Insulin Glargine 300 U/mL and Insulin Glulisine Treatment in Patients with Type 2 Diabetes: A Non-Interventional Study of Effectiveness in Routine Clinical Practice.

INTRODUCTION: The EDITION development program confirmed that insulin glargine 300 U/mL (Gla-300) provides comparable glycemic control to insulin glargine 100 U/mL (Gla-100) but with lower hypoglycemia risk. Our study aimed to evaluate the effectiveness of Gla-300 in everyday practice. METHODS: This one-arm, non-interventional study included patients with type 2 diabetes who were switched to Gla-300-based basal-bolus therapy (BBT) and followed for 6 months. Indications for switching included inadequate glycemic control and/or hypoglycemic events with the previous regimen. RESULTS: Overall 229 patients were included, with mean age of 60.9 years. All glycemic variables improved between baseline and 6 months significantly (mean ± standard deviation [SD] hemoglobin A1c [HbA1c] from 8.9 ± 1.5% to 7.5 ± 1.1%, fasting blood glucose from 9.5 ± 3.1 mmol/L to 7.0 ± 2.1 mmol/L, postprandial blood glucose from 12.0 ± 3.8 mmol/L to 8.9 ± 2.5 mmol/L). Gla-300 doses were increased and mealtime insulin doses were unchanged. Rates of both non-severe and severe hypoglycemic events decreased significantly compared to pre-study and 6-month follow-up periods. Patients switched because of elevated HbA1c had higher baseline HbA1c and greater decrease in HbA1c paralleled with increase in insulin doses compared to those switched because of hypoglycemia. CONCLUSIONS: In day-to-day practice, switching from human insulin to Gla-300-based BBT resulted in significant improvement in glycemic control and decrease in hypoglycemia risk.

[Rhabdomyolysis - may it be a metabolic myopathy? Case report and diagnostic algorithm]. / Rhabdomyolysis ­ Mikor vessük fel metabolikus myopathia lehetoségét? Esetismertetés és diagnosztikus algoritmus.

We report the case of a 46-year-old female patient with recurrent rhabdomyolysis. In the background of her metabolic myopathy an inherited metabolic disorder of the fatty acid oxidation, very long-chain acyl-coenzyme A-dehydrogenase deficiency was diagnosed. The diagnosis was based on abnormal acyl-carnitine- and urine organic-acid profile in addition to low residual enzyme activity, and was confirmed by genetic testing. After introduction of dietotherapy metabolic crisis necessitating hospital admission has not occurred neither have fixed myopathic changes developed. We present here the differential diagnosis of rhabdomyolysis and exertional muscle complaints, with the metabolic myopathies in focus. The main features of fatty acid oxidation disorders are highlighted, acute and chronic managements of very long-chain acyl-coenzyme A-dehydrogenase deficiency are discussed. Metabolic myopathies respond well to treatment, so good quality of life can be achieved. However, especially in fatty acid oxidation disorders, a metabolic crisis may develop quickly and can be fatal, albeit rarely. Some of these disorders can be identified by newborn screening, but occasionally the symptoms may manifest only in adulthood. With the presentation of this case we would like to point out that in the differential diagnosis of recurrent rhabdomyolysis inherited metabolic disorders should be considered regardless of the patient's age. Orv Hetil. 2017; 158(46): 1873-1882.

Large increase in the prevalence of self-reported diabetes based on a nationally representative survey in Hungary.

AIMS: To estimate and compare the prevalence of self-reported diabetes based on nationally representative surveys of the Hungarian adult population in 2002 (published data - Hungarostudy) and a survey in 2012. METHODS: A cross-sectional computer-assisted telephone interview survey on a stratified representative sample of community-dwelling adults (n=1000) in 2012. To describe self-reported diabetes prevalence and its temporal changes generalized linear models were used and results were compared to figures from Hungarostudy. RESULTS: Age standardized prevalence of self-reported type 2 diabetes was 11.7% (95%CI 10.0-13.8%) without gender or rural-urban differences in 2012. People with self-reported diabetes were older than controls (mean [SE]: 63.9 [0.9] vs. 45.9 [0.3] years, p<0.0001). The prevalence of diabetes sharply increased after 40 years of age and peaked at age 70 (27.7% [2.5], page*age<0.0001). The prevalence of self-reported diabetes increased by 89% (OR 1.89, 95%CI 1.53-2.32) from 6.2 to 11.7% between the two surveys with the most pronounced increase in the age group 55-64 years (from 11.6 to 24.4%). CONCLUSIONS: We reported an alarming increase in the prevalence of self-reported type 2 diabetes in the last decade that mostly affects working age people. If this trend continues, a major public health crisis in Hungary can be envisaged.

