in apparently healthy young adults aged <40 years. Methods: This study used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey conducted by the Korean Ministry of Health and Welfare from 2014 to 2017. A total of 4442 apparently healthy young adults enrolled in this study. Multivariate logistic regression analyses were conducted separately to evaluate associated risk factors with undiagnosed diabetes and undiagnosed prediabetes in groups stratified by sex. Results: The prevalence of undiagnosed diabetes and undiagnosed prediabetes was 1.2% and 25.0%, respectively. Obesity (body mass index ≥ 30.0 kg/m2) was a significant risk factor of undiagnosed diabetes regardless of sex (men, odds ratio (OR): 9.808, 95% confidence interval (CI): 1.619–59.412; women, OR: 7.719, 95% CI: 1.332–44.747). Family history of diabetes was significantly associated with undiagnosed diabetes (OR: 3.407, 95% CI: 1.224–9.481) in women only. Increased age, obesity status, and family history of diabetes were significant risk factors for undiagnosed prediabetes. Alcohol consumption was found to be negatively associated with undiagnosed prediabetes in women. Conclusions: Increased attention and implementation of precise strategies for identifying young adults at high risk for undiagnosed diabetes would allow for increased wellbeing as well as reduced healthcare burdens associated with diabetes.
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Affiliation(s)
- Young Sang Lyu
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Sang Yong Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Hak Yeon Bae
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Jin Hwa Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea.
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21
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Russell E, Oh KM, Zhao X. Undiagnosed diabetes among Hispanic and white adults with elevated haemoglobin A 1c levels. Diabetes Metab Res Rev 2019; 35:e3153. [PMID: 30884138 DOI: 10.1002/dmrr.3153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/03/2019] [Accepted: 03/09/2019] [Indexed: 01/03/2023]
Abstract
AIMS The aim of this study is to compare the frequency and correlates of undiagnosed diabetes between Hispanic and white American adults ages 20 and older with known diabetes or elevated HbA1c . METHODS Using 2007 to 2012 National Health and Nutrition Survey data, 1792 white and Hispanic Americans age 20 and older with known diabetes or elevated HbA1c (≥6.5%) were included in the analysis. Undiagnosed diabetes was defined as elevated HbA1c more than or equal to 6.5% without prior diabetes diagnosis. Covariates included demographics, health care access, and survey language. RESULTS Hispanics were younger (54.92 vs 61.45 y, p < .001) and had a higher rate of undiagnosed diabetes (28.2% vs 18.0%, p < .001) than their white counterparts. For Hispanics, those with undiagnosed diabetes had higher mean HbA1c than those with known diabetes (p = .03), but no significant difference was found between diagnosed and undiagnosed diabetes among whites. Covariates that decreased the odds of undiagnosed diabetes among Hispanic Americans included having a routine place to receive health care. For whites, covariates that decreased the odds of undiagnosed diabetes were a higher ratio of income to poverty level, having health insurance and having a routine place for health care. CONCLUSION The high proportion of unknown diabetes among Hispanic Americans suggests the need for a culturally competent health campaign to improve community diabetes awareness. Emphasizing the importance of having a routine place of health care for regular health check-ups and expanded community resources for diabetes early detection and prevention among this population could decrease the burden of diabetes.
