Assessment of simple strategies for identifying undiagnosed diabetes and prediabetes in the general population.

BACKGROUND AND AIMS: The rising tide of diabetes mellitus (DM) and prediabetes (PDM) is urgently calling for strategies easily applicable to anticipate diagnosis. We assessed the effectiveness of random capillary blood glucose (RCBG), administration of a validated DM risk questionnaire, or the combination of both. MATERIALS AND METHODS: RCBG measurement and/or questionnaire administration were offered to all individuals presenting at gazebos organized during the World Diabetes Day or similar public initiatives on diabetes awareness. Subjects with suspicious DM or PDM were invited to the Diabetes Center (DC) for laboratory confirmation (fasting plasma glucose and HbA1c). RESULTS: Among 8563 individuals without known diabetes undergoing RCBG measurement, 341 (4%) had suspicious values. Diagnosis of DM was confirmed in 36 (41.9%) of the 86 subjects who came to the DC and PDM was found in 40 (46.5%). Among 3351 subjects to whom the questionnaire was administered, 480 (14.3%) had suspicious scores. Diagnosis of DM was confirmed in 40 (10.1%) of the 397 who came to the DC and PDM was found in 214 (53.9%). These 3351 subjects also had RCBG measurement and 30 out of them had both tests positive. Among them, 27 subjects came to DC and DM was diagnosed in 17 (63.0%) and PDM was found in 9 (33.3%). CONCLUSIONS: These data suggest that RCBG definitely outperforms the questionnaire to identify unknown DM and PDM. RCBG measurement, with questionnaire as an adjunctive tool, appears to be a simple, fast, and feasible opportunistic strategy in detecting undiagnosed DM and PDM.

Assessment of hypoglycaemia during basal insulin therapy: Temporal distribution and risk of events using a predefined or an expanded definition of nocturnal events.

AIM: To describe in type 2 diabetes the 24-hour distribution of hypoglycaemia and compare the frequency of nocturnal events based on a predefined nocturnal window or an expanded interval, using illustrative data for two insulin glargine formulations. METHODS: Temporal distribution of hypoglycaemic events was assessed descriptively and by profile using participant-level data from three randomized trials comparing insulin glargine 300 U/mL (Gla-300) and 100 U/mL (Gla-100). Risk of hypoglycaemia and annualized event rates were compared for the predefined nocturnal interval (00:00 to 05:59h) and an expanded window (22:00h to the pre-breakfast glucose measurement). RESULTS: Confirmed (≤3.9mmol/L [≤70 mg/dL]) or severe hypoglycaemic events were reported most frequently between 06:00 and 10:00 h with both insulins. Nearly threefold more events were identified using the expanded nocturnal interval. Risk of ≥1 nocturnal event was 25% lower with Gla-300 than Gla-100 with the predefined, and 16% lower with the expanded interval; annualized event rates were 31% and 24% lower with the predefined and expanded window, respectively. The between-insulin difference in number of nocturnal events depended markedly on the chosen nocturnal interval (556 vs. 1145 fewer events with Gla-300 using the predefined vs. expanded interval). CONCLUSIONS: The predefined 00:00-05:59h nocturnal interval excluded many hypoglycaemic events occurring during the actual overnight interval. While Gla-300 reduced hypoglycaemic events versus Gla-100 (regardless of the interval considered), the results obtained using the expanded window better reflect the clinical experience of people treated with basal insulin.

Impact of physicians' age on the clinical management of global cardiovascular risk: analysis of the results of the Evaluation of Final Feasible Effect of Control Training and Ultra Sensitisation Educational Programme.

AIM: To evaluate the potential impact of physicians' age on global cardiovascular (CV) risk management in the population of the Evaluation of Final Feasible Effect of Ultra Control Training and Sensitisation (EFFECTUS) study. METHODS: Involved physicians were stratified into three age groups (≤ 45, 46-55 and > 55 years), and asked to provide clinical data covering the first 10 adult outpatients, consecutively seen in May 2006. RESULTS: Overall 1078 physicians, among whom 219 (20%) were aged ≤ 45, 658 (61%) between 46 and 55, and 201 (19%) > 55 years, collected data of 9904 outpatients (46.5% female patients, aged 67 ± 9 years), who were distributed into three corresponding groups: 2010 (20%), 6111 (62%) and 1783 (18%), respectively. A higher prevalence of myocardial infarction and stroke was recorded by younger physicians rather than those aged > 46 years. Older physicians frequently recommended life-style changes, whereas a higher number of antihypertensive, antiplatelet, glucose and lipid-lowering prescriptions was prescribed by physicians aged ≤ 45 years. CONCLUSIONS: This analysis of the EFFECTUS study indicates a higher prevalence of vascular diseases among outpatients who were followed by younger physicians, who prescribed a higher number of CV drugs than older physicians. These older physicians have more attitude for prescribing favourable life-style changes than younger physicians.

The hot but not the cold minimal model allows precise assessment of insulin sensitivity in NIDDM subjects.

Assessment of insulin sensitivity in subjects with non-insulin-dependent diabetes mellitus (NIDDM) is of paramount importance but intrinsically difficult. The standard (hereafter cold) minimal model, in conjunction with an insulin-modified protocol, has been recently proposed, but the estimates of insulin sensitivity showed poor precision (Saad et al. Diabetes 43: 1114-1121, 1994). We propose the tracer (hereafter hot) minimal model as a highly reliable method to estimate insulin sensitivity (SI*) and fractional glucose clearance (SG*), reflecting glucose disposal only, in NIDDM subjects. A [6,6- 2H2] glucose-labeled insulin-modified intravenous glucose tolerance test was performed in seven NIDDM subjects. In particular, SI* was 1.07 +/- 0.34 x10(-4)min(-1).microU-1.ml estimated with an average precision (mean coefficient of variation of 12%, range 4-22%), whereas the cold minimal model SI was 0.96 +/- 0.26 x 10(-4) min-1. microU-1.ml (mean coefficient of variation of 105%, range 3-353%). Another advantage of the hot indexes with respect to the cold indexes is their ability to reflect glucose and insulin effect on glucose disposal only, and not also on hepatic glucose production. Finally, we also studied by simulation the effect of glucose urinary loss on cold and hot minimal model indexes; only cold glucose effectiveness (SG) was significantly affected, resulting in a mean approximately 40% lower. The hot minimal model appears therefore more reliable than the cold model for assessing glucose tolerance in NIDDM subjects. In particular its ability to dissect disposal from production processes, coupled with the very good precision of the estimated metabolic indexes, supports the clinical use of this method in NIDDM subjects.

Is the "pool-fraction" paradigm a valid model for assessment of in vivo turnover in non-steady state?

Quantification of in vivo turnover of endogenous substances in nonsteady state is of fundamental importance for understanding a variety of physiological and clinical metabolic situations. Toward this end, a pool-fraction model has become a paradigm in the glucose and ketone body areas. We discuss the basic assumptions on which the pool-fraction model is based and the criteria on which it has been validated. Specific comments are then made on its current and potential use for quantifying the non-steady-state turnover of glucose, ketone bodies, and insulin. We conclude that the quantitative reliability of predictions provided by the pool-fraction model is quite poor and that new developments are needed for quantifying the non-steady-state situation.