[The effect of nonnutritives weeteners on certain metabolic parameters]. / Az energiamentes édesítoszerek hatása az egyes anyagcsere-paraméterekre.

Nonnutritive sweeteners can be found in many other foods apart from soft drinks. Producers of foodstuffs often use a combination of several sweeteners or sweetener and sugar mixes in a single product mainly to achieve a sweeter taste with a lower calorie count. According to the 2012 Scientific Statement of the American Heart and Diabetes Association, reduction of sugar intake plays an important role in establishing an optimal diet and the maintenance of an appropriate body weight. Controlled intervention studies show that during use of calorie-free sweeteners body weight did not change, moreover, in some cases weight even fell. This was also demonstrated in a recently published summary study of randomized controlled studies, according to which calorie-free sweeteners contributed to both loss and maintenance of body weight. According to the summary of the American Dietetic Association, the use of calorie-free sweeteners does not influence the glycemic response and does not increase postprandial blood glucose levels in diabetics. The results thus far, then, show that the use of nonnutritive sweeteners can reduce the consumption of carbohydrates, by which total calorie intake can also be lowered. Their use can promote weight loss and maintenance as well as can help to improve the values of other metabolic parameters (eg. blood sugar, triglycerides). In addition to this, it is important to note that these benefits will not fully materialize if consumption of nonnutritive sweeteners is accompanied by an increase in compensatory caloric intake. Orv. Hetil., 2016, 157(Suppl. 1), 8-13.

[The effect of patient education on glycemic status and self-monitoring activity in type 2 diabetic patients recently switched to basal insulin analogue treatment]. / Bázisinzulinanalóg-kezelés elkezdésével együtt végzett csoportos betegedukáció hatásának vizsgálata a glykaemiás értékekre és az önellenorzési aktivitásra.

INTRODUCTION: In addition to medications, patient education is thought to have important beneficial effects in the management of patients with type 2 diabetes mellitus. AIM: The aim of the authors was to evaluate the additional effect of patient education on glycemic control and some aspects of lifestyle in a non-interventional study. METHOD: Patients between the ages of 18 and 75 were involved. Study sites which provided standardized education program recruited educated patients, while sites which provided diabetes counseling recruited control patients. RESULTS: Patients included in the educated group were younger, had an earlier detection of diabetes, and had better baseline glycemic control. Changes of HbA1c levels in the control and educated group arms were -1.41% and -1.23%, (p = 0.277) and the changes of fasting blood glucose levels were -1.89 mmol/L and -1.88 mmol/L (p = 0.854) in the control and educated groups, respectively. The changes in postprandial glucose levels were significantly greater in the control group (-2.88 mmol/L vs. -2.26 mmol/L in the educated group, p = 0.010). Body mass index in the control group did not actually change between baseline and end of study, but it decreased significantly in the educated group. In the educated group the number of self-monitoring days and the patients' physical activity increased between education sessions 1 and 3. CONCLUSIONS: The possible reason for baseline differences between the two groups was that younger and more motivated patients with better glycemic control tended to join the education program. Education was associated with beneficial body mass changes but not with improvement in glycemic status. Improved self-monitoring and physical activity can be documented in the group of educated patients.

Mapping the Nottingham Health Profile onto the Preference-Based EuroQol-5D Instrument for Patients with Diabetes.