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Affiliation(s)
- Elaine Russell
- School of Nursing, George Mason University, Fairfax, Virginia
| | - Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, Virginia
| | - Xiaoquan Zhao
- Department of Communication, George Mason University, Fairfax, Virginia
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22
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Mahikul W, White LJ, Poovorawan K, Soonthornworasiri N, Sukontamarn P, Chanthavilay P, Pan-Ngum W, Medley GF. A Population Dynamic Model to Assess the Diabetes Screening and Reporting Programs and Project the Burden of Undiagnosed Diabetes in Thailand. Int J Environ Res Public Health 2019; 16:E2207. [PMID: 31234452 DOI: 10.3390/ijerph16122207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/07/2023]
Abstract
Diabetes mellitus (DM) is rising worldwide, exacerbated by aging populations. We estimated and predicted the diabetes burden and mortality due to undiagnosed diabetes together with screening program efficacy and reporting completeness in Thailand, in the context of demographic changes. An age and sex structured dynamic model including demographic and diagnostic processes was constructed. The model was validated using a Bayesian Markov Chain Monte Carlo (MCMC) approach. The prevalence of DM was predicted to increase from 6.5% (95% credible interval: 6.3-6.7%) in 2015 to 10.69% (10.4-11.0%) in 2035, with the largest increase (72%) among 60 years or older. Out of the total DM cases in 2015, the percentage of undiagnosed DM cases was 18.2% (17.4-18.9%), with males higher than females (p-value < 0.01). The highest group with undiagnosed DM was those aged less than 39 years old, 74.2% (73.7-74.7%). The mortality of undiagnosed DM was ten-fold greater than the mortality of those with diagnosed DM. The estimated coverage of diabetes positive screening programs was ten-fold greater for elderly compared to young. The positive screening rate among females was estimated to be significantly higher than those in males. Of the diagnoses, 87.4% (87.0-87.8%) were reported. Targeting screening programs and good reporting systems will be essential to reduce the burden of disease.
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Levy N, Dhatariya K. Pre-operative optimisation of the surgical patient with diagnosed and undiagnosed diabetes: a practical review. Anaesthesia 2019; 74 Suppl 1:58-66. [PMID: 30604420 DOI: 10.1111/anae.14510] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2018] [Indexed: 01/08/2023]
Abstract
Peri-operative hyperglycaemia, whether the cause is known diabetes, undiagnosed diabetes or stress hyperglycaemia, is a risk factor for harm, increased length of stay and death. There is increasing evidence that peri-operative hyperglycaemia is a modifiable risk factor, and many of the interventions required to improve the outcome of surgery must be instituted before the actual surgical admission. These interventions depend on communication and collaboration within the multidisciplinary team along each stage of the patient journey to ensure that integration of care occurs across the whole of the patient-centred care pathway.
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Affiliation(s)
- N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - K Dhatariya
- Diabetes and Endocrinology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich Medical School, University of East Anglia, Norwich, UK
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Hasan MM, Tasnim F, Tariqujjaman M, Ahmed S. Socioeconomic Inequalities of Undiagnosed Diabetes in a Resource-Poor Setting: Insights from the Cross-Sectional Bangladesh Demographic and Health Survey 2011. Int J Environ Res Public Health 2019; 16:E115. [PMID: 30609855 DOI: 10.3390/ijerph16010115] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/22/2018] [Accepted: 12/27/2018] [Indexed: 01/21/2023]
Abstract
Diabetes mellitus is rising disproportionately but is not frequently diagnosed until complications appear, which results in adverse health consequences. We estimated the prevalence of undiagnosed diabetes among adult diabetic patients and associated socioeconomic inequalities in Bangladesh. We used nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2011 data. Among patients with diabetes, we identified undiagnosed cases as having fasting plasma glucose ≥ 7.0 mmol/L, never having taken prescribed medicine and being told by health professionals. Among 938 patients with diabetes, 53.4% remained undiagnosed. The poorest (75.9%) and rural (59.0%) patients had significantly higher undiagnosed cases than the richest (36.0%) and urban (42.5%), respectively. Multiple logistic regression analysis revealed that the likelihood of being undiagnosed was lower among patients with age ≥ 70 years vs. 35–39 years (adjusted odds ratio (AOR) = 0.35; 95% confidence interval (CI) 0.19, 0.64) and patients with higher education vs. no education (AOR = 0.36; 95% CI 0.21, 0.62). Conversely, a high level of physical activity and being in a poor socioeconomic quintile were associated with a higher risk of remaining undiagnosed for diabetes. The Concentration Index (C) also showed that undiagnosed diabetes was largely distributed among the socioeconomically worse-off group in Bangladesh (C = −0.35). Nationwide diabetes screening programs may reduce this problem in Bangladesh and other similar low-income settings.
