This study developed and validated a multivariate logistic regression equation to screen for undiagnosed diabetes using readily available clinical data. The equation incorporated age, sex, BMI, time since eating, and random blood glucose. When applied to the derivation and validation datasets, the equation had sensitivities of 65% and 62%, specificities of 96%, and positive predictive values of 67% and 63%. The equation performed better than recommended static blood glucose cut-off points in identifying undiagnosed diabetes cases and had fewer false positives. The study concludes the equation improves diabetes screening over current methods and can easily be implemented using a handheld calculator.
Clinical Usefulness of a New Equation for Estimating Body Fat
(Utilidad clínica de una nueva ecuación para estimar la grasa corporal)
Javier Gómez-Ambrosi, PHD1,2⇓, Camilo Silva, MD2,3, Victoria Catalán, PHD1,2, Amaia Rodríguez, PHD1,2, Juan Carlos Galofré, MD, PHD3, Javier Escalada, MD, PHD2,3, Victor Valentí, MD, PHD2, Fernando Rotellar, MD, PHD2, Sonia Romero, MSC2,3, Beatriz Ramírez, MSC1,2, Javier Salvador, MD, PHD2,3 and Gema Frühbeck, MD, PHD1,2,3
Corresponding author: Javier Gómez-Ambrosi, jagomez@unav.es.
Diabetes Care 2012 Feb; 35(2): 383-388. https://doi.org/10.2337/dc11-1334
This study examined whether different levels of glucose variability in patients with type 1 diabetes predict responses to continuous subcutaneous insulin infusion (CSII) therapy in terms of hypoglycemic events. The study found that:
1) Baseline low blood glucose index (LBGI), a measure of glucose variability, was the best predictor of reduced hypoglycemia on CSII therapy.
2) Patients in the highest LBGI tertile experienced a 23.3% reduction in hypoglycemic events without changes in A1C on CSII.
3) Patients in the lowest LBGI tertile had the greatest reduction in A1C on CSII of 20.99% but also experienced increased
Background and Aims.Metabolic syndrome (MetS) is a disorder that includes a cluster
of several risk factors for the development of type 2 diabetes and cardiovascular disease.
The R230C variant of theABCA1gene has been associated with low HDL-cholesterol in
several studies, but its association with MetS in children remains to be determined. The
aim of this study was to analyze the association of the R230C variant with MetS and other
metabolic traits in school-aged Mexican children.
Methods.The study was performed in seven urban primary schools in the State of
Mexico. Four hundred thirty-two Mexican school-age children 6e13 years old were
recruited. MetS was identified using the International Diabetes Federation definition.
The R230C variant of theABCA1gene was genotyped to seek associations with MetS
and other metabolic traits.
Results.The prevalence of MetS was 29% in children aged 10e13 years. The R230C
variant was not associated with MetS (OR51.65;p50.139). Furthermore, in the whole
population, the R230C variant was associated with low HDL-cholesterol levels
(bcoefficient53.28,p!0.001). Interestingly, in the total population we found a novel
association of this variant with high triglyceride levels (b coefficient 514.34;
p50.027).
Conclusions.We found a new association of the R230C variant of the ABCA1 gene with
high triglyceride levels. Our findings also replicate the association of this variant with low
HDL-cholesterol levels in Mexican school-age children.
1) The study examined whether serum carbon isotope values (d13C), which reflect consumption of corn- and cane-based foods like sugar-sweetened beverages (SSBs), change in response to changes in SSB intake over an 18-month behavioral intervention trial.
2) At baseline, average SSB intake was 13.8 ounces per day and average serum d13C value was -19.3 per mil. A reduction of 12 ounces per day in SSB intake was associated with a 0.17 per mil reduction in serum d13C.
3) After adjusting for potential confounders, a reduction of 12 ounces per day in SSB intake over 18 months was associated with a
A predictive model to reduce allogenic transfusions in primary total hip arth...anemo_site
This document presents a predictive model to reduce allogenic blood transfusions in primary total hip arthroplasty patients. The authors developed a model to predict bleeding and subsequent anemia based on age, gender, and pre-operative hemoglobin levels using data from 580 patients. Statistical analysis showed that post-operative hemoglobin levels were significantly associated with gender, age, and pre-operative hemoglobin concentration. The predictive model estimates expected post-operative hemoglobin differences compared to a threshold of 10 g/dL based on patient characteristics to help guide transfusion decisions. The goal is to ensure adequate hemoglobin levels to reduce risks and speed rehabilitation while minimizing unnecessary transfusions.
The document summarizes a study that examined the prevalence of metabolic syndrome among 101 kinesiology majors at a predominantly Hispanic university in South Texas. Key findings include:
1) 10 subjects (8 males and 2 females) met the criteria for metabolic syndrome by exhibiting abnormal values in 3 or more of the 5 components measured.
2) On average, subjects' measurements were below the thresholds for metabolic syndrome, however some males exhibited elevated blood pressure readings.
3) There were some gender differences observed, with males more likely than females to exhibit large waists, high triglycerides, high blood glucose, and high blood pressure.
4) While the prevalence of metabolic syndrome was low in this group
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Crimson Publishers: Insulin Therapy and Cardiovascular Outcome Trials (CVOTs)...CrimsonGastroenterology
The therapeutic management of diabetes may on its own increase the risk of cardiovascular (CV) risk markers – directly or indirectly – through their pharmacological actions (e.g. side effects as hypoglycaemia), or some metabolic changes (e.g. Weight-Gain, increased BP, etc.). As these risks may not have been anticipated or immediately noticed during clinical trials, 1 post hoc analyses and epidemiological follow up of clinical trials have raised concerns about the CV safety of some drugs used in the management of diabetes.
Clinical Usefulness of a New Equation for Estimating Body Fat
(Utilidad clínica de una nueva ecuación para estimar la grasa corporal)
Javier Gómez-Ambrosi, PHD1,2⇓, Camilo Silva, MD2,3, Victoria Catalán, PHD1,2, Amaia Rodríguez, PHD1,2, Juan Carlos Galofré, MD, PHD3, Javier Escalada, MD, PHD2,3, Victor Valentí, MD, PHD2, Fernando Rotellar, MD, PHD2, Sonia Romero, MSC2,3, Beatriz Ramírez, MSC1,2, Javier Salvador, MD, PHD2,3 and Gema Frühbeck, MD, PHD1,2,3
Corresponding author: Javier Gómez-Ambrosi, jagomez@unav.es.
Diabetes Care 2012 Feb; 35(2): 383-388. https://doi.org/10.2337/dc11-1334
This study examined whether different levels of glucose variability in patients with type 1 diabetes predict responses to continuous subcutaneous insulin infusion (CSII) therapy in terms of hypoglycemic events. The study found that:
1) Baseline low blood glucose index (LBGI), a measure of glucose variability, was the best predictor of reduced hypoglycemia on CSII therapy.
2) Patients in the highest LBGI tertile experienced a 23.3% reduction in hypoglycemic events without changes in A1C on CSII.
3) Patients in the lowest LBGI tertile had the greatest reduction in A1C on CSII of 20.99% but also experienced increased
Background and Aims.Metabolic syndrome (MetS) is a disorder that includes a cluster
of several risk factors for the development of type 2 diabetes and cardiovascular disease.
The R230C variant of theABCA1gene has been associated with low HDL-cholesterol in
several studies, but its association with MetS in children remains to be determined. The
aim of this study was to analyze the association of the R230C variant with MetS and other
metabolic traits in school-aged Mexican children.
Methods.The study was performed in seven urban primary schools in the State of
Mexico. Four hundred thirty-two Mexican school-age children 6e13 years old were
recruited. MetS was identified using the International Diabetes Federation definition.
The R230C variant of theABCA1gene was genotyped to seek associations with MetS
and other metabolic traits.
Results.The prevalence of MetS was 29% in children aged 10e13 years. The R230C
variant was not associated with MetS (OR51.65;p50.139). Furthermore, in the whole
population, the R230C variant was associated with low HDL-cholesterol levels
(bcoefficient53.28,p!0.001). Interestingly, in the total population we found a novel
association of this variant with high triglyceride levels (b coefficient 514.34;
p50.027).
