scholarly journals Performance and costs of multiple screening strategies for type 2 diabetes: two population-based studies in Shanghai, China

2020 ◽  
Vol 8 (1) ◽  
pp. e001569
Author(s):  
Yanyun Li ◽  
Huiru Jiang ◽  
Minna Cheng ◽  
Weiyuan Yao ◽  
Hua Zhang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Survey Data ◽  
Cross Validation ◽  
Assessment System ◽  
Youden Index ◽  
Oral Glucose ◽  
Chinese Adults ◽  
Screening Strategies

IntroductionTo compare the performance and the costs of various assumed screening strategies for type 2 diabetes mellitus (T2DM) among Chinese adults, and identify an optimal one for the population.Research design and methodsTwo multistage-sampling surveys were conducted in Shanghai, China, in 2009 and 2017. All participants were interviewed, had anthropometry, measured fasting plasma glucose (FPG), hemoglobin A1c (A1c) and/or postprandial glucose. The 1999 WHO diagnostic criteria was used to identify undiagnosed T2DM. A previously developed Chinese risk assessment system and a specific risk assessment system developed in this study were applied to calculate diabetes risk score (DRS) 1 and 2. Optimal screening strategies were selected based on the sensitivity, Youden index and the costs using the 2009 survey data as the training set and the 2017 survey data as the validation set. A twofold cross-validation was also performed.ResultsOf numerous assumed strategies, FPG ≥5.6 mmol/L alone performed well (Youden index of 71.8%) and cost least (US$18.4 for each case detected), followed by the strategy of DRS2 ≥8 combining with FPG ≥5.6 mmol/L (Youden index of 71.7% and US$20.2 per case detected) and the strategy of DRS1 ≥17 combining with FPG ≥5.6 mmol/L (Youden index of 72.0% and US$21.6 per case detected). However, FPG alone resulted in more subjects requiring oral glucose tolerance test (OGTT) than did combining with DRS. The strategy of FPG ≥5.6 mmol/L combining with A1c ≥4.7% achieved a Youden index of 72.1%, but had a cost as high as US$48.8 for each case identified. Twofold cross-validation also supported the use of FPG alone, but with an optimal cut-off of 6.1 mmol/L.ConclusionsOur results support the use of FPG alone in T2DM screening in Chinese adults. DRS may be used combining with FPG in populations with available electronic health records to reduce the number of OGTT and save costs of screening.

scholarly journals Waist Circumference and its Changes Are More Strongly Associated with the Risk of Type 2 Diabetes than Body Mass Index and Changes in Body Weight in Chinese Adults

2020 ◽  
Vol 150 (5) ◽  
pp. 1259-1265 ◽  
Author(s):  
Yuxin Fan ◽  
Ruodan Wang ◽  
Li Ding ◽  
Zhaowei Meng ◽  
Qing Zhang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Waist Circumference ◽  
Weight Status ◽  
Area Under The Curve ◽  
Diabetes Risk ◽  
Oral Glucose ◽  
Chinese Adults ◽  
Short Term

ABSTRACT Background The associations of different adiposity indicators and short-term adiposity change with diabetes risk are not fully elucidated. Objective We aimed to assess the independent and joint effects of different baseline adiposity indicators and short-term body adiposity change on the risk of type 2 diabetes. Methods We prospectively followed 10,419 Chinese adults aged 20–80 y in 2008–2012. Incident diabetes was diagnosed based on fasting glucose, 2-h glucose, or glycated hemoglobin (HbA1c) after an oral glucose tolerance test using the American Diabetes Association standard. Cox proportional hazard regression models were used to assess the associations of adiposity indicators and adiposity change with diabetes risk. Results During a mean follow-up of 2.8 y, we identified 805 type 2 diabetes cases. Baseline BMI, waist circumference, and waist-height ratio (WHtR) were all positively associated with diabetes risk. The area under the curve was significantly greater for waist circumference (0.624) and WHtR (0.627) than for BMI (0.608) (P <0.05). Compared with subjects with stable adiposity levels (±2 kg or ± 3 cm in changes in body weight or waist circumference) from baseline to Year 1, those subjects with the most weight gain or the most waist circumference gain had a 1.53-fold or 1.37-fold greater risk of diabetes; those with the most weight loss had a 46% lower risk of diabetes. Furthermore, regardless of baseline weight status, weight or waist circumference change in the first year was associated with diabetes risk. Conclusion Abdominal adiposity indicators, waist circumference and its change, are more strongly associated with the risk of type 2 diabetes than general adiposity indicators, BMI, and changes in body weight among Chinese adults.