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Walker RJ, Grusnick J, Garacci E, Mendez C, Egede LE. Trends in Food Insecurity in the USA for Individuals with Prediabetes, Undiagnosed Diabetes, and Diagnosed Diabetes. J Gen Intern Med 2019; 34:33-5. [PMID: 30215178 DOI: 10.1007/s11606-018-4651-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
INTRODUCTION Type 2 diabetes mellitus is a major source of morbidity and mortality in South Africa, spurred by increased urbanisation and unhealthy lifestyle factors. Local epidemiological data are required to inform health planning and policy. The purpose of this systematic review is to identify, collate and synthesise all studies reporting the prevalence of diabetes in South Africa. A secondary aim is to report the prevalence of impaired glucose tolerance and impaired fasting glucose, conditions which are associated with an increased risk of progression to overt diabetes, and the prevalence of undiagnosed diabetes. METHODS AND ANALYSIS Multiple databases will be searched for diabetes prevalence studies conducted in South Africa between 1997 and 2018. Two authors will independently select studies that meet the inclusion criteria, extract data and appraise studies using a risk of bias tool for prevalence studies. Studies with low or moderate risk of bias will be included. Sources of heterogeneity will be explored using subgroup analysis. ETHICS AND DISSEMINATION The systematic review does not require ethics clearance since published studies with non-identifiable data will be used. This review will provide best estimates to inform the Second National Burden of Disease study which can guide health and policy planning. PROSPERO REGISTRATION NUMBER CRD42017071280.
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Affiliation(s)
- Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa
- Division of Medical Physiology, University of Stellenbosch, Tygerberg, South Africa
| | - Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jané D Joubert
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi Levitt
- Division of Endocrinology and Diabetic Medicine, University of Cape Town, Cape Town, South Africa
| | - Mweete D Nglazi
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, University of Stellenbosch, Tygerberg, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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O'Brien MJ, Bullard KM, Zhang Y, Gregg EW, Carnethon MR, Kandula NR, Ackermann RT. Performance of the 2015 US Preventive Services Task Force Screening Criteria for Prediabetes and Undiagnosed Diabetes. J Gen Intern Med 2018; 33:1100-1108. [PMID: 29651678 PMCID: PMC6025671 DOI: 10.1007/s11606-018-4436-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/29/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND In 2015, The US Preventive Services Task Force (USPSTF) recommended screening for prediabetes and undiagnosed diabetes (collectively called dysglycemia) among adults aged 40-70 years with overweight or obesity. The recommendation suggests that clinicians consider screening earlier in people who have other diabetes risk factors. OBJECTIVE To compare the performance of limited and expanded screening criteria recommended by the USPSTF for detecting dysglycemia among US adults. DESIGN Cross-sectional analysis of survey and laboratory data collected from nationally representative samples of the civilian, noninstitutionalized US adult population. PARTICIPANTS A total of 3643 adults without diagnosed diabetes who underwent measurement of hemoglobin A1c (A1c), fasting plasma glucose (FPG), and 2-h plasma glucose (2-h PG). MAIN MEASURES Screening eligibility according to the limited criteria was based on age 40 to 70 years old and overweight/obesity. Screening eligibility according to the expanded criteria was determined by meeting the limited criteria or having ≥ 1 of the following risk factors: family history of diabetes, history of gestational diabetes or polycystic ovarian syndrome, and non-white race/ethnicity. Dysglycemia was defined by A1c ≥ 5.7%, FPG ≥ 100 mg/dL, and/or 2-h PG ≥ 140 mg/dL. KEY RESULTS Among the US adult population without diagnosed diabetes, 49.7% had dysglycemia. Screening based on the limited criteria demonstrated a sensitivity of 47.3% (95% CI, 44.7-50.0%) and specificity of 71.4% (95% CI, 67.3-75.2%). The expanded criteria yielded higher sensitivity [76.8% (95% CI, 73.5-79.8%)] and lower specificity [33.8% (95% CI, 30.1-37.7%)]. Point estimates for the sensitivity of the limited criteria were lower in all minority groups and significantly different for Asians compared to non-Hispanic whites [29.9% (95% CI, 23.4-37.2%) vs. 49.8% (95% CI, 45.9-53.7%); P < .001]. CONCLUSIONS Diabetes screening that follows the limited USPSTF criteria will identify approximately half of US adults with dysglycemia. Screening other high-risk subgroups defined in the USPSTF recommendation would improve detection of dysglycemia and may reduce associated racial/ethnic disparities.