Conclusions.We found a new association of the R230C variant of the ABCA1 gene with
high triglyceride levels. Our findings also replicate the association of this variant with low
HDL-cholesterol levels in Mexican school-age children.
1) The study examined whether serum carbon isotope values (d13C), which reflect consumption of corn- and cane-based foods like sugar-sweetened beverages (SSBs), change in response to changes in SSB intake over an 18-month behavioral intervention trial.
2) At baseline, average SSB intake was 13.8 ounces per day and average serum d13C value was -19.3 per mil. A reduction of 12 ounces per day in SSB intake was associated with a 0.17 per mil reduction in serum d13C.
3) After adjusting for potential confounders, a reduction of 12 ounces per day in SSB intake over 18 months was associated with a
A predictive model to reduce allogenic transfusions in primary total hip arth...anemo_site
This document presents a predictive model to reduce allogenic blood transfusions in primary total hip arthroplasty patients. The authors developed a model to predict bleeding and subsequent anemia based on age, gender, and pre-operative hemoglobin levels using data from 580 patients. Statistical analysis showed that post-operative hemoglobin levels were significantly associated with gender, age, and pre-operative hemoglobin concentration. The predictive model estimates expected post-operative hemoglobin differences compared to a threshold of 10 g/dL based on patient characteristics to help guide transfusion decisions. The goal is to ensure adequate hemoglobin levels to reduce risks and speed rehabilitation while minimizing unnecessary transfusions.
The document summarizes a study that examined the prevalence of metabolic syndrome among 101 kinesiology majors at a predominantly Hispanic university in South Texas. Key findings include:
1) 10 subjects (8 males and 2 females) met the criteria for metabolic syndrome by exhibiting abnormal values in 3 or more of the 5 components measured.
2) On average, subjects' measurements were below the thresholds for metabolic syndrome, however some males exhibited elevated blood pressure readings.
3) There were some gender differences observed, with males more likely than females to exhibit large waists, high triglycerides, high blood glucose, and high blood pressure.
4) While the prevalence of metabolic syndrome was low in this group
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Crimson Publishers: Insulin Therapy and Cardiovascular Outcome Trials (CVOTs)...CrimsonGastroenterology
The therapeutic management of diabetes may on its own increase the risk of cardiovascular (CV) risk markers – directly or indirectly – through their pharmacological actions (e.g. side effects as hypoglycaemia), or some metabolic changes (e.g. Weight-Gain, increased BP, etc.). As these risks may not have been anticipated or immediately noticed during clinical trials, 1 post hoc analyses and epidemiological follow up of clinical trials have raised concerns about the CV safety of some drugs used in the management of diabetes.
The document summarizes a study comparing childhood blood pressure trends and risk factors for high blood pressure between two national health surveys from 1988-1994 and 1999-2008. The study found an increase in the prevalence of elevated blood pressure in children over this period. Body mass index, waist circumference, and sodium intake were independently associated with higher rates of elevated blood pressure. After adjusting for potential risk factors, children in the later survey period still had slightly higher odds of elevated blood pressure compared to the earlier period.
This document summarizes a presentation given by Md. Rejaul Islam on assessing the prevalence of dyslipidemia and fatty liver disease in overweight and obese children in the United Arab Emirates. The study found high rates of dyslipidemia (55.3%) and fatty liver disease (84% of those with elevated liver enzymes) in the obese children. Waist circumference was significantly associated with dyslipidemia. The study provides insight into metabolic health issues faced by obese children in the region where childhood obesity is prevalent.
The document discusses recommendations for assessing glycemic control in patients with diabetes, including guidelines for A1C testing. It recommends performing A1C testing at least twice per year for patients meeting treatment goals, and quarterly for patients not meeting goals or whose therapy has changed. The document also establishes the relationship between A1C levels and average blood glucose levels based on clinical studies. It notes some limitations of A1C testing and differences in various populations. The guidelines recommend glucose monitoring for insulin-treated patients to help achieve glycemic targets.
Predictive value of exercise myocardial perfusion imaging in the Medicare population: the impact of the ability to exercise
Authors: Deborah H. Kwon, Venu Menon, Penny Houghtaling, Elizabeth Lieber, Richard C. Brunken, Manuel D. Cerqueira, Wael A. Jaber
1) A study examined the effects of EPA supplementation on coronary artery disease (CAD) risk in patients with multiple risk factors enrolled in the Japan EPA Lipid Intervention Study.
2) The risk of CAD increased with the number of risk factors present, including high cholesterol, obesity, abnormal triglycerides/HDL levels, diabetes, and hypertension.
3) EPA supplementation reduced CAD risk across all risk factor levels but had an especially large effect in patients with high triglycerides and low HDL cholesterol, reducing their CAD risk by 53%.
Comparative study of sympathetic cardiovascular parameters in overweight, nor...IOSR Journals
This study was undertaken to investigate and compare the sympathetic cardio vascular parameters in age matched overweight, underweight and normal weight school going boys in southern Odisha. 75 Boys between age group of 12-16 were subjected to study out of which 25 were overweight (BMI>25), next 25 were underweight(BMI<18.5),rest 25 were control group having normal BMI. Cold pressure test and hand grip dynamometer test were performed and blood pressure was measured during and after the tests as measures of cardiovascular parameter. Baseline SBP and MAP were significantly higher in overweight boys & lower in underweight boys. Maximum rise of SBP, DBP & MAP during hand grip dynamometer test were significantly higher in overweight boys & lower in underweight boys. Increase in SBP & MAP from their basal value during cold pressure test were significantly lower in overweight boys & higher in underweight boys. Thus it is concluded that both overweight & underweight boys have derangement of sympathetic cardiovascular function. SBP- Systolic blood pressure, DBP- Diastolic blood pressure , MAP- Mean arterial pressure
This document discusses a study comparing the implications of using the CKD-EPI equation versus the MDRD equation to estimate GFR and diagnose chronic kidney disease (CKD) in a large healthcare system. The study found:
1) The number of patients identified with CKD stages 3-5 decreased by 10% when using the CKD-EPI equation compared to the MDRD equation.
2) Changes in CKD identification varied by patient characteristics, with a 35% decrease in patients under 60 years old and a 10% increase in patients over 90 years old.
3) Only 14% of patients identified with CKD based on either equation also had a related ICD-9 diagnosis
This study investigated whether a 4-week balance protocol could improve quality of life in cancer patients. Eight female cancer patients participated in the experimental balance program, while five female cancer patients were the control group. Measures of balance, fall risk, and quality of life were taken before and after for both groups. The results found no significant difference in quality of life or fall risk between the groups or from pre- to post-test. The study concluded that the lack of improvement in balance meant they could not examine if quality of life scores improved among cancer patients from the balance program. Further research with a longer intervention is needed.
This study estimated the prevalence of chronic kidney disease (CKD) among 132 patients attending a diabetes clinic in Jamaica. Approximately 86% of patients had CKD based on estimated glomerular filtration rate (eGFR) below 60 or albuminuria of 30 mg/g or higher. Over 20% had moderate albuminuria and 62% had severe albuminuria. Based on risk categories from the KDIGO guidelines, 51% were at high risk and 17% at very high risk of adverse outcomes like mortality, cardiovascular disease, and kidney failure. The high prevalence of CKD and risk of adverse outcomes shows the need for further studies on preventing CKD in diabetes patients in developing countries.
1) This study examined whether pre-deployment levels of the inflammatory marker C-reactive protein (CRP) predicted post-traumatic stress disorder (PTSD) symptoms in US Marines following a war zone deployment.
2) Using a zero-inflated negative binomial regression model adjusting for baseline PTSD symptoms, combat exposure, and other factors, the study found that higher baseline CRP levels were significantly associated with greater PTSD symptoms three months post-deployment.
