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Clinical Implications of Using Post-Challenge Plasma Glucose Levels for Early Diagnosis of Type 2 Diabetes Mellitus in Older Individuals
Kyong Hye Joung, Sang Hyun Ju, Ji Min Kim, Sorim Choung, Jae Min Lee, Kang Seo Park, Hyun Jin Kim, Bon Jeong Ku
Diabetes Metab J. 2018;42(2):147-154.   Published online February 13, 2018
DOI: https://doi.org/10.4093/dmj.2018.42.2.147
  • 4,590 View
  • 36 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFPubReader   
Background

The aim of this study was to explore the differences in the clinical characteristics and diagnostic rates of diabetes mellitus (DM) according to various criteria in different age groups and to evaluate the efficacy of each criterion for screening older patients.

Methods

We studied 515 patients and measured the fasting plasma glucose level (FPG), 2-hour plasma glucose level after the 75 g oral glucose tolerance test (2-hour postload glucose [2-h PG]), and glycosylated hemoglobin (HbA1c) for re-evaluation of hyperglycemia without a history of diabetes. Patients with newly diagnosed DM were grouped by age as younger (<65 years) or older (≥65 years).

Results

Older patients had significantly lower HbA1c, FPG, and 2-h PG levels and a higher homeostatic level of pancreatic β-cell function compared with younger patients (P<0.001). The older group had the lowest diagnostic rate when using the FPG level (45.5%) and the highest diagnostic rate when using the 2-h PG level (84.6%). These results were mostly due to the higher frequency of isolated post-challenge hyperglycemia in the older patients than in the younger group (28.8% vs. 9.2%). The use of both the FPG and HbA1c levels significantly enhanced the low diagnostic power when employing only the FPG levels in the older group (71.2% vs. 45.5%).

Conclusion

In the older patients, the 2-h PG level was the most accurate diagnostic criterion. When we consider the costs and convenience, a combination of the FPG and HbA1c criteria may be recommended as a screening test for DM in older people.

Citations

Citations to this article as recorded by  
  • International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes
    Michael Bergman, Melania Manco, Ilhan Satman, Juliana Chan, Maria Inês Schmidt, Giorgio Sesti, Teresa Vanessa Fiorentino, Muhammad Abdul-Ghani, Ram Jagannathan, Pramod Kumar Thyparambil Aravindakshan, Rafael Gabriel, Viswanathan Mohan, Martin Buysschaert,
    Diabetes Research and Clinical Practice.2024; 209: 111589.     CrossRef
  • A unified technique for entropy enhancement based diabetic retinopathy detection using hybrid neural network
    Fatima, Muhammad Imran, Anayat Ullah, Muhammad Arif, Rida Noor
    Computers in Biology and Medicine.2022; 145: 105424.     CrossRef
  • In-silico identification of peroxisome proliferator-activated receptor (PPAR)α/γ agonists from Ligand Expo Components database
    Xiao-Yan Feng, Ting-Ting Ding, Ya-Ya Liu, Wei-Ren Xu, Xian-Chao Cheng
    Journal of Biomolecular Structure and Dynamics.2021; 39(5): 1853.     CrossRef
The Effects of D-Chiro-Inositol on Glucose Metabolism in 3T3-L1 Cells.
Kang Seo Park, Jae Min Lee, Bon Jeong Ku, Young Suk Jo, Seong Kyu Lee, Kyung Wan Min, Kyung Ah Han, Hyo Jeong Kim, Hyun Jin Kim
Korean Diabetes J. 2008;32(3):196-203.   Published online June 1, 2008
DOI: https://doi.org/10.4093/kdj.2008.32.3.196
  • 2,498 View
  • 26 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
The target of the treatment of metabolic syndrome and diabetes is an improvement of insulin resistance. D-chiro-inositol (DCI) plays a role in a phospholipid mediating intracellular insulin action. In the previous studies, the urine level of DCI were decreased in the diabetic animal with insulin resistance. Some clinical studies showed that DCI improved a glucose level and HbA1c. Therefore we studied the relationship between DCI and glucose metabolism, especially insulin resistance. METHODS: To investigate the mechanism of DCI affecting the glucose metabolism, we examined the effects of DCI on 2-deoxyglucose uptake, gene expression of adipocytokines and AMPK pathway by using RT-PCR and western blot in 3T3-L1 cells. RESULTS: Insulin-stimulated 2-deoxyglucose uptake increased in DCI-treated cells by about 1.2-fold (relative to the control) and was inhibited by phosphoinositide 3-kinase (PI3 Kinase) inhibitors (Wortmanin, LY294002) and AMPK inhibitor (STO-609). In Western blot analysis, it didn't show the difference of phosphorylation of Akt and AMPK between DCI-treated group and control in 3T3-L1 cells. However, DCI decreased the gene expression of resistin in 3T3-L1 cells. CONCLUSION: DCI may involve other pathway of insulin signaling, but not PI3 Kinase and AMPK signaling pathways and it may be useful in managing metabolic syndrome by improving insulin resistance through increasing glucose uptake and decreasing resistin relevant to insulin resistance.