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Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Center for Community Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yan Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Community Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Community Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Moonesinghe R, Beckles GLA, Liu T, Khoury MJ. The contribution of family history to the burden of diagnosed diabetes, undiagnosed diabetes, and prediabetes in the United States: analysis of the National Health and Nutrition Examination Survey, 2009-2014. Genet Med 2018; 20:1159-1166. [PMID: 29369292 PMCID: PMC6060023 DOI: 10.1038/gim.2017.238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/20/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Given the importance of family history in the early detection and prevention of type 2 diabetes, we quantified the public health impact of reported family health history on diagnosed diabetes (DD), undiagnosed diabetes (UD), and prediabetes (PD) in the United States. METHODS We used population data from the National Health and Nutrition Examination Survey 2009-2014 to measure the association of reported family history of diabetes with DD, UD, and PD. RESULTS Using polytomous logistic regression and multivariable adjustment, family history prevalence ratios were 4.27 (confidence interval (CI): 3.57, 5.12) for DD, 2.03 (CI: 1.56, 2.63) for UD, and 1.26 (CI: 1.09, 1.44) for PD. In the United States, we estimate that 10.1 million DD cases, 1.4 million UD cases, and 3.9 million PD cases can be attributed to having a family history of diabetes. CONCLUSION These findings confirm that family history of diabetes has a major public health impact on diabetes in the United States. In spite of the recent interest and focus on genomics and precision medicine, family health history continues to be an integral component of public health campaigns to identify persons at high risk for developing type 2 diabetes and early detection of diabetes to prevent or delay complications.
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Affiliation(s)
- Ramal Moonesinghe
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, USA, Georgia.
| | - Gloria L A Beckles
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA, Georgia
| | - Tiebin Liu
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, USA, Georgia
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, USA, Georgia
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Wondemagegn AT, Bizuayehu HM, Abie DD, Ayalneh GM, Tiruye TY, Tessema MT. Undiagnosed Diabetes Mellitus and Related Factors in East Gojjam (NW Ethiopia) in 2016: A Community-Based Study. J Public Health Res 2017; 6:834. [PMID: 28480176 PMCID: PMC5402184 DOI: 10.4081/jphr.2017.834] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/31/2017] [Indexed: 12/16/2022] Open
Abstract
Introduction Currently, diabetes is the second most common non-communicable disease (NCD) in Ethiopia. Its burden is 4.8% in this country, even though three quarter of its population live with undiagnosed diabetes mellitus (DM), which causes complications like heart failure, blood vessels, eyes, kidneys and nerves damages. Early detection of DM is vital for a timely intervention to prevent these life threatening complications. The aim of this study was to assess the prevalence of undiagnosed DM and related factors in East Gojjam, North West Ethiopia, in 2016. Materials and methods A community-based cross-sectional study was conducted among 757 individuals in East Gojjam from June to September 2016. The sampled population was selected using multi-stage cluster sampling method. Basic data were collected in Amharic (local language) and a pretested interviewer administered the questionnaire. Peripheral blood samples were collected by puncturing the ring finger in order to measure fasting blood glucose. Univarite and multivariate logistic regressions analysis were performed using Statistical Package for Social Sciences (SPSS) software version 20.0. Results The percentage of undiagnosed DM in the study area was 11.5% (95%CI=9.2, 13.7). The prevalence was 11.3% among male vs. 11.8% among female; 13.4% in urban areas vs. 10.3% in rural areas. The occurrence of undiagnosed DM was mainly associated with older age (AOR=5.99, 95%CI=1.54, 23.24), family history of diabetes (AOR=9.86, 95%CI=4.25, 22.89), history of gestational diabetes (AOR=3.01, 95%CI=1.17, 8.39) and sedentary