Subclinical States of Glucose Intolerance and Risk of Death in the U.S.

Saydah, Sharon; Loria, Catherine M.; Eberhardt, Mark S.; Brancati, Frederick L.

doi:10.2337/diacare.24.3.447

Cited by 218 publications

(136 citation statements)

References 26 publications

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“…In the general population, there is evidence from several epidemiologic trials that up to 50% of patients whose diabetes is diagnosed by 2HBG will have FBG Ͻ126 mg/dl (7.0 mmol/L) (12,23,32,33), and a similar prevalence was observed in this small study. In nontransplant subjects, the 2HBG is more sensitive at diagnosing IGT than FBG (34) and is also a more sensitive predictor of cardiovascular mortality and all-cause mortality than FBG (10,35,36).…”

Section: Screening and Diagnostic Recommendations For Ptd And Igt In Rtrsupporting

confidence: 67%

Should an Oral Glucose Tolerance Test Be Performed Routinely in All Renal Transplant Recipients?

Armstrong

Prins

Beller

et al. 2006

Clinical Journal of the American Society of Nephrology

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Posttransplantation diabetes (PTD) contributes to cardiovascular disease and graft loss in renal transplant recipients (RTR). Current recommendations advise fasting blood glucose (FBG) as the screening and diagnostic test of choice for PTD. This study sought to determine (1) the predictive power of FBG with respect to 2-h blood glucose (2HBG) and (2) the prevalence of PTD using FBG and 2HBG compared with that using FBG alone, in prevalent RTR. A total of 200 RTR (mean age 52 yr; 59% male; median transplant duration 6.6 yr) who were >6 mo posttransplantation and had no known history of diabetes were studied. Patients with FBG <126 mg/dl (7.0 mmol/L; n ‫؍‬ 188) underwent an oral glucose tolerance test (OGTT). Receiver operating characteristic analyses evaluated the optimal level of FBG predictive of PTD (2HBG >200 mg/dl [11.1 mmol/L]) and impaired glucose tolerance (IGT; 2HBG 140 to 200 mg/dl [7.8 to 11.0 mmol/L]). An abnormal OGTT was reported in 79 (42%) nondiabetic RTR: PTD (n ‫؍‬ 22) and IGT (n ‫؍‬ 57). The optimal FBG that was predictive of PTD was 101 mg/dl (5.6 mmol/L; area under the curve 0.70; sensitivity 64%, specificity 67%, positive predictive value 20%, negative predictive value 93%). The optimal FBG that was predictive of IGT was less well defined (area under the curve 0.54). The prevalence of PTD was higher by OGTT than by FBG alone (17 versus 6%; P < 0.001). FBG may not be the optimal screening or diagnostic tool for PTD or IGT in RTR. Consideration should be given to introducing the OGTT as a routine posttransplantation investigation, although the implications of a pathologic OGTT are still to be determined in this population.

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Section: Screening and Diagnostic Recommendations For Ptd And Igt In Rtrsupporting

confidence: 67%

Should an Oral Glucose Tolerance Test Be Performed Routinely in All Renal Transplant Recipients?

Armstrong

Prins

Beller

et al. 2006

Clinical Journal of the American Society of Nephrology

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“…Indeed, the prevalence of macrovascular disease in undiagnosed diabetes has been suggested to be approximately equal to that of diagnosed diabetes, both being at least twice that for patients without diabetes (3). The Second National Health and Nutrition Examination Survey data (3) suggests that approximately 50% of participants with diabetes in all age groups are previously undiagnosed, and this trend has been further corroborated by several other population studies (18)(19)(20)(21). In higher risk populations such as patients undergoing cardiac bypass surgery, the prevalence of undiagnosed diabetes was found to be 5.2%, compared to 29.6% of participants with diagnosed diabetes, which is similar to estimates from our study (5).…”

