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DWP3-1 The effect of lowering the threshold for diagnosis of impaired fasting glucose
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DIABETES RESEARCH A N D CLINICAL PRACTICE
related lower limb amputations annually; and diabetes is the leading cause of blindness on 20-65 yr olds in industrialised countries. Pacific Island countries (PICs) experience severe human, technical and material resource deficits which limits efforts to improve care. Many PICS have been shown to have high rates of diabetes-related morbidity but the rate of complications in Vanuatu had not previously been systematically assessed. Aim: The aim of this study was to: 1. Assess a) metabolic status b) complications associated with diabetes and c) diabetes treatment/management in a cohort of people with Type 2 diabetes in Vanuatu in order to guide and serve as a baseline for interventions to improve the quality and accessibility of diabetes care and services. 2. Determine if there were any changes in the parameters assessed after one year. Methods: A convenience sample of 199 people (83 males, 116 females) with diabetes in the Port Vila Central Hospital catchment area underwent a comprehensive assessment of metabolic status and diabetes complications in June 2005. In November 2006, 105 people from the original cohort were re-assessed. Using paired data analysis, comparisons were made between the 2005 and 2006 screening results. Both screenings used the same physical and biochemical assessment methods and were conducted by the same team comprising a visiting diabetologist and optometrist and the local doctor and nurses responsible for the Port Vila Central Hospital Diabetes Clinic. Results presented are mean ± SEM. Results: The average age of the cohort was 55.4 ± 0.69 years with an average duration of diabetes since diagnosis of 5.2 ± 0.36 years. The mean HbA1c in the 2005 survey was 8.1 ± 0.14% and this had not changed (8.0 ± 0.18%) in 2006. In 2005, lipid levels were in or close to recommended levels (cholesterol: 4.7 ± 0.09mM; LDL: 2.8 ± 0.08mM; HDL: 0.8 ± 0.02mM; triglycerides: 2.8± 0.14mM) and these were unchanged in the 2006 survey. High rates of diabetes-related complications such as foot ulceration, lower limb amputation, microalbuminuria and retinopathy were prevalent in the cohort in the 2005 screening (5.0%, 10.6%, 50.3% and 41.7% respectively). In the 2006, screening the rates of these respective complications were still substantial. From the paired analysis, in the period between June 2005 and November 2006, a further 19% had developed retinopathy, a further 6% had developed foot ulcers and 1 patient had a lower limb amputated. Conclusion: Unsatisfactory blood glucose control and high complication rates were evident in this cohort. As the prevalence of diabetes in Vanuatu is estimated at around 10-12% and rising, processes have been implemented to increase and standardise the capacity of all health workers in Vanuatu to deliver the best possible quality of care and thereby reduce diabetes-related complications. Clinical targets and treatment recommendations have been agreed and established and an extensive national diabetes training program for health care providers has been implemented. With an improved and standardised quality of diabetes care the burden of diabetes-related complications should be reducible. Acknowledgement: Funded by a World Diabetes Foundation Project Grant
79 (2008) S1 – S127
DWP3-1 The effect of lowering the threshold for diagnosis of impaired fasting glucose So Hun Kim 1 , Yong Seong Kim 1 , Wan Sub Shim 1 , Hun-Jae Lee 4 , Seong Bin Hong 1 , Moonsuk Nam 1,2 , Shin Goo Park 3 , Jong Whan Lim 3 1 Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea, 2 Center for Advanced Medical Education (BK 21 project), Incheon, Korea, 3 Department of Occupational and Environmental Medicine, Inha University College of Medicine, Incheon, Korea, 4 Department of Preventive and Social Medicine, Inha University College of Medicine, Incheon, South Korea Purpose: The aim of this study was to evaluate the effect of lowering the fasting plasma glucose (FPG) criteria for impaired fasting glucose (IFG) on the prevalence of IFG and the risk for the development of diabetes associated with IFG in Koreans. Materials and methods: A total of 7,211 subjects who had normal glucose tolerance (NGT) or IFG were recruited. Subjects were evaluated at baseline and after two years follow up. Clinical data including total cholesterol, FPG and blood pressure were examined. Results: Lowering the criteria for IFG from 6.1 mmol/L (110 mg/dL) to 5.6 mmol/L (100 mg/dL) increased the prevalence of IFG from 6.6% (494 subjects) to 24.4% (1829 subjects). After the two years follow up period, a total of 91 subjects (1.3%) developed diabetes. Twenty one (0.3%) subjects developed diabetes among the 5,382 NGT subjects and 70 (3.8%) subjects developed diabetes among 1,829 IFG (5.6-7.0 mmol/L) subjects. 1.6% of the subjects whose FPG was 5.6-6.0 mmol/L (newly included IFG subjects, n=1335) and 9.7% of the subjects whose FPG was in the range of 6.1-7.0 mmol/L (old IFG subjects, n=494) developed diabetes mellitus after 2 years. Lowering the IFG threshold from 6.1 mmol/L to 5.6 mmol/L resulted in a 18.4% decrease in specificity and 23.9% increase in sensitivity. The baseline FPG for predicting the development of diabetes after 2 years at a point on the receiver operating characteristic curve that was closest to the ideal 100% sensitivity and 100% specificity was 5.7 mmol/L (103 mg/dl). Conclusion: Lowering the FPG criterion of IFG may have benefits in predicting new onset Type 2 diabetes mellitus in Koreans. The economic and health benefit of applying the new IFG criteria should be evaluated in future studies.
