Low serum creatinine levels as risk factor of diabetes mellitus: prediabetes considerations.

OBJECTIVE: It has been reported that low serum creatinine level is a risk factor of diabetes. We hypothesize that should this be true, serum creatinine levels would be lower and more prevalent in prediabetes than in normal individuals. MATERIALS AND METHODS: 1017 glucose tolerance tests performed at South West Pathology Service of the New South Wales Health, Australia, in 2008 were sorted into normal (control), prediabetes and diabetes based on decisive interpretation. All cases with creatinine results in the control (n=48), diabetes (n=18) and prediabetes (n=36) groups were selected. RESULTS: Mean levels of serum creatinine levels in the controls (80 +/- 32 micromol/L), diabetes (82 +/- 26 micromol/L) and prediabetes (82 +/- 23 micromol/L) were not statistically significantly different. The prevalence of low levels of serum creatinine is less in prediabetes (11%) than in the control (23%). CONCLUSION: Further studies using a larger number and adjusting for confounding factors is needed to ascertain the role of low serum creatinine level as a risk factor of diabetes.

Cardiovascular risk assessment in prediabetes: A hypothesis.

There are screening programs for future risk of cardiovascular disease (CVD) complications in diabetes, but not in subclinical diabetes. There is little or no risk and no differences between genders when a man or woman at age below 50 years presents blood pressure below 140/90 mmHg and total cholesterol/HDL less down 7.0. In the current screening programs, a hypothetical apparently non-diabetic and non-smoking person aged 49 years old; who present blood pressure 140/90 mmHg, fasting blood sugar 5.8 mmol/L and total cholesterol/HDL 6.5 has no risk of future CVD and does not require any intervention. However, by counting numbers, the person has two risk factors, hyperglycaemia and hyperlipidaemia. Furthermore, considering smoking as a factor and the propensity for hyperglycaemia-induced oxidative stress being a smoker-like effect of hyperglycaemia toxicity, the person actually has three risk factors, which qualifies the person for intervention. The issue is that a prediabetes sufferer is treated like a healthy person in the current screening programs. The problem here is that risk of CVD in prediabetes is inadequately assessed. We present a hypothesis that employs a combination of blood glucose level and an index of oxidative damage to improve CVD screening in prediabetes. We propose a longitudinal study to repeat the whole lipid modelling exercise in order to develop a separate model chart for the screening of future CVD in people with diagnosed or undiagnosed prediabetes. The proposal would also serve for people with undiagnosed diabetes.