3) The results suggest that elevated peripheral inflammation before trauma exposure may predispose individuals to developing PTSD, rather than PTSD causing inflammation. This has implications for understanding the biological mechanisms involved in PTSD.
Lipid_Profile_Changes_in_the_Severly_Obese_After_Laparoscopic Sleeve GastrectomyRicky Costa
This study examined changes in lipid profiles in severely obese patients up to 5 years after undergoing laparoscopic sleeve gastrectomy (LSG). The study found that while average lipid levels were within normal ranges before surgery, 77% of patients had at least one abnormal lipid level. At 1 year post-surgery, triglycerides decreased and HDL increased significantly. At 3 years, HDL levels remained significantly higher than baseline levels. Weight loss correlated with decreases in LDL at 3 years and triglycerides at 5 years. However, the percentage of patients with dyslipidemia or taking medication for it did not significantly change over the 5-year period.
This randomized clinical trial studied 150 overweight or obese patients with atrial fibrillation who were assigned to either an intensive weight loss and risk factor management program (intervention group) or general lifestyle advice (control group). The intervention group had significantly greater reductions in weight, atrial fibrillation symptom burden and severity scores, number of atrial fibrillation episodes, cumulative duration of atrial fibrillation, and improvements in cardiac structure compared to the control group. The findings support managing weight and risk factors to reduce atrial fibrillation symptoms and burden.
This study analyzed data from the National Inpatient Sample from 2012-2013 to examine the impact of postpartum hemorrhage (PPH) on hospital length of stay and inpatient mortality in the United States. The results showed that PPH was associated with a small but statistically significant longer hospital length of stay compared to non-PPH deliveries. PPH, especially non-atonic PPH, was also associated with higher rates of inpatient mortality. However, the overall mortality rates were low, reflecting recent improvements in managing PPH. This large study provided novel insights into how PPH affects both length of hospitalization and mortality in the United States.
CVD Egypt Clinical Diabetes Reprint Summer 2010Mahmoud IBRAHIM
This document summarizes a study on screening Egyptian patients for diabetes and cardiovascular risk factors. The study found:
- 22.9% of patients had diabetes, 30.7% had hypertension, 33.4% had dyslipidemia, and 43% were smokers.
- Cardiovascular risk factors were more prevalent in females (57.7%) and urban populations (72.2%).
- Obesity affected 29% of patients and was correlated with higher blood pressure. Family history of diabetes was associated with higher BMI, waist circumference, blood sugar, and triglycerides.
- The high prevalence of risk factors indicates a need for national prevention programs in Egypt targeting obesity, diabetes, hypertension
This document provides a summary of articles across various medical specialties discussed in the April 2015 edition of the UTSW Journal Watch. In the Hepatology section, an article is summarized that finds corticosteroids may be safely used in patients with severe alcoholic hepatitis who present with an upper GI bleed after bleeding is controlled. In Pulmonary/Critical Care, a summary is provided of a trial finding no difference in mortality between early goal-directed therapy and usual care for treating septic shock. The study suggests protocols for goals of care are less important than early antibiotics and fluids. In Nephrology, a meta-analysis summary indicates preoperative use of renin-angiotensin system inhibitors may be linked to
Diabetic is a well known public health problem of today. There are many risk factors of it, which can be identified in pre-diabetic state. So the present study was conducted with the aim to know the status of anthropometric and haematological parameters in pre-diabetic states. For this hospital based study pre-diabetic subjects were identified from first degree relatives of type 2 DM Patients, enrolled in diabetic research centre P.B.M. hospital Bikaner. Relevant investigations were done. Data thus collected on semi-structured questionnaire and analysed using content analysis. Data analysis revealed that although mean Body Mass Index (BMI) was within normal range but Waist circumference (WC), West Hip (W/H) Ratio, Systolic blood pressure were higher than the normal range accepted for that parameter. But mean value of all the studied haematological parameter were within the normal range accepted for that parameter. So it can be conclude that anthropology of an individual may be associated with the pre-diabetic state. Hypertension was found in 25.35% of pre-diabetics. Further researches are necessary to find out this possible association of anthropologic parameter and pre-diabetic state.
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
This study examined the association between the ratio of serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) and risk of cardiovascular disease in a Japanese population. Over 5 years of follow up, 127 participants experienced cardiovascular events. The risk of cardiovascular disease was higher among those with a lower EPA/AA ratio and higher levels of high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation. A lower EPA/AA ratio was associated with a 52% increased risk of cardiovascular disease per 0.20 decrease in those with hs-CRP over 1.0 mg/L. The results suggest that a lower EPA/AA ratio may be linked to greater risk of
This document describes a study that aimed to determine if there is a relationship between insulin levels in the blood and various chemical and demographic variables using data from the National Health and Nutrition Examination Survey. The researchers analyzed relationships between insulin levels and urinary levels of iodine, creatinine, perchlorate, nitrate, and thiocyanate as well as demographic factors including gender, age, and household income. Initial models showed violations of assumptions that were addressed through data transformations, resulting in a log-transformed linear model that better fit the data.
Systematic Reviews and Meta- and Pooled AnalysesEffects of.docxssuserf9c51d
Systematic Reviews and Meta- and Pooled Analyses
Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk
Factors: A Meta-Analysis of Randomized Controlled Clinical Trials
Tian Hu, Katherine T. Mills, Lu Yao, Kathryn Demanelis, Mohamed Eloustaz, William S. Yancy, Jr,
Tanika N. Kelly, Jiang He, and Lydia A. Bazzano*
* Correspondence to Dr. Lydia A. Bazzano, Department of Epidemiology, Tulane University School of Public Health and Tropical
Medicine. 1440 Canal Street, SL-18, Suite 2000, New Orleans, LA 70112 (e-mail: [email protected]).
Initially submitted December 16, 2011; accepted for publication May 11, 2012.
The effects of low-carbohydrate diets (≤45% of energy from carbohydrates) versus low-fat diets (≤30% of
energy from fat) on metabolic risk factors were compared in a meta-analysis of randomized controlled trials.
Twenty-three trials from multiple countries with a total of 2,788 participants met the predetermined eligibility crite-
ria (from January 1, 1966 to June 20, 2011) and were included in the analyses. Data abstraction was conducted
in duplicate by independent investigators. Both low-carbohydrate and low-fat diets lowered weight and improved
metabolic risk factors. Compared with participants on low-fat diets, persons on low-carbohydrate diets experi-
enced a slightly but statistically significantly lower reduction in total cholesterol (2.7 mg/dL; 95% confidence inter-
val: 0.8, 4.6), and low density lipoprotein cholesterol (3.7 mg/dL; 95% confidence interval: 1.0, 6.4), but a greater
increase in high density lipoprotein cholesterol (3.3 mg/dL; 95% confidence interval: 1.9, 4.7) and a greater de-
crease in triglycerides (−14.0 mg/dL; 95% confidence interval: −19.4, −8.7). Reductions in body weight, waist
circumference and other metabolic risk factors were not significantly different between the 2 diets. These
findings suggest that low-carbohydrate diets are at least as effective as low-fat diets at reducing weight and
improving metabolic risk factors. Low-carbohydrate diets could be recommended to obese persons with abnor-
mal metabolic risk factors for the purpose of weight loss. Studies demonstrating long-term effects of low-
carbohydrate diets on cardiovascular events were warranted.
carbohydrate-restricted diet; fat-restricted diet; meta-analysis; metabolic syndrome; obesity
Abbreviations: CI, confidence interval; HDL, high density lipoprotein cholesterol; LDL, low density lipoprotein cholesterol.
There were an estimated 937 million overweight and 396
million obese people worldwide in 2005 (1). Moreover, it
was estimated that 68.0% of American adults were either
overweight or obese in 2009 (2). Overweight and obesity
are important risk factors for diabetes, cardiovascular dis-
ease, cancer, and premature death. The high prevalence of
obesity has become a serious public health challenge. The
dietary recommendations for weight loss from the Ameri-
can Heart Association and the National Insti ...