Section: Discussionsupporting

confidence: 80%

Severity of coronary artery disease and retinal microvascular signs in patients with diagnosed versus undiagnosed diabetes: cross-sectional study

et al. 2016

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Background: There is increasing evidence that a considerable proportion of patients with diabetes remain undiagnosed and untreated, however, it is unclear whether this is associated with more severe coronary artery disease (CAD) and microvasculature changes compared with diagnosed patients. We assessed CAD extent and severity, along with changes to the retinal microvascular structure in participants with undiagnosed versus diagnosed type 2 diabetes. Methods: Participants of the Australian Heart Eye Study were stratified into participants with previously diagnosed diabetes (n=489), undiagnosed diabetes (n=76) and no diabetes (n=1,112). Retinal vessel caliber was measured from digital retinal images. Extent and severity of CAD was assessed using Extent and Gensini scores from angiography findings, respectively.Results: Participants with undiagnosed and diagnosed diabetes versus those with no diabetes (reference group) had increased odds of being in the highest quartile of Gensini scores, multivariate adjusted odds ratios (OR) =7.02 [95% confidence interval (CI), 2.04-24.1] and OR =2.76 (95% CI, 1.67-4.55), respectively.Participants with undiagnosed and diagnosed diabetes versus those with no diabetes also had increased odds of being in the highest quartile of Extent scores, multivariate adjusted OR =7.63 (95% CI, 2.15-27.10) and OR =3.72 (95% CI, 2.22-6.27), respectively. No significant differences were observed in retinal vessel caliber between participants with undiagnosed versus diagnosed diabetes.Conclusions: The present study demonstrated that participants with undiagnosed diabetes compared to those with previously diagnosed diabetes, had a stronger likelihood of having more severe and extensive CAD. However, retinal microvascular signs did not differ by diabetes status.

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“…In addition, the highest diabetes risk group (patients with HGA use) had risks for mortality similar to men who had incident NF-CVD and no incident diabetes. Previous studies also have shown a risk gradient with glucose (38) or HbA 1c levels (39) (not available in MRFIT). The Cardiovascular Health Study focused on older adults and found the prevalence of both clinical and subclinical CVD, as well as the proportion of clinical disease relaIncident diabetes, nonfatal CVD, and mortality tive to subclinical disease, to be higher in patients with glucose disorders than in subjects with normoglycemia (40).…”

Section: Statistical Analysesmentioning

confidence: 99%

Impact of Incident Diabetes and Incident Nonfatal Cardiovascular Disease on 18-Year Mortality

et al. 2003

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FOR THE MULTIPLE RISK FACTOR INTERVENTION TRIAL RESEARCH GROUPOBJECTIVE -To report long-term risks for total, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality associated with incident diabetes (using current diagnostic criteria) and with incident nonfatal CVD (NF-CVD).RESEARCH DESIGN AND METHODS -A total of 11,645 participants without diabetes or CVD at baseline from the Multiple Risk Factor Intervention Trial who survived to the end of the trial were grouped by during-trial incident diabetes and/or NF-CVD events: neither diabetes nor NF-CVD, diabetes only, NF-CVD only, or both diabetes and NF-CVD. Incident diabetes was defined by use of hypoglycemic agents or fasting glucose Ն126 mg/dl at any time over the 6 trial years. Proportional hazards models tested group differences in mortality over 18 post-trial years.RESULTS -Among 3,859 total deaths were 1,846 from CVD and 1,277 from CHD, with death rates per 10,000 person-years of 203, 97, and 67, respectively. Multivariate-adjusted hazard ratios (HRs) for total mortality were 2.75 (P Ͻ 0.0001) for those with NF-CVD and diabetes both, 1.92 (P Ͻ 0.0001) for those with NF-CVD only, and 1.49 (P Ͻ 0.0001) for those with diabetes only, relative to neither diabetes nor NF-CVD. NF-CVD was associated with a higher hazard of death than diabetes for total (HR 1.29, P ϭ 0.0004), CVD (HR 1.76, P Ͻ 0.0001), and CHD (HR 1.88, P Ͻ 0.0001) mortality. Only the subgroup of participants on hypoglycemic agents showed an equivalent risk of total mortality relative to participants with NF-CVD (HR 0.93, P ϭ 0.54).CONCLUSIONS -Current diabetes diagnostic criteria conferred significantly increased total, CVD, and CHD mortality risks independent of the impact of NF-CVD. NF-CVD was more strongly predictive of mortality.

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Subclinical States of Glucose Intolerance and Risk of Death in the U.S.

Cited by 218 publications

References 26 publications

Should an Oral Glucose Tolerance Test Be Performed Routinely in All Renal Transplant Recipients?

Should an Oral Glucose Tolerance Test Be Performed Routinely in All Renal Transplant Recipients?

Severity of coronary artery disease and retinal microvascular signs in patients with diagnosed versus undiagnosed diabetes: cross-sectional study

Impact of Incident Diabetes and Incident Nonfatal Cardiovascular Disease on 18-Year Mortality

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