behaviour >4 hours per day (AOR=2.13, 95%CI=1.04, 4.34). Being non-smoker (AOR=0.05, 95%CI=0.01, 0.17) and unmarried (AOR=0.09, 95%CI=0.02, 0.42) were also predictive characteristics for undiagnosed DM in the study area. Conclusions In conclusion, this study revealed a relatively high prevalence of undiagnosed DM in the study area. The occurrence of undiagnosed DM was significantly higher when associated with the age of the participants, their marital status, history of hypertension, diabetes family history, history of gestational diabetes mellitus, current smoking practices and sedentary behaviour. Thus, efforts have to be made, particularly by the individuals involved in health practice, to early detect the disease and thereby initiate a suitable therapeutic service, before complications arise Significance for public health Currently, diabetes is the second most common non-communicable disease in Ethiopia. Its burden is 4.8% in this country, though three quarter of its population live with undiagnosed diabetes mellitus (DM), which could lead to several complications such as heart failure, blood vessels, eyes, kidneys, and nerves damages. Evidence shows that the disease is increasing through time. Early detection of DM is vital for a timely intervention to prevent life-threatening complications. Efforts should be made by politicians, decision makers and other healthy institutions to implement screening modality and early interventions.
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Affiliation(s)
| | | | - Dagninet Derebe Abie
- Department of Pharmacy, College of Medicine and Health Science, Bahir Dar University
| | | | - Tenaw Yimer Tiruye
- Department of Public Health, College of Health Science, Debre Markos University
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Wong CKH, Siu SC, Wan EYF, Jiao FF, Yu EYT, Fung CSC, Wong KW, Leung AYM, Lam CLK. Simple non-laboratory- and laboratory-based risk assessment algorithms and nomogram for detecting undiagnosed diabetes mellitus. J Diabetes 2016; 8:414-21. [PMID: 25952330 DOI: 10.1111/1753-0407.12310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/26/2015] [Accepted: 05/05/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of the present study was to develop a simple nomogram that can be used to predict the risk of diabetes mellitus (DM) in the asymptomatic non-diabetic subjects based on non-laboratory- and laboratory-based risk algorithms. METHODS Anthropometric data, plasma fasting glucose, full lipid profile, exercise habits, and family history of DM were collected from Chinese non-diabetic subjects aged 18-70 years. Logistic regression analysis was performed on a random sample of 2518 subjects to construct non-laboratory- and laboratory-based risk assessment algorithms for detection of undiagnosed DM; both algorithms were validated on data of the remaining sample (n = 839). The Hosmer-Lemeshow test and area under the receiver operating characteristic (ROC) curve (AUC) were used to assess the calibration and discrimination of the DM risk algorithms. RESULTS Of 3357 subjects recruited, 271 (8.1%) had undiagnosed DM defined by fasting glucose ≥7.0 mmol/L or 2-h post-load plasma glucose ≥11.1 mmol/L after an oral glucose tolerance test. The non-laboratory-based risk algorithm, with scores ranging from 0 to 33, included age, body mass index, family history of DM, regular exercise, and uncontrolled blood pressure; the laboratory-based risk algorithm, with scores ranging from 0 to 37, added triglyceride level to the risk factors. Both algorithms demonstrated acceptable calibration (Hosmer-Lemeshow test: P = 0.229 and P = 0.483) and discrimination (AUC 0.709 and 0.711) for detection of undiagnosed DM. CONCLUSION A simple-to-use nomogram for detecting undiagnosed DM has been developed using validated non-laboratory-based and laboratory-based risk algorithms.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Shing-Chung Siu
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Fang-Fang Jiao
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Esther Y T Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Colman S C Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Ka-Wai Wong
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong
| | | | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Najafipour H, Sanjari M, Shokoohi M, Haghdoost AA, Afshari M, Shadkam M, Etemad K, Mirzazade A. Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes and its predictors in general population aged 15 to 75 years: A community-based study (KERCADRS) in southeastern Iran. J Diabetes 2015; 7:613-21. [PMID: 25042896 DOI: 10.1111/1753-0407.12195] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/31/2014] [Accepted: 07/02/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The goal of this research was to measure the age-sex standardized prevalence of pre-diabetes (pre-DM) and diabetes (DM), and the effectiveness of diabetes management (using HbA1C as the indicator) in an urban area in Iran. METHODS Using a randomized cluster household survey, we recruited 5900 individuals whose age ranged from 15 to 75 from Kerman for assessing coronary artery disease risk factors (KERCADRS) including diabetes. In 2010 and 2011, all of the participants were interviewed by trained staff for medical history and physical activities, and were then examined for blood pressure and anthropometric measures. Venus blood sample was also collected for fasting plasma glucose and HbA1c. RESULTS The age-sex standardized prevalence of pre-diabetes, diagnosed and undiagnosed was 18.7%, 6.3% and 2.7%, respectively. Diabetes increased by age (from 14.7% in the 15-24 years old group to 28.4% in the 65-75 years old group), particularly after 40 years. Occasional opium users had the highest prevalence of Pre-DM (34.6%). Seventy-nine percent of the depressed and 75.5% of the anxious participants with diagnosed-DM were identified as uncontrolled-DM. More than 60% of diagnosed diabetic cases had impaired HbA1c. Overweight and obesity (adjusted odds ratio (AOR) 1.6) and low physical activity (AOR 1.5) were the most preventable risk factors associated with diabetes. CONCLUSION Considerable prevalence of diabetes, susceptibility in progressing to diabetes and uncontrolled diabetes among individuals living in Kerman, suggested ineffective prevention and treatment of diabetes in urban areas in Iran. Successful experience regarding primary health-care in rural areas should be expanded to urban settings.
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Affiliation(s)
- Hamid Najafipour
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojgan Sanjari
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Endocrinology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Afshari
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Shadkam
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Koorosh Etemad
- Center for Non-Communicable Diseases, Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Mirzazade
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Demmer RT, Zuk AM, Rosenbaum M, Desvarieux M. Prevalence of diagnosed and undiagnosed type 2 diabetes mellitus among US adolescents: results from the continuous NHANES, 1999-2010. Am J Epidemiol 2013; 178:1106-13. [PMID: 23887044 DOI: 10.1093/aje/kwt088] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although prevalence and incidence of type 2 diabetes mellitus (T2DM) are reportedly increasing among adolescents, national data are lacking, particularly in regard to undiagnosed T2DM. To estimate the prevalence of diagnosed and undiagnosed T2DM among US adolescents, we analyzed a nationally representative cross-section of 11,888 adolescents aged 12-19 years who received a diabetes interview in the Continuous National Health and Nutrition Examination Survey during 1999-2010. Among them, a random subsample of 4,661 adolescents also had fasting blood samples collected. Persons who reported a previous diabetes diagnosis and were either taking no medication or taking an oral hypoglycemic agent (with or without insulin) were classified as having T2DM; persons who reported using insulin alone were classified as having type 1 diabetes. Undiagnosed diabetes was defined as a fasting plasma glucose concentration of ≥126 mg/dL and was assumed to be type 2. In the fasting subsample, 31 diabetes cases (types 1 and 2) were identified, representing a prevalence of 0.84% (weighted 95% confidence interval (CI): 0.51, 1.40) (276,638 cases; 95% CI: 134,255, 419,020). Estimates of the prevalences of type 1 and type 2 diabetes were 0.48% (95% CI: 0.23, 1.02) and 0.36% (95% CI: 0.20, 0.67), respectively, indicating that T2DM accounted for 43% of all cases. Further, undiagnosed T2DM prevalence was 0.12% (95% CI: 0.05, 0.31), representing 34% of T2DM cases (40,611 cases; 95% CI: 2,850, 78,373). T2DM accounts for approximately half of adolescent diabetes in the United States, and one-third of these cases are undiagnosed.
