Diabetes Metab J.  2018 Apr;42(2):147-154. 10.4093/dmj.2018.42.2.147.

Clinical Implications of Using Post-Challenge Plasma Glucose Levels for Early Diagnosis of Type 2 Diabetes Mellitus in Older Individuals

• Joung KH
• Ju SH
• Kim JM
• Choung S
• Lee JM
• Park KS
• Kim HJ
• Ku BJ

• KMID: 2418707
• DOI: http://doi.org/10.4093/dmj.2018.42.2.147

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.

Keyword

Age; Diabetes mellitus; Postprandial glucose

MeSH Terms

Blood Glucose*
Diabetes Mellitus
Diabetes Mellitus, Type 2*
Early Diagnosis*
Fasting
Glucose
Glucose Tolerance Test
Hemoglobin A, Glycosylated
Humans
Hyperglycemia
Mass Screening
Plasma*
Glucose

Figure

• 

  Fig. 1 Receiver operating characteristic curves. (A) Single diagnostic criterion and (B) combination of two diagnostic criteria for screening of diabetes mellitus in the older group. (A) When the single criterion was used, area under the curve (AUC) of glycosylated hemoglobin (HbA1c) was 0.859 (95% confidence interval [CI], 0.809 to 0.901), the AUC of fasting plasma glucose (FPG) was 0.817 (95% CI, 0.762 to 0.863), and the AUC of 2-hour plasma glucose (2-h PG) after the 75 g oral glucose tolerance test, which was the largest, was 0.946 (95% CI, 0.910 to 0.971). (B) When the combination of two criteria was used, the AUC of HbA1c and FPG was 0.884 (95% CI, 0.836 to 0.921), the AUC of HbA1c and 2-h PG, which was the largest, was 0.966 (95% CI, 0.935 to 0.985), and the AUC of FPG and 2-h PG was 0.959 (95% CI, 0.925 to 0.980).

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