OBJECTIVE: The aim of this study was to derive a function that can map the Nottingham Health Profile (NHP) questionnaire onto a utility measure, the EuroQol five-dimensional (EQ-5D) questionnaire index, for diabetic patients. METHODS: A cross-sectional study was performed on diabetic patients in Hungary with different complications in which quality of life was measured by using both the NHP questionnaire and the EQ-5D questionnaire. Ordinary stepwise-backward least-squares regression was used to develop a mapping function. Adjusted R2, Akaike's information criterion, and root mean square error were used to assess the performance of the model. The robustness of the models was tested using 10-fold cross-validation and bootstrapping. RESULTS: The best-fitting models were those that contained all the NHP statements as predictors and a stepwise reduced version that contained only 19 statements. The latter model, however, showed considerable variability in the selection of predictors. The adjusted R2 of the former model was 0.68, the root mean square error was 174, and the Akaike's information criterion was -559.9. CONCLUSIONS: The expected value of the EQ-5D questionnaire can be reasonably predicted on the basis of results of the NHP in patients with diabetes mellitus. The mapping function of the NHP onto the EQ-5D questionnaire is capable of estimating the expected EQ-5D questionnaire utility values in a group of patients with diabetes. The function's applicability for individual-level predictions, however, is limited. Further research is needed to find out whether mapping functions developed in Central-Eastern European countries are transferable to Western European countries.

Prevalence of undiagnosed abnormal glucose tolerance in adult patients cared for by general practitioners in Hungary. Results of a risk-stratified screening based on FINDRISC questionnaire.

BACKGROUND: The prevalence of type 2 diabetes mellitus is rapidly increasing, worldwide and also in Hungary. Timely diagnosis and early treatment could be aided by targeted screening. Recognizing this, the Hungarian Diabetes Association initiated a risk-stratified screening with the involvement of primary care physicians. MATERIAL/METHODS: In the first phase of screening, the FINDRISC questionnaire was completed, followed by an oral glucose tolerance test (OGTT) for those with a score of ≥12. Between September 1, 2010 and March 31, 2011, 70,432 non-diabetic adults, who visited their general practitioners for any reason, were involved in the screening. Of these, 68,476 questionnaires proved to be suitable for processing. RESULTS: From the questionnaires, 28,077 (41.0%) had a score of ≥12. A valid OGTT was performed in 22,846 cases; of this group 3,217 subjects (14.1%) had elevated fasting glucose levels, 5,663 (24.8%) had impaired glucose tolerance, and 1,750 (7.6%) had manifest, previously undiagnosed, diabetes mellitus. Overall, from the valid OGTT group, 46.5% subjects had some degree of glucose intolerance. CONCLUSIONS: Based on the FINDRISC questionnaire, the risk-stratified screening for diabetes mellitus proved to be simple and cost-effective method for the early detection of carbohydrate metabolism disorders. Using this method, the prevalence rate of previously undiagnosed abnormal glucose tolerance was high in adult patients cared for by general practitioners in Hungary.

Assessment of cardiometabolic risk among shift workers in Hungary.

AIM: Shift workers may be at risk of different diseases. In order to assess cardiometabolic risk in shift workers, a cross-sectional study was performed among active workers. METHODS: A total of 481 workers (121 men, 360 women) were investigated; most of them were employees in light industry (58.2%) or in public services (23.9%). Past medical history was recorded and physical examination was performed. Questionnaires were used to characterize daily activity. Fasting venous blood sample was collected for measuring laboratory parameters. Data from shift workers (n = 234, age: 43.9 ± 8.1 years) were compared to those of daytime workers (n = 247, age: 42.8 ± 8.5 years), men and women were analyzed separately. RESULTS: In men, systolic blood pressure was higher in shift workers compared to daytime workers (133 ± 8 vs 126 ± 17 mmHg; p < 0.05). In women, weight (73.6 ± 15.5 vs 67.7 ± 13.2 kg; p < 0.001), body mass index (27.5 ± 5.7 vs 25.0 ± 4.3 kg/m2; p<0.001) and the prevalence rate of hypertension in the past medical history (24.4 vs 13.4%; p < 0.01) were higher in shift workers compared to daytime workers. In addition, the proportion of current smokers was higher (37.7 vs 21.7%; p < 0.001) and HDL-cholesterol level was lower (1.56 ± 0.32 vs 1.68 ± 0.36 mmol/l; p < 0.01) in female shift workers than in female daytime workers. Both in men and in women, rotating shift workers spent less time sleeping both on working days and on non-working days, spent less time with sport activity, drank more coffee and they spent less time working per day, especially in light physical work, compared to daytime workers. In addition, low and middle educational levels were most frequently found among rotating shift workers as opposed to the daytime workers where high educational level was more common. CONCLUSION: Middle-aged active shift workers, especially women, have a less healthy lifestyle and are at higher cardiometabolic risk as compared to daytime workers. Our study highlights the importance of measures for identifying and preventing cardiometabolic risk factors in shift workers.

