Australian diabetes screening study: Impaired glucose tolerance and non—insulin-dependent diabetes mellitus

doi:10.1016/S0026-0495(97)90315-2

Metabolism

Volume 46, Supplement 1, December 1997, Pages 35-39

https://doi.org/10.1016/S0026-0495(97)90315-2 Get rights and content

Abstract

In preventing non—insulin-dependent diabetes mellitus (NIDDM) and its complications, screening high-risk individuals complements public health measures. Our screening instrument for patients of general practitioners was a questionnaire for self-determined high-risk groups plus a laboratory measurement of a random venous plasma glucose level. Collaborating practitioners evaluated 100 consecutive outpatients aged 40 years or older. The questionnaire identified patients with two or more diabetic symptoms or with two or more risk factors, and they were recommended to have their blood tested. For those with a random plasma glucose greater than 5.5 mmol/L, oral glucose tolerance tests (OGTTs) were advised. Of 50,859 subjects completing the study, there were 1,013 cases (2.0%) of new diabetes, 1,704 cases (3.4%) of impaired glucose tolerance (IGT), and 5,508 cases (10.8%) of previously diagnosed diabetes. Symptoms alone were a relatively poor discriminant. Almost all newly identified NIDDM and IGT patients had two or more risk factors for NIDDM. The risk ratios for abnormal glucose tolerance were as follows: high blood pressure, 2.4; overweight, 2.0; and positive family history, 1.7. Selection of cutoff points higher than 5.5 mmol/L would have substantially reduced the rate of newly discovered NIDDM and IGT. Screening for NIDDM and IGT in general practice is feasible and can be achieved with little disruption of office procedures. In preventive programs of this nature, the low screening threshold of 5.5 mmol/L for random venous plasma glucose maximizes the case-finding rate.

