Repercussões metabólicas: quais, como e por que investigar? / Metabolic repercussions: which ones, how and why investigate?

A síndrome dos ovários policísticos (SOP) é frequentemente acompanhada de distúrbio metabólico, principalmente dos carboidratos e dos lipídeos, aumentando o risco de síndrome metabólica. Por essa razão, alguns investigadores ainda denominam a SOP de síndrome metabólica-reprodutiva. O objetivo deste capítulo é descrever as principais repercussões metabólicas, bem como como investigá-las e saber como suas consequências podem ser deletérias para a saúde da mulher. Esta é uma revisão narrativa mostrando a implicação do metabolismo dos carboidratos e dos lipídeos nas dislipidemias, bem como da síndrome metabólica sobre o sistema reprodutor, e o risco cardiovascular da mulher com SOP. Conclui-se que o manejo adequado dos distúrbios metabólicos na SOP é benéfico a curto e a longo prazo tanto para o sistema reprodutor quanto para o cardiovascular.(AU)

A importância do teste de tolerância à glicose oral no diagnóstico da intolerância à glicose e diabetes mellitus do tipo 2 em mulheres com síndrome dos ovários policísticos / The importance of oral glucose tolerance test in diagnosis of glucose intolerance and type 2 diabetes mellitus in women with polycystic ovary syndrome

OBJETIVO: Avaliar a importância do teste de tolerância à glicose oral (TTGO) no diagnóstico da intolerância à glicose (IG) e diabetes mellitus do tipo 2 (DM-2) em mulheres com SOP. MÉTODOS: Estudo retrospectivo em que foram incluídas 247 pacientes portadoras de SOP, selecionadas de forma aleatória. O diagnóstico de IG foi obtido por meio do TTGO de duas horas com 75 gramas de glicose de acordo com os critérios do World Health Organization (WHO) (IG: glicemia plasmática aos 120 minutos >140 mg/dL e <200 mg/dL); e o de DM-2 tanto pelo TTGO (DM: glicemia plasmática aos 120 minutos >200 mg/dL) quanto pela glicemia de jejum segundo os critérios da American Diabetes Association (glicemia de jejum alterada: glicemia plasmática >100 e <126 mg/dL; DM: glicemia de jejum >126 mg/dL). Para comparar o TTGO com a glicemia de jejum foi aplicado o modelo de regressão logística para medidas repetidas. Para a análise das características clínicas e bioquímicas das pacientes com e sem IG e/ou DM-2 foi utilizada a ANOVA seguida do teste de Tukey. O valor p<0,05 foi considerado estatisticamente significante. RESULTADOS: As pacientes com SOP apresentaram média etária de 24,8±6,3 e índice de massa corpórea (IMC) entre 18,3 e 54,9 kg/m² (32,5±7,6). O percentual de pacientes obesas foi de 64%, de sobrepeso 18,6%, e peso saudável 17,4%. O TTGO identificou 14 casos de DM-2 (5,7%), enquanto a glicemia de jejum detectou somente três casos (1,2%), sendo que a frequência destes distúrbios foi maior com o aumento da idade e IMC. CONCLUSÕES: Os resultados do presente estudo demonstram a superioridade do TTGO em relação à glicemia de jejum em diagnosticar DM-2 em mulheres jovens com SOP e deve ser realizado neste grupo de pacientes.

PURPOSE: To evaluate the importance of the oral glucose tolerance test for the diagnosis of glucose intolerance (GI) and type 2 diabetes mellitus (DM-2) in women with PCOS. METHODS: A retrospective study was conducted on 247 patients with PCOS selected at random. The diagnosis of GI was obtained from the two-hour oral glucose tolerance test with 75 g of glucose according to the criteria of the World Health Organization (WHO) (GI: 120 minutes for plasma glucose >140 mg/dL and <200 mg/dL), and the diagnosis of DM-2 was obtained by both the oral glucose tolerance test (DM: 120 minutes for plasma glucose >200 mg/dL) and fasting glucose using the criteria of the American Diabetes Association (impaired fasting glucose: fasting plasma glucose >100 and <126 mg/dL; DM: fasting glucose >126 mg/dL). A logistic regression model for repeated measures was applied to compare the oral glucose tolerance test with fasting plasma glucose. ANOVA followed by the Tukey test was used for the analysis of the clinical and biochemical characteristics of patients with and without GI and/or DM-2. A p<0.05 was considered statistically significant. RESULTS: PCOS patients had a mean age of 24.8±6.3, and body mass index (BMI) of 18.3 to 54.9 kg/m² (32.5±7.6). The percentage of obese patients was 64%, the percentage of overweight patients was 18.6% and 17.4% had healthy weight. The oral glucose tolerance test identified 14 cases of DM-2 (5.7%), while fasting glucose detected only three cases (1.2%), and the frequency of these disorders was higher with increasing age and BMI. CONCLUSIONS: The results of this study demonstrate the superiority of the oral glucose tolerance test in relation to fasting glucose in diagnosing DM-2 in young women with PCOS and should be performed in these patients.

Análise de fatores que se associam a alterações no teste de tolerância oral à glicose, independentemente dos valores da glicemia de jejum / Analysis of factors associated with changes in the oral glucose tolerance test, regardless of the values of fasting glucose

OBJETIVO: Identificar fatores associados a alterações do teste oral de tolerância à glicose (TOTG), independentemente da glicemia de jejum (GJ). SUJEITOS E MÉTODOS: 377 pacientes (53,8 ± 15,2 anos; 77,7 por cento mulheres e IMC = 31,4 ± 5,9 kg/m²), sem história de diabetes melito (DM), foram submetidos ao TOTG e comparados de acordo com o resultado: normal (NGT), intolerantes (IGT) e DM. RESULTADOS: 202 pacientes (53,6 por cento) apresentaram TOTG alterado, sendo identificados 69 com DM (18,3 por cento) e 133 com IGT (35,3 por cento). Na análise multivariada, os fatores, além da GJ, que se associaram (P < 0,05) ao TOTG alterado foram: idade (DM = 58,7 ± 12,9; IGT = 56,7 ± 14,3; NGT = 49,6 ± 15,6 anos), hipertensão arterial (DM = 69,6 por cento; IGT = 63,9 por cento; NGT = 43,4 por cento), GJ (DM = 111,9 ± 9,2; IGT = 103,5 ± 10,3; NGT = 96,6 ± 11,1 mg/dL), HbA1C (DM = 6,1 ± 0,7 por cento; IGT = 6,1 ± 0,5 por cento; NGT = 5,8 ± 0,4 por cento), triglicérides (DM = 179,3 ± 169,9; IGT = 154,2 ± 84,1; NGT = 129,1 ± 71,9 mg/dL), HDL-c (DM = 44,7 ± 9,2; IGT = 47,5 ± 12,3; NGT = 50,6 ± 13,4 mg/dL) e ácido úrico em mulheres (DM = 5,3 ± 1,5; IGT = 5,3 ± 1,3; NGT = 4,7 ± 1,3 mg/dL). CONCLUSÃO: Idade, hipertensão arterial, níveis elevados de triglicérides, de HbA1C e de ácido úrico (em mulheres) e baixos níveis de HDL-c se associam a alterações do TOTG em pacientes com sobrepeso/obesidade, independentemente da GJ.