scholarly journals Waist circumference thresholds predicting incident dysglycemia and type 2 diabetes in Black African men and women

2021 ◽  
Author(s):  
Julia H. Goedecke ◽  
Kim Nguyen ◽  
Clement Kufe ◽  
Maphoko Masemola ◽  
Tinashe Chikowore ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Waist Circumference ◽  
Glucose Tolerance ◽  
Prospective Study ◽  
Fasting Glucose ◽  
International Diabetes Federation ◽  
Youden Index ◽  
Oral Glucose ◽  
Men And Women

Objective: To determine the waist circumference (WC) thresholds for the prediction of incident dysglycemia and type 2 diabetes in Black South African (SA) men and women and compare these to advocated International Diabetes Federation (IDF) Europid thresholds. Research design and methods: In this prospective study, Black SA men (n=502) and women (n=527) from the Middle Aged Sowetan Cohort (MASC) study who had normal or impaired fasting glucose at baseline (2011-2015) were followed up through 2017-2018. Baseline measurements included anthropometry, blood pressure and fasting glucose, HDL-cholesterol and triglyceride concentrations. At follow-up, glucose tolerance was assessed using an oral glucose tolerance test. The Youden index was used to determine the optimal threshold of WC to predict incident dysglycemia and type 2 diabetes. Results: In men, the optimal WC threshold was 96.8 cm for both dysglycemia and type 2 diabetes (sensitivity 56 and 70%, specificity 74 and 70%, respectively), which performed similarly to the IDF threshold of 94 cm. In women, the optimal WC threshold for incident dysglycemia was 91.8 cm (sensitivity 86%, specificity 37%) and for type 2 diabetes was 95.8 cm (sensitivity 85%, specificity 45%). In comparison, the IDF threshold of 80 cm in women had higher sensitivity (97 and 100%), but lower specificity (12 and 11%) to predict incident dysglycemia and type 2 diabetes, respectively. Conclusions: In this first prospective study of incident type 2 diabetes in Africa, we show that African-specific WC thresholds perform better than the IDF WC thresholds to predict incident dysglycemia and type 2 diabetes.

scholarly journals Associations Between Dietary Added Sugars, Glycemia, and BMI (P21-066-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Kassidy Sharpe ◽  
Hala El Mikati ◽  
Julie Pike ◽  
Lisa Smith ◽  
Carol Boushey ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Dietary Guidelines ◽  
Assessment System ◽  
Oral Glucose ◽  
Food Record ◽  
Cross Sectional ◽  
Added Sugar ◽  
Added Sugars ◽  
Normal Status

Abstract Objectives American adolescents have a nutrient-poor diet pattern, which is particularly high in added sugars, putting them at risk for obesity and type 2 diabetes (T2D). We aimed to assess dietary intake of added sugars in adolescents and relationships with glycemia and body mass index (BMI). Methods Cross-sectional, baseline measures were obtained from an ongoing, randomized controlled behavioral intervention to prevent adolescent T2D. Participants, using the Technology Assisted Dietary Assessment system (TADA), created a mobile, imaged-based, four-day food record which the Nutrition Data System for Research (NDSR, University of Minnesota, Minneapolis, MN) analyzed. Glucose dynamics were measured at fasting and during an oral glucose tolerance test (OGTT), using point of care instruments (DCA Analyzer, Siemens Medical Solutions, Malvern, PA; YSI Analyzers, Xylem Inc., Yellow Springs, OH). High added sugar intake was defined as consuming above the recommendation of 10% of calories from the US Dietary Guidelines. Independent sample T-tests assessed the differences between groups consuming high versus recommended amounts of added sugars. Values are expressed as mean ± standard deviation. Results Thirty-one adolescents, ages 15.5 ± 2.4 years, were screened. The sample was composed of 12 boys and 19 girls, and 45% had prediabetes. The BMI of the sample was 34.3 ± 6.8 kg/m2 with no differences between normal status and prediabetes groups. Similarly, normal status (11.2 ± 4.6%) and prediabetes (11.3 ± 5.0%) groups each consumed excess amounts of added sugars with no differences between groups. There were no significant differences between glycated hemoglobin (HbA1c, 5.5 ± 0.5% and 5.3 ± 0.2%), 2 hour glucose concentrations (125.4 ± 28.7 mg/dL and 111.9 ± 22.0 mg/dL), or BMI (33.9 ± 6.0 kg/m2 and 34.9 ± 8.2 kg/m2) between the groups with high versus recommended intakes of added sugar, respectively. The fasting plasma glucose concentrations in the group with high intakes of added sugar tended to be higher compared to the group with recommended intake of added sugar (94.6 ± 5.7 mg/dL versus 90.8 ± 5.1 mg/dL, P = 0.095). Conclusions Fasting glucose may be higher in adolescents consuming excess compared to recommended amounts of added sugars. This research highlights the need for additional research to clarify the metabolic consequences of high amounts of added sugars in the diets of adolescents with obesity and a risk for developing type 2 diabetes. Funding Sources McKinley Foundation, Indiana CTSI Project Development Team UL1TR002529.