[Patient education: an indispensable element of care of patients with diabetes mellitus]. / Páciensedukáció - a cukorbeteg-gondozás nélkülözhetetlen eleme.

Diabetes is a chronic and progressive disorder that impacts upon almost every aspect of life. The number of people with diabetes is continuously growing and diabetes is associated with a high mortality rate. Diabetes education is a critical element of care of people with diabetes in order to improve clinical outcomes. The therapeutic patient education is a planned and structured program that is comprehensive in scope, flexible in content, responsive to an individual's clinical and psychological needs, and adaptable to patients' educational and cultural background. The diabetes educator should control the implementation of education and should evaluate the patient's knowledge. The educator should be trained for care of patients with chronic diseases and for education of patients with diabetes mellitus.

Prevalence rate of diabetes mellitus and impaired fasting glycemia in Hungary: cross-sectional study on nationally representative sample of people aged 20-69 years.

AIM: To obtain correct evaluation of the prevalence rate of diabetes mellitus and impaired fasting glycemia (IFG) in Hungary. METHOD: The study was performed on a nationally representative sample covered by the Hungarian General Practitioners' Morbidity Sentinel Stations Program. The source population consisted of all persons aged 20-69 years who were registered with the participating centers. The prevalence rates were adjusted to age and sex distribution of the total Hungarian population. Fasting blood samples of 1803 participants were evaluated. Response rate was 90.7%. RESULTS: In addition to 130 (7.21%) patients with established diabetes, 26 participants with newly diagnosed diabetes were found, resulting in a total crude diabetes prevalence of 8.65% (men: 11.16%; women: 6.41%; P<0.001). After weighting for age and sex, the prevalence rate of diabetes in participants aged 20-69 years should be set at 7.47% (95% confidence interval [CI], 6.26-8.69) (men: 9.49%; 95% CI, 7.52-11.46; women: 5.58%; 95% CI, 4.12-7.04). In addition to 41 (2.27%) patients with established IFG (fasting blood glucose: 6.1-6.9 mmol/L), 47 participants with newly diagnosed IFG were found, resulting in a total crude IFG prevalence of 4.88% (men: 6.11%; women: 3.78%; P=0.022). After making corrections for weighting age and sex, the total IFG prevalence rate in participants aged 20-69 years should be set at 4.39% (95% CI, 3.44-5.34) (men: 5.52%; 95% CI, 3.99-7.06; women: 3.33%; 95% CI, 2.19-4.47). CONCLUSION: The prevalence rate of diabetes and IFG in Hungary is higher than previously estimated by experts and authorities. The present data may serve as a base for comparative investigations in the future.

[Screening for type 2 diabetes and prediabetes--methodological concerns and feasibility in Hungary]. / A 2-es típusú diabetes és elôállapotainak szûrése--módszertani megfontolások, hazai lehetôségek.

It is well documented that type 2 diabetes often has a long and latent pathogenetic process before its manifestation; even patients with short duration of diabetes can be asymptomatic. At these stages, patients with type 2 diabetes or prediabetes can be identified by screening. Several screening procedures have been developed; however, risk-stratified screening method is the most accepted worldwide. Risk-stratified screening implies two stages, starting with the selection of people at higher risk. At the second stage, blood glucose measurement should be carried out. For selection of subjects at higher risk, the FINDRISC (Finnish Diabetes Risk Score) questionnaire proved to be useful in different settings. Based upon the results of a screening procedure, early treatment of patients with type 2 diabetes and primary prevention of diabetes in subjects with prediabetes can be performed. All these activities can lead to a decrease of prevalence rate of type 2 diabetes. Similarly to other countries, all these concerns should be addressed within a frame of a new National Diabetes Programme in Hungary.

[Risk-stratified screening for diabetes in adults: results of the first investigation in Hungary]. / Kockázatalapú diabetesszûrés felnôttek körében: az elsô hazai vizsgálat eredményei.

