Hemoglobin A1c in predicting progression to diabetes.
ABSTRACT The predictive value of hemoglobin A1c (HbA1c) in comparison to fasting plasma glucose (FPG) is evaluated for 5-year incident diabetes (DM), as HbA1c may be more practical than FPG in the screening for DM in the future. Of 1189 non-DM subjects aged 35-89 years old from the Funagata Study, 57 subjects (4.8%) had developed DM on the WHO criteria at 5-year follow-up. The odds ratio (95% confidence interval: CI) for a one standard deviation increase in FPG/HbA1c was 3.40 (2.44-4.74)/3.49 (2.42-5.02). The area under the receiver operating characteristic curve for FPG/HbA1c was 0.786 (95% CI: 0.719-0.853)/0.785 (0.714-0.855). The HbA1c corresponding to FPG 5.56 mmol/l was HbA1c 5.3%. There was no statistical difference in sensitivity between FPG 5.56 mmol/l and HbA1c 5.3% (61.4% vs. 56.1%), while specificity was higher in HbA1c 5.3% than FPG 5.56 mmol/l (87.8% vs. 82.5%, p-value<0.001). The fraction of incident case from those with baseline IGT was similar between the groups, however the fraction of people above the cut-off was significantly lower in HbA1c 5.3% than FPG 5.56 mmol/l (14.3% vs. 19.6%, p-value<0.001). HbA1c is similar to FPG to evaluate DM risk, and HbA1c could be practical and efficient to select subjects for intervention.
- SourceAvailable from: Tadashi Iwao
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- "However, the DECODA study suggests that FPG suggested by WHO would underestimate the prevalence of IGT and diabetes in Asian populations . Recent Japanese studies indicate on the basis of diabetes incidence that the optimal cut-off value of FPG was around 100 mg/dL    . Thus, these studies suggest that the cut-off FPG value should be lowered in terms of prediction of diabetes in Japanese subjects. "
ABSTRACT: AIMS: There are conflicting interpretations regarding the normal fasting plasma glucose level in Japanese subjects. We therefore aimed to define the upper limit of fasting plasma glucose level. METHODS: A total of 962 subjects who had a 75-g oral glucose tolerance test were examined. Subjects were divided into two groups - post-load normal glycemic group (2-h plasma glucose <140mg/dL) and post-load hyperglycemic group (2-h plasma glucose≥140mg/dL). RESULTS: There were 434 subjects with post-load normal glycemia and 528 subjects with post-load hyperglycemia. Receiver operating characteristic curve (ROC) demonstrated that the optimal cut-off value for predicting post-load hyperglycemia was a fasting plasma glucose of 99mg/dL (area under ROC curve=0.81), which had a sensitivity, specificity, and overall diagnostic accuracy of 68%, 81%, 74%, respectively. CONCLUSIONS: These data suggest that for predicting post-load hyperglycemia, the optimal cut-off value of fasting plasma glucose was 99mg/dL in Japanese subjects. Thus, the current cut-off value of fasting plasma glucose of 110mg/dL in Japan might be lowered.Diabetes research and clinical practice 01/2013; 99(3). DOI:10.1016/j.diabres.2012.12.015 · 2.54 Impact Factor
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ABSTRACT: The comorbidity of Attention Deficit Hyperactivity Disorder (ADHD) with sleep disorders has been extensively studied. In particular, Restless Legs Syndrome (RLS) appears to be consistently more frequent in children with ADHD. Several papers also draw attention to the frequent occurrence of epileptic seizures and EEG abnormalities in ADHD children. We performed a preliminary open label study to evaluate the efficacy of Levetiracetam (LEV) to ameliorate the sleep pattern and reduce RLS symptoms in children with a complex comorbidity between Attention Deficit Hyperactivity Disorder (ADHD), RLS and focal interictal epileptic discharges (IEDs) on EEG. We recruited seven children (all males, aged between 5 and 12years) who fulfilled the following criteria: ADHD diagnosis combined subtype; presence of idiopathic RLS; and presence of focal IEDs on EEG. All children were given LEV at a starting dose of approximately 10-20mg/kg/day followed by 10mg/kg/day incrementing at 1-week intervals up to 50-60mg/kg/day given in two separate doses. At a 3 and 6month follow-up, all children showed significant improvement (p<0.05) in global International RLS Rating Scale (IRLS-RS). Parents' reports revealed improved sleep quality with fewer awakenings and restorative sleep in their children. LEV was well tolerated and no major side effects were reported. With an accessory report we observed the reduction of epileptiform EEG activity during sleep. In most patients (6 on 7) the discharges completely disappeared; in the last patient epileptiform EEG activity was significantly reduced. These children may represent a subgroup of ADHD patients in which the hyperactivity and attention difficulties might be aggravated by sleep disturbances and by IEDs. LEV could represent a therapeutic option for these comorbid conditions.Brain & development 10/2010; 33(6):480-6. DOI:10.1016/j.braindev.2010.09.008 · 1.54 Impact Factor