Risk assessment of adult residents in ile-ife, South-Western Nigeria for type 2 diabetes mellitus

2013 ◽  
pp. 1-1
Author(s):  
Gbadebo Ajani ◽  
Rosemary Ikem ◽  
Adenike Enikuomehin ◽  
David Soyoye ◽  
Babatope Kolawole
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Type 2 Diabetes Mellitus

Cinammon (Cinnamomum Spp.) and Type 2 Diabetes Mellitus

2019 ◽  
Vol 18 (3) ◽  
pp. 247-255
Author(s):  
Sierra-Puente D. ◽  
Abadi-Alfie S. ◽  
Arakanchi-Altaled K. ◽  
Bogard-Brondo M. ◽  
García-Lascurain M. ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Fasting Blood Glucose ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Key Aspects

Spices such as cinnamon (Cinnamomum Spp.) have been of interest due to their phytochemical composition that exert hypoglycemic effects with potential for management of type 2 diabetes mellitus (T2DM). We summarize data from 27 manuscripts that include, one book chapter, 3 review articles, 10 randomized controlled trials, 4 systematic reviews with meta-analysis, and 9 preclinical studies. The most frequently used cinnamon variety was Cinnamomum cassia rather than the Cinnamomum zeylanicum, whereas outcomes were defined as fasting blood glucose, glycated hemoglobin, and oral glucose tolerance test. A great variability in methodology such as different doses (from 120 mg to 6 g), duration of intervention, data retrieved and use of different concomitant medication, were found to be key aspects of most of trials and systematic reviews with meta-analysis available to date. Low quality studies have been made in most cases with a lot of heterogeneity clouding significance of results. More research needs to be done in order to yield accurate evidence for evidence-based recommendations. Its use is not currently a reliable nor advisable option for the treatment of T2DM.

scholarly journals Skin autofluorescence predicts new cardiovascular disease and mortality in people with type 2 diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henderikus E. Boersma ◽  
Robert P. van Waateringe ◽  
Melanie M. van der Klauw ◽  
Reindert Graaff ◽  
Andrew D. Paterson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Fasting Blood Glucose ◽  
Multivariable Analysis ◽  
Oral Glucose ◽  
Skin Autofluorescence ◽  
Z Score

Abstract Background Skin autofluorescence (SAF) is a non-invasive marker of tissue accumulation of advanced glycation endproducts (AGE). Recently, we demonstrated in the general population that elevated SAF levels predict the development of type 2 diabetes (T2D), cardiovascular disease (CVD) and mortality. We evaluated whether elevated SAF may predict the development of CVD and mortality in individuals with T2D. Methods We included 2349 people with T2D, available baseline SAF measurements (measured with the AGE reader) and follow-up data from the Lifelines Cohort Study. Of them, 2071 had no clinical CVD at baseline. 60% were already diagnosed with diabetes (median duration 5, IQR 2–9 years), while 40% were detected during the baseline examination by elevated fasting blood glucose ≥7.0 mmol/l) and/or HbA1c ≥6.5% (48 mmol/mol). Results Mean (±SD) age was 57 ± 12 yrs., BMI 30.2 ± 5.4 kg/m2. 11% of participants with known T2D were treated with diet, the others used oral glucose-lowering medication, with or without insulin; 6% was using insulin alone. Participants with known T2D had higher SAF than those with newly-detected T2D (SAF Z-score 0.56 ± 0.99 vs 0.34 ± 0.89 AU, p < 0.001), which reflects a longer duration of hyperglycaemia in the former group. Participants with existing CVD and T2D had the highest SAF Z-score: 0.78 ± 1.25 AU. During a median follow-up of 3.7 yrs., 195 (7.6%) developed an atherosclerotic CVD event, while 137 (5.4%) died. SAF was strongly associated with the combined outcome of a new CVD event or mortality (OR 2.59, 95% CI 2.10–3.20, p < 0.001), as well as incidence of CVD (OR 2.05, 95% CI 1.61–2.61, p < 0.001) and death (OR 2.98, 2.25–3.94, p < 0.001) as a single outcome. In multivariable analysis for the combined endpoint, SAF retained its significance when sex, systolic blood pressure, HbA1c, total cholesterol, eGFR, as well as antihypertensive and statin medication were included. In a similar multivariable model, SAF was independently associated with mortality as a single outcome, but not with incident CVD. Conclusions Measuring SAF can assist in prediction of incident cardiovascular disease and mortality in individuals with T2D. SAF showed a stronger association with future CVD events and mortality than cholesterol or blood pressure levels.