Prevalence rate of diabetes mellitus, especially of type 2 diabetes, has been increasing worldwide; this is the case in Hungary as well. The early diagnosis of diabetes should be considered as one of the most important factors improving the late prognosis of the disease. Due to cost-effectiveness, screening should primarily be implemented in subjects at high risk to glucose intolerance. A risk-stratified nationwide screening procedure was performed by the Hungarian Diabetes Association in collaboration with general practitioners (GPs) in adult subjects without known diabetes. The screening procedure, which was sponsored by the 77 Elektronika Ltd (Budapest), was performed in a two steps manner. At first step, the Hungarian version of the internationally validated FINDRISC questionnaire (maximal score 26) was filled out by subjects while waiting for GP. At second step, blood glucose value in venous sample was locally measured by standard laboratory methods in subjects with a score value of > or = 12. The further diagnostic steps were carried out by WHO guidelines. As a total, 8921 subjects (59.7% women, 40.3% men) were screened between 01, April 2008 and 31, March 2009. Out of 4286 subjects with a score of > or = 12 (age 53.4 +/- 11.4 years; BMI: 29.9 +/- 4.8 kg/m2; waist circumference: 101.7 +/- 12.7 cm) 3733 (87.1%) had normal fasting blood glucose values, while 283 subjects (6.6%) had IFG, 122 (2.85%) had IGT and 19 participants (0.44%) had isolated IGT. Unknown diabetes was found in 129 subjects (3.01%). If the score value requiring laboratory confirmation was set at higher level (> or = 15 or > or = 20), the proportion of subjects with any degree of glucose intolerance increased. Among anthropometric parameters, BMI had the strongest association with the risk of glucose intolerance: 1 kg/m 2 increase in BMI value increased the risk of abnormal score category (> or = 12) by 24.7% (95% confidence interval: 23.3-26.2%). The risk-stratified screening procedure proved to be simple and effective for detecting early impairment of the carbohydrate metabolism, therefore, its wider implementation should be considered advisable.

Efficacy and safety of lacosamide in painful diabetic neuropathy.

OBJECTIVE: To evaluate efficacy and safety of lacosamide compared with placebo in painful diabetic polyneuropathy. RESEARCH DESIGN AND METHODS: Diabetic patients with at least moderate neuropathic pain were randomized to placebo or lacosamide 400 (in a slow or standard titration) or 600 mg/day over 6-week titration and 12-week maintenance periods. Primary efficacy criterion was intra-individual change in average daily Numeric Pain Rating Scale score from baseline to the last 4 weeks. RESULTS: For the primary end point, pain reduction was numerically but not statistically greater with lacosamide compared with placebo (400 mg/day, P = 0.12; 600 mg/day, P = 0.18). Both doses were significantly more effective compared with placebo over the titration (P = 0.03, P = 0.006), maintenance (P = 0.01, P = 0.005), and entire treatment periods (P = 0.03, P = 0.02). Safety profiles between titration schemes were similar. CONCLUSIONS: Lacosamide reduced neuropathic pain and was well tolerated in diabetic patients, but the primary efficacy criterion was not met, possibly due to an increased placebo response over the last 4 weeks.

[Improvement in glycemic control, cardiovascular risk factors and anthropometric data in type 2 diabetic patients after the switch from biphasic human insulin to biphasic premix analog insulin aspart]. / 2-es típusú cukorbetegek szénhidrát-anyagcseréjének, cardiovascularis és alkati paramétereinek változása bifázisos humán inzulinról analóg premix inzulinra történt terápiaváltás után.