OBJECTIVE: To identify factors associated with changes in oral glucose tolerance test (OGTT), regardless of fasting glucose (FG). SUBJECTS AND METHODS: 377 patients (53.8 ± 15.2 years, 77.7 percent women and BMI = 31.4 ± 5.9 kg/m²) with no history of diabetes mellitus(DM), underwent OGTT and compared according to the results: normal (NGT), impaired (IGT) and DM. RESULTS: 202 patients (53.6 percent) had altered glucose tolerance: 69 with DM (18.3 percent) and 133 with IGT (35.3 percent). In multivariate analysis, factors regardless of FG that were associated (P < 0.05) with changes in the OGTT were age (DM = 58.7 ± 12.9; IGT = 56.7 ± 14.3; NGT = 49.6 ± 15.6 years), hypertension (DM = 69.6 percent; IGT = 63.9 percent; NGT = 43.4 percent), FG (DM = 111.9 ± 9.2; IGT = 103.5 ± 10.3; NGT = 96.6 ± 11.1 mg/dL), HbA1C (DM = 6.1 ± 0.7 percent; IGT = 6.1 ± 0.5 percent; NGT = 5.8 ± 0.4 percent), triglycerides (DM = 179.3 ± 169.9; IGT = 154.2 ± 84.1; NGT = 129.1 ± 71.9 mg/dL), HDL-c (DM =44.7 ± 9.2; IGT = 47.5 ± 12.3; NGT = 50.6 ± 13.4 mg/dL) and uric acid in women (DM = 5.3 ± 1.5; IGT = 5.3 ± 1.3; NGT = 4.7 ± 1.3 mg/dL). CONCLUSION: Age, hypertension, elevated triglycerides, HbA1C, uric acid (in women) and low HDL-C are associated with changes in the OGTT patients with overweight / obesity, irrespective of FG.

Diagnóstico de intolerancia a la glucosa, en el servicio de patología clínica del Hospital II Suárez Angamos û EsSalud, 2010 Lima - Perú / Diagnosis of glucose intolerance in the clinical pathology service at Hospital II Suárez Angamos û EsSalud, 2010 Lima - Perú

Introducción: La diabetes mellitus tipo 2 se ha convertido en uno de los más graves problemas sanitarios de nuestro tiempo, y sus proporciones son ya epidémicas en la mayor parte del mundo. Existe por tanto un interés creciente en identificar individuos con alto riesgo de diabetes para planificar estrategias de prevención. Objetivo: Determinar el número de pacientes que acuden a realizarse un test de tolerancia oral a la glucosa y presentan intolerancia a la misma. Material y métodos: Se realizó un estudio descriptivo observacional en pacientes de ambos sexos, a quienes se les realizó el test de tolerancia oral a la glucosa, durante el año 2010, en la ciudad de Lima. Se utilizaron los criterios diagnósticos establecidos por la American Diabetes Association. El análisis de resultados se realizó utilizando el programa SPSS 18.0. Resultados: La edad promedio fue de 65 años. La mayoría, 1335 (71.3%) fueron mujeres. De 1872 pacientes que ingresaron al estudio, el 88.5% (1657) presentó glucemia alterada en ayunas y 215 (1 1.5%), valores normales de glucemia. Un total de 486 (26%) pacientes presentaron intolerancia a la glucosa. Conclusiones: El número de pacientes con intolerancia a la glucosa es elevado. La institución debería priorizar la atención de estos pacientes para que ingresen a un programa de prevención de diabetes y poder disminuir la incidencia y complicaciones de esta enfermedad que genera un gran gasto social.

Introduction:Diabetes mellitus type 2 has become one of the most serious sanitary problems of our time, and their proportions are already epidemic in most of the world. An increasing interest to identify individuals with high risk of diabetes exists therefore to plan prevention strategies. Objective: To determine the number of patients who perform a glucose tolerance test and present glucose intolerance. Materials and Methods: A descriptive observational study was realized, in patients, of both sexes, the test of oral tolerance to the glucose was realized to them, during year 2010 at Lima city. The diagnostic criteria established by the American Association Diabetes were used. The analysis of results was realized using program SPSS 18.0. Results: The average age was 65 years. The majority, 1335 (71.3%) was women. Of 1872 patients who entered the study, the 88.5% (1657) presented glycemia altered in fasting and 215 (1 1.5%) normal values of glycemia. A total of 486 (26%) patient ones presented glucose in tolerance. Conclusions: The number of patients with glucose intolerance is high. The institution would have to prioritize the attention of these patients so that they get in a diabetes prevention program and decrease the incidence and complications of this disease that generates a great social cost.

Obesidad pregestacional y riesgo de intolerancia a la glucosa en el embarazo y diabetes gestacional / Pregestational obesity and risk of glucose intolerance in pregnancy and gestational diabetes

ANTECEDENTES: La obesidad en mujeres en edad reproductiva es cada vez más frecuente y complica el embarazo aumentando el riesgo de enfermedades como la diabetes mellitus gestacional (DMG). OBJETIVO: Determinar el riesgo de presentar DMG e intolerancia a la glucosa (ITG) de acuerdo con el índice de masa corporal pregestacional (IMCPG). MÉTODO: Muestra de 489 pacientes, se clasificaron por IMCPG y se les realizó una curva de tolerancia oral a la glucosa (CTOG) de 100 g de 120 minutos. Se definió DMG con dos valores alterados en la CTOG e ITG con un solo valor alterado. Se aplicó prueba de chi cuadrada para determinar diferencia entre grupos y se obtuvo un Odds Ratio (OR), con intervalo de confianza del 95%. RESULTADOS: 9 pacientes con bajo peso, 194 con peso normal, 158 con sobrepeso y 128 con obesidad, edad gestacional promedio 31,3 ± 5,6 semanas. El 13% de las pacientes presentaron DMG, el 10,6% ITG. Las mujeres con sobrepeso presentaron un OR de 3,81 para desarrollar ITG (IC95% 1,62-8,95) y un OR de 3,7 para DMG (IC95% 1,65-8,38), mientas que las pacientes con obesidad pregestacional presentaron un OR de 6,6 para desarrollar ITG (IC95% 2,83-15,66) y un OR de 8,8 para DMG (IC95% 4,05-19,51), comparadas con mujeres con peso pregestacional normal. CONCLUSIÓN: La población mexicana tiene mayor riesgo de DMG que otras poblaciones y mayor prevalencia de sobrepeso y obesidad, por lo que se debe realizar un diagnóstico y tratamiento oportuno de DMG, previniendo complicaciones y diabetes mellitus tipo 2.

