| Strategies to detect abnormal glucose metabolism in people at high risk for cardiovascular disease from the ORIGIN trial population (Outcome Reduction with Initial Glargine Intervention). | |
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MedLine Citation:
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PMID: 21631894 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Objective: To investigate if the combination of HbA1c and fasting plasma glucose (FPG) can be used for the diagnosis of diabetes and impaired glucose tolerance (IGT) in people at high risk for cardiovascular disease. Methods: We did a cross-sectional study in 2907 people at high risk for cardiovascular events without previously diagnosed diabetes. Optimal cutpoints and diagnostic properties of FPG, HbA1c and their combination were calculated to diagnose diabetes and IGT as determined by an oral glucose tolerance test. Results: Sensitivity of the usually applied FPG cutpoint of 7.0 mmol/l to diagnose diabetes mellitus was low at 59.0%. The optimal cut-point for the diagnosis of diabetes by receiver operating characteristic (ROC) curve analysis was 6.4 mmol/l for FPG (sensitivity 75.7%, specificity 77.5% and likelihood ratio 3.37) and 5.9% (41 mmol/mol) for HbA1c (sensitivity 68.7%, specificity 67.1%, and likelihood ratio 2.09). For IGT, optimal cut-points were 6.1 mmol/l for FPG (sensitivity 57.1%, specificity 57.9%) and 5.7% (39 mmol/mol) for HbA1c (sensitivity 63.8%, specificity 60.3%). For diabetes, combining cut-points for FPG and HbA1c identified four categories with likelihood ratios varying from 5.59 to 0.21, and post-test probabilities between 69.3% and 7.8%. For IGT, likelihood ratios varied form 2.05 to 0.56 and post-test probabilities varied from 84.0% to 58.8%. Conclusions: FPG alone under-detects glucometabolic abnormalities in people at high risk for cardiovascular disease. An algorithm with both HbA1c and FPG improves detection of diabetes but not of IGT and could easily be implemented in patient care. |
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Authors:
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Erik A Badings; Lyanne Dyal; Lydia Schoterman; Dirk J A Lok; Ies Stoel; Martin N Gerding; Hertzel C Gerstein; Jan G P Tijssen |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-9 |
Journal Detail:
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Title: Journal of diabetes Volume: - ISSN: 1753-0407 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-6-2 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101504326 Medline TA: J Diabetes Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Ruijin Hospital and Blackwell Publishing Asia Pty Ltd. |
Affiliation:
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Dpt. of Cardiology Research, Deventer Hospital, Deventer, The Netherlands dpt.of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario Canada dpt. of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands dpt. of Internal Medicine, Deventer Hospital, Deventer, The Netherlands dpt. of Cardiology, Academic Medical Centre, University of Amsterdam, The Netherlands. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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