Long-term studies involving large number of type 2 diabetic patients supplied evidence that constant adequate metabolic control may prevent the late (micro- and macrovascular) diabetic complications. In the present non-interventional, retrospective study, authors performed an analysis of type 2 diabetic patients who had been previously treated with biphasic human insulin (BHI) and their therapy was changed to biphasic analog insulin aspart 30/70 (BIAsp = NovoMix 30). The switch of the insulin therapy was carried out in years 2007 and 2008 with the cooperation of 50 accredited diabetes centers. Data were obtained at the time of therapeutical change and six months later. The number of suitable patients was 2898 with an age of 66.20 +/- 10.10 year, and the duration of diabetes was >10 years in 43% of the patients. After the six-month therapy with NovoMix 30, the mean HbA 1c level decreased statistically significantly from the initial value of 9.10 +/- 1.44% to 7.62 +/- 1.00% ( p < 0.001). The lipid profile also improved although target values were not always attained. A reduction was also observed in both systolic and diastolic blood pressure. Mean body weight decreased from 84.2 +/- 14.9 kg to 82.6 +/- 13.9 kg ( p < 0.01). All these changes occurred in spite of a significantly reduced daily insulin dose (48.4 +/- 17.6 IU) as compared with the initial value (49.0 +/- 17.4 IU, p < 0.001). A marked decrement was also observed in the frequency of hypoglycemic reactions. These results confirm that treatment with NovoMix 30 insulin leads to a significant amelioration of glycemic control as reflected by the decreased level of HbA 1c and the higher proportion of patients attaining the target value, as well as the lower frequency of hypoglycemic episodes. The significant improvements in cardiovascular risk factors are also important, but the explanation is still missing and would require the accomplishment of prospective, controlled studies.

[Effectiveness of cardiometabolic risk reduction in patients with type 1 diabetes mellitus]. / A kardiometabolikus kockázati tényezôk kezelésének eredményessége 1-es típusú diabetesben szenvedôk körében.

UNLABELLED: The attainment and maintenance of therapeutic goal of cardiovascular risk factors are of great clinical importance. The effectiveness of cardiovascular risk management is not well characterized during regular care of patients with type 1 diabetes mellitus. AIM: The aim of the study was to estimate the effectiveness of cardiovascular risk management in type 1 diabetic patients. METHODS: Adult patients with type 1 diabetes mellitus (n = 533; 256 men, 277 women; age: 35.6 +/- 11.6 years; duration of diabetes: 18.0 +/- 11.1 years; x +/- SD) were consecutively enrolled from 11 diabetes outpatient departments. Data on medical history, actual treatment, anthropometric and laboratory parameters as well as actual blood pressure were registered, while eating and smoking habits, education level and physical activity were evaluated by standardized questionnaires. The treating goal was set according to the national guideline which corresponds to the current international task force. RESULTS: Of 533 patients, the body mass index target level (< 25 kg/m 2 ) was achieved by 295 (55.5%) patients. Ideal waist circumference (< 80 cm for women and < 94 cm for men) was measured in 140 (50.5%) and in 165 (63.7%) patients, respectively. Optimal glycaemic control (HbA 1c level < 6.5%) was documented in 45 (8.4%) patients. Lipid lowering drugs (statins, fibrates or ezetimibe) were used by 130 patients, among which 53.1% reached the target triglyceride level, 71.5% the target HDL-cholesterol and 27.8% the target LDL-cholesterol levels. Taking the lipid target values together, only 23 (17.7%) patients were at goal. Antihypertensive drugs were used by 173 patients among which 29.5% reached the systolic and 34.8% the diastolic target values (< 130/80 mmHg). Regarding smoking habits, 94 (17.7%) patients were current smokers and 102 (19.2%) ex-smokers. CONCLUSIONS: The attainment of therapeutic goal of cardiovascular risk factors proved to be difficult in a substantial part of patients. Further efforts are needed for attaining and maintaining the established goal of cardiovascular risk management during regular care of adult patients with type 1 diabetes mellitus.

Screening for metabolic syndrome in hypertensive and/or obese subjects registered in primary health care in Hungary.