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
The document summarizes a study comparing childhood blood pressure trends and risk factors for high blood pressure between two national health surveys from 1988-1994 and 1999-2008. The study found an increase in the prevalence of elevated blood pressure in children over this period. Body mass index, waist circumference, and sodium intake were independently associated with higher rates of elevated blood pressure. After adjusting for potential risk factors, children in the later survey period still had slightly higher odds of elevated blood pressure compared to the earlier period.
This document summarizes a presentation given by Md. Rejaul Islam on assessing the prevalence of dyslipidemia and fatty liver disease in overweight and obese children in the United Arab Emirates. The study found high rates of dyslipidemia (55.3%) and fatty liver disease (84% of those with elevated liver enzymes) in the obese children. Waist circumference was significantly associated with dyslipidemia. The study provides insight into metabolic health issues faced by obese children in the region where childhood obesity is prevalent.
The document discusses recommendations for assessing glycemic control in patients with diabetes, including guidelines for A1C testing. It recommends performing A1C testing at least twice per year for patients meeting treatment goals, and quarterly for patients not meeting goals or whose therapy has changed. The document also establishes the relationship between A1C levels and average blood glucose levels based on clinical studies. It notes some limitations of A1C testing and differences in various populations. The guidelines recommend glucose monitoring for insulin-treated patients to help achieve glycemic targets.
Predictive value of exercise myocardial perfusion imaging in the Medicare population: the impact of the ability to exercise
Authors: Deborah H. Kwon, Venu Menon, Penny Houghtaling, Elizabeth Lieber, Richard C. Brunken, Manuel D. Cerqueira, Wael A. Jaber
1) A study examined the effects of EPA supplementation on coronary artery disease (CAD) risk in patients with multiple risk factors enrolled in the Japan EPA Lipid Intervention Study.
2) The risk of CAD increased with the number of risk factors present, including high cholesterol, obesity, abnormal triglycerides/HDL levels, diabetes, and hypertension.
3) EPA supplementation reduced CAD risk across all risk factor levels but had an especially large effect in patients with high triglycerides and low HDL cholesterol, reducing their CAD risk by 53%.
Comparative study of sympathetic cardiovascular parameters in overweight, nor...IOSR Journals
This study was undertaken to investigate and compare the sympathetic cardio vascular parameters in age matched overweight, underweight and normal weight school going boys in southern Odisha. 75 Boys between age group of 12-16 were subjected to study out of which 25 were overweight (BMI>25), next 25 were underweight(BMI<18.5),rest 25 were control group having normal BMI. Cold pressure test and hand grip dynamometer test were performed and blood pressure was measured during and after the tests as measures of cardiovascular parameter. Baseline SBP and MAP were significantly higher in overweight boys & lower in underweight boys. Maximum rise of SBP, DBP & MAP during hand grip dynamometer test were significantly higher in overweight boys & lower in underweight boys. Increase in SBP & MAP from their basal value during cold pressure test were significantly lower in overweight boys & higher in underweight boys. Thus it is concluded that both overweight & underweight boys have derangement of sympathetic cardiovascular function. SBP- Systolic blood pressure, DBP- Diastolic blood pressure , MAP- Mean arterial pressure
This document discusses a study comparing the implications of using the CKD-EPI equation versus the MDRD equation to estimate GFR and diagnose chronic kidney disease (CKD) in a large healthcare system. The study found:
1) The number of patients identified with CKD stages 3-5 decreased by 10% when using the CKD-EPI equation compared to the MDRD equation.
2) Changes in CKD identification varied by patient characteristics, with a 35% decrease in patients under 60 years old and a 10% increase in patients over 90 years old.
3) Only 14% of patients identified with CKD based on either equation also had a related ICD-9 diagnosis
This study investigated whether a 4-week balance protocol could improve quality of life in cancer patients. Eight female cancer patients participated in the experimental balance program, while five female cancer patients were the control group. Measures of balance, fall risk, and quality of life were taken before and after for both groups. The results found no significant difference in quality of life or fall risk between the groups or from pre- to post-test. The study concluded that the lack of improvement in balance meant they could not examine if quality of life scores improved among cancer patients from the balance program. Further research with a longer intervention is needed.
This study estimated the prevalence of chronic kidney disease (CKD) among 132 patients attending a diabetes clinic in Jamaica. Approximately 86% of patients had CKD based on estimated glomerular filtration rate (eGFR) below 60 or albuminuria of 30 mg/g or higher. Over 20% had moderate albuminuria and 62% had severe albuminuria. Based on risk categories from the KDIGO guidelines, 51% were at high risk and 17% at very high risk of adverse outcomes like mortality, cardiovascular disease, and kidney failure. The high prevalence of CKD and risk of adverse outcomes shows the need for further studies on preventing CKD in diabetes patients in developing countries.
1) This study examined whether pre-deployment levels of the inflammatory marker C-reactive protein (CRP) predicted post-traumatic stress disorder (PTSD) symptoms in US Marines following a war zone deployment.
2) Using a zero-inflated negative binomial regression model adjusting for baseline PTSD symptoms, combat exposure, and other factors, the study found that higher baseline CRP levels were significantly associated with greater PTSD symptoms three months post-deployment.
3) The results suggest that elevated peripheral inflammation before trauma exposure may predispose individuals to developing PTSD, rather than PTSD causing inflammation. This has implications for understanding the biological mechanisms involved in PTSD.
Lipid_Profile_Changes_in_the_Severly_Obese_After_Laparoscopic Sleeve GastrectomyRicky Costa
This study examined changes in lipid profiles in severely obese patients up to 5 years after undergoing laparoscopic sleeve gastrectomy (LSG). The study found that while average lipid levels were within normal ranges before surgery, 77% of patients had at least one abnormal lipid level. At 1 year post-surgery, triglycerides decreased and HDL increased significantly. At 3 years, HDL levels remained significantly higher than baseline levels. Weight loss correlated with decreases in LDL at 3 years and triglycerides at 5 years. However, the percentage of patients with dyslipidemia or taking medication for it did not significantly change over the 5-year period.
This randomized clinical trial studied 150 overweight or obese patients with atrial fibrillation who were assigned to either an intensive weight loss and risk factor management program (intervention group) or general lifestyle advice (control group). The intervention group had significantly greater reductions in weight, atrial fibrillation symptom burden and severity scores, number of atrial fibrillation episodes, cumulative duration of atrial fibrillation, and improvements in cardiac structure compared to the control group. The findings support managing weight and risk factors to reduce atrial fibrillation symptoms and burden.
This study analyzed data from the National Inpatient Sample from 2012-2013 to examine the impact of postpartum hemorrhage (PPH) on hospital length of stay and inpatient mortality in the United States. The results showed that PPH was associated with a small but statistically significant longer hospital length of stay compared to non-PPH deliveries. PPH, especially non-atonic PPH, was also associated with higher rates of inpatient mortality. However, the overall mortality rates were low, reflecting recent improvements in managing PPH. This large study provided novel insights into how PPH affects both length of hospitalization and mortality in the United States.
CVD Egypt Clinical Diabetes Reprint Summer 2010Mahmoud IBRAHIM
This document summarizes a study on screening Egyptian patients for diabetes and cardiovascular risk factors. The study found:
- 22.9% of patients had diabetes, 30.7% had hypertension, 33.4% had dyslipidemia, and 43% were smokers.
- Cardiovascular risk factors were more prevalent in females (57.7%) and urban populations (72.2%).
- Obesity affected 29% of patients and was correlated with higher blood pressure. Family history of diabetes was associated with higher BMI, waist circumference, blood sugar, and triglycerides.