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Goto A, Morita A, Goto M, Sasaki S, Miyachi M, Aiba N, Kato M, Terauchi Y, Noda M, Watanabe S. Validity of diabetes self-reports in the Saku diabetes study. J Epidemiol 2013; 23:295-300. [PMID: 23774288 PMCID: PMC3709549 DOI: 10.2188/jea.je20120221] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/24/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diabetes is an important risk factor for cardiovascular disease, certain types of cancer, and death, and self-reports are one of the most convenient methods for ascertaining diabetes status. We evaluated the validity of diabetes self-reports among Japanese who participated in a health checkup. METHODS Self-reported diabetes was cross-sectionally compared with confirmed diabetes among 2535 participants aged 28 to 85 years in the Saku cohort study. Confirmed diabetes was defined as the presence of at least 1 of the following: fasting plasma glucose (FPG) level of 126 mg/dL or higher, 2-hour post-load glucose (2-hPG) level of 200 mg/dL or higher after a 75-gram oral glucose tolerance test, glycated hemoglobin (HbA1c) level of 6.5% or higher, or treatment with hypoglycemic medication(s). RESULTS Of the 251 participants with self-reported diabetes, 121 were taking hypoglycemic medication(s) and an additional 69 were classified as having diabetes. Of the 2284 participants who did not self-report diabetes, 80 were classified as having diabetes. These data yielded a sensitivity of 70.4%, a specificity of 97.3%, a positive predictive value of 75.7%, and a negative predictive value of 96.5%. The frequency of participants with undiagnosed diabetes was 3.0%. Of these, 64.2% had FPG within the normal range and were diagnosed by 2-hPG and/or HbA1c. CONCLUSIONS Our findings provide additional support for the use of self-reported diabetes as a measure of diabetes in epidemiologic studies performed in similar settings in Japan if biomarker-based diagnosis is difficult.
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Hunt KJ, Gebregziabher M, Egede LE. Racial and ethnic differences in cardio-metabolic risk in individuals with undiagnosed diabetes: National Health and Nutrition Examination Survey 1999-2008. J Gen Intern Med 2012; 27:893-900. [PMID: 22415867 DOI: 10.1007/s11606-012-2023-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 01/11/2012] [Accepted: 02/10/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although early recognition and treatment of diabetes may be essential to prevent complications, roughly one-fifth of diabetes remains undiagnosed. OBJECTIVE Examine cardio-metabolic risk factors and their control in non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA) individuals with undiagnosed diabetes. DESIGN Nationally representative cross-sectional study of participants in the National Health and Nutrition Examination Survey (NHANES) continuous cycles conducted 1999 through 2008. PARTICIPANTS Of 22,621 non-pregnant individuals aged ≥20 years, 2521 had diagnosed diabetes. Of the remaining 20,100 individuals, 17,963 had HbA1c measured, 551 of whom were classified as having undiagnosed diabetes and comprise the study population. MAIN MEASURES Undiagnosed diabetes was defined as HbA1c ≥ 6.5% without a self-report of physician diagnosed diabetes. Cardio-metabolic risk factor control was examined using regression methods for complex survey data. KEY RESULTS Among individuals with undiagnosed diabetes, mean HbA1c level was 7.7% (95% CI: 7.5, 7.9), 19.3% (95% CI: 14.2, 24.3) smoked, 59.7% (95% CI: 54.5, 64.8%) had hypertension and 96.5% (95% CI: 94.6, 98.4%) had dyslipidemia. Lipid profiles were remarkably different across racial-ethnic groups: NHB had the highest LDL- and HDL-cholesterol, but the lowest triglycerides, while MA had the highest triglycerides and the lowest LDL-cholesterol. After adjusting for age, sex, NHANES examination cycle and use of either blood pressure or lipid medication, the odds of having blood pressure ≥130/80 mmHg was higher in NHB [1.92 (95% CI: 1.09, 3.55)] than NHW, while the odds of having LDL-cholesterol >100 mg/dl was higher in NHW[2.93 (95% CI: 1.37, 6.24)] and NHB[3.34 (95% CI: 1.08, 10.3)] than MA. CONCLUSIONS In a nationally representative sample of individuals with undiagnosed diabetes, cardio-metabolic risk factor levels were high across all racial/ethnic groups, but NHB and MA had poorer control compared to NHW. Interventions that target identification of diabetes and treatment of cardio-metabolic risk factors are needed.
