The Library

Detection of impaired glucose tolerance and undiagnosed type 2 diabetes in UK South Asians : an effective screening strategy

Tools

Hanif, M. W., Valsamakis, Georgios, Dixon, A., Boutsiadis, A., Jones, A. F., Barnett, A. H. and Kumar, Sudhesh. (2008) Detection of impaired glucose tolerance and undiagnosed type 2 diabetes in UK South Asians : an effective screening strategy. Diabetes, Obesity and Metabolism, Vol.10 (No.9). pp. 755-762. ISSN 1462-8902

Full text not available from this repository.

Abstract

Aim: We tested a stepwise, community-based screening strategy for glucose intolerance in South Asians using a health questionnaire in conjunction with body mass index (BMI). Anthropometric measurements (waist and hip circumference, sagittal diameter and percentage body fat) were then conducted in a hospital setting followed by an oral glucose tolerance test (OGTT) to identify subjects at the highest risk and analyse the factors predicting that risk.

Methods: A health questionnaire was administered to 435 subjects in a community setting and BMI was measured. Subjects were graded by a risk score based on the health questionnaire as high, medium and low. Subjects with high and medium risk scores and a representative sample of those with low scores had anthropometric measurements in hospital followed by an OGTT. In total, 205 (47%) of the subjects had an OGTT performed.

Results: In total, 48.7% of the subjects tested with an OGTT had evidence of glucose dysregulation: 20% had diabetes and 28.7% had impaired glucose tolerance (IGT). Logistic regression model explained 49.1% of the total variability. The significant predictors of diabetes and IGT were Blood Glucose Monitoring Strips (BMI), random blood glucose (BM), sibling with diabetes and presence of diagnosed hypertension or ischaemic disease. Most of these predictors along with other heredity diabetes factors create a composite score, with high predictability, as the receiver operating curve analysis shows.

Conclusions: We describe a simple, stepwise strategy in a community setting, based on a health questionnaire and anthropometric measurements, to explain about 50% of cases with IGT and diabetes and diagnose about 50% of cases from the population screened. We have also identified factors that predict the risk.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Non-insulin-dependent diabetes -- Diagnosis -- Great Britain, South Asians -- Health and hygiene -- Research -- Great Britain, Medical screening -- Great Britain, Glucose tolerance tests, Non-insulin-dependent diabetes -- Risk factors
Journal or Publication Title: Diabetes, Obesity and Metabolism
Publisher: Wiley-Blackwell Publishing Ltd.
ISSN: 1462-8902
Official Date: September 2008
Volume: Vol.10
Number: No.9
Number of Pages: 8
Page Range: pp. 755-762
Identification Number: 10.1111/j.1463-1326.2007.00806.x
Status: Not Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
Funder: Produits Roche S.A., Takeda Yakuhin Kōgyō Kabushiki Kaisha [Takeda Pharmaceutical Industries]
References:

1 King H, Rewers M. Global estimates for prevalence of
diabetes mellitus and impaired glucose tolerance in
adults. Diabetes Care 1993; 16: 157–177.
2 Verma N, Mehta S, Madhu S, Mather H, Keen H. The
prevalence of known diabetes in an urban Indian environment.
BMJ 1986; 293: 423–424.
3 Ramchandran A, Snehalatha C, Dharmraj D, Viswanathan
M. Prevalence of glucose intolerance in Asian
Indians. Diabetes Care 1992; 15: 1348–1355.
4 Mather H, Keen H. The Southall Diabetes Survey: prevalence
of known diabetes in Asians and Europeans.
BMJ 1985; 291: 1081–1084.
5 Mckeigue PM, Shah B, Marmott MG. Relation of central
obesity and insulin resistance with diabetes prevalence
and cardiovascular risk. Lancet 1991; 337: 382–386.
6 Simmons D, Williams DRR, Powell MJ. Prevalence of
diabetes in a predominantly Asian community: preliminary
findings of Coventry Diabetes Study. BMJ
1989; 298: 18–21.
7 Simmons D, Williams DRR, Powell MJ. The Coventry
Diabetes Study Group: prevalence of diabetes and
impaired glucose tolerance in Europeans and Asians.
Q J Med 1991; 81: 1021–1030.
8 Beckles GLA, Miller GJ, Kirkwood B, Alexis SD,
Carson DC, Byam NTA. High total and cardiovascular
mortality in adults of Indian descent in Trinidad,
unexplained by major coronary risk factors. Lancet
1986; i: 1298–1301.
9 Allayne SA, Cruiskshank JK, Golding AR, Morrison EY.
Mortality from diabetes in Jamaica. Bull Pan Am Health
Organ 1989; 23: 306–315.
10 Cruikshank JK, Cooper J, Burnett M, MacDuff J, Drubra U.
Ethnic differences in fasting plasma C-peptide and
insulin in relation to glucose tolerance and blood pressure.
Lancet 1991; 338: 842–847.
11 Dowse DG, Gareeboo H, Zimmett PZ et al. High prevalence
of NIDDM and impaired glucose tolerance in
Indians, Creole and Chinese Mauritians. Diabetes Care
1990; 39: 390–396.
12 Simmons D, Williams DRR, Powell MJ. Prevalence of
diabetes in different regional and religious South
Asian communities in Coventry. Diabet Med 1992; 9:
428–431.
13 Neil HAW, Gatling W, Mather HM et al. The Oxford
Community Diabetes Study: evidence for an increase in
prevalence of known diabetes in Great Britain. Diabet
Med 1987; 4: 539–543.
14 Balajaran R. Ethnicity and variations in mortality
from coronary heart disease. Health Trends 1996; 28:
45–51.
15 Raleigh VS, Kim V, Balajaran R. Variation in mortality
from diabetes mellitus, hypertension and renal disease
in England and Wales by country of birth. Health
Trends 1997; 28: 122–127.
16 Wilson E, Wardle EV, Chandel P, Walford S. Diabetes
education and Asian perspective. Diabet Med 1993; 10:
177–180.
17 Diabetes Prevention Programme Research Group.
Reduction in the incidence of type 2 diabetes with life
style intervention or metformin. N Engl J Med 2002;
346: 393–403.
18 Tuomilehto J, Lindstrom J, Eriksson JG et al. Prevention
of type 2 diabetes mellitus by changes in lifestyle
among subjects with impaired glucose tolerance.
N Engl J Med 2001; 344: 1343–1350.
19 Pan XR, Li GW, Hu YH et al. Effects of diet and exercise
in preventing NIDDM in people with impaired glucose
tolerance. The Da Qing IGT and Diabetes Study.
Diabetes Care 1997; 20: 537–544.
20 Yudkin JS. Therapeutic targets for type 2 diabetes post-
UKPDS. J R Coll Physicians Lond 2000; 34: 254–256.
21 The National Service Framework for Diabetes Implementation
Group. National Service Framework for
Diabetes: Delivery Strategy. 2003. www.doh.gov.uk/nsf/
diabetes.htm.
22 Diabetes Prevention Programme Research Group.
Diabetes Risk Analysis. University of Washington,
2001; 346: 393–403.
23 The Conference on standardization of anthropometric
techniques and terminology. Am J Phys Anthropol
1968; 28: 1–16.
24 Griffin SJ, Little PS, Hales CN, Kinnmonth AL, Warenham
AJ. Diabetes risk score: towards earlier detection of
type 2 diabetes in general practice. Diabetes Metab Res
Rev 2000; 16: 164–171.
25 Wareham NJ, Griffin SJ. Should we screen for type 2
diabetes? Evaluation against National Screening Committee
criteria. BMJ 2001; 322: 986–988.
26 International Obesity Task Force. Defining Obesity in
Indo-Asians: International Obesity Task Force. 2002.
www.iotf.org.
27 Davey G, Ramachandran A, Snehalatha C, Hitman GA,
McKeigue PM. Familial aggregation of central obesity
in Southern Indians. Int J Obes Relat Metab Disord
2000; 24: 1523–1527.
28 Herman WH, Engelgau MM, Smith PJ, Aubert RE,
Thompson TJ. A new and simple questionnaire to identify
people at risk for undiagnosed diabetes. Diabetes
Care 1995; 18: 382–387.
URI: http://wrap.warwick.ac.uk/id/eprint/29516

Data sourced from Thomson Reuters' Web of Knowledge

Request changes or add full text files to a record

Actions (login required)

View Item View Item