BACKGROUND: Obesity in women in reproductive age is becoming more frequent and it self complicates preg-nancy increasing the risk of diseases such as gestational diabetes mellitus (GDM). AIMS: To determine the risk of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) according to the pregestational body mass index (PGBMI). METHODS: Sample of 489 patients, they were classified by PGBMI and underwent an oral glucose tolerance test (OGTT) with 100 g of glucose during 120 minutes. GDM was defined with two altered valúes in the OGTT and IGT with a single altered value. A chi-square test was applied to determine difference between groups, and we obtained an Odds Ratio (OR), with a confidence level of 95%. RESULTS: 9 patients were low weight, 194 normal weight, 158 overweight and 128 obese, average gestational age 31.3 ± 5.6 weeks. 13% of the patients had GDM, 10.6% had IGT. Overweight women had an OR of 3.81 of developing IGT (95% Cl 1.62-8.95) and an OR of 3.7 of developing GDM (95% Cl 1.65-8.38), while women with prepregnancy obesity showed an OR of 6.6 of developing ITG (95% Cl 2.83-15.66) and an OR of 8.8 of developing GDM (95% Cl 4.05-19.51), all compared to women with prepregnancy normal weight. CONCLUSIONS: Mexican population has a higher risk of GDM than other populations and also a higher prevalence of overweight and obesity, so that every pregnant woman should be screening for GDM, has a diagnosis and receive treatment, preventing complications and Type 2 Diabetes.

Prevalence of diabetes mellitus and impaired glucose tolerance in patients with decompensated cirrhosis being evaluated for liver transplantation: the utility of oral glucose tolerance test

CONTEXT: Cirrhosis, diabetes mellitus, impaired glucose tolerance, insulin resistance, and protein calorie malnutrition are important issues in cirrhotic patients because they can increase the progression of liver disease and worsen its prognosis. OBJECTIVE:To determine the prevalence of diabetes mellitus, impaired glucose tolerance and insulin resistance in cirrhotic patients being evaluated for liver transplantation and their impacts on a 3-month follow-up, and to compare fasting glycemia and oral glucose tolerance test. METHODS: A cross-sectional study was performed in consecutively included adult patients. Diabetes mellitus was established through fasting glycemia and oral glucose tolerance test in diagnosing diabetes mellitus in this population. HOMA-IR and HOMA-β indexes were calculated, and nutritional assessment was performed by subjective global assessment, anthropometry and handgrip strength through dynamometry. RESULTS: Diabetes mellitus was found in 40 patients (64.5 percent), 9 (22.5 percent) of them by fasting glycemia and 31 (77.5 percent) of them by oral glucose tolerance test. Insulin resistance was found in 40 (69 percent) of the patients. There was no relationship between diabetes mellitus and the etiology of cirrhosis. Protein calorie malnutrition was diagnosed in a range from 3.22 percent to 45.2 percent by anthropometry, 58.1 percent by subjective global assessment and 88.7 percent by handgrip strength. Diabetes mellitus identified by oral glucose tolerance test was related significantly to a higher prevalence of infectious complications and deaths in a 3-month period (P = 0.017). CONCLUSION: The prevalence of diabetes mellitus, impaired glucose tolerance, insulin resistance and protein calorie malnutrition is high in cirrhotic patients on the waiting list for liver transplantation. There were more infectious complications and/or deaths in a 3-month follow-up period in patients with diabetes mellitus diagnosed ...

CONTEXTO: Cirrose, diabetes mellitus, intolerância à glicose e resistência insulínica é uma associação que vem sendo discutida, bem como a desnutrição nesta população, pelo risco de pior evolução de hepatopatia. OBJETIVO: Determinar a prevalência de diabetes mellitus, intolerância à glicose e resistência insulínica e desnutrição protéico-calórica em cirróticos (vírus C+ ou -) candidatos a transplante hepático e avaliar a capacidade diagnóstica dos testes de diabetes mellitus e seu impacto na evolução em 3 meses. MÉTODOS: Estudo transversal prospectivo de pacientes consecutivos, com avaliação de diabetes mellitus por glicemia de jejum e/ou teste de tolerância oral à glicose, cálculo dos índices HOMA-IR e avaliação nutricional através da avaliação subjetiva global, antropometria e força do aperto de mão não-dominante. RESULTADOS: Sessenta e quatro virgula cinco por cento tinham diabetes mellitus, 9 (22,5 por cento) deles foram diagnosticados por glicemia de jejum e 31 (77,5 por cento) por tolerância oral à glicose. A resistência insulínica foi encontrada em 40 pacientes (69 por cento). Não houve relação com a causa da cirrose. A desnutrição protéico-calórica foi encontrada em 3,22 por cento dos pacientes através do índice de massa corporal, 45,2 por cento por antropometria, 58,1 por cento pela avaliação subjetiva global e 88,7 por cento pela força do aperto de mão não-dominante. Houve associação entre diabetes mellitus diagnosticado pelo teste de tolerância oral à glicose e a maior prevalência de complicações infecciosas e/ou morte em 3 meses (P = 0,017). CONCLUSÃO: A prevalência de diabetes mellitus, intolerância à glicose, resistência insulínica e desnutrição protéico-calórica é alta em cirróticos em lista de transplante hepático. A evolução em 3 meses é pior quando há diabetes mellitus. O teste de tolerância oral à glicose teve rendimento superior à glicemia de jejum no diagnóstico de diabetes mellitus. Sugere-se o emprego rotineiro ...