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Citation Excerpt :
Finally, although we regarded subjects with an admission BG <7.8 mmol/L as having normal glucose tolerance, if these subjects had a follow-up GTT it is possible that some would have abnormal glucose tolerance. In a study where community subjects had a random BG and then a follow-up GTT, 8% of those with a random BG <7.6 mmol/L had abnormal glucose tolerance.34 Given that the subjects in our study were stressed with myocardial infarction, it is unlikely that a dramatically greater percentage than this of our normal glucose tolerance group were misclassified.
We aimed to explore the relationship between stress, hyperglycemia and diabetes in myocardial infarction (MI), using serum cortisol as a surrogate marker for the severity of stress.
Subjects with acute MI were prospectively recruited upon hospital admission. Serum glucose and cortisol were measured in addition to standard testing. Subjects were defined as having stress hyperglycemia (SH) if they had an admission glucose ≥7.8 mmol/L without a history of glucose intolerance. Subjects were followed up with glucose tolerance testing post-discharge.
Of the 200 subjects in the study, 58 had known diabetes/impaired glucose tolerance (IGT), and 45 had SH. There was a positive association between admission glucose and cortisol for the entire cohort (r_s = 0.26, p < 0.01). This relationship was present in the subgroup who had SH and then normal glucose post-discharge (r_s = 0.53, p = 0.03), but not in SH subjects who had diabetes/IGT on post-discharge testing. It was also evident amongst all subjects with normal glucose (r_s = 0.46, p < 0.01), but not those with diabetes/IGT in general. On multivariate analysis, admission glucose was a positive predictor and cortisol a negative predictor of abnormal glucose tolerance.
Our data suggests that SH with MI reflects either underlying glucose intolerance or more severe stress in people without glucose intolerance.
Prevalence of diagnosed type 2 diabetes mellitus in the French general population: The INSTANT study
2009, Diabetes and Metabolism
To estimate the prevalence of diagnosed type 2 diabetes mellitus in the French general population. Secondary objectives were to evaluate treatments and diabetic complications.
In this cross-sectional epidemiological survey, a representative sample of the French adult population was selected using a stratified quota method: 10,038 individuals were evaluated by a standardized face-to-face interview. The diagnosis of type 2 diabetes was determined on the basis of replies to six questions using a specific algorithm. Data were collected on risk factors, diabetes history, familial antecedents and diabetic complications. These patients also identified their treatments from an exhaustive list.
The prevalence of type 2 diabetes was 5.08% in men and 4.11% in women, and rose progressively after the age of 50. Of these, 79 patients (13.4%) received no pharmacological treatment, 477 (80.9%) were taking an oral antidiabetic drug and 134 (22.7%) were taking insulin. Renal and ocular complications were reported by 6.8% and 21.0%, respectively, of the patients. Also, 10.4% had been hospitalized at some time of that year for a diabetes-related problem. The most frequently reported treatments were metformin and sulphonylureas, used by more than 50% of the patients. In addition, 380 patients (65.9%) claimed to be following a diet and 228 (39.2%) were consulting a dietitian.
The prevalence of treated and untreated type 2 diabetes mellitus in France was 4.57%.
Estimer la prévalence du diabète de type 2 en population générale française. Les objectifs secondaires étaient d’évaluer les traitements et les complications diabétiques.
Dans cette étude épidémiologique transversale, un échantillon représentatif de la population adulte française a été constitué à l’aide de la méthode stratifiée des quotas. Dix mille trente-huit personnes ont été interrogées lors d’une interview standardisée en face à face. Un diagnostic de diabète de type 2 était posé à partir des réponses données à six questions selon un algorithme spécifique. Des données ont été recueillies concernant les facteurs de risque, l’histoire du diabète, les antécédents familiaux et les complications diabétiques. Les patients ont identifié les traitements à partir d’une liste exhaustive.
La prévalence du diabète de type 2 était de 5,08 % chez les hommes et de 4,11 % chez les femmes, et augmentait progressivement avec l’âge à partir de 50 ans. Soixante-dix-neuf patients (13,4 %) ne recevaient pas de traitement médicamenteux ; un traitement antidiabétique oral était prescrit à 477 patients (80,9 %) et de l’insuline à 134 (22,7 %). Des complications rénales ont été rapportées par 6,8 % des sujets et des complications oculaires par 21,0 % d’entre eux. Dans 10,4 % des cas, on relevait une hospitalisation à l’occasion d’un problème lié au diabète. Les traitements les plus fréquemment rapportés étaient la metformine et les sulfonylurées utilisées par plus de 50 % des patients. Trois cent quatre-vingt patients (65,9 %) ont déclaré avoir suivi un régime et 228 (39,2 %) avoir consulté un diététicien.
En France, selon les résultats de cette étude transversale en population, la prévalence du diabète de type 2 traité et non traité était de 4,57 %.
Prevalence of diabetes in rural Victoria
2005, Diabetes Research and Clinical Practice
To compare the prevalence of diabetes in adults in small and medium sized towns in a part of rural Victoria
Participants were usual residents, aged ≥25 years, from randomly selected households in the crossroads undiagnosed disease study (CUDS: six small rural towns and their regional center in rural Victoria). Response rates to an initial census at the household and attendance at a subsequent biomedical examination involved were 70% and 61% (1454), respectively. All non-diabetic participants had an oral glucose tolerance test.
Prevalence of diabetes, IGT, IFG were 7.3 (5.5–9.5)%, 6.9 (5.1–9.9)% and 3.2 (2.0–4.7)% respectively in the regional center and 8.9 (6.9–11.1)%, 4.9 (3.5–6.7)%, 3.0 (1.9–4.5)% in the Shire Capitals. Overall, 31/118 (26.3%) of those with diabetes were previously undiagnosed. Most (83.9%) of those with undiagnosed diabetes remembered having been screened for diabetes in the previous 2 years. Overall screening rates for diabetes were higher than across Victoria as a whole.
The prevalence of diabetes has probably doubled over the last 15 years in this area. Undiagnosed diabetes is less common than expected, possibly as a result of a more vigorous approach to screening in general practice and in spite of the lower numbers of GPs in the area.
Random capillary plasma glucose measurement in the screening of diabetes mellitus in high-risk subjects in Thailand
2001, Diabetes Research and Clinical Practice
To assess the usefulness of random capillary plasma glucose (RCPG) measurement in screening for diabetes mellitus in high-risk subjects, a RCPG measurement and a 75-g oral glucose tolerance test (OGTT) were performed in 684 women and 164 men, aged 16–76 years (mean±SD: 41.9±11.3 years). Risk factors included family history of diabetes in first degree relatives (53.8%), obesity (BMI≥27 kg/m²) in 37.9%, dyslipidemia (78.4%), hypertension, i.e. BP⩾140/90 mmHg (28.5%), and history of gestational diabetes mellitus (16.6%). According to the 1997 ADA/1998 WHO Consultation criteria for a full OGTT, 118 cases (13.9%) were found to have diabetes. Each of 19 cases with RCPG≥13.3 mmol/l had diabetes according to OGTT, 4.7% of 427 cases with RCPG<6.1 mmol/l had diabetes. Among 402 subjects with RCPG between 6.1 and <13.3 mmol/l, 19.7% were found to have diabetes. Thus, 446 (52.6%) of 848 subjects would have been saved from OGTT if RCPG was used as a screening test, in comparison to 33.1% if the cutpoints for RCPG (12.2 and 5.5 mmol/l) recommended by WHO Study Group (1985)/WHO Consultation (1998) were applied. Therefore, RCPG measurement is a useful screening test for the screening of diabetes mellitus in high-risk subjects.
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Australian diabetes screening study: Impaired glucose tolerance and non—insulin-dependent diabetes mellitus

Abstract

Prevention of diabetes mellitus. Report of a WHO Study Group

World Health Organ Tech Rep Ser

Primary prevention of type 2 (non—insulin dependent) diabetes mellitus

Diabetologia

Preventing non—insulin dependent diabetes

Diabetes

Direct and Indirect Costs of Diabetes in the United States in 1992

Health care expenses for people with diabetes mellitus

J Clin Endocrinol Metab

Onset of NIDDM occurs at least 4–7 years before clinical diagnosis

Diabetes Care

Prevalence of neuropathy in newly diagnosed NIDDM and non-diabetic control subjects

Diabetes

Cardiovascular risk factors in confirmed pre-diabetic individuals

JAMA

Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non—insulin dependent diabetes mellitus in a community of older adults

Am J Epidemiol

The Bedford Survey: 10 year mortality rates in newly diagnosed diabetics, borderline diabetes, and normoglycaemic controls, and risk indices for coronary heart disease in borderline diabetes

Diabetologia

Mortality from coronary heart disease in relation to degree of glycaemia: The Whitehall Study

Br Med J