- The high prevalence of risk factors indicates a need for national prevention programs in Egypt targeting obesity, diabetes, hypertension
This document provides a summary of articles across various medical specialties discussed in the April 2015 edition of the UTSW Journal Watch. In the Hepatology section, an article is summarized that finds corticosteroids may be safely used in patients with severe alcoholic hepatitis who present with an upper GI bleed after bleeding is controlled. In Pulmonary/Critical Care, a summary is provided of a trial finding no difference in mortality between early goal-directed therapy and usual care for treating septic shock. The study suggests protocols for goals of care are less important than early antibiotics and fluids. In Nephrology, a meta-analysis summary indicates preoperative use of renin-angiotensin system inhibitors may be linked to
Diabetic is a well known public health problem of today. There are many risk factors of it, which can be identified in pre-diabetic state. So the present study was conducted with the aim to know the status of anthropometric and haematological parameters in pre-diabetic states. For this hospital based study pre-diabetic subjects were identified from first degree relatives of type 2 DM Patients, enrolled in diabetic research centre P.B.M. hospital Bikaner. Relevant investigations were done. Data thus collected on semi-structured questionnaire and analysed using content analysis. Data analysis revealed that although mean Body Mass Index (BMI) was within normal range but Waist circumference (WC), West Hip (W/H) Ratio, Systolic blood pressure were higher than the normal range accepted for that parameter. But mean value of all the studied haematological parameter were within the normal range accepted for that parameter. So it can be conclude that anthropology of an individual may be associated with the pre-diabetic state. Hypertension was found in 25.35% of pre-diabetics. Further researches are necessary to find out this possible association of anthropologic parameter and pre-diabetic state.
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
This study examined the association between the ratio of serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) and risk of cardiovascular disease in a Japanese population. Over 5 years of follow up, 127 participants experienced cardiovascular events. The risk of cardiovascular disease was higher among those with a lower EPA/AA ratio and higher levels of high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation. A lower EPA/AA ratio was associated with a 52% increased risk of cardiovascular disease per 0.20 decrease in those with hs-CRP over 1.0 mg/L. The results suggest that a lower EPA/AA ratio may be linked to greater risk of
This document describes a study that aimed to determine if there is a relationship between insulin levels in the blood and various chemical and demographic variables using data from the National Health and Nutrition Examination Survey. The researchers analyzed relationships between insulin levels and urinary levels of iodine, creatinine, perchlorate, nitrate, and thiocyanate as well as demographic factors including gender, age, and household income. Initial models showed violations of assumptions that were addressed through data transformations, resulting in a log-transformed linear model that better fit the data.
Systematic Reviews and Meta- and Pooled AnalysesEffects of.docxssuserf9c51d
Systematic Reviews and Meta- and Pooled Analyses
Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk
Factors: A Meta-Analysis of Randomized Controlled Clinical Trials
Tian Hu, Katherine T. Mills, Lu Yao, Kathryn Demanelis, Mohamed Eloustaz, William S. Yancy, Jr,
Tanika N. Kelly, Jiang He, and Lydia A. Bazzano*
* Correspondence to Dr. Lydia A. Bazzano, Department of Epidemiology, Tulane University School of Public Health and Tropical
Medicine. 1440 Canal Street, SL-18, Suite 2000, New Orleans, LA 70112 (e-mail: [email protected]).
Initially submitted December 16, 2011; accepted for publication May 11, 2012.
The effects of low-carbohydrate diets (≤45% of energy from carbohydrates) versus low-fat diets (≤30% of
energy from fat) on metabolic risk factors were compared in a meta-analysis of randomized controlled trials.
Twenty-three trials from multiple countries with a total of 2,788 participants met the predetermined eligibility crite-
ria (from January 1, 1966 to June 20, 2011) and were included in the analyses. Data abstraction was conducted
in duplicate by independent investigators. Both low-carbohydrate and low-fat diets lowered weight and improved
metabolic risk factors. Compared with participants on low-fat diets, persons on low-carbohydrate diets experi-
enced a slightly but statistically significantly lower reduction in total cholesterol (2.7 mg/dL; 95% confidence inter-
val: 0.8, 4.6), and low density lipoprotein cholesterol (3.7 mg/dL; 95% confidence interval: 1.0, 6.4), but a greater
increase in high density lipoprotein cholesterol (3.3 mg/dL; 95% confidence interval: 1.9, 4.7) and a greater de-
crease in triglycerides (−14.0 mg/dL; 95% confidence interval: −19.4, −8.7). Reductions in body weight, waist
circumference and other metabolic risk factors were not significantly different between the 2 diets. These
findings suggest that low-carbohydrate diets are at least as effective as low-fat diets at reducing weight and
improving metabolic risk factors. Low-carbohydrate diets could be recommended to obese persons with abnor-
mal metabolic risk factors for the purpose of weight loss. Studies demonstrating long-term effects of low-
carbohydrate diets on cardiovascular events were warranted.
carbohydrate-restricted diet; fat-restricted diet; meta-analysis; metabolic syndrome; obesity
Abbreviations: CI, confidence interval; HDL, high density lipoprotein cholesterol; LDL, low density lipoprotein cholesterol.
There were an estimated 937 million overweight and 396
million obese people worldwide in 2005 (1). Moreover, it
was estimated that 68.0% of American adults were either
overweight or obese in 2009 (2). Overweight and obesity
are important risk factors for diabetes, cardiovascular dis-
ease, cancer, and premature death. The high prevalence of
obesity has become a serious public health challenge. The
dietary recommendations for weight loss from the Ameri-
can Heart Association and the National Insti ...
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
In this presentation i have tried to explain in brief about nomograms and their applications, the general approach to individualise doage regimen by using pharmacokinetic data
อ้างอิง 5 prevalence and effect of hemoglobin e disorders on hb a1c and lipid...สปสช นครสวรรค์
1. The author evaluated the prevalence of hemoglobin E disorders (HbE) in diabetic patients at Surin Hospital in Thailand, which is near the Cambodian border.
2. HbE was found in 43.2% of patients, with 7.9% having homozygous HbE (HbEE) and 35.3% having HbE trait.
3. Patients with HbEE had significantly lower HbA1c, cholesterol, and LDL levels compared to other groups. HbA1c assays can be interfered with by HbE.
1) The Mini Nutritional Assessment (MNA) is a screening tool developed to identify malnutrition in elderly aged 65+. It consists of 18 questions that assess anthropometric, dietary, and health factors.
2) Validation studies in the 1990s involving over 600 subjects found the MNA to have 96% sensitivity and 98% specificity in detecting malnutrition. It could classify nutritional status without invasive tests.
3) More recent studies have also found the MNA to be effective at predicting health outcomes like mortality and infection risk. However, some studies found other tools may better predict certain outcomes.
La Hipertensión, es una de las mayores enfermedades que sufren los Hispanohablantes en el planeta . Es grato poder colocar este documento al público y haber podido hacer parte del equipo , ojalá sirvan a muchos las implementaciones. idioma más hablado según el foro Económico mundial - Me refiero al español ó castellano según sea -
segundo idioma y haber podido hacer parte de este equipo. Genuinamente, espero que se curen la mayor cantidad de personas con . Espero genuinamente puedan hacer algúna donación a este esfuerzo grupal. Espero Compartamos este "Paper" así como compartimos memes - En el sentido literal de la significancia-
** Refierase a Wikipedia sino tiene un diccionario a mano.
1) The researchers developed a scoring system to identify potential drug combinations for treating diseases based on gene expression profiles from the Connectivity Map database.
2) Applying this system to type 2 diabetes, they identified Trolox C and Cytisine as a potential combination.
3) Testing this combination in diabetic mice, they found that the combination significantly reduced blood glucose levels compared to either drug alone or the saline control, demonstrating its potential for treating type 2 diabetes.
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Modifiable Lifestyle Risk Factors and Incident Diabetes
in African Americans
Joshua J. Joseph, MD,1,2 Justin B. Echouffo-Tcheugui, MD, PhD,3,4
Sameera A. Talegawkar, PhD,5 Valery S. Effoe, MD,6 Victoria Okhomina, MPH,7
Mercedes R. Carnethon, PhD,8 Willa A. Hsueh, MD,1 Sherita H. Golden, MD2
Introduction: The associations of modifiable lifestyle risk factors with incident diabetes are not well
investigated in African Americans (AAs). This study investigated the association of modifiable
lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden)
with incident diabetes among AAs.