DWP3-2 Insulin resistance and beta-cell dysfunction using HOMA in Asian patients with Type 2 diabetes mellitus (T2DM) treated with oral anti-hyperglycemic agents (OHA) Ji Linong, Baik Sei Hyun, Nitiyanant Wannee, Sheu Wayne Huey-Herng, Sheu Wayne Huey-Herng, Chan, Siew Pheng. on behalf of Asia RECAP-DM Study Group People’s Hospital Affiliated to Peking University, China; Korea University Guro Hospital, Seoul, Korea; Siriraj Hospital, Bangkok, Thailand; Taichung Veterans General Hospital, Taiwan; University of Malaya Medical Centre, Kuala Lumpur, Malaysia Objectives: There is a paucity of data in Asia regarding the level of insulin resistance and beta-cell dysfunction in patients with T2DM. This study was done to assess measures of the levels of insulin resistance and beta-cell dysfunction among T2DM patients treated with OHA in China, Korea, Malaysia, Taiwan and Thailand. Methods: Blood for fasting glucose, insulin and HbA1c (A1C), patient surveys, and medical record review at a routine follow-up visit between January and September 2007 were conducted in Asian patients in China, Korea, Malaysia, Taiwan and Thailand.
DIABETES RESEARCH A N D CLINICAL PRACTICE
related lower limb amputations annually; and diabetes is the leading cause of blindness on 20-65 yr olds in industrialised countries. Pacific Island countries (PICs) experience severe human, technical and material resource deficits which limits efforts to improve care. Many PICS have been shown to have high rates of diabetes-related morbidity but the rate of complications in Vanuatu had not previously been systematically assessed. Aim: The aim of this study was to: 1. Assess a) metabolic status b) complications associated with diabetes and c) diabetes treatment/management in a cohort of people with Type 2 diabetes in Vanuatu in order to guide and serve as a baseline for interventions to improve the quality and accessibility of diabetes care and services. 2. Determine if there were any changes in the parameters assessed after one year. Methods: A convenience sample of 199 people (83 males, 116 females) with diabetes in the Port Vila Central Hospital catchment area underwent a comprehensive assessment of metabolic status and diabetes complications in June 2005. In November 2006, 105 people from the original cohort were re-assessed. Using paired data analysis, comparisons were made between the 2005 and 2006 screening results. Both screenings used the same physical and biochemical assessment methods and were conducted by the same team comprising a visiting diabetologist and optometrist and the local doctor and nurses responsible for the Port Vila Central Hospital Diabetes Clinic. Results presented are mean ± SEM. Results: The average age of the cohort was 55.4 ± 0.69 years with an average duration of diabetes since diagnosis of 5.2 ± 0.36 years. The mean HbA1c in the 2005 survey was 8.1 ± 0.14% and this had not changed (8.0 ± 0.18%) in 2006. In 2005, lipid levels were in or close to recommended levels (cholesterol: 4.7 ± 0.09mM; LDL: 2.8 ± 0.08mM; HDL: 0.8 ± 0.02mM; triglycerides: 2.8± 0.14mM) and these were unchanged in the 2006 survey. High rates of diabetes-related complications such as foot ulceration, lower limb amputation, microalbuminuria and retinopathy were prevalent in the cohort in the 2005 screening (5.0%, 10.6%, 50.3% and 41.7% respectively). In the 2006, screening the rates of these respective complications were still substantial. From the paired analysis, in the period between June 2005 and November 2006, a further 19% had developed retinopathy, a further 6% had developed foot ulcers and 1 patient had a lower limb amputated. Conclusion: Unsatisfactory blood glucose control and high complication rates were evident in this cohort. As the prevalence of diabetes in Vanuatu is estimated at around 10-12% and rising, processes have been implemented to increase and standardise the capacity of all health workers in Vanuatu to deliver the best possible quality of care and thereby reduce diabetes-related complications. Clinical targets and treatment recommendations have been agreed and established and an extensive national diabetes training program for health care providers has been implemented. With an improved and standardised quality of diabetes care the burden of diabetes-related complications should be reducible. Acknowledgement: Funded by a World Diabetes Foundation Project Grant
