A large proportion of prediabetes and diabetes goes undiagnosed when only fasting plasma glucose and/or HbA1c are measured in overweight or obese patients [Proportion considérable de prédiabète et de diabète méconnus par la glycémie à jeun ou l'HbA1c seule chez des patients en surpoids ou obèses]
Cosson E.,Diabetology Nutrition |
Cosson E.,University of Paris 13 |
Hamo-Tchatchouang E.,Diabetology Nutrition |
Banu I.,Diabetology Nutrition |
And 5 more authors.
Diabetes and Metabolism
Aims: The purposes of the study were to determine the prevalence of unrecognized dysglycaemia in overweight (body mass index [BMI] 25-29.9kg/m2) and obese (BMI ≥30kg/m2) patients, to assess the extent to which measures of fasting plasma glucose (FPG) and/or HbA1c, compared with oral glucose tolerance tests (OGTTs), misdiagnose dysglycaemia, and to determine the factors associated with an isolated abnormal post-OGTT glucose value. Methods: OGTT was performed and HbA1c was measured in 1283 inpatients with BMI scores ≥25kg/m2 and no history of dysglycaemia. Results: Prediabetes was found in 257 (20.0%) subjects (197 with impaired glucose tolerance, 29 with impaired fasting glucose, 31 with both) and diabetes in 77 (6.0%), including 22 with FPG ≥7mmol/L (WHO definition). The sensitivity of FPG >6mmol/L, FPG >5.5mmol/L, HbA1c ≥6% and the recommendations of the French National Agency of Accreditation and Evaluation in Health Care (ANAES) to identify patients with abnormal OGTTs was 29.9, 41.3, 36.8 and 15.6%, respectively. The factors that were independently associated with diabetes in obese women with FPG <7mmol/L were age (per 10 years: OR 1.54 [1.00-2.11]; P=0.049) and FPG (OR 6.1 [1.4-30.0]; P=0.014), whereas age (OR 1.26 [1.09-1.44]; P<0.01) and waist circumference (per 10cm: OR 1.17 [1.01-1.33]; P<0.05) were independently associated with dysglycaemia in obese women with FPG <6.1mmol/L. Conclusion: In overweight and obese patients: dysglycaemia is commonly seen; FPG alone, compared with OGTT, failed to diagnose 70% of dysglycaemia cases; FPG >5.5mmol/L and HbA1c ≥6.0% are not necessarily substitutes for OGTT; and older age and larger waist circumference should be used to select those obese women with normal FPG who might further benefit from OGTTs to diagnose dysglycaemia. © 2010 Elsevier Masson SAS. Source