The simultaneous assessment of glycosylated hemoglobin, fasting plasma glucose and oral glucose tolerance test does not improve the detection of type 2 diabetes mellitus in Colombian adults

Objective.To elucidate the specific features of diagnostics, clinical course and manifestations of type 2 diabetes mellitus (DM2) in the children of the Russian population.Material and methods.A total of 80 children presenting with DM2 were enrolled in the study including 70 available for the dynamic examination, with the follow-up period of 2.6 years (1.5; 4.5). The general clinical examination of the patients was supplemented by measuring insulin secretion, studying HLA-polymorphism of the DQ and DR-genes, and determination of type 1 diabetes (DM1) — related specific antibodies (At).Results.The median age at diagnosis of DM2 was 13 years (11.5; 15.5). 58.8% of the children had a family history of DM2 but only 26.3% of them had classical complaints of diabetes mellitus. In 65% of the children, DM2 was diagnosed when they were passing medical examination in connection with obesity (in 51.9% with the use the oral glucose tolerance test (OGTP); 48.1% of these children had the fasting blood glucose level above 7.0 mmol/l. Ketonuria at the onset of the disease was documented in 21.3% of the patients while 85% were either obese or overweight. Antibodies (ICA and IAA) were detected in 15.2% of the children at a low titer. The HLA-genotype associated with a high risk of development of DM1 was identified in 5.5% of the cases. The glycosylated hemoglobin test revealed its mean level of 7.1% (6.3; 8.5%) at the onset of diabetes; in the majority of the children, it fell down below 6.5% within the first 3 years of the disease. During this period, insulin and C-peptide secretion remained elevated. Insulin resistance was initially documented in 81.3% of the children; the dynamic observation failed to show its appreciable decrease. Insulin therapy initiated at the onset of the disease was prescribed to 30% of the patients. After 3 years, only 8% of the children retaining endogenous insulin secretion continued to use insulin.Conclusion.The asymptomatic onset of type 2 diabetes mellitus in the children and adolescents emphasizes the importance of its active diagnostics during the pubertal period in the high risk groups comprising the patients with obesity and the family history of DM2. In one third of the children, the diagnosis of DM2 was possible only with the use the oral glucose tolerance test. DM2 in the children and adolescents is characterized by clinical polymorphism in the form of acute manifestations in 21% of the cases and the absence of obesity and insulin resistance in 15 and 18% respectively. This finding suggests the necessity of differential diagnostics of such cases from DM1 and MODY. Rather high insulin and C-peptide secretion persists for 3 years after the onset of DM2 in the children. Therefore, they do not need insulin therapy during this period. The presence of ICA and IAA antibodies at low titers does not compromise diagnosis of DM2.

Download Full-text

Fasting Insulin is Better Partitioned according to Family History of Type 2 Diabetes Mellitus than Post Glucose Load Insulin of Oral Glucose Tolerance Test in Young Adults

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2017/27684.9910 ◽

2017 ◽

Author(s):

Saritha Francis

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Fasting Insulin ◽

Oral Glucose Tolerance ◽

Glucose Load ◽

History Of

Download Full-text

The Effect of Prior Gestational Diabetes on the Shape of the Glucose Response Curve during an Oral Glucose Tolerance Test 3 Years after Delivery

Journal of Diabetes Research ◽

10.1155/2020/4315806 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Timea Tänczer ◽

Márk M. Svébis ◽

Beatrix Domján ◽

Viktor J. Horváth ◽

Adam G. Tabák

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Glucose Response

Objective. Monophasic glucose response (MGR) during an oral glucose tolerance test (OGTT) and gestational diabetes mellitus (GDM) are predictors of type 2 diabetes mellitus (T2DM). We investigated the association between current MGR and (1) glucose tolerance during a pregnancy 3 years before and (2) current glucose tolerance status. We also sought (3) other determinants of MGR. Research Design and Methods. We conducted a nested case-control study of GDM (n=47 early GDM, diagnosed between 16 and 20 weeks of gestation; n=40 late GDM, diagnosed between 24 and 28 weeks of gestation) and matched healthy controls (n=37, normal glucose tolerance during pregnancy) all free from diabetes at follow-up 3.4±0.6 years after delivery. Glucose tolerance was determined by 2-hour 75 g OGTT. Monophasic and biphasic groups were defined based on serum glucose measurements during OGTT. Results. The biphasic group was younger, had lower triglyceride levels and area under the OGTT glucose curve, and was less frequently diagnosed with early GDM (25 vs. 45%, all p<0.05). Women with a biphasic response also tended to have lower systolic blood pressure (p<0.1). No differences were found in fasting and 2-hour glucose and insulin levels, or BMI. According to multiple logistic regression, MGR was associated with prior early GDM (OR 2.14, 95% CI 0.92-4.99) and elevated triglyceride levels (OR 2.28, 95% CI 1.03-5.03/log (mmol/l)). Conclusions. We found that more severe, early-onset GDM was an independent predictor of monophasic glucose response suggesting that monophasic response may represent an intermediate state between GDM and manifest type 2 diabetes.

Download Full-text