Avaliação da tolerência à glicose em crianças e adolescentes com fibrose cística / Glucose tolerance evaluation in children and adolescents with cystic fibrosis

Introdução: Cerca de 20% dos adolescentes com fibrose cística têm diabetes melito (DM) relacionado à fibrose cística (FC). O teste oral de tolerância à glicose (TOTG) tem sido utilizado para identificar alterações no metabolismo da glicose. Objetivo: O objetivo deste estudo foi identificar as alterações no metabolismo da glicose em crianças e adolescentes com FC e descrever as características clínicas e laboratoriais relacionadas à tolerância diminuída à glicose (TDG) e DM nesse grupo de pacientes. Pacientes e métodos: Foi realizado um estudo transversal envolvendo crianças e adolescentes com diagnóstico de FC em atendimento no Hospital de Clínicas de Porto Alegre. TOTG com glicose na dose de 1,75 g/kg de peso com dose máxima de 75 g foi realizado. Resultados: No total foram avaliados 58 pacientes (1,9-16,9 anos). TDG foi encontrada em 6 pacientes e presença de DM em 1, todos acima de dez anos de idade. Estes 7 pacientes foram comparados com os outros 29 pacientes de mesma faixa etária com TOTG normal. Os pacientes com o TOTG alterado eram mais velhos (14±1,2 vs. 10,6±4 anos, P<0,001), apresentaram maior tempo de duração da FC (13±2,6 vs. 9±4 anos, P<0,0006) e apresentaram maior número de internações (6 [5-16] vs. 3 [1,5-8,5], P<0,029). Conclusão: Neste estudo foi observada uma prevalência de alteração da tolerância à glicose de 12% em crianças e adolescentes com FC.

Background: About 20% of adolescents with cystic fibrosis (CF) present diabetes related to this condition. The oral glucose tolerance test (OGTT) has been used to identify alterations in glucose metabolism in these patients. Aim: The aim of this study was to identify changes in glucose metabolism in children and adolescents with CF and to describe the clinical and laboratory characteristics related to impaired glucose tolerance (IGT) and diabetes. Patients and methods: This was a cross-sectional study involving children and adolescents with cystic fibrosis (CF). An OGTT with 1.75 g glucose/kg - max 75 g was performed. Results: Fifty-eight individuals (1.9-16.9 years) were evaluated. IGT was found in six and diabetes in one; all were older than 10 years. These 7 patients were compared to the 29 with normal OGTT with the same age. The patients with altered OGTT were older (14±1.2 vs 10.6±4years, P<0.001), had longer FC duration (13±2.6 vs. 9±4 years, P<0.006), and had a higher number of hospitalizations (6 [5-16] vs 3[1.5- 8.5], P<0.029). Conclusion: In this study the prevalence of impaired glucose tolerance was 12% in children and adolescents with CF.

Características maternas y perinatales diferenciales en el diagnóstico de la intolerancia a la glucosa en la primera o segunda mitad del embarazo / Maternal characteristics and perinatal differential diagnosis of glucose intolerance in the first or second half of pregnancy

Objetivo: conocer las diferencias maternas y perinatales en gestantes con diagnóstico de Diabetes Gestacional realizado en la primera mitad del embarazo y aquellas en que el diagnóstico se realizó en la segunda mitad. Pacientes y métodos: estudiamos retrospectivamente 963 diabéticas gestacionales en el período 1992-2005. Las pacientes fueron diagnosticadas siguiendo las normas y criterios de la OMS. En 252 el diagnóstico se efectuó con 20 semanas o menos y en las restantes 711 después de las 20 semanas. Los factores de riesgo para intolerancia a la glucosa utilizados fueron los propuestos por Valdés Amador y cols en 1985...

Prevalência de diabetes melito e tolerância à glicose diminuída na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo / Prevalence of diabetes and impaired glucose tolerance in the urban population of 30 to 79 years of the city of São Carlos, São Paulo

OBJETIVO: Estimar a prevalência de diabetes melito (DM) e tolerância à glicose diminuída (TGD) na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo. MÉTODOS: Foi realizado estudo de base populacional entre agosto de 2007 e junho de 2008. Todos os indivíduos, exceto mulheres grávidas, não diabéticos e aqueles com glicemia capilar em jejum < 199 mg/dl foram submetidos a teste oral de tolerância à glicose e classificados em diabéticos, com TGD ou com tolerância normal à glicose. RESULTADOS: Participaram da pesquisa 1.116 voluntários. As prevalências gerais de DM e TGD foram 13,5 por cento e 5 por cento, respectivamente. Houve associação entre DM e TGD e as variáveis "idade", "escolaridade", "índice de massa corpórea" e "circunferência abdominal". Não houve associação entre DM ou TGD e as variáveis "gênero", "cor da pele" e "rendimento mensal". CONCLUSÕES: Houve aumento na prevalência de DM em comparação a estudos anteriores no Brasil e na região. Embora tenha havido avanços no diagnóstico, o tratamento do DM requer otimização.

OBJECTIVE: To assess the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the urban population aged 30-79 years of the city of São Carlos, São Paulo, Brazil. METHODS: It was performed a population survey, from August 2007 to June 2008. Non diabetic individuals, excluding pregnant women, and those with fasting capillary glycemia < 199 mg/dl were administered oral glucose tolerance test and classified as diabetic, with IGT or with normal glucose tolerance. RESULTS: The number of individuals who participated in the study was 1,116. The overall rates of DM and IGT were 13.5 percent and 5 percent, respectively. DM and IGT were associated with age, education, body mass index and waist. They were not associated with gender, race or income. CONCLUSIONS: The prevalence of DM has increased when compared with previous studies in Brazil and in the state. Improvement in the diagnosis has occurred, however, treatment requires optimization.

Factor analysis of metabolic syndrome using direct measurement of insulin resistance in Chinese with different degrees of glucose tolerance.

BACKGROUND & OBJECTIVE: With the increasing prevalence of type 2 diabetes and cardiovascular disease in Taiwan, the understanding of metabolic syndrome (MetS) becomes more important. The purpose of this study was to investigate the clustering patterns of the risk variables of the MetS with factor analysis (FacAn). METHODS: A total of 564 Chinese individuals with normal glucose tolerance (N, n=345), impaired glucose tolerance (IGT, n=164) or diabetes mellitus (DM, n=55) were enrolled. Insulin resistance was measured by insulin suppression test (IST). The components of MetS such as waist hip ratio (WHR), fasting plasma glucose (FPG), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), high density lipoprotein cholesterol (HDLC) and steady state plasma glucose (SSPG) from IST were put into the model of exploratory FacAn. RESULTS: In spite of the minor different loading patterns, three dimensions were identified in the three subgroups; a "blood pressure" dimension, loading with mainly SBP and DBP, an "insulin resistance" dimension, loading mainly with SSPG, and an "adiposity/glucose" dimension loading with TG, WHR or FPG. INTERPRETATION & CONCLUSION: Our results were consistent with different ethnic groups in earlier reports that more than two dimensions were identified and that the MetS is not unified by a single underlying aetiology, i.e., insulin resistance. Longitudinal analysis in this and other populations will be required to validate our findings and to test their generalisability.