BACKGROUND: The screening of subjects at risk for metabolic syndrome is of considerable importance in order to prevent atherosclerosis. MATERIAL/METHODS: In order to assess the clinical-laboratory characteristics of metabolic syndrome,a screening procedure was performed in subjects (age 20 -65)who exhibited hypertension and/or abnormal body mass index (BMI)and/or elevated waist-hip ratio,excluding patients with known diabetes. An oral glucose tolerance test with 75 g glucose was performed. Plasma glucose and insulin values were measured,as well as plasma lipids. RESULTS: In subjects available for complete statistical analysis (n=944;women/men ratio 1.37:1),hyperinsulinemia was detected in 52.9%. Hyperinsulinemia with normal glucose tolerance was more often detected (33.2%),hyperinsulinemia with impaired glucose tolerance [IGT ]or diabetes less frequently (13.0%and 6.7%,respectively). When abnormal clinical signs were separately analysed,hyperinsulinemia was found in 56.8%of subjects with abnormal BMI,in 43.8% of subjects with abnormal waist-hip ratio,and in 27.1% of subjects with hypertension. Metabolic syndrome (WHO criteria,modified)was diagnosed in 35.2%of subjects,with male predominance (men:40.6%;women:31.2%;p<0.01). CONCLUSIONS: Obesity (abnormal BMI;abnormal waist-hip ratio)is of greater importance than hypertension alone for detecting subjects with hyperinsulinemia.Routine clinical and laboratory investigations (anthropometric data,measuring blood pressure,oral glucose tolerance test)are simple but useful for identifying subjects with metabolic syndrome,enabling the implementation of a primary strategy to prevent cardiovascular morbidity.

[Fasting or post-challenge blood glucose values for detection of glucose intolerance in screening for metabolic syndrome?]. / Ehomi vagy terhelés utáni vércukorértékre alapozzuk a glukózintolerancia felismerését a metabolikus szindróma szúrésekor?

INTRODUCTION: The normal-pathological threshold of fasting blood glucose values was modified by the new WHO diagnostic criteria (1999) and, in addition, impaired fasting glucose (IFG) was introduced as a new clinical entity. Nevertheless, the 2-h post-glucose challenge criteria and the concept of the impaired glucose tolerance (IGT) remained unchanged. There is no unequivocal agreement whether new fasting or unchanged post-challenge blood glucose criteria should be used for classification of glucose intolerance. AIMS: To assess the clinical-laboratory characteristics of metabolic syndrome a screening procedure was performed in hypertensive or obese subjects registered within primary health care and the reliability of the new fasting blood glucose criteria was analysed. PATIENTS AND METHODS: For inclusion, subjects of both sexes aged from 20 to 65 years exhibited at least one of the following clinical characteristics: hypertension (ongoing antihypertensive treatment or raised (> or = 140/90 mmHg) actual blood pressure), abnormal (> 30.0 kg/m2) body mass index [BMI] or elevated waist-hip ratio (> 0.85 in women, > 0.90 in men). Subjects with known diabetes were not involved. An oral glucose tolerance test (OGTT) with 75 g glucose was performed in each subject. Subjects with complete clinical and laboratory findings were statistically analysed (n = 944; women/men: 545/399; age: 46.1 +/- 7.3 years; BMI 32.2 +/- 5.4 kg/m2; waist-hip ratio 0.90 +/- 0.09; x +/- SD). RESULTS: In the total cohort newly diagnosed diabetes mellitus (based on the 120 min post-challenge glucose values) was found in 87 subjects (9.2%), IGT was detected in 136 cases (14.4%) while normal glucose tolerance was documented in 721 subjects (76.4%). Using fasting blood glucose values for classification, diabetes mellitus was detected in 79 subjects (8.4%), IFG was found in 124 cases (13.1%) while 741 subjects (78.5%) had normal glucose tolerance. Impaired glucoregulation (IGT + IFG) was found in 223 subjects (IGT alone 99 cases [44.4%], IFG alone 87 cases [39.0%], IGT and IFG in combination 37 cases [16.6%]). The sensitivity and specificity of fasting blood glucose criteria for detecting diabetes were 63.2% and 97.1%, respectively, while those for detecting glucose intolerance (IFG and diabetes as well as IGT and diabetes) were 52.9% and 88.2%, respectively. Clinical characteristics of subjects with abnormal post-challenge but normal fasting blood glucose values (n = 105) did not differ significantly from those of subjects with normal post-challenge but abnormal fasting blood glucose values (n = 85) (age: 46.7 +/- 6.9 years vs 46.7 +/- 6.1 years; BMI: 33.1 +/- 5.4 kg/m2 vs 32.3 +/- 4.5 kg/m2; waist-hip ratio: 0.91 +/- 0.09 vs 0.92 +/- 0.07; p > 0.05). CONCLUSION: OGTT and 2-h post-glucose challenge criteria should be used for the diagnosis of different categories of glucose intolerance in screening for metabolic syndrome.