Use of clinical scores to detect dysglycaemia in overweight or obese women.

To test if the use of either HbA(1c) level or calculated clinical scores including two published scores and a new score (the Bondy score) could help in selecting overweight or obese women who should benefit from oral glucose tolerance test (OGTT) to detect dysglycaemia. The French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) score and the Finnish Diabetes risk score (Findrisk) were calculated, whereas the Bondy score was built in a development sample of 698 women, BMI 37±7 kg/m(2), without known diabetes. External validation was performed in a validation sample of 212 women. A dysglycaemia (according to OGTT results, WHO criteria) was diagnosed in 161 (23.1%) patients. Sensitivity of fasting plasma glucose (FPG)≥6.1 mmol/l and HbA(1c)≥6% to identify dysglycaemia were respectively 27 and 41%. Areas under Receiver Operator Curve (AROC) of HbA(1c), DESIR score and Findrisk to detect dysglycaemia were 0.630 [95% confidence interval 0.580-0.680], 0.606 [0.561-0.652] and 0.635 [0.588-0.683], respectively. The Bondy score, based on age and waist circumference, had a better AROC (0.674 [0.626-0.721]) than the DESIR score (P<0.05). These performances were confirmed in the validation sample. Performing OGTT only in subjects with a Bondy score≥4 (41% of the sample) had a sensitivity of 61% and a better net benefit (0.128) than measuring FPG in all subjects (0.069). Performing OGTT in obese women selected on a simple clinical score is more sensitive to identify dysglycaemia than measuring FPG in all of them and may be cost-effective.

Cosson E ，Chiheb S ，Hamo-Tchatchouang E ，Nguyen MT ，Aout M ，Banu I ，Pillegand C ，Vicaut E ，Valensi P ... -  《-》

A large proportion of prediabetes and diabetes goes undiagnosed when only fasting plasma glucose and/or HbA1c are measured in overweight or obese patients.

The purposes of the study were to determine the prevalence of unrecognized dysglycaemia in overweight (body mass index [BMI] 25-29.9 kg/m(2)) and obese (BMI ≥30 kg/m(2)) patients, to assess the extent to which measures of fasting plasma glucose (FPG) and/or HbA(1c), compared with oral glucose tolerance tests (OGTTs), misdiagnose dysglycaemia, and to determine the factors associated with an isolated abnormal post-OGTT glucose value. OGTT was performed and HbA(1c) was measured in 1283 inpatients with BMI scores ≥ 25 kg/m(2) and no history of dysglycaemia. 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 ≥ 7 mmol/L (WHO definition). The sensitivity of FPG >6 mmol/L, FPG >5.5 mmol/L, HbA(1c) ≥ 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 <7 mmol/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 10 cm: OR 1.17 [1.01-1.33]; P<0.05) were independently associated with dysglycaemia in obese women with FPG <6.1 mmol/L. In overweight and obese patients: dysglycaemia is commonly seen; FPG alone, compared with OGTT, failed to diagnose 70% of dysglycaemia cases; FPG >5.5 mmol/L and HbA(1c) ≥ 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.

Cosson E ，Hamo-Tchatchouang E ，Banu I ，Nguyen MT ，Chiheb S ，Ba H ，Valensi P ... -  《-》

Prevalence of metabolic syndrome and insulin resistance in overweight and obese women according to the different diagnostic criteria.

Kocełak P ，Chudek J ，Olszanecka-Glinianowicz M 《-》

Predicting isolated postchallenge hyperglycaemia: a new approach; Tehran Lipid and Glucose Study (TLGS).

Hosseinpanah F ，Rambod M ，Reza Ghaffari HR ，Azizi F ... -  《-》

Validating the CANRISK prognostic model for assessing diabetes risk in Canada's multi-ethnic population.

Robinson CA ，Agarwal G ，Nerenberg K 《-》