Avaliação do metabolismo da glicose em pacientes acromegálicos antes e após tratamento com octreotide LAR / Evaluation of glucose metabolism in acromegalic patients before and after treatment with octreotide LAR

OBJETIVO: Avaliar o metabolismo da glicose em pacientes acromegálicos antes e após o tratamento com octreotide LAR. PACIENTES E MÉTODOS: Este foi um estudo longitudinal e prospectivo com 30 pacientes do ambulatório de pesquisa em acromegalia do Serviço de Endocrinologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ). Eles foram submetidos à avaliação clínica e laboratorial com dosagens de hormônio do crescimento (GH), fator de crescimento semelhante à insulina tipo I (IGF-I), insulina, pró-insulina, peptídeo C, hemoglobina glicosilada (HbA1c), proteína de ligação do IGF tipo 1 (IGFBP-1) e a um teste oral de tolerância à glicose (TOTG), antes e após seis meses de tratamento com octreotide LAR. Foi aplicado o teste dos postos sinalizados de Wilcoxon e o critério de determinação de significância adotado foi o nível de 5 por cento. RESULTADOS: Encontraram-se 16 pacientes (54 por cento) com tolerância normal à glicose, sete (23 por cento) com intolerância à glicose e sete (23 por cento) com diabetes melito (DM). Doze pacientes completaram os seis meses de tratamento, sendo que houve piora da tolerância à glicose em três e piora do controle glicêmico dos dois pacientes diabéticos. Houve aumento da circunferência abdominal (p = 0,03) e queda do GH (p = 0,04), por cento IGF-I acima do limite superior do valor de referência ( por centoLSVR) (p = 0,001), insulina (p = 0,019), peptídeo C (p = 0,002) e do modelo de avaliação homeostática (HOMA-IR) (p = 0,039). CONCLUSÕES: Nesta série, o tratamento com octreotide LAR acarretou piora da tolerância à glicose em três pacientes não-diabéticos e piora do controle glicêmico em dois diabéticos, apesar da diminuição da resistência insulínica (RI).

AIM OF THE STUDY: To evaluate the glucose metabolism in acromegalic patients before and after treatment with octreotide LAR. PATIENTS AND METHODS: This was a prospective and longitudinal study involving 30 patients from the acromegaly research outpatient clinic of the Endocrinology unit of the HUCFF/UFRJ. They underwent clinical and laboratorial evaluations, with measurements of growth hormone (GH), insulin-like growth factor type I (IGF-I), insulin, proinsulin, C peptide, glycosylated hemoglobin (HbA1c), IGF binding protein type 1 (IGFBP-1) and glucose, during oral glucose tolerance test (OGTT), before and after six months of treatment with octreotide LAR. The Wilcoxon signed-rank test was used and values of 5 percent were considered statistically significant. RESULTS: We found 16 (54 percent) patients with normal glucose tolerance, 7 (23 percent) with impaired glucose tolerance and 7 (23 percent) diabetics. Twelve patients completed the six-month treatment, out of which three showed worsening of glucose tolerance and two (diabetics) had worse blood glucose control. Whereas there was an increase in waist circumference (p=0.03), there was a decrease in GH (p=0.04), with percentIGF-I above the upper limit of reference values ( percent ULRV) [p=0.001], insulin (p=0.019), C peptide levels (p=0.002) and homeostatic model assessment (HOMA-IR) [p=0.039]. CONCLUSIONS: In this series, treatment with octreotide LAR led to a worsening of glucose tolerance in three non-diabetic patients and worsened glycemic control in two diabetics, in spite of reducing insulin resistance.

Avaliação da secreção e resistência insulínica em indivíduos com diferentes graus de tolerância à glicose - do metabolismo normal ao diabetes mellitus / Insulin resistance and secretion assessment across a range of glucose tolerance from normal individuals through diabetes

OBJETIVO: Os principais objetivos são determinar a associação entre os parâmetros clínicos e demográficos e os diferentes índices de secreção e resistência insulínica em indivíduos aparentemente saudáveis, sem conhecimento prévio de seu grau de tolerância à glicose. PACIENTES E MÉTODOS: Submetemos ao teste oral de tolerância à glicose (TOTG), no período de fevereiro a agosto de 2003, 105 indivíduos com média de idade de 33,4 ± 1,4 anos, sendo 57,1 por cento do sexo feminino, subdividindo-os em 4 grupos: grupo 0 (normais): indivíduos com IMC < 25 e metabolismo glicídico normal, grupo 1 (obesos): IMC > 25 e metabolismo glicídico normal, grupo 2 (IFG): glicemia de jejum alterada e grupo 3 (IOG): intolerância oral à glicose. RESULTADOS: Encontramos diferença estatística para todas as variáveis analisadas durante o TOTG dentre os 4 grupos de indivíduos: glicemias de jejum e em 2 horas (p < 0,05; p < 0,05), valor de pico (p < 0,05), delta (p = 0,02), percentual de incremento (p = 0,047), área sob a curva (p < 0,05) e tempo de pico da glicose (p = 0,022). Não encontramos diferença para a velocidade de incremento da glicose, assim como para nenhuma variável da curva de insulina. Em relação aos índices de secreção insulínica, não houve significância estatística para os índices insulinogênico ou delta, porém estes tornaram-se significantes após correção da secreção pela resistência insulínica (p = 0,008). Quanto aos índices de resistência insulínica, os índices HOMA e QUICKI foram estatisticamente significativos (p = 0,005; p = 0,005, respectivamente), assim como a relação glicose/insulina em jejum (p = 0,053). CONCLUSÃO: Apesar do tamanho limitado da amostra, podemos inferir que indivíduos com intolerância à glicose em jejum e pós-prandial possivelmente estão em momentos diferentes da história natural da doença. Nossos dados demonstram que os melhores índices para a avaliação de resistência insulínica são o HOMA e o QUICKI, e que os...

AIM AND METHODS: Our main aim was to determine the association between clinical, demographical parameters and different insulin resistance and secretion indices in apparently healthy subjects, without previous knowledge of their own level of glucose tolerance. For that purpose, we evaluated 105 individuals from February to August 2003 by means of OGTT, aged 33.4 ± 1.4 years old, 57.1 percent female. We allocated them in four groups: group 0 (normal): individuals with BMI < 25 Kg/m² and normal glucose metabolism, group 1 (obese): BMI > 25 Kg/m² and normal glucose metabolism, group 2 (IFG): impaired fasting glucose and group 3 (IGT): impaired glucose tolerance. RESULTS: We have found statistical difference on all variables during OGTT between all groups: fasting glucose (p < 0.05), 2-hour glucose (p < 0.05), glucose peak value (p < 0.05), glucose delta (p = 0.02), glucose incremental percentage (p = 0.047), area under curve (p < 0.05), and glucose peak time (p = 0.022). We have not found difference on any variable in insulin curves or on glucose incremental velocity. Regarding insulin secretion indices there were no statistical significance in insulinogenic or delta indices, but they became significant after being corrected by insulin resistance (p = 0.008). When we evaluated insulin resistance alone, by using HOMA and QUICKI indices and the fasting glucose to insulin index, we have found statistical significance (p = 0.005; p = 0.005; p = 0.053). CONCLUSION: Although studying a small sample, we could suggest that individuals with impaired fasting glucose and impaired glucose tolerance are in different stages of diabetes natural history disease. We found out that the best indices of insulin resistance are both HOMA and QUICKI. We also suggest that pancreatic secretion indices should be corrected by the insulin resistance, which could best reflect type 2 diabetes natural history.