Methods: Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson
Heart Study who were free of diabetes at baseline (2000–2004) using baseline questionnaires and
combined into risk factor categories: poor (0–3 points), average (4–7 points), and optimal (8–11
points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis,
use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson
regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI.
Outcomes were collected 2005–2012 and data analyzed in 2016.
Results: Over 7.6 years, there were 560 incident diabetes cases (mean age¼53.3 years, 64% female).
An average or optimal compared to poor risk factor categorization was associated with a 21%
(IRR¼0.79, 95% CI¼0.62, 0.99) and 31% (IRR¼0.69, 95% CI¼0.48, 1.01) lower risk of diabetes.
Among participants with BMI o30, IRRs for average or optimal compared to poor categorization
were 0.60 (95% CI¼0.40, 0.91) and 0.53 (95% CI¼0.29, 0.97) versus 0.90 (95% CI¼0.67, 1.21) and
0.83 (95% CI¼0.51, 1.34) among participants with BMI ≥30.
Conclusions: A combination of modifiable lifestyle factors are associated with a lower risk of
diabetes among AAs, particularly among those without obesity.
Am J Prev Med 2017;53(5):e165–e174. & 2017 American Journal of Preventive Medicine. Published by
Elsevier Inc. All rights reserved.
INTRODUCTION
epartment of Medicine, The Ohio State University, Wexner
ter, Columbus, Ohio; 2Johns Hopkins University, School of
ltimore, Maryland; 3Division of Endocrinology, Diabetes and
, Brigham and Women’s Hospital, Harvard Medical School,
achusetts; 4Rollins School of Public Health, Emory University,
rgia; 5Sumner M. Redstone Global Center for Prevention and
ilken Institute School of Public Health at the George
University, Washington, District of Columbia; 6Division of
h Sciences, Wake Forest University, School of Medicine,
m, North Carolina; 7Univer.
Nonfasting Glucose, Ischemic Heart Disease, and Myocardial Infarction A Mende...Bladimir Viloria
This study used a Mendelian randomization approach to test whether elevated nonfasting glucose levels are causally associated with increased risk of ischemic heart disease (IHD) and myocardial infarction (MI). The study found that:
1) Risk of IHD and MI increased with higher nonfasting glucose levels.
2) Genetic variants associated with higher fasting glucose were also associated with higher nonfasting glucose levels.
3) These glucose-increasing genetic variants were associated with increased risk of IHD and MI.
4) Instrumental variable analysis estimated that a 1 mmol/L increase in nonfasting glucose due to genetic variants was associated with a 25% increased risk of IHD and 69% increased
Novel Approach Of Diabetes Disease Classification By Support Vector Machine W...IJARIIT
Early diagnosis of any disease with less cost is always preferable. Diabetes is one such disease. It has become the fourth leading cause of death in developed countries and is also reaching epidemic proportions in many developing and newly industrialized nations. Diabetes leads to increase in the risks of developing kidney disease, blindness, nerve damage, blood vessel damage and heart disease also. In this study, we investigate an automatic approach to diagnose Diabetes disease based on Bacterial Foraging Optimization and Artificial Neural Network .firstly, we applied Bacterial Foraging Optimization for features selection and then we implement artificial neural network for finding out the classification accuracy. The proposed SVM method obtains 87.23% accuracy on UCI diabetes dataset which is better than other models.
Secondly, we applied again Bacterial foraging optimization for features selection and then we applied support vector machine for finding out the classification accuracy .The proposed Correlation with SVM method obtains on UCI dataset.
ABSTRACT- Introduction: Importance of measurement of glycated hemoglobin (HbA1c) has been recommended for
the diagnosis of diabetes and pre-diabetes. However, various epidemiological studies conducted different parts of the
universe have shown significant discordance between HbA1c and glucose-based tests. Glycated hemoglobin (HbA1c) is
assumed to be the gold standard for monitoring glycemic control in patients with diabetes mellitus disorder. The Glycated
hemoglobin (HbA1c) assay provided an accurate, precise measure of chronic glycemic levels, and associates with the risk
of diabetes complications.
Materials and Methods: This is a cross sectional prospective study. A total of 868 individuals attended to the medicine
outpatient clinic at Lord Buddha Koshi Medical College, Saharsa, Bihar between Jan 2016 to Dec 2016 were selected for
the study after screening a large cohort visited OPD. The results of FPG, OGTT, and HbA1c for 868 individual were
analyzed as well as all grouped as diabetic patients, glucose intolerant (pre-diabetes) patients, and non-diabetic patients
according to new ADA criteria for the diagnosis of diabetes.
Results: Diagnostic sensitivity of all diabetic criteria were 80.33% for A1c; 75% for OGTT and only 41.87% for FPG
respectively.
Conclusion: The proposed A1c diagnostic criteria have greater diagnostic than FPG and 2-h OGTT regarding a diagnosis
of diabetes mellitus disorder.
Key-words- Glycated Hemoglobin, Fasting Plasma Glucose, Oral glucose tolerances test (OGTT), Diabetes Mellitus,
and Pre- diabetes
This study examined the effect of different diabetes treatment regimens on serum ferritin levels and the relationship between ferritin and diabetes risk factors. 130 diabetic patients were categorized based on treatment as receiving oral drugs only, diet only, or a combination of drugs and diet. Serum ferritin levels were lowest in those on combination therapy and highest in those receiving single therapies. Correlations between ferritin and risk factors like blood glucose, cholesterol levels existed for single therapy groups but not the combination group, suggesting treatment type impacts the ferritin-risk factor relationship. The findings indicate combination therapy may be more effective at reducing ferritin and associated diabetes risk than single therapies alone.
iHealth2016 Submission-VA Diabetes Risk AssessmentGanesh N Prasad
This document discusses an approach to using statistical machine learning and information visualization techniques to assess patients' risk of diabetes complications. The approach was evaluated on data from over 8,600 patients. Key results include:
- A two-dimensional visualization was able to stratify patients into high- and low-risk groups for heart attack based on relevant risk factors like smoking and BMI.
- The tool allows exploring risk predictions at both the population level and for individual patients. It also shows the potential impact of interventions on modifying patient risk levels.
- An integrated risk assessment and visualization tool could benefit clinicians, patients, and other stakeholders by facilitating risk prediction, stratification, and exploring optimal treatments in a personalized way.
The prevalence and severity of obesity is increasing dramatically
among children and adolescents in many parts of the
world, whereas prevalence rates are estimated to increase in
the next decades [1]. In children, excess body fat appears to
be strongly associated with the clustering of risk factors, such
as hyperglycemia, dyslipidemia, and hypertension, which
play a key role in the pathogenesis of the metabolic syndrome
(MetS) [2].
Obesity and the MetS risk in children have been
recently associated with systemic inflammatory markers,
in particular C-reactive protein (CRP) [3, 4], implying
that low-grade inflammation can already exist in childhood
and may be a potential link between the obesity and the
MetS. Among behavioral variables, cardiorespiratory fitness
has a protective role in MetS and inflammatory factors;
however, it is not entirely clear if the interrelations among
cardiorespiratory fitness, MetS risk, and inflammation in
children are independent or partly due to the mediating
effect of obesity, since the existing data are limited and
equivocal [5, 6].
Recent evidence indicates that the prevalence rates
of childhood obesity in Greece remain high [1, 7] and
often coexist with low cardiorespiratory fitness [8] and
an unfavorable cardiometabolic risk profile [9]. For the
Greek pediatric population these data suggest an increased
cardiovascular morbidity in adulthood, given that highrisk
children and adolescents are likely to become highrisk
adults [10]. Although the relationship among obesity
and dyslipidemia in Greek children has been thoroughly
investigated [9, 11], there is a paucity of data regarding the
clustering of metabolic risk factors, inflammation, and their
relationship with cardiorespiratory fitness. The present study
was undertaken in an attempt to investigate the prevalence of
theMetS and examine the associations among cardiorespiratory
fitness, MetS risk, and CRP in 11-year-old children.
Background: There are very a few studies on psychiatric symptoms in patients with Diabetes Mellitus (DM) patients and assessing glycemic controls.