Citations

Citations to this article as recorded by  
  • Variation of Pinitol Content for Domestic Legume Species in Korea
    Seung-Min Seo, Yeon-Shin Jeong, Dhakal Krisna Hari, Dong-Hyun Shin, In-Jung Lee, Eun-Sook Park, Jeong-Dong Lee, Young-Hyun Hwang
    Korean Journal of Crop Science.2011; 56(1): 50.     CrossRef
Case Report
A case of Rhino-Orbital Mucormycosis in Newly Diagnosed type 1 Diabetic patient.
Jae Min Lee, Kyu Yuop Hwang, Gi Young Choi, Hyo Jung Nam, Dong Hyun Seo, Sun Hyun Park, Jun hwa Hong, Hyun Jin Kim, Kang Seo Park
Korean Diabetes J. 2005;29(5):495-499.   Published online September 1, 2005
  • 1,125 View
  • 16 Download
AbstractAbstract PDF
Rhino-orbital mucormycosis was a rare, but mostly fatal fungal infection, usually found in poorly controlled diabetics or other immunocompromised hosts. This fungal infection begins from the nose, and rapidly spreads to the paranasal sinus (PNS), orbits and central nervous system(CNS), and finally extends to the entire organ. Early diagnosis and treatment is the only way to increase the survival rate. Herein Is reported We experienced a case of rhino-orbital mucormycosis, with type 1 diabetes mellitus, which was confirmed by a maxillary sinus biopsy. A 38-year-old male had been frequently treated for tonsillitis, but with no history of diabetes mellitus. He was admitted with mental change, accompanied by a fever, facial tenderness and swelling, with progressive visual acuity loss. During admission, CT and MRI of the in orbital area were performed. A biopsy in of the nasal cavity was also performed, and the mucormycosis was diagnosed through the pathological finding. The patient was treated with intravenous amphotericn B and an endoscopic antrostomy.
Original Article
Change of Cardiac Function and NT-proBNP According to Degree of Albuminuria in Type 2 Diabetic Patients.
Bon Jeong Ku, Jeong Hee Kim, Jin Ok Jeong, Eun Seok Jeon, Dong Hyun Seo, Jae Min Lee, Si Wan Choi, In Whan Seong, Young Kun Kim
Korean Diabetes J. 2004;28(1):28-35.   Published online February 1, 2004
  • 1,075 View
  • 18 Download
AbstractAbstract PDF
BACKGROUND
The prevalence of diabetes mellitus has increased recently. The morbidity and mortality of diabetic patients are mainly caused by chronic complications, especially cardiovascular events. N-terminal proB-type natriuretic peptide(NT-proBNP) is a neurohormone that is secreted from ventricular myocardium due to myocardial dilatation or pressure overload. NT-proBNP has prognostic value, and reflects cardiac function in patients with myocardial infarction or heart failure. This study was performed to evaluate functional changes of the heart, according to the degree of albuminuria and the prognostic value of NT-proBNP in type 2 diabetic patients. METHODS: 57 patients with type 2 diabetes were divided into three groups according to their degree of albuminuria, these being normal(below 30mg/day), microalbuminuria(30 between 300mg/day) and overt proteinuria(over 300mg/ day). The clinical parameters in each of the patients were evaluated, echocardiography performed and the levels of NT-proBNP checked, and compared between the three groups. RESULTS: Of the 57 patients with type 2 diabetes the male:female ratio of 32:25, with mean age, duration of diabetes and BMI of 55.8+/-10.1 and 11.3+/-8.2 years, and 23.2+/-4.0kg/m2, respectively. Twenty-eight patients showed normal(49.1%), 15 microalbuminuria(26.3%) and 14 overt proteinuria(24.6%). The age, BMI, diastolic BP and glycosylated hemoglobin showed no significant difference between the three groups. The duration of diagnosed diabetes was significantly longer, the systolic blood pressure and serum creatinine levels significantly higher and the serum hemoglobin significantly lower (p<0.05) in the overt proteinuria compared to the normal group. The duration of diabetes was significantly longer and serum creatinine levels significantly higher in the overt proteinuria than the microalbuminuria group(p<0.05). The echocardiographic data showed no difference among the groups. The NT-proBNP levels also showed no significant difference, but tended to be elevated toward albuminuria. CONCLUSION: The cardiac function and NT-proBNP levels showed no significant difference between each of the albuminuric groups. This study suggests that the degree of albuminuria is not a predictive factor for changes of the cardiac function and NT-proBNP levels

Diabetes Metab J : Diabetes & Metabolism Journal