Development of a validated Diabetes risk chart as a simple tool to predict the onset of Diabetes in Bogor, Indonesia / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To develop a simple, non-invasive tool for predicting the onset of type 2 diabetes mellitus (T2DM).@*Methodology@#A total of 4418 nondiabetic respondents living in Bogor were included in this cohort study. Their ages ranged from 25 to 60 years old and were followed for 6 years with interviews, physical examinations and laboratory tests. The investigators used logistic regression to create a tool for diabetes risk determination.@*Results@#The cumulative incidence of T2DM was 17.9%. Risk factors significantly associated with T2DM included age, obesity, central obesity, hypertension and lack of physical activity. The Bogor Diabetes Risk Prediction (BDRP) chart had a cut-off of 0.128, with sensitivity of 76.6% and specificity of 50.3%. The Positive Predictive Value (PPV) was 21.6% and Negative Predictive Value (NPV) was 92.3%. The Area under the Curve (AUC) was 0.70 with a 95% confidence interval ranging from 0.675-0.721.@*Conclusion@#The BDRP chart is a simple and non-invasive tool to predict T2DM. In addition, the BDRP chart is reliable and can be easily used in primary health care.

A cross-sectional survey of patients with diabetic foot in Jinyang Community of Shanghai / 上海预防医学

Objective:To determine the current situation of patients with diabetic foot and influencing factors in Jinyang community of Shanghai. Methods:A total of 1400 patients with diabetes registered in community management from January 2019 through December 2019 were randomly selected for survey. All patients completed the screen for diabetic foot and then were divided into control group （n=159） and observation group （n=1 241） according to the occurrence of diabetic foot. Patient's demographics and medical history were recorded， including gender， age， history of long-term smoking， course of disease， history of trauma infection， fasting blood glucose， 2 h postprandial blood glucose （2hPG）， glycosylated hemoglobin （HbAlc）， blood lipid level， history of hyperglycemia， diabetic nephropathy， and diabetic retinopathy. Univariate and multivariate logistic analyses were performed with these possible influencing factors. Results:Univariate analysis showed that the incidence of diabetic foot was not significantly associated with gender， age， history of trauma infection， course of disease or blood lipid level （P>0.05）， whereas had statistical significance with long-term smoking history， fasting blood glucose and 2-hour diabetes mellitus PG， HbAlc， history of hypertension， diabetic nephropathy and diabetic retinopathy （P<0.05）. Multivariate logistic analysis showed that the incidence of diabetic foot was not statistically associated with gender， age， history of trauma infection， course of disease or blood lipid level （P>0.05）； it was significantly associated with long-term smoking history， fasting blood glucose and 2-hour diabetes mellitus PG， HbAlc， history of hypertension， diabetic nephropathy and diabetic retinopathy （P<0.05）. Conclusion:There are multiple influencing factors of diabetic foot in Jinyang community. We should take corresponding measures to control the blood glucose level of diabetic patients and reduce the incidence of diabetic foot.

Evaluation of 1, 5 -Anhydroglucitol as a Biomarker for Type 2 Diabetes Mellitus in Patients without Overt Nephropathy

1,5-Anhydroglucitol (1,5-AG) is a non-fasting glycemic marker that responds to hyperglycemia excursions. The reduction in serum levels of 1,5-AG is associated with an increase in postprandial glycemia and glycosuria, phenomena that increase the risk and severity of diabetic complications. The objective is to assess the ability of 1,5-AG to discriminate type 2 diabetes (T2D) patients without overt kidney disease, for screening or diagnostic purposes. The Human Research Ethics Committee of Universidade Federal do Paraná (UFPR) approved the project. Serum samples from 567 individuals classified as healthy subjects (n = 291) and T2D (n = 276) with moderate glycemic control (HbA1c of 7-8%), matched by gender, were analyzed. Serum 1,5-AG levels were measured using an automated enzymatic method (GlycoMark, Inc.). Receiver Operating Characteristic (ROC) curve analysis for 1,5-AG showed sensibility of 65.3% and specificity of 91.1% to detect T2D at cut-off point of 92 µmol/L. The results were similar to the groups' discrimination by glycemia (sensibility/specificity, 62.2%; 89.0%) at cut-off point of 6.3 mmol/L. HbA1c was the best discriminator (sensibility/specificity, 87.4%; 94.2%) at a cut-off point of 5.8% (40 mmol/mol). The serum 1,5-AG concentration was not able to discriminate T2D in the presence of moderate glycemic control with no overt nephropathy.

