SCREENING OF DISGLYCEMIA IN URBAN SETTING

Abstract:

Keywords:

Recent estimates suggest that 195 million people throughout the world have diabetes and that this number will increase to 330,maybe even to 500 million,by 2030.Many patients ,up to 50% in most investigations,with type 2 diabetes are undiagnosed since they remain asymptomatic and therefore undectected for many years.Detecting people with undiagnosed type 2 diabetes is important for both public health and every day clinical practice.Mass screening for asymptomatic diabetes has not been recommended in the general population pending evidence that the prognosis of such patients will improve by early detection and treatment. Importantly, lack of evidence relates to lack of studies testing the hypothesis that early screening would indeed be advantageos.One such study (ADDITION)is ongoing in Denmark, the Nederlands and the UK.Indirect evidence suggests that screening might be beneficial as it improves the posibility of early detection of diabetes and thereby improved prevention of cardiovascular complication.

The following Table summarises the 2006 WHO recomandations for the diagnostic criteria for diabetes and intermediate hyperglycemia.

Diabetes Fasting plasma glucose 2-h plasma glucose * Impaired Glucose Tolerance(IGT) Fasting plasma glucose 2-h plasma glucose * Impaired Fasting Glucose(IFG) Fasting plasma glucose * 2-h plasma glucose *

7mmol/l(126mg/dl) or 11.1mmol/l(200mg/dl) <7.0mmol/l(126mg/dl) and 7.8and<11.1mmol/l (140mg/dl and 200mg/dl) 6.1 to 6.9 mmol/l (110mg/dl to125 mg/dl) and (if measured ) <7.8mmol/l(140mg/dl)

*Venous plasma glucose 2-h after ingestion of 75 g oral glucose load *If 2-h plasma glucose not measured ,status is uncertain as diabetes or IGT cannot be excluded The fasting plasma glucose cut-point for Impaired Fasting Glucose(IFG) should remain at 6.1mmol/l. Venous plasma glucose should be the standard method for measuring and reporting .However in recognition of the widespread use of capillary sampling ,especially in under-resourced countries, conversion values for capillary plasma glucose are provided for post load glucose values.Fasting values for venous and capillary plasma glucose are identical. Objectives of the study The objective of the study was to identify persons with type 2 diabetes and with impaired fasting glucose in general population. Material and methods

The study enrolled 2086 participants,selected from general population,from urban settings,during 1-year period. The persons included in the study were ..to ..year old.Blood samples were taken from a high school collective in Cluj-Napoca and from the employees of the Cluj County Departament of the Romanian Railway Society. We measured fasting glycemia,total cholesterol,and serum triglycerides from capillary blood, using Glucotrend 2 and Accutrend GCT blood glucose meters. The parameters recorded were the following:identification information,personal and familial medical history-focused on cardiovascular and metabolic pathology,lifestyle information and anthropometrical data:height,abdominal circumference, and body mass index calculated using the World Health Organisation criteria for the classification of obesity.We measured also the blood pressure. The database was built using Microsoft Excel and SPSS for Windows.The statistical analysis was done using these applications and the calculation methods were those of descripitive statistics. The studied group The study randomly enrolled 2086 participants, with a mean age of .years.The distribution by gender is the following:59.95% women and 40.05% men.
Figure 1. Distribution by gender

40,05%

MEN WOMEN

59,95%

Figure2. Distribution by age

32,71%
35%

30%

23,93%

25%

18,51%
20%

17,22%

15%

10%

7,63%

5%

0% 30 31-40 41-50 51-60 60

Figure 3. Lifestyle information :physical activity(sedentary , moderate and active )and smokers or non-smokers
69,40%
70% 60% 50% 40% 30% 20% 10% 0% Act. fizica crescuta / moderata / redusa Fumatori / Nefumatori

66,24%

30,60% 23,55% 10,22%

Figure 4. Family history of the subjects - procentual distribution

35%

30,60%
30%

25%

20%

18,08% 15,01% 12,37% 9,40% 9,78%

15%

10%

5%

2,97%

0% dzfam = dzp + dzf BCVF HTAF DLPF OBF

Figure 5.Personal history of the subjects

16,98%
18% 16% 14% 12% 10% 8% 6% 4% 2% 0% CI HTA IM / AVC

10,70%

1,73%

Figure 6.Subjects distribution by body mass index (BMI)

60%

51,22%

50%

37,89%

40%

30%

20%

10,89%

10%

0% <25 25-30 >30

Figure 7.Subjects distribution by waist circumference and gender

58,08%
60%

49,68%

50%

40%

32,88% 22,99% 17,44% 18,92%

30%

20%

10%

CA < 80

CA 80 - 87

CA 88

CA < 94

CA 94 - 101

CA 102

0% WOMEN MEN

Figure 8.Procentual distribution of the subjects with normoglycemia impaired plasma glucose by old criteria and actual criteria 80,34%
90% 80% 70% 60% 50% 40% 30% 20% 10% 0% criteriu 2006 NG GBM criteriu 2007 DZ

55,11%

39,04%

13,81% 5,85% 5,85%

Figure 9.Procentual distribution of the subjects with normoglycemia impaired plasma glucose by gender

90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

84,32% 74,34%

18,35% 10,80% 4,88%

WOMEN MEN

7,31%

<110

110-125

>125

Figure 10.Procentual distribution of the subjects with normoglycemia impaired plasma glucose by age 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 30
<110

93,70% 84,46% 73,35% 75,47% 62,40%

23,40% 5,13% 1,17% 12,69% 2,85% 31-40 20,24% 6,41% 41-50

110-125

11,95% 51-60

12,58%

14,21%

60
>125

Figure 10.Procentual distribution of the subjects with normoglycemia impaired plasma glucose by age
100% 90% 80% 70% 60% 62,40% 50% 40% 30% 20% 10% 0% 30 31-40 41-50 51-60 60 5,13% 1,17% 12,69% 2,85% 20,24% 6,41% 11,95% 12,58% 23,40% 14,21% 93,70% 84,46% 73,35% 75,47%

<110

110-125

>125