Performance of homeostasis model assessment and serum high‐sensitivity C‐reactive protein for prediction of isolated post‐load hyperglycaemia

Lai, Yerui; Li, H.-Y.; Hung, Chi‐Feng; Lin, Ming-Chia; Shih, Shyang–Rong; Ma, Wei; Hua, Cyue-Huei; Chuang, Lee‐Ming; Sung, Feng-Yu; Wei, Jung Nan

doi:10.1111/dme.12008

Cited by 4 publications

(4 citation statements)

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“…In support of our findings, several studies have shown that the prevalence of isolated post-load hyperglycemia (IPH) increased with age in non-pregnant adults [15–20]. In the DECODE study, IPH was more prevalent in women than in men in all age groups [21].…”

Section: Discussionsupporting

confidence: 89%

“…This is different from the situation in many healthcare systems and countries, especially in most developed countries, where women get pregnant at older ages [12–14]. Besides, in non-pregnant adults, diagnosis of diabetes using FPG criteria alone would miss a significant proportion of older subjects with diabetes [15, 16]. These data suggest that a screening strategy for GDM based on an FPG cutoff value may not be appropriate when women become pregnant at an older age.…”

Section: Introductionmentioning

confidence: 99%

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Screening gestational diabetes mellitus: The role of maternal age

et al. 2017

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ObjectiveUsing a specific cutoff of fasting plasma glucose (FPG) to screen gestational diabetes mellitus (GDM) can reduce the use of oral glucose tolerance tests (OGTT). Since the prevalence of GDM increases with age, this screening method may not be appropriate in healthcare systems where women become pregnant at older ages. Therefore, we aimed to develop a screening algorithm for GDM that takes maternal age into consideration.MethodsWe included 945 pregnant women without history of GDM who received 75g OGTT to diagnose GDM in 2011. Screening algorithms using FPG with or without age were developed. Another 362 pregnant women were recruited in 2013–2015 as the validation cohort.ResultsUsing FPG criteria alone, more GDM diagnoses were missed in women ≥35 years than in women <35 years (13.2% vs. 5.8%, p <0.001). Among GDM women ≥35 years, 63.6% had FPG <92 mg/dL (5.1 mmol/L). Use of the algorithm with an “age plus FPG” cutoff could reduce the use of OGTT (OGTT%) from 77.6% to 62.9%, while maintaining good sensitivity (from 91.9% to 90.2%) and specificity (from 100% to 100%). Similar reduction in OGTT% was found in the validation cohort (from 86.4% to 76.8%). In the simulation, if the percentage of women ≥35 years were 40% or more, the screening algorithm with an “age plus FPG” cutoff could further reduce OGTT% by 11.0%-18.8%.ConclusionsA screening algorithm for GDM that takes maternal age into consideration can reduce the use of OGTT when women become pregnant at older ages.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Screening gestational diabetes mellitus: The role of maternal age

et al. 2017

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“…In nonpregnant adults, plasma glucose levels increase with age [16]. Several studies have shown that glucose tolerance declines progressively with age [17][18][19][20][21][22][23][24]. Aging-related glucose intolerance is more prominent in the third decade and continues throughout adulthood [25,26].…”

Section: Plos Onementioning

confidence: 99%

Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study

et al. 2020

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Aim The addition of maternal age to fasting plasma glucose (FPG) at 24-28 gestational weeks improves the performance of GDM screening as maternal age increases. However, this method delays the diagnosis of GDM. Since FPG at the first prenatal visit (FPV) is a screening option for pre-existing diabetes, we evaluated the performance of age plus FPG at the FPV to reduce the need for the OGTT. Methods Pregnant women were recruited consecutively in 2013-2018 (the training cohort) and 2019 (the validation cohort). We excluded women with twin pregnancies, unavailable FPG at the FPV or OGTT data, pre-pregnancy diabetes, or a history of GDM. All participants underwent FPG and haemoglobin A1c (HbA1c) at the FPV and received 75-g OGTT at 24-28 gestational weeks if FPG at the FPV was <92 mg/dL. GDM was diagnosed by the IADPSG criteria. Two algorithms were developed with the cutoffs determined when the percentage requiring OGTT (OGTT%) was the lowest and the sensitivity was �90%. Results The incidence of GDM increased with age. The "FPG at the FPV" algorithm reduced OGTT % to 68.8% with the FPG cutoff at 79 mg/dl. The "age plus FPG at the FPV" algorithm, with the cutoff of 114, further reduced OGTT% to 58.3%, with the sensitivity of 90.7% (9.3% GDM missed) and the specificity of 100%. These findings were replicated in the validation cohort.

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“…Of the patients with type 2 diabetes, 16.1% were treated with insulin, and 90.4% were treated with oral antidiabetic agents. Nondiabetic individuals were invited from the Taiwan Lifestyle Study (Lai et al, 2013), which is a cohort study of the local community in Yun-Lin, Taiwan, that enrolled subjects older than 18 years who did not report having diabetes during an interview. The nondiabetic subjects were volunteers with a mean age of 48 ± 11 years and an apparently healthy medical history.…”

Section: Participantsmentioning

confidence: 99%

Decreased glomerular filtration rate and increased albuminuria for identification of cardiovascular autonomic neuropathy in subjects with and without diabetes

Lai

Jiang

et al. 2021

Autonomic Neuroscience

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The purpose of this study was to determine the relationship between chronic kidney disease (CKD) and cardiovascular autonomic neuropathy (CAN). Research design and methods: From October 2008 to May 2011, we enrolled 218 patients with diabetes and 62 nondiabetic subjects. Heart rate variability was represented as the maximal heart rate minus the minimal heart rate (HR max-min) during a one-minute deep breathing test. Normal, impaired cardiovascular autonomic function and CAN were defined as s HR max-min > 15 beats/min, HR max-min of 10-15 beats/min and HR max-min < 10 beats/ min, respectively. CKD was diagnosed if the estimated glomerular filtration rate (eGFR) was <60/min/1.73 m 2 or albuminuria. Results: In our sample, 19.4% of nondiabetic subjects and 49.5% of diabetic subjects had CKD. The prevalence of CAN was higher among patients with diabetes than among nondiabetic subjects (26.4 vs. 4.9%). A significant association was observed between eGFR and HR max-min. CAN was independently associated with CKD with an adjusted odds ratio of 2.77 (95% CI, 1.15-6.68) in diabetic patients. A positive linear trend was observed for the odds of CAN with increasing CKD severity in diabetes. The areas under the curve (AUCs) for the predictive ability of eGFR for the risk of impaired cardiovascular autonomic function for nondiabetic group and CAN for the diabetic group were 0.734 and 0.703, respectively. Adding age, sex, body mass index, and albuminuria to the prediction model increased the AUCs to 0.852 and 0.791, respectively. Conclusion: CKD is associated with the risk of CAN in both nondiabetic and diabetic subjects. eGFR and albuminuria improve the prediction of CAN.

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Performance of homeostasis model assessment and serum high‐sensitivity C‐reactive protein for prediction of isolated post‐load hyperglycaemia

Cited by 4 publications

References 30 publications

Screening gestational diabetes mellitus: The role of maternal age

Screening gestational diabetes mellitus: The role of maternal age

Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: A prospective cohort study

Decreased glomerular filtration rate and increased albuminuria for identification of cardiovascular autonomic neuropathy in subjects with and without diabetes

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