Harnessing mHealth to improve the diabetes screening and diagnosis rate in rural Indian settings: a learning from health systems initiative

Background: Diabetes forms huge burden of non-communicable diseases that is affecting health care systems in India. India has large number undiagnosed and undetected cases. mHealth initiatives are cost effective, quick and less resource intensive technology assisted initiatives which help to strengthen the health system. High mobile penetration and availability of cheap and high-speed data network across India has been conducive to implement mHealth initiatives in Indian health system. We present our experience in using mHealth initiative to improve the diabetes screening and diagnosis in rural Indian settings.Methods: The study is a descriptive analysis of all the tasks undertaken as part of “Disease free Village” Initiative of our organization. The study data is operational data from our organizational health information management systems. The study is divided into three phase. Phase 1, was dedicated to enrolling entire village population using android smartphone and ODK collect application; phase 2 used clinical decision support system for screening of high risk individuals and phase 3 used traditional door to door campaign to motivating the high risk individuals to get their fast and post prandial blood glucose levels checked at health care facility.Results: Phase 1 was to set a baseline, with 3624 base population, 2651 was target adult population. Rapid screening in phase 2, screened 2204 (83.14%). Out of 2204 screened cases 1307 were high risk cases. 1307 high risk cases were followed in Phase 3, and blood glucose screening was carried out 1156 (88.44%) high and moderate risk individuals out of 1307 (100%).Conclusions: We concluded that the mHealth initiatives for screening and diagnosis of diabetes in rural India, combined with traditional techniques could help to improve screening and diagnosis rate and help to reduce the hidden burden of disease.

Clinical value of non-invasive advanced glycation end product measurement in screening for diabetes mellitus and impaired glucose tolerance / 中华健康管理学杂志

Objective To evaluate the clinical value of non-invasive skin autofluorescence measurement of advanced glycation end products (AGE) to screen for both diabetes mellitus and impaired glucose tolerance (IGT). Methods A total of 389 individuals who underwent physical examination at Renmin Hospital of Wuhan University from December 2016 to August 2017, and were willing to participate were enrolled in our study. 293 people meeting the criteria were included finally. AGE value in the skin tissue was measured non-invasively via autofluorescence with the DM Scanner. Two-hour oral glucose tolerance testing, and measurements of fasting blood glucose and glycosylated hemoglobin were also performed for each patient. Results Among 293 subjects, 209 had normal glucose metabolism, 50 had IGT, and 34 had diabetes mellitus. The measured Advanced glycation end product values in these groups were (69.44 ± 7.28) AU, (79.67 ± 5.65) AU, and (81.17 ± 9.28) AU, respectively. The differences between groups were statistically significant (P<0.05). Pearson correlation analysis showed a significant positive correlation between autofluorescence measurements and fasting blood glucose, glycosylated hemoglobin and glucose level 2 hours after oral glucose loading (r=0.472, 0.433, and 0.546, respectively;P<0.001). The sensitivity of DM Scan screening for IGT was 84.00％, with a specificity of 84.87％. For diabetes mellitus, the sensitivity was 79.41％, and the specificity 84.87％. Conclusion DM Scan has high sensitivity in screening for diabetes mellitus and IGT. It has important clinical value in the early diagnosis of IGT.

A Review on the Factors Influencing the Attendance of Postpartum Diabetes Screening for Mothers with Gestational Diabetes Mellitus

Abstract@#Women with gestational diabetes mellitus (GDM) during their pregnancy have a greater risk of developing overt diabetes mellitus and dysglycemia (prediabetes, impaired glucose tolerance or impaired fasting glucose) later in future, compared to mothers with normal pregnancy. Postpartum screening is crucial for early identification of type 2 diabetes (T2DM) in women with GDM. Nevertheless, despite various strategies, its rate remains low. A systematic review using databases of PubMed/Medline, Science Direct and CINAHL from 2008 to 2018, was conducted to identify the factors influencing the attendance of postpartum diabetes screening. Open access English articles, focusing on observational studies were reviewed. Primary screening of titles and abstracts of 91 articles were done, secondary screening of 31 articles resulted in 6 articles, included in this manuscript. Various factors identified to be associated with the attendance to postpartum diabetes screening, which are age, education, ethnicity, some obstetric factors like multiparty, and history of insulin usage previously. Many women fail to be screened for diabetes during the postpartum period, and this delays T2DM diagnosis, which in turn gives rise to various complications. Further research that considers these factors is necessary for developing interventions to improve postpartum T2DM screening for mothers with GDM during their pregnancy

Serum Fluorescent Advanced Glycation End (F-AGE) products in gestational diabetes patients