scholarly journals Early vascular aging risk assessment in patients with metabolic syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Salasyuk ◽  
S Nedogoda ◽  
I Barykina ◽  
V Lutova ◽  
E Popova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Metabolic Syndrome ◽  
Vascular Aging ◽  
Clinical Markers ◽  
Cvd Risk ◽  
Vascular Age

Abstract Background Metabolic syndrome (MetS) and abdominal obesity are one of the most common CVD risk factors among young and mature patients. However, the currently used CVD risk assessment scales may underestimate the CV risk in people with obesity and MS. Early vascular aging rather than chronological aging can conceptually offer better risk prediction. MetS, as accumulation of classical risk factors, leads to acceleration of early vascular aging. Since an important feature of MetS is its reversibility, an adequate risk assessment and early start of therapy is important in relation to the possibilities of preventing related complications. Purpose To derive a new score for calculation vascular age and predicting EVA in patients with MetS. Methods Prospective open cohort study using routinely collected data from general practice. The derivation cohort consisted of 1000 patients, aged 35–80 years with MetS (IDF,2005 criteria). The validation cohort consisted of 484 patients with MetS and carotid-femoral pulse wave velocity (cfPWV) values exceeding expected for average age values by 2 or more SD (EVA syndrome). Results In univariate analysis, EVA was significantly correlated with the presence of type 2 diabetes and clinical markers of insulin resistance (IR), body mass index (BMI), metabolic syndrome severity score (MetS z-score), uric acid (UA) level, hsCRP, HOMA-IR, total cholesterol (TC), triglycerides (TG), heart rate (HR), central aortic blood pressure (CBP), diastolic blood pressure (DBP). Multiple logistic regression shown, that presence of type 2 diabetes and IR were associated with greater risk of EVA; the odds ratios were 2.75 (95% CI: 2.34, 3.35) and 1.57 (95% CI: 1.16, 2.00), respectively. In addition, the risk of having EVA increased by 76% with an increase in HOMA-IR by 1 unit, by 17% with an increase in hsCRP by 1 mg/l, by 4% with an increase in DBP by 1 mm Hg, and by 1% with each 1 μmol / L increase in the level of UA. The area under the curve for predicting EVA in patients with MetS was 0,949 (95% CI 0,936 to 0,963), 0,630 (95% CI 0,589 to 0,671), 0,697 (95% CI 0,659 to 0,736) and 0,686 (95% CI 0,647 to 0,726), for vascular age, calculated from cfPWV, SCORE scale, QRISK-3 scale and Framingham scale, respectively. Diabetes mellitus and clinical markers of IR (yes/no), HOMA-IR and UA level were used to develop a new VAmets score for EVA prediction providing a total accuracy of 0.830 (95% CI 0,799 to 0,860). Conclusion cfPWV at present the most widely studied index of arterial stiffness, fulfills most of the stringent criteria for a clinically useful biomarker of EVA in patients with MetS. Although, parallel efforts for effective integration simple clinical score into clinical practice have been offered. Our score (VAmets) may accurately identify patients with MetS and EVA on the basis of widely available clinical variables and classic cardiovascular risk factors can prioritize using of vascular age in routine care. ROC-curves for predicting EVA in MetS Funding Acknowledgement Type of funding source: None

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