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Purty AJ, Vedapriya DR, Bazroy J, Gupta S, Cherian J, Vishwanathan M. Prevalence of diagnosed diabetes in an urban area of Puducherry, India: Time for preventive action. Int J Diabetes Dev Ctries 2011; 29:6-11. [PMID: 20062557 PMCID: PMC2802365 DOI: 10.4103/0973-3930.50708] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND: Epidemiological studies in India have shown that the prevalence of diabetes in the population is at least twice the number of persons diagnosed with diabetes residing in the given area. Similarly, community-based prevalence figures are unavailable in Puducherry,. AIMS: The aim of this study was to estimate the number of persons diagnosed with diabetes mellitus in Puducherry. SETTING AND DESIGN: This study was conducted in the service area of the Urban Health Centre (UHC), Pondicherry Institute of Medical Sciences (PIMS), Puducherry with retrospective data from family records. METHODS: The diagnosis of diabetes was retrospectively documented by reviewing all family folders of 2667 families (Population 11,835) for the period of 1/1/2003 to 31/12/2006. The data was verified by home visits from January until March, 2007. The case definition used, was a resident diagnosed with diabetes by a medical doctor and who was on antidiabetes treatment for at least the past six months. RESULTS: We found 643 individuals who had been diagnosed with diabetes. The prevalence of known diabetes was estimated to be 5.6% (5.31% in males and 6.1% in females). The age-sex specific prevalence was estimated using the 2001 Census data. There are about 48,876 known diabetics living in Puducherry. CONCLUSIONS: (1) Community-based health surveillance data comprise a useful tool to measure the prevalence of diagnosed cases of diabetes mellitus within the Indian context; 2) Diabetes mellitus is an important public health priority requiring urgent preventive action as there are about 97,752 persons in Puducherry who have either been diagnosed with diabetes or remain undiagnosed for the disease.
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Affiliation(s)
- Anil J Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Pondicherry-605 014, India
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Abstract
AIM To audit Type 2 diabetes screening in general practice in France and to determine the frequency of undiagnosed diabetes in patients at high risk, after systematic screening and diagnosis. METHODS For this study, 288 general practitioners volunteered to include all consecutive non-diabetic patients aged < 65 years who had at least two risk factors for diabetes, whatever the reason for consultation. If a plasma glucose had not been recorded in the previous 12 months, a fasting plasma glucose (FPG) was performed, with a second test if FPG >or= 7.0 mmol/l. RESULTS There were 5950 patients included. The most frequent diabetes risk factors were: age >or= 40 years, 92%; overweight [body mass index (BMI) >or= 27 kg/m2], 59%; treated hypertension, 48%; treated dyslipidaemia, 37%; family history of diabetes, 24%. Of these subjects at high risk for diabetes, 88% had a FPG measurement in their medical record (75% measured during the preceding 12 months). In the 1499 patients in whom FPG was measured, diabetes was diagnosed in 40 patients (2.7% 95% CI 1.9-3.5) and 22% had impaired fasting glucose (IFG). Thus, the frequency of undiagnosed diabetes in the 5950 high-risk patients was 0.67% (0.46-0.88). CONCLUSION Screening for diabetes by general practitioners in France appears to be adequate and undiagnosed diabetes is rare in patients with risk factors for diabetes, at least in those consulting the general practitioners studied.
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