Prevalence of abnormalities of glucose metabolism in patients with polycystic ovary syndrome

Patients with polycystic ovary syndrome (PCOS) present a higher risk for abnormalities of glucose metabolism (AGM). For to study this in our population, we submitted 85 patients, with body mass index (BMI) of 28.5 ± 6.6 kg/m² and aged 25.5 ± 5.4 years old, to an oral glucose tolerance test (OGTT), and assessed the impact of BMI on the prevalence of impaired glucose tolerance (IGT) and of diabetes mellitus (DM). The states of glucose tolerance were classified considering fasting plasma glucose (FPG) according to the American Diabetes Association (ADA) criterion and plasma glucose at 120 minutes according to the Word Health Organization (WHO) criterion. According to the ADA criteria, 83.5 percent classified as normal and 16.5 percent as with AGM, with 15.3 percent presenting impaired fasting glucose and 1.2 percent DM, while according to the WHO criteria, 68.2 percent were classified as normal and 31.8 percent as with AGM, with 27.0 percent of them presenting IGT and 4.8 percent DM. Seventy-three percent of PCOS patients with IGT by WHO criterion had normal FPG by ADA criterion. The prevalence of AGM for both criteria increased with the body mass index. In conclusion, we found a higher prevalence of AGM in PCOS patients than that found in the general population, being the highest in obese patients. Glycemia at 120 minutes on the OGTT identified more patients with AGM than fasting glycemia. We recommended that the assessment of AGM must be done by the OGTT in all patients with PCOS.

Pacientes com a síndrome dos ovários policísticos (SOP) têm um risco maior para desenvolver anormalidades do metabolismo da glicose (AMG). Para avaliarmos a prevalência dessas anormalidades na nossa população, submetemos 85 pacientes, com índice de massa corporal (IMC) de 28,5 ± 6,6 kg/m² e média etária de 25,5 ± 5,4 anos, a teste de tolerância oral à glicose (TTOG). Os estados de tolerância à glicose foram classificados considerando a glicemia de jejum (GJ; American Diabetes Association - ADA) e glicemia aos 120 minutos (G120; Organização Mundial de Saúde - OMS). De acordo com a ADA, 83,5 por cento das pacientes foram normais e 16,5 por cento com AMG, com 15,3 por cento apresentando glicemia de jejum imprópria e 1,2 por cento diabetes mellitus (DM). De acordo com a OMS, 68,2 por cento foram normais e 31,8 por cento com AMG, com 27,0 por cento apresentando intolerância à glicose (IG) e 4,8 por cento DM. Observamos que 73 por cento das pacientes com IG pelos critérios da OMS apresentavam GJ normal pelos critérios da ADA. A prevalência de AMG para ambos os critérios foi maior entre as pacientes com IMC mais elevado. Conclusão: encontramos maior prevalência de AMG nas pacientes com a SOP do que na população geral, sendo mais elevada entre as pacientes obesas. Além disso, a G120 no TTOG identificou maior número de pacientes com AMG do que a GJ. Assim, recomendamos avaliação de AMG através do TTOG para todas as pacientes portadoras da SOP.

Diabetes mellitus: ¿subdiagnosticada o sobrediagnosticada? / Diabetes mellitus: underdiagnosed or overdiagnosed?

De los grandes tipos de DM, la de tipo 1, de comienzo agudo y muy sintomática debe ser siempre sospechada y confirmada por el laboratorio; la de tipo 2 poco sintomática, es generalmente un hallazgo en exámenes de rutina. La intolerancia a la glucosa no es una patología en si misma, sino un estado intermedio entre la normalidad y la diabetes clínica. Actualmente se reconocen dos tipos de intolerancia a la glucosa, la llamada de ayunas y la post carga de glucosa a las 2 horas. Ambas asintomáticas, se diagnostican por exámenes de laboratorio. Los individuos normales presentan glicemias de ayunas menor de 100 mg/dl; los intolerantes a la glucosa de ayunas, mayor de 100 mg/dl pero menor de 126 mg/dl. Los intolerantes a la glucosa de post carga registran valores entre 140 mg/dl y 200 mg/dl. Los diabéticos en ayunas tienen cifras de 126 mg/dl o más y a las 2 horas mayor de 200 mg/dl. Todos estos exámenes deben repetirse en más de una oportunidad.

Evaluación crítica del test de tolerancia oral a la glucosa para el diagnóstico de resistencia insulínica en pacientes con síndrome de ovario poliquístico / Critical evaluation of the oral glucose tolerance test for the diagnosis of insulin resistance in patients with polycystic ovary syndrome

El test de tolerancia oral a la glucosa (TTOG) es el más frecuentemente utilizado en la práctica clínica para el diagnóstico de resistencia insulínica (RI). El objetivo del presente trabajo fue la evaluación de la utilidad de los índices basales e índices TTOG, en mujeres con síndrome de ovario poliquístico (SOP) y del valor predictivo de los índices basales sobre la glucemia a los 120 minutos postprandial (G 120). Se estudiaron 114 pacientes con diagnóstico de SOP y 29 mujeres normales. A todas se les realizó un TTOG. Se dosó insulina y glucosa séricas cada 30 min durante las 2 horas del test y se determinaron los siguientes índices: Indices basales: GLU/lNS (glucemia en ayunas / insulinemia en ayunas), HOMA (modelo homeostático) y QUICKI (índice cuantitativo de sensibilidad insulínica) e índices TTOG: AI (área bajo la curva de insulina) e ISI composite (índice de sensibilidad insulínica). Se observaron correlaciones significativas entre los índices basales y los índices TTOG. Hubo 9 pruebas con índices basales normales que presentaban índice TTOG patológicos. Ninguna paciente con niveles de insulina menores a 9.9 Ul/ml presentó RI, mientras que todas las pacientes con niveles de insulina mayores a 18.4 Ul/ml tuvieron RI. Catorce pacientes (10.5%) presentaron G 120 ³ a 140 mg%. En 4 de los 14 casos (12.2%), los valores basales no hicieron sospechar la posibilidad del diagnóstico de hiperglucemia post prandial. En conclusión, en pacientes con SOP, los índices basales son útiles para diagnosticar RI. Proponemos realizar TTOG para diagnóstico de RI en aquellas pacientes que presenten insulinemias en ayunas entre 9.9 y 18.4 Ul/ml. En pacientes con SOP, se recomienda la evaluación periódica de la G 120.

