5 :: KDA, Korean Diabetes Association ::
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Subject    :    [2018 Apr;42(2)] Clinical Implications of Using Post-Challenge Plasma Glucose Levels for Early Diagnosis of Type 2 Diabetes Mellitus in Older Individuals
Writer KDA
Date 2019-03-05 18:01:07 Hit 369
Diabetes Metab J. 2018 Apr;42(2):147-154. English.
Published online Feb 13, 2018.  https://doi.org/10.4093/dmj.2018.42.2.147 
Copyright © 2018 Korean Diabetes Association
   
Clinical Implications of Using Post-Challenge Plasma Glucose Levels for Early Diagnosis of Type 2 Diabetes Mellitus in Older Individuals
Kyong Hye Joung,1,* Sang Hyun Ju,1,* Ji Min Kim,1 Sorim Choung,2 Jae Min Lee,3 Kang Seo Park,3Hyun Jin Kim,1 and Bon Jeong Ku1,2
1Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
2Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.
3Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea.

Corresponding author: Bon Jeong Ku. Department of Internal Medicine, Chungnam National University School of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. Email: bonjeong@cnu.ac.kr

 

*Kyong Hye Joung and Sang Hyun Ju contributed equally to this study as first authors.
 
Received August 04, 2017; Accepted November 15, 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

 
Abstract

Background

The aim of this study was to explore the differences in the clinical characteristics and diagnostic rates of diabetes mellitus (DM) according to various criteria in different age groups and to evaluate the efficacy of each criterion for screening older patients.

Methods

We studied 515 patients and measured the fasting plasma glucose level (FPG), 2-hour plasma glucose level after the 75 g oral glucose tolerance test (2-hour postload glucose [2-h PG]), and glycosylated hemoglobin (HbA1c) for re-evaluation of hyperglycemia without a history of diabetes. Patients with newly diagnosed DM were grouped by age as younger (<65 years) or older (≥65 years).

Results

Older patients had significantly lower HbA1c, FPG, and 2-h PG levels and a higher homeostatic level of pancreatic β-cell function compared with younger patients (P<0.001). The older group had the lowest diagnostic rate when using the FPG level (45.5%) and the highest diagnostic rate when using the 2-h PG level (84.6%). These results were mostly due to the higher frequency of isolated post-challenge hyperglycemia in the older patients than in the younger group (28.8% vs. 9.2%). The use of both the FPG and HbA1c levels significantly enhanced the low diagnostic power when employing only the FPG levels in the older group (71.2% vs. 45.5%).

Conclusion

In the older patients, the 2-h PG level was the most accurate diagnostic criterion. When we consider the costs and convenience, a combination of the FPG and HbA1c criteria may be recommended as a screening test for DM in older people.

   
Keywords:
AgeDiabetes mellitusPostprandial glucose
 

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