Comparison of fasting plasma glucose and glycated hemoglobin for diagnosing diabetes in a Taiwanese population.

BACKGROUND: The purposes of this study were to examine the impact of using glycated hemoglobin (HbA1c) as a diagnostic criterion for (pre)diabetes and to determine the appropriate HbA1c cutoff value in a Taiwanese population. METHODS: We used a dataset from the Clinical Informatics Research & Development Center of Taichung Veteran General Hospital. Fasting plasma glucose (FPG) and HbA1c test results were obtained from outpatient laboratory reports produced from January 1, 2011, to April 30, 2012. A total of 4920 blood tests were analyzed. For each potential HbA1c cutoff value, the sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristic curve (AUC) were calculated at FPG levels of 100 and 126 mg/dL. Two-sample t- and chi-sqaured tests were used to compare differences in characteristics between individuals matching the definitions of diabetes set by the American Diabetes Association (ADA) in 2009 and 2010. RESULTS: Among the 4920 study subjects, 580 people had an FPG value < 126 mg/dL and an HbA1c ≥ 6.5%. After the diagnostic criterion of HbA1c percentage was applied, the numbers of patients with normoglycemia and prediabetes decreased, whereas the number of diabetic patients increased. For FPG levels of 100 and 126 mg/dL, the HbA1c cutoff points were 5.95% and 6.35%, respectively. CONCLUSIONS: More patients were diagnosed with diabetes when HbA1c was added as a diagnostic criterion. HbA1c thresholds of 5.95% and 6.35% were highly specific for prediabetes and diabetes, respectively, in Taiwanese adults.

Incidence and risk factors of lower extremity amputations in people with type 2 diabetes in Taiwan, 2001-2010.

BACKGROUND: Diabetic patients have an increased risk of lower extremity amputations (LEAs). In the present study we analyzed the incidence of LEA in patients with type 2 diabetes mellitus (T2DM) in Taiwan from 2001 to 2010, and determined risk factors for LEA. METHODS: Data from the Taiwan National Health Insurance Research Database collected between 1 January 2001 and 31 December 2010 were analyzed. First, the incidence of LEA in the diabetic population was calculated. Subsequently, patients with new-onset T2DM during the study period were selected, and Cox's proportional hazards model was used to identify factors associated with LEA. The characteristics of patients who underwent major and multiple amputations were also analyzed. RESULTS: From 2001 to 2010, 1588 non-traumatic LEAs were performed among the study subjects; 776 (48.9%) were minor and 812 (51.1%) were major LEAs. Over the period in question, the incidence of LEAs decreased from 3.08 to 1.65 per 1000 person-years. Factors associated with LEA included peripheral arterial occlusive disease (hazard ratio [HR] 4.134; 95% confidence interval [CI] 2.72-6.29), diabetic neuropathy (HR 2.34; 95% CI 1.62-3.38), diabetic retinopathy (HR 2.07; 95% CI 1.12-3.82), heart failure (HR 2.13; 95% CI 1.45-3.15), male gender (HR 1.64; 95% CI 1.24-2.18), and adult onset diabetes (HR 1.02; 95% CI 1.01-1.04). Patients with a history of stroke were more likely to undergo major and multiple amputations (P < 0.001 and P < 0.01, respectively). CONCLUSIONS: The incidence of LEA in the Taiwan diabetic population decreased over the study period. The results indicate that efforts to improve diabetic care should be supported and sustainable, especially for those at high risk.

Spinal cord injury increases the risk of type 2 diabetes: a population-based cohort study.

BACKGROUND CONTEXT: Previous studies on the risk and prevalence of diabetes among spinal cord injury (SCI) patients are limited and controversial. PURPOSE: To compare the risk and incidence rate (IR) of Type 2 diabetes in SCI and non-SCI patients. STUDY DESIGN: This is a population-based retrospective cohort study. PATIENT SAMPLE: Data from Taiwan's National Health Insurance Research Database for the period 1997 to 2010 were analyzed. Patients aged 20 years and older newly identified with SCIs during this period were included in the SCI cohort. A non-SCI comparison cohort was randomly selected from National Health Insurance beneficiaries and matched with the SCI cohort based on age, sex, and index date. OUTCOME MEASURES: Both cohorts were followed until the first of the following occurred: the diagnosis of Type 2 diabetes (International Classification of Disease, Ninth Revision, Clinical Modification codes 250), withdrawal from the insurance system, the end of 2010, or death. METHODS: A Cox proportional hazards regression analysis was used to estimate the risk of developing diabetes. RESULTS: Taiwan possesses an older SCI population, with a mean age of 51.6 years. The IR for diabetes in patients with and without SCIs was 22.1 per 10,000 person-years and 17.2 per 10,000 person-years, respectively. The adjusted hazard ratio (HR) for diabetes was 1.33 times higher in patients with SCIs than in those without SCIs. In patients with SCIs, men (adjusted HR=1.23, 95% confidence interval (CI)=1.04-1.44), older people (adjusted HR=4.26 in patients older than 65 years, 95% CI=3.16-5.74), patients with comorbidity (adjusted HR=1.36, 95% CI=1.14-1.62), and patients with a complete thoracic SCI (T-spine injury) (adjusted HR=2.13, 95% CI=0.95-4.79) were more likely to be diagnosed with diabetes than other patient subgroups. CONCLUSIONS: Our findings may facilitate the prioritizing of preventive health strategies and planning of long-term care for SCI patients.

Population-based cohort study on the increase in the risk for type 2 diabetes mellitus development from nonapnea sleep disorders.

OBJECTIVES: The evidence concerning the relationship between nonapnea sleep disorders and the risk for type 2 diabetes mellitus (DM) is scant and elusive. Our study aimed to examine if nonapnea sleep disorders increase the risk for DM using a population-based retrospective cohort study from 1997 to 2010. METHODS: In the Taiwan's National Health Insurance Research Database (NHIRD), 45,602 patients with nonapnea sleep disorders were identified as the study cohort. The comparison cohort was formed by 91,204 age- and gender-matched controls. Cox proportional hazards regression model was used to estimate the risk for developing DM. RESULTS: In 45,602 patients with nonapnea sleep disorders, 7241 new cases of DM were reported during the follow-up period. The mean follow-up time was 9.04 (standard deviation [SD], 3.33) and 8.96 (SD, 3.47) for the nonapnea sleep disorders cohort and the comparison cohort, respectively. The incidence rate of DM was higher in the nonapnea sleep disorder cohort than in the comparison cohort (17.6 vs 13.3 per 1000 individuals-years). Overall, patients with nonapnea sleep disorders had a higher risk for DM compared to patients without nonapnea sleep disorders (adjusted hazard ratio [HR], 1.05 [95% confidence interval {CI}, 1.02-1.08]). Men with nonapnea sleep disorders had a higher risk for DM than the men in the comparison group (adjusted HR, 1.08 [95% CI, 1.03-1.14]). Among subjects aged less than 40years, patients with nonapnea sleep disorders had a higher risk for DM than the comparison group (adjusted HR, 1.42 [95% CI, 1.27-1.59]). Compared with the comparison cohort, patients with sleep disturbance had an 11% higher risk for DM (adjusted HR, 1.11 [95% CI, 1.07-1.16]). CONCLUSION: Compared to patients without nonapnea sleep disorders, patients with nonapnea sleep disorders had a higher risk for developing DM, especially among those who were less than 40years of age and who had sleep disturbances.