Aim: To describe the level of glycemic control, complications and psychosocial functioning among DM patients using the Depression Anxiety Stress Scales (DASS-21) instrument and its predictors among diabetic Turkish population.
This study examined the incidence rates of diabetes and prediabetes among Asian Indians over a 10-year period. It found that the incidence rates of diabetes, prediabetes, and overall dysglycemia were high at 22.2, 29.5, and 51.7 per 1,000 person-years respectively. Predictors of progression to dysglycemia included older age, family history of diabetes, higher 2-hour plasma glucose, HbA1c, low HDL cholesterol, and physical inactivity. The results indicate that Asian Indians have among the highest rates of conversion from normal blood sugar to dysglycemia, highlighting the need for public health interventions targeting modifiable risk factors.
This study aimed to validate a proposed systemic risk spectrum for predicting foot complications in type 2 diabetes patients. The risk spectrum included five constructs: macrovascular disease, microvascular disease, functional microvascular disease, metabolic syndrome, and family history. The study reviewed medical charts of type 2 diabetes patients and found a significant but weak correlation between the sum of risk constructs and total complications. Regression models showed the risk spectrum sum modestly predicted developing complications, explaining only 1.9-2.3% of variance. While validating the proposed spectrum, the study found it modestly predicted complications.
The efficacy of supplementation with the novel medical food, Souvenaid, in pa...Nutricia
Three randomized controlled trials involving 1,011 patients found:
1) Souvenaid supplementation did not significantly improve cognition or functional ability compared to placebo based on meta-analyses.
2) One study found Souvenaid improved verbal recall in patients with very mild Alzheimer's disease.
3) No serious adverse events were reported with Souvenaid supplementation.
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
1999.full
1. A Multivariate Logistic Regression
Equation to Screen for Diabetes
Development and validation
BAHMAN P. TABAEI, MPH
1
WILLIAM H. HERMAN, MD, MPH
1,2
OBJECTIVE — To develop and validate an empirical equation to screen for diabetes.
RESEARCH DESIGN AND METHODS — A predictive equation was developed using
multiple logistic regression analysis and data collected from 1,032 Egyptian subjects with no
history of diabetes. The equation incorporated age, sex, BMI, postprandial time (self-reported
number of hours since last food or drink other than water), and random capillary plasma glucose
as independent covariates for prediction of undiagnosed diabetes. These covariates were based
on a fasting plasma glucose level Ն126 mg/dl and/or a plasma glucose level 2 h after a 75-g oral
glucose load Ն200 mg/dl. The equation was validated using data collected from an independent
sample of 1,065 American subjects. Its performance was also compared with that of recom-
mended and proposed static plasma glucose cut points for diabetes screening.
RESULTS — The predictive equation was calculated with the following logistic regression
parameters: P ϭ 1/(1 Ϫ eϪx
), where x ϭ Ϫ10.0382 ϩ [0.0331 (age in years) ϩ 0.0308 (random
plasma glucose in mg/dl) ϩ 0.2500 (postprandial time assessed as 0 to Ն8 h) ϩ 0.5620 (if
female) ϩ 0.0346 (BMI)]. The cut point for the prediction of previously undiagnosed diabetes
was defined as a probability value Ն0.20. The equation’s sensitivity was 65%, specificity 96%,
and positive predictive value (PPV) 67%. When applied to a new sample, the equation’s sensi-
tivity was 62%, specificity 96%, and PPV 63%.
CONCLUSIONS — This multivariate logistic equation improves on currently recom-
mended methods of screening for undiagnosed diabetes and can be easily implemented in a
inexpensive handheld programmable calculator to predict previously undiagnosed diabetes.
Diabetes Care 25:1999–2003, 2002
S
creening for undiagnosed diabetes is
controversial. In 1978, the Ameri-
can Diabetes Association (ADA), the
Centers for Disease Control and Preven-
tion, and the National Institutes of Health
recommended against screening for dia-
betes in nonpregnant adults (1). In 1989
and again in 1996, the U.S. Preventive
Services Task Force recommended
against screening for diabetes in nonpreg-
nant adults (1,2), and in 2001, the ADA
recommended against community
screening for diabetes (3). Several recent
studies have shown that age, sex, BMI,
and current metabolic status affect blood
glucose levels and have raised concerns
about the performance of diabetes screen-
ing tests (4–8).
The performance of all screening tests
is dependent on the threshold or cut point
used to define a positive test. In diabetes
screening, choosing a higher glucose cut
point reduces sensitivity (probability of a
positive screening test given disease) but
improves specificity (probability of a neg-
ative screening test given absence of dis-
ease). Choosing a lower glucose cut point
improves sensitivity but reduces specific-
ity. Because the optimal cut point for a
positive test may depend on age, sex, BMI,
and the time since last food or drink, we
propose an alternative approach to inter-
preting capillary glucose screening tests
by developing a multivariate equation
using the best combination of readily
available data to predict previously undi-
agnosed diabetes.
RESEARCH DESIGN AND
METHODS — To assess the likeli-
hood of previously undiagnosed diabetes,
a predictive equation was developed us-
ing data from 1,032 Egyptian subjects
without a history of diabetes who partic-
ipated in the Diabetes in Egypt Project
between July 1992 and October 1993 (9).
In a household examination, all subjects
were assessed for age, sex, height, weight,
postprandial time (self-reported number
of hours since last food or drink other
than water), and random capillary whole
blood glucose. On a separate day, fasting
plasma glucose (FPG) and plasma glucose
2 h after a 75-g oral glucose load (2-h PG)
were measured. Multiple logistic regres-
sion analysis was used to develop an
equation for prediction of undiagnosed
diabetes based on FPG Ն126 mg/dl
and/or 2-h PG Ն200 mg/dl. Diabetes risk
factors included in the equation were age
(years), sex (female), BMI (calculated as
weight in kilograms divided by height in
meters squared [kg/m2
]), postprandial
time (0 to Ն8 h), and random capillary
plasma glucose (mg/dl). Age, BMI, and
capillary plasma glucose were modeled as
continuous variables, postprandial time
was modeled as a continuous variable be-
tween 0 and 8 h (after which random cap-
illary glucose did not vary as a function of
postprandial time), and sex was modeled
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
From the 1
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan;
and the 2
Department of Epidemiology, University of Michigan Health System, Ann Arbor, Michigan.
Address correspondence and reprint requests to William H. Herman, MD, MPH, University of Michigan
Health System, Division of Endocrinology and Metabolism, 1500 E. Medical Center Dr., 3920 Taubman
Center, Ann Arbor, MI 48109-0354. E-mail: wherman@umich.edu.
Received for publication 21 January 2001 and accepted in revised form 26 June 2002.
Abbreviations: 2-h PG, plasma glucose 2 h after a 75-g oral glucose load; ADA, American Diabetes
Association; EPV, events per variable; FPG, fasting plasma glucose; OAPR, odds of being affected given a
positive result; PPV, positive predictive value; ROC, receiver-operating characteristic.
A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion
factors for many substances.
E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s
O R I G I N A L A R T I C L E
DIABETES CARE, VOLUME 25, NUMBER 11, NOVEMBER 2002 1999
2. as a categorical variable (0 ϭ male and
1 ϭ female). The final mathematical
equation provides an estimate of a sub-
ject’s likelihood of previously undiag-
nosed diabetes expressed as a probability
between 0.0 and 1.0.
The linearity assumption for logistic
regression was assessed by categorizing
each continuous variable into multiple di-
chotomous variables of equal units and
plotting each variable’s coefficient against
the midpoint of the variable. We also per-
formed the Mantel-Haenszel 2
test for
trend. Multicollinearity was assessed us-
ing the Pearson correlation coefficient sta-
tistic. Accuracy, reliability, and precision
of regression coefficients were assessed by
calculating the number of events per vari-
able (EPV)—the ratio of the number of
outcome events to the number of predic-
tor variables. An EPV number of at least
10 indicates that the estimates of regres-
sion coefficients and their CIs are reliable
(10,11). The possible interactions among
variables were assessed using the Breslow
and Day 2
test (12).