79 (2008) S1 – S127
DWP3-1 The effect of lowering the threshold for diagnosis of impaired fasting glucose So Hun Kim 1 , Yong Seong Kim 1 , Wan Sub Shim 1 , Hun-Jae Lee 4 , Seong Bin Hong 1 , Moonsuk Nam 1,2 , Shin Goo Park 3 , Jong Whan Lim 3 1 Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea, 2 Center for Advanced Medical Education (BK 21 project), Incheon, Korea, 3 Department of Occupational and Environmental Medicine, Inha University College of Medicine, Incheon, Korea, 4 Department of Preventive and Social Medicine, Inha University College of Medicine, Incheon, South Korea Purpose: The aim of this study was to evaluate the effect of lowering the fasting plasma glucose (FPG) criteria for impaired fasting glucose (IFG) on the prevalence of IFG and the risk for the development of diabetes associated with IFG in Koreans. Materials and methods: A total of 7,211 subjects who had normal glucose tolerance (NGT) or IFG were recruited. Subjects were evaluated at baseline and after two years follow up. Clinical data including total cholesterol, FPG and blood pressure were examined. Results: Lowering the criteria for IFG from 6.1 mmol/L (110 mg/dL) to 5.6 mmol/L (100 mg/dL) increased the prevalence of IFG from 6.6% (494 subjects) to 24.4% (1829 subjects). After the two years follow up period, a total of 91 subjects (1.3%) developed diabetes. Twenty one (0.3%) subjects developed diabetes among the 5,382 NGT subjects and 70 (3.8%) subjects developed diabetes among 1,829 IFG (5.6-7.0 mmol/L) subjects. 1.6% of the subjects whose FPG was 5.6-6.0 mmol/L (newly included IFG subjects, n=1335) and 9.7% of the subjects whose FPG was in the range of 6.1-7.0 mmol/L (old IFG subjects, n=494) developed diabetes mellitus after 2 years. Lowering the IFG threshold from 6.1 mmol/L to 5.6 mmol/L resulted in a 18.4% decrease in specificity and 23.9% increase in sensitivity. The baseline FPG for predicting the development of diabetes after 2 years at a point on the receiver operating characteristic curve that was closest to the ideal 100% sensitivity and 100% specificity was 5.7 mmol/L (103 mg/dl). Conclusion: Lowering the FPG criterion of IFG may have benefits in predicting new onset Type 2 diabetes mellitus in Koreans. The economic and health benefit of applying the new IFG criteria should be evaluated in future studies.
DWP3-2 Insulin resistance and beta-cell dysfunction using HOMA in Asian patients with Type 2 diabetes mellitus (T2DM) treated with oral anti-hyperglycemic agents (OHA) Ji Linong, Baik Sei Hyun, Nitiyanant Wannee, Sheu Wayne Huey-Herng, Sheu Wayne Huey-Herng, Chan, Siew Pheng. on behalf of Asia RECAP-DM Study Group People’s Hospital Affiliated to Peking University, China; Korea University Guro Hospital, Seoul, Korea; Siriraj Hospital, Bangkok, Thailand; Taichung Veterans General Hospital, Taiwan; University of Malaya Medical Centre, Kuala Lumpur, Malaysia Objectives: There is a paucity of data in Asia regarding the level of insulin resistance and beta-cell dysfunction in patients with T2DM. This study was done to assess measures of the levels of insulin resistance and beta-cell dysfunction among T2DM patients treated with OHA in China, Korea, Malaysia, Taiwan and Thailand. Methods: Blood for fasting glucose, insulin and HbA1c (A1C), patient surveys, and medical record review at a routine follow-up visit between January and September 2007 were conducted in Asian patients in China, Korea, Malaysia, Taiwan and Thailand.