Oral glucose tolerance test (OGTT) is the most commonly used method to evaluate insulin resistance (IR) in the clinical practice. Our objective was to evaluate the diagnostic utility of fasting tests compared with OGTT tests in women with PCO, and the ability of fasting tests to detect postprandial hyperglycemia. One hundred fourteen women with PCO and 29 normal women were evaluated by a 2 hours OGTT. Fasting plasma insulin (INS) and glucose were measured during the test. GLU:INS ratio (r) (fasting glucose/fasting insulin), HOMA (homeostatic model assessment), QUICKI (quantitative insulin sensitivity check index) (fasting tests), as well as the AUCI (area under the curve of INS) and ISI composite (ISI) (insulin sensitivity index) (OGTT tests), were determined. A significant correlation between fasting tests and OGTT tests was found. Normal fasting tests with abnormal OGTT tests were found in 9 patients. No patient with fasting insulin levels less than 9.9 UI/ml were IR, and all women with fasting insulin levels over 18.4 UI/ml were classified as having IR. We found glucose levels 120 min post glucose load (G 120) ³ 140 mg/dl in 14 patients (12.2%). Fasting glucose and insulin levels and the fasting tests, were poor predictors of impaired glucose tolerance (IGT) and type 2 diabetes (DBT 2). Thus, fasting tests are useful in the diagnostic of IR in PCO patients. OGTT is necessary when the fasting insulin levels range between 9.9 and 18.4 UI/ml. Women with PCO should undergo periodic screening for abnormal glucose tolerance.

Frequência de indivíduos com intolerância à glicose em jejum em um hospital universitário: comparação de critérios diagnósticos / Frequency of individuals with impaired fasting glucose in a university hospital: comparison of diagnostic criteria

A intolerância à glicose de jejum (IGJ), uma condição metabólica que na maioria das vezes precede o diabetes, geralmente não causa sintomas, necessitando da dosagem da glicemia de jejum para ser diagnosticada. Em 2003, o Comitê de Especialistas em Diagnóstico e Classificação do Diabetes Mellitus (Expert Committee on the Diagnosis and Classification of Diabetes Mellitus) recomendou a redução do ponto de corte para o diagnóstico da IGJ de 110mg/dl para 100mg/dl, endossado pela Sociedade Brasileira de Diabetes (SBD), em 2005. No entanto ainda não há consenso sobre a adoção desses valores. O objetivo deste estudo foi avaliar a frequência de pacientes com IGJ atendidos, de agosto a novembro de 2005, no Hospital Universitário Oswaldo Cruz da Universidade de Pernambuco (HUOC/UPE), comparando os critérios de diagnóstico. Foram avaliadas glicemias de 428 indivíduos, sendo 65 por cento do sexo femino. A média de idade dos pacientes foi de 52,3 anos (± 15,4), sendo que 78,3 por cento desses estavam na faixa etária 40 anos. Do total da amostra, 4 por cento tiveram glicemia de jejum sugestiva de diabetes ( 126mg/dl), enquanto 7 por cento dos resultados foram compatíveis com IGJ, segundo os critérios anteriormente adotados ( 110mg/dl e < 126mg/dl), e esses pacientes tinham idade 40 anos. Porém, utilizando os novos critérios de diagnóstico ( 100mg/dl e < 126mg/dl), a incidência de indivíduos com IGJ passou para 14,7 por cento e a faixa etária dos indivíduos acometidos para 20 anos. Esses resultados indicam maior sensibilidade na detecção de pacientes com IGJ, após redefinição dos critérios de diagnóstico, nas faixas etárias avaliadas.

Impaired fasting glucose (IFG), a condition that most times precedes diabetes, generally does not produce any symptoms. In 2003, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus recommended a lower cutoff point (from 110mg/dl to 100mg/dl) for fasting plasma glucose to confirm its diagnosis, a measure officially endorsed by the Brazilian Society of Diabetes (BSD) in 2005. The objective of this study was to evaluate the frequency of patients who presented IFG seen at the State University Hospital Oswaldo Cruz, utilizing both criteria of diagnosis, from August to November 2005. The sample consisted of 428 individuals, 65 percent of whom were females, with a mean age of 52.3 years (� 15.4) and a percentage of 78.3 percent of this population were 40 years old. From the total sample, 4 percent presented a fasting glucose level suggestive of diabetes ( 126mg/dl), while 7 percent presented glycemia values between 110mg/dl and < 126mg/dl, all of these patients were aged 40 years. The new criteria proposed for the diagnosis of IFG showed that the frequency of IFG patients has increased to 14.7 percent and their age has fallen to > 20. These results suggest, with this new diagnosis criterion, a higher sensibility in the detection of IFG among subjects in the age range studied.

Alteraciones de la tolerancia a la glucosa y frecuencia de síndrome metabólico en pacientes con enfermedad por hígado graso no alcohólico / Glucose tolerance alterations and frequency of metabolic syndrome among patients with non alcoholic fatty liver disease

Background: Non alcoholic fatty liver disease (NAFLD) is associated to diabetes mellitus, obesity, disturbances in serum lipid levels, insulin resistance and metabolic syndrome. Aim: To assess glucose tolerance and the presence of metabolic syndrome among patients with biopsy proven NAFLD. Patients and methods: Serum lipid levels, hepatic function tests were measured and an oral glucose tolerance test was performed in 46 patients (mean age 45±12 years, 36 females) without history of diabetes mellitus and with steatosis in a liver biopsy. Results: Mean body mass index of the sample was 37±12 kg/m². Seventeen percent had pure steatosis, 78 percent had steatohepatitis with or without fibrosis and 50 percent had fibrosis in the liver biopsy. Glucose intolerance and diabetes was found in 57 percent and 15 percent of cases, respectively. The presence of steatohepatitis was higher in diabetics, compared with subjects with glucose intolerance or a normal glucose response (43, 38 and 8 percent, respectively, p <0.0001). Ninety three percent had a metabolic syndrome and the proportion of biopsies with fibrosis was higher among subjects with more than three diagnostic criteria for metabolic syndrome compared with those with three or less criteria (59 and 46 percent, respectively, p <0.05). Conclusions: Glucose intolerance, diabetes and metabolic syndrome are common among patients with NAFLD, even when they are not obese.

