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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
Perception of Clinicians and Diabetic Patients on the Importance of Postprandial Glucose Control and Diabetes Education Status: A Cross Sectional Survey
Ji Hun Choi, Cheol Young Park, Bong Soo Cha, In Joo Kim, Tae Sun Park, Joong Yeol Park, Kyung Soo Park, Kun Ho Yoon, In Kyu Lee, Sung Woo Park
Diabetes Metab J. 2012;36(2):120-127.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.120
  • 3,834 View
  • 33 Download
  • 5 Crossref
AbstractAbstract PDFPubReader   
Background

Recent studies have shown the importance of postprandial glucose (PPG) in the development of diabetes complications. This study was conducted in order to survey the perceptions of clinicians and diabetic patients with respect to PPG management and the current status of diabetes education.

Methods

This was a cross-sectional study involving face-to-face interviews and an open questionnaire survey conducted in Korea. A total of 300 patients and 130 clinicians completed questionnaires, which included current education status, self monitoring of blood glucose (SMBG), criteria of diagnosis and management, and perceptions relating to PPG management.

Results

While there was a significantly higher perceived need for diabetes education, the sufficiency of the current education was considered to be severely lacking. Fasting plasma glucose (FPG), PPG, and glycosylated hemoglobin (HbA1c) were all important considerations for clinicians when making a diagnosis of diabetes, although PPG was considered less important than FPG or HbA1c in the treatment of diabetes. Most clinicians and patients were aware of the importance of PPG, but actual education on the importance of PPG was not actively being delivered.

Conclusion

Our study showed that the current status of diabetes education is insufficient to meet the needs of the Korean population. A considerable gap was found to exist between awareness and what was actually taught in the current education program in regard to the importance of PPG. These results suggest that clinicians need to be more active in patient education, especially in regard to the importance of PPG.

Citations

Citations to this article as recorded by  
  • Addressing Overbasalization to Achieve Glycemic Targets
    Kevin Cowart, Rachel Franks, Olivia Pane, Ellen Murphy, Kelly Oldziej
    ADCES in Practice.2022; 10(2): 30.     CrossRef
  • Post hoc efficacy and safety analysis of insulin glargine/lixisenatide fixed- ratio combination in North American patients compared with the rest of world
    George Dailey, Harpreet S Bajaj, Terry Dex, Melanie Groleau, William Stager, Aaron Vinik
    BMJ Open Diabetes Research & Care.2019; 7(1): e000581.     CrossRef
  • Experiences of Diabetes Education among Educators of Diabetes : a content analysis approach
    Soo Jin Kang, Soo Jung Chang
    Journal of Korean Public Health Nursing.2016; 30(2): 221.     CrossRef
  • Does Availability of Reliable Home Blood Glucose Data at Diabetes Appointments Improve Glycemia?
    Gillian S. Boyd-Woschinko, David L. Kaiser, Michael Diefenbach, Ronald Tamler
    Endocrine Practice.2014; 20(4): 299.     CrossRef
  • Safety and effectiveness of insulin aspart in type 2 diabetic patients: Results from the ASEAN cohort of the A1chieve study
    Wan Mohamad Wan Bebakar, Mary Anne Lim-Abrahan, Ananá B. Jain, Darren Seah, Pradana Soewondo
    Diabetes Research and Clinical Practice.2013; 100: S17.     CrossRef
Randomized Controlled Trial
Comparative Study about the Effects of Acarbose and Voglibose in Type 2 Diabetic Patients.
In Kyung Jeong, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Yun Ey Chung, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee
Korean Diabetes J. 2002;26(2):134-145.   Published online April 1, 2002
  • 1,199 View
  • 33 Download
AbstractAbstract PDF
BACKGROUND
Acarbose and voglibose are alpha-glucosidase inhibitors. Although different pharmacological effects and adverse abdominal events associated with the two drugs have been reported, no study directly compared acarbose and voglibose in diabetes has been undertaken. To compare the pharmacological effects and gastrointestinal adverse events between two drugs, a randomized, placebo-controlled, double-blind study was performed in type 2 diabetes patients. METHODS: The period of study was 12 weeks (observation period: 4 weeks; treatment period: 8 weeks). Fifty-three patients were randomized into two groups (the acarbose group: 24 patients; the voglibose group: 29 patients). The serum glucose, insulin, fructosamine, HbA1c, cholesterol, triglyceride and the incidence of adverse events were measured. RESULTS: 1) The reduction of glucose from before treatment to 4 weeks after treatment was significantly higher in the acarbose group, but the change before treatment and 8 weeks after treatment in the two groups was similar (p = 0.569). 2) The insulin significantly decreased after voglibose treatment (p = 0.040). 3) HbA1c level tended to decrease in voglibose group, and there was a significant decrease after acarbose treatment. However, the change in HbA1c level before and after treatment was similar between the two groups (p = 0.412). 4) The two drugs did not cause any other changes in the total, HDL-cholesterol and triglyceride. 5) The number of patients with gastrointestinal adverse events was significantly low 4 weeks after voglibose treatment (p = 0.049), but the incidence in the two groups was similar after 8 weeks (p = 0.215). CONCLUSIONS: Acarbose and voglibose significantly improved postprandial hyperglycemia in diabetes. The incidence of gastrointestinal adverse events was low 4 weeks after voglibose treatment.

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