Screening and diagnosis of prediabetes: Where are we headed?

Department of Endocrinology and Metabolic Medicine, Imperial College, St Mary's Hospital, London, UK.
Diabetes Obesity and Metabolism (Impact Factor: 6.36). 10/2007; 9 Suppl 1(s1):12-6. DOI: 10.1111/j.1463-1326.2007.00764.x
Source: PubMed


It is currently estimated that more than 300 million people have impaired glucose tolerance (IGT), putting them at increased risk for type 2 diabetes mellitus (T2DM) and its adverse consequences. In addition, many others are at risk on the basis of a family history of T2DM, obesity, dyslipidaemia and hypertension. Screening for risk should include both blood glucose testing in high-risk populations and prescreening (e.g. by questionnaire, waist circumference measurement) to identify high-risk individuals in overall low-risk populations; these individuals should then undergo glucose testing. Fasting plasma glucose measurement cannot diagnose IGT; the preferred definite test for diagnosis is oral glucose tolerance testing.

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Available from: George Alberti, Apr 16, 2014
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    • "A limitation of the present study is that IGT and IFG could not be analyzed separately because of the low number of incident cases of IFG. These are different conditions11,19,20 and might be associated with differences in the types or severity of complications associated with hyperglycemia21. Although the present study was carried out in Japanese, it is likely that similar results would be obtained in other ethnic groups, because the pathogenesis of glucose intolerance has been reported to be similar among four different ethnic groups: Caucasians, Blacks, Hispanics and Asians22. "
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    ABSTRACT: Aims/Introduction: Reduced insulin sensitivity and secretion are important in the pathogenesis of type 2 diabetes. Their relationships to prediabetes, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) have been previously studied with the oral glucose tolerance test (OGTT). We investigated whether or not baseline measures of insulin secretion and sensitivity obtained from fasting blood specimens were related to the development of prediabetes and how these measures compared with those based on the OGTT. Materials and Methods: In 152 Japanese subjects with normal glucose tolerance, we measured baseline plasma glucose and insulin after an overnight fast and during a 75 g OGTT, insulin resistance index (homeostasis model assessment [HOMA‐IR]), and insulin secretion (insulinogenic index [30 min insulin − fasting insulin] ÷ [30 min glucose − fasting glucose] or HOMA‐β). Results: At a 5–6 year (mean 5.7 years) follow‐up examination, we confirmed 36 cases of prediabetes. After adjusting for age, sex, family history of diabetes, body mass index, and 2‐h plasma glucose, the odds ratio comparing the lowest tertile (≤0.82) of insulinogenic index with the highest tertile (≥1.43) was 6.98 (95% confidence interval, 1.96–24.85) and was 10.72 (2.08–55.3) comparing the lowest tertile (≤76.3) of HOMA‐β with the highest tertile (≥122.1), whereas the respective odds ratios of HOMA‐IR were 3.74 (1.03–13.57) and 10.89 (1.93–61.41) comparing the highest tertile (≥1.95) with the lowest tertile (≤1.25). Conclusions: Lower insulin secretion and sensitivity are independent risk factors for prediabetes. Clinically practical identification of those at risk for prediabetes is obtainable from HOMA‐β and HOMA‐IR, both of which are measured in fasting state. (J Diabetes Invest, doi: 10.1111.j.2040‐1124.2010.00041.x, 2010)
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    • "In the 1960's, the term pre-diabetes was only used to describe pregnancy induced hyperglycemia or those with a high risk for diabetes due to a strong family history (Alberti, 2007). The term pre-diabetes was abolished by the World Health Organization in 1980 and redefined in 1988 by Reaven as Metabolic Syndrome X as mentioned above. "

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