Glicemia de ayuno versus prueba de tolerancia oral a la glucosa en la detección de intolerancia a la glucosa en niños y adolescentes obesos / Fasting glucose versus oral glucose tolerance test for detection of glucose intolerance in obese children

Background: Recently, the cut-off point for normal fasting glucose (FG) level, was decreased to 100 mg/dl. Aim: To determine the frequency of abnormal carbohydrate abnormalities in children with obesity and evaluate if the fasting glucose level is a useful tool for the screening of glucose intolerance (GI). Patients and methods: Children and adolescents, referred for evaluation of obesity were evaluated with an oral glucose tolerance test (OGTT) and FG. The sensitivity of FG for detection of GI, using the 100 and 110 mg/dl cut-off point, was evaluated. Results: We studied 186 patients (125 females) aged 12.1 (range: 5.4-19.3) years with a body mass index (BMI) of 29.9 (18.3-44.6) kg/mt² and a BMI Z score of 2.1 (1.7-3.2). Seven patients (3.8 percent) had abnormalities in the carbohydrate metabolism. The sensitivity of FG for the detection of GI using the 100 and 110 mg/dl cut-off values was 42.9 and 14.3 percent, respectively. Receiver operating characteristic (ROC) curves showed that the optimal diagnostic level for FG corresponds to 80 mg/dl (sensitivity: 85.7 percent and specificity of 74.9 percent). Conclusions: An abnormal carbohydrate metabolism was detected in 3.8 percent of the obese children and adolescents in this sample. FG of 100 mg/dl does not detect 57.1 percent of the patients with glucose intolerance. These data suggest that FG is not a useful screening tool for glucose intolerance in young patients.

Impaired glucose regulation in adults in Jamaica: who should have the oral glucose tolerance test?

OBJETIVO: Comparar los criterios publicados por la Organización Mundial de la Salud (OMS) en 1999 acerca del uso de la prueba de glucemia en ayunas (PGA) y de la prueba de tolerancia a una dosis oral de glucosa con valoración a las dos horas (PTG2h) para identificar a adultos hiperglucémicos en Jamaica. Como la PTG2h no se administra normalmente en un contexto clínico, se investigaron los factores asociados con la inutilidad de la PGA para detectar a personas con hiperglucemia según la PTG2h. MÉTODOS: Se examinó una muestra aleatoria de 2 096 adultos de 25 a 47 años de edad que vivían en la ciudad de Spanish Town, Jamaica, para determinar la presencia de diabetes. Una vez que se eliminó a 215 personas por diversos motivos, entre ellos la ausencia de datos, quedaron 1 881 personas entre las cuales se encontraban 187 que se sabía de antemano que tenían diabetes y otras 1 694 que fueron sometidas tanto a la PGA como a la PTG2h. RESULTADOS: La PGA permitió detectar 83 casos de diabetes, mientras que la PTG2h permitió detectar 72. El estadístico kappa de comparación entre los dos criterios de valoración fue de 0,31 (intervalo de confianza de 95%: 0,28û0,34), valor que revela una concordancia moderada. Se observaron 261 casos de intolerancia a la glucosa tras la PTG2h y 92 casos de hiperglucemia en ayunas. En estas últimas 92 personas, la PTG2h sirvió para identificar 34 casos de intolerancia a la glucosa y 14 casos de diabetes. De las personas que se mostraron normoglucémicas según la PGA, 14% tenían intolerancia a la glucosa o diabetes, según la PTG2h. Algunos factores tuvieron valor pronóstico en relación con la falta de detección de la intolerancia a la glucosa o la diabetes. Estos fueron la edad, el índice de masa corporal, la concentración de la obesidad en el tronco y el abdomen, la tensión sistólica y el sexo femenino. De acuerdo con la curva de eficacia diagnóstica, una glucemia en ayunas de 5,1 mmol/L tendría valor pronóstico con respecto a la presencia de una glucemia de 7,8 mmol/L según la PTG2h. CONCLUSIONES: Algunas personas cuya glucemia en ayunas está dentro de lo normal tienen intolerancia a la glucosa o diabetes; por lo tanto, para identificarlas es necesario hacer la PTG2h. Se puede mejorar la detección de casos de intolerancia a la glucosa en Jamaica si se reduce el umbral de normalidad para la PGA o si se toman en cuenta los datos clínicos para identificar a las personas en alto riesgo.

Comparison of The World Health Organization (WHO) two-step strategy and OGTT for diabetes mellitus screening.

The new diagnostic criteria recommended by the American Diabetes Association (ADA) will only detect diabetic patients with fasting hyperglycemia, and leave patients with isolated post-challenge hyperglycemia (IPCH) and imparied glucose tolerance (IGT) unidentified. The WHO recommends that all those with abnormal fasting glucose should undergo the oral glucose tolerance test (OGTT) to exclude the diagnosis of diabetes (two-step strategy). This two-step strategy will leave out subjects with normal fasting glucose (<109 mg/dl). The aim of this study is to compare the WHO two-step strategy and the gold standard OGTT for all subjects. We re-analyzed the results of 907 high-risk patients who have been screened for diabetes mellitus and impaired glucose tolerance. All subjects were screened with an OGTT containing a 75-gram glucose load after fasting for 12 hours. The results were classified into three categories: the ADA criteria, the two-step strategy, and the OGTT. Using the ADA criteria, these 907 subjects can be classified has having normal fasting glucose (fasting plasma glucose - FPG < 109 mg/dl) in 715 subjects (78.9%), abnormal fasting glucose (FPG 110 - 125 mg/dl) in 107 subjects (11.8%), and diabetes mellitus (FPG > 126 mg/dl) in 85 subjects (9.4%). The WHO two-step strategy performed in 107 IFG subjects identified another 30 diabetic patients (FPG < 109 mg/dl and 2 hour post load > 200 mg/dl = IPCH) or 3.3%, and 49 patients with IGT, or 5.4% from all subjects. If the OGTT was performed on the 715 normal fasting glucose, it could identify another 40 diabetic patients or 4.4%, and another 178 IGT patients, or 19.6% of all subjects. This means that without OGTT to all subjects, 40 diabetic patients or 25.8% of all diabetic patients and 178 patients or 78.4% from all IGT subjects would have remained unidentified. From this study we can conclude that applying the WHO two-step strategy in subjects with IFG would fail to detect 25.8% of diabetic patients and 78.4% of IGT subjects. It is recommended that the old strategy of screening--the gold standard OGTT--should be used instead of the two-step strategy, at least in high-risk groups.