ABSTRACT Objectives Advanced glycation end products (AGEs) are involved in the pathogenesis and complications of diabetes mellitus (DM). Gestational DM (GDM) is characterized by increased glycemia and oxidative stress, which are factors associated with high serum AGE concentrations. The aim of this study was to evaluate the utility of a serum fluorescence AGE (F-AGE) method as a screening tool for gestational diabetes. Subjects and methods Serum samples from 225 GDM patients and 217 healthy pregnant women (healthy controls) were diluted 50-fold in phosphate-buffered saline, and the AGEs were estimated by fluorometric analysis (λEx 350 nm/ λEm 440 nm). Results No significant (P > 0.05) differences in AGE concentrations, expressed in Arbitrary Units (UA/mL × 104), were observed in the women with GDM or in the healthy controls. Furthermore, F-AGE concentrations did not change significantly during the pregnancy (12-32 weeks of gestation). Only the GDM group had a positive correlation (r = 0.421; P < 0.001) between F-AGEs and serum creatinine concentrations. Conclusion It was not possible to distinguish women with gestational diabetes from the healthy controls on the basis of serum F-AGE concentrations.

The methods of exploring obesity cutoffs for screening/diagnosing diabetes / 中华流行病学杂志

It is important to establish an appropriate obesity-cutoff method to identify people with diabetes or at high risk of the disease.Aside from restricted cubic splines and fractional polynomial model,the receiver operating characteristic curve is the most frequently one used to define these cutoffs.In this study,we explored the obesity cutoffs across different ethnic populations and evaluated the merits/demerits of different Methods by reviewing the currently used obesity cutoffs.

Alteraciones clínico-metabólicas en mujeres con diabetes gestacional previa / Clinical metabolic disorders in women with previous gestational diabetes

Conocer la frecuencia de diabetes y otros factores de riesgo cardiovascular en mujeres con diabetes mellitus gestacional (DMG) previa. Se evaluaron 92 mujeres con DMG previa, a quienes no se les había diagnosticado diabetes, que asistieron a la pesquisa posparto inicial o anual durante 2008. Se determinó presión arterial, circunferencia abdominal (CA) e índice de masa corporal (IMC). Se practicó prueba de tolerancia oral a la glucosa, medición de niveles de insulina y lípidos séricos. Se estableció la presencia de síndrome metabólico (SM), aplicando los criterios ATP III e índice de resistencia a la insulina mediante el modelo Homa-R. Se usó t Student para la asociación de variables. La media de edad fue 34,7 ± 6,6 años y del período posparto, 3,5 ± 2,6 años. En 8,7 por ciento se hizo el diagnóstico de diabetes, 32,6 por ciento intolerancia a la glucosa y 12,0 por ciento, glucemia alterada en ayunas. 62,1 por ciento presentaba obesidad abdominal, 62,5 por ciento, algún tipo de dislipidemia y 23,80 por ciento, elevación de la presión arterial. 46,4 por ciento reunía los criterios de SM y 29,6 por ciento mostró un índice HOMA-R > 2,5. Las cifras de CA, IMC, triglicéridos, glucemia basal, glucemia 2 horas post-carga, e insulina 2 horas poscarga fueron más altas (P< 0,05) en mujeres con anormalidades de la tolerancia a la glucosa que en aquellas con tolerancia normal. Las mujeres con DMG previa muestran una elevada frecuencia de alteraciones clínicas y metabólicas que representan un potencial incremento del riesgo cardiovascular en un grupo poblacional relativamente joven

To know the frequency of diabetes and other cardiovascular risk factors in women with previous gestational diabetes mellitus (GDM). 92 women with previous GDM, without diagnosis of diabetes, who underwent initial or annual postpartum diabetes screening during 2008, were assessed. Blood pressure, abdominal circumference and body mass index were measured. They were tested for an oral glucose tolerance test (OGTT) and determination of plasma insulin and lipid levels. Metabolic syndrome (MS) was diagnosed according ATP III criteria and the HOMA-R model was used for the insulin resistance index calculation. Student’s t test was used for variables association. The average age was 34.7 ± 6.6 years and postpartum period, 3.5 ± 2.6 years. 8.7 percent was diagnosed with diabetes, 32.6 percent with impaired glucose tolerance and 12.0 percent with impaired fasting glucose. 62.1 percent showed abdominal obesity, 62.5 percent presented some type of dyslipidemia and 23.8 percent, high blood pressure. 46.4 percent met the criteria for MS, and 29.6 percent showed a HOMA-R Index > 2.5. Abdominal circumference, body mass index, blood pressure, triglycerides, basal glucose, 2-h post-load glucose and 2-h post-load insulin values were higher (P< 0.05) in women with abnormal glucose tolerance than those with normal glucose tolerance. Women with previous GDM show a high frequency of clinical and metabolic abnormalities that point towards a potential increase of cardiovascular risk in a relatively young population