Comparison of glycated haemoglobin and fasting blood glucose in the diagnosis of diabetes mellitus and pre-diabetes in a cohort of obese patients.

Background: Diabetes mellitus (DM) has historically been diagnosed by measurement of blood glucose concentrations. More recently, the use of glycated haemoglobin (HbA1c) has been advocated in the diagnosis of diabetes, complementing its existing role in the monitoring of glycaemic control. A recent study has shown that obesity is an important problem in the UK Armed Forces. Obese patients are at increased risk of diabetes and intermediate hyperglycaemia (pre-diabetes). It is unclear whether the application of diagnostic criteria based on HbA1c would produce different categorisation of obese patients compared with standard glucose-based criteria. In the current study, we compared HbA1c with fasting plasma glucose in the diagnosis of type 2 diabetes and intermediate hyperglycaemia in a cohort of obese patients. Methods: Patients were recruited from the NHS Tayside Specialist Weight Management Service. They were classified into three categories (normoglycaemia, pre-diabetes, and diabetes) according to their fasting plasma glucose (FPG) and HbA1c. The diagnostic criteria of three organisations were applied: the World Health Organisation (WHO); the American Diabetes Association (ADA); and the International Expert Committee (IEC). Glucose, insulin, cholesterol, triglycerides, uric acid, liver function tests and sex hormone-binding globulin (SHBG) were measured. Results: By WHO (fasting glucose) criteria, 102 subjects were classified as normal, 13 as having impaired fasting glycaemia (IFG) and 5 as having diabetes mellitus (DM). By IEC (HbA1c) criteria, 89 subjects were classified as normal, 21 as pre-diabetes and 7 as DM. By ADA (HbA1c) criteria, 69 subjects were classified as normal, 41 as pre-diabetes and 7 as DM. Alkaline phosphatase was significantly higher in hyperglycaemic states compared with normal subjects, with ANOVA F statistics of 9.45 for WHO (p < 0.001), 9.24 for IEC (p < 0.001), and 6.87 for ADA (p < 0.01). Conclusion: Although the numbers were small, more obese patients were categorised as hyperglycaemic (pre-diabetes and diabetes) when HbA1c-based criteria were applied, compared with WHO (glucose-based) criteria. Further studies are required to confirm this preliminary observation.

Anxiety disorders in Chinese patients with Parkinson's disease.

OBJECTIVE: Anxiety disorders (AND1) commonly occur in patients with Parkinson's disease (PD) but their socio-demographic and clinical correlates have not yet been unequivocally determined. This study aimed to assess the frequency of ANDI and their correlates in Chinese PD patients. METHODS: A cohort of 133 patients of PD were recruited from three neurology outpatient clinics. Participants' neurological, cognitive, and psychiatric status was assessed using standardized rating instruments. ANDI were diagnosed by qualified psychiatrists using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders--4th Edition (SCID-DSM IV). RESULTS: Thirty-six patients (27.1%) were diagnosed with some types of ANDI; Generalized Anxiety Disorder, Agoraphobia, and Social Phobia were the commonest subtypes of ANDI in PD (n = 11, 8.3%, in each of the three subtypes). Nine patients had more than one subtype of ANDI. In multivariate logistic regression, younger age of onset of PD [odds ratio (OR) = 2.654, 95% confident intervals (CI) = 1.120-6.289, p = 0.027), Geriatric Depression Scale score (OR = 1.179, 95% CI = 1.056-1.316, p = 0.003) and muscle cramps (> or = 1/week) (OR = 2.605, 95% CI = 1.098-6.184, p = 0.030) were independent correlates of ANDI. CONCLUSIONS: ANDI are common in Chinese PD patients. Younger age of onset of PD, severity of depressive symptoms, and muscle cramps may be independent correlates of ANDI suggesting that anxiety in PD has multifactorial origin.