The Ϫ2 log-likelihood ratio test was
used to test the overall significance of the
predictive equation. The significance of
the variables in the model was assessed by
the Wald 2
test and CIs. The fit of the
model was assessed by the Hosmer-
Lemeshow goodness of fit 2
test (13,14).
To assess outliers and detect extreme
points in the design space, logistic regres-
sion diagnostics were performed by plot-
ting the diagnostic statistic against the
observation number using hat matrix di-
agonal and Pearson and Deviance residu-
als analyses (13,14).
To select the optimal cut point to de-
fine a positive test, a receiver-operating
characteristic (ROC) curve was con-
structed by plotting sensitivity against the
false-positive rate (1 Ϫ specificity) over a
range of cut-point values. Generally, the
best cut point is at or near the shoulder of
the ROC curve, where substantial gains
can be made in sensitivity with only mod-
est reductions in specificity. Sensitivity
was defined as the proportion of subjects
predicted to have the outcome who really
have it (true-positive test) and calculated
as [true positives/(true positives ϩ false
negatives)] ϫ 100. Specificity was de-
fined as the proportion of subjects pre-
dicted not to have the outcome who do
not have it (true-negative test) and calcu-
lated as [true negatives/(true negatives ϩ
false positives)] ϫ 100. Positive predic-
tive value (PPV) was defined as the per-
centage of individuals with a positive test
result who actually have the disease and
was calculated as [true positives/(true
positives ϩ false positives)] ϫ 100. The
odds of being affected given a positive re-
sult (OAPR) was defined as the ratio of the
number of affected to unaffected individ-
uals among those with positive results
and was calculated as true positives/false
positives.
Concordance and discordance val-
ues, derived from the logistic regression
analysis, were used to measure the asso-
ciation of predicted probabilities and
to check the ability of the model to predict
outcome. The higher the value of the con-
cordance and the lower the value of dis-
cordance, the greater the ability of
the model to predict outcome. To evalu-
ate the overall performance of the equa-
tion, we considered several measures of
predictive performance, including dis-
crimination and calibration (15–20). Dis-
crimination was defined as the ability of
the equation to distinguish high-risk sub-
jects from low-risk subjects and is quan-
tified by the area under the ROC curve
(15,19,20). Calibration was defined as
whether the predicted probabilities agree
with the observed probabilities and is
quantified by the calibration slope calcu-
lated as [model 2
Ϫ (df Ϫ 1)[/model 2
(16,20,21). Well-calibrated models have
a slope of ϳ1, whereas models providing
too extreme of predictions have a slope of
Ͻ1 (17,20).
To validate the equation, we applied
it to data that had not been used to gen-
erate the equation. Thus, we applied the
equation to data collected from 1,065
subjects with no history of diabetes who
were studied between September 1995
and July 1998 by health care systems
serving communities in Springfield, MA;
Robeson County, NC; Providence, Paw-
tucket, RI; and Central Falls, RI (7). All
subjects were assessed for age, sex, height,
weight, postprandial time, random capil-
lary plasma glucose, and, on a separate
day, FPG and 2-h PG.
To compare the results obtained with
the predictive equation and the results
obtained with various recommended and
proposed random capillary plasma glu-
cose cut points, we applied the equation
and those cut points to the combined
Egyptian and American datasets. Capil-
lary plasma glucose values were calcu-
lated by multiplying capillary whole
blood glucose values by 1.14. All statisti-
cal analyses were performed using SAS
software version 6.12 (SAS Institute,
Cary, NC).
RESULTS — Table 1 describes the de-
mographic characteristics of the Egyptian
and American subjects. The American
participants included Hispanics (58%),
non-Hispanic whites (19%), African-
Americans (12%), Native Americans
(4%), and others (7%). The diabetes pre-
dictive equation was calculated with the
following logistic regression parameters:
P ϭ 1/(1 Ϫ eϪx
), where x ϭ Ϫ10.0382 ϩ
[0.0331 (age in years) ϩ 0.0308 (random
plasma glucose in mg/dl) ϩ 0.2500 (post-
prandial time assessed as 0 to Ն8 h) ϩ
0.5620 (if female) ϩ 0.0346 (BMI)]. Ta-
ble 2 shows the maximum likelihood es-
timates for the logistic regression
function. The overall significance of the
equation by the Ϫ2 log-likelihood test
was 299.6 (P ϭ 0.0001) with 5 df, with
89% concordant pairs and 11% discor-
dant pairs. The Hosmer-Lemeshow good-
ness of fit test was 5.27 (P ϭ 0.73) with 8
df. The EPV number was 134/5 ϭ 26.8.
Because no interactions, either alone or in
combination, added significantly to the
equation, we did not add any of these pa-
rameters. No potential outliers were de-
tected, and the equation met the linearity
assumption for logistic regression analysis.
Table 1—Demographic characteristics of the study populations
Variable Egyptian subjects American subjects
n 1,032 1,065
Age (years) 45 Ϯ 14 46 Ϯ 15
Sex (F) 609 (59) 731 (69)*
BMI (kg/m2
) 29.8 Ϯ 7.6 28.4 Ϯ 6.4
Capillary plasma glucose (mg/dl) 124.7 Ϯ 51.8 100.8 Ϯ 24.1*
Postprandial time (0–8ϩ h) 3.2 Ϯ 1.7 4.8 Ϯ 2.9*
Data are means Ϯ SD or n (%). *Statistically significant at P Ͻ 0.0001 vs. Egyptian subjects.
Diabetes screening equation
2000 DIABETES CARE, VOLUME 25, NUMBER 11, NOVEMBER 2002
3. The probability level that provided an
optimal cut point was 0.20. Based on the
classification table, derived from the lo-
gistic regression and ROC curve analysis,
sensitivity was 65%, specificity 96%, and
PPV 67% (Fig. 1). The area under the
ROC curve was 0.88. The calibration
slope was (299.6 Ϫ 4)/299.6 ϭ 0.99.
When applied to a new sample of 1,065
subjects, the equation’s sensitivity was
62%, specificity 96%, and PPV 63%.
These represented relatively small decre-
ments from the original equation.
The diabetes predictive equation per-
formed better than the various proposed
static random capillary plasma glucose
cut points for a positive test when applied
to the combined population with 10%
prevalence of undiagnosed diabetes (the
prevalence observed in the combined
Egyptian and American data sets) (Table
3). In general, the equation yielded higher
sensitivity, identified more new cases
(true positives), and missed fewer new
cases (false negatives) than the static cap-
illary plasma glucose cut points Ն140,
Ն150, Ն160, Ն170, and Ն180 mg/dl.
The equation yielded higher specificity
and identified fewer false-positive cases
than the static capillary plasma glucose
cut points Ն110, Ն120, Ն130, Ն140,
and Ն150 mg/dl. The equation yielded
higher PPV and OAPR than the static cap-
illary plasma glucose cut points Ն110,
Ն120, Ն130, Ն140, Ն150, Ն160, and
Ն170 mg/dl.
CONCLUSIONS — The perfor-
mance of all screening tests depends on
the cut points used to define a positive
test. The choice of a higher cut point
leaves more cases undetected, and the
choice of a lower cut point classifies more
healthy individuals as abnormal (5). Cur-
rently, there are no widely accepted or
rigorously validated cut points to define
positive screening tests for diabetes in
nonpregnant adults (6). The ADA has rec-
ommended a random capillary whole
blood glucose cut point of Ն140 mg/dl
(capillary plasma glucose Ն160 mg/dl),
and Rolka et al. (7) have recommended a
random capillary plasma glucose cut
point of Ն120 mg/dl.
Optimal cut points for random capil-
lary glucose tests depend on age, sex,
BMI, and postprandial time (6,7). Multi-
variate equations incorporate multiple
pieces of diagnostic information and can
provide a flexible alternative to static cut
points for the definition of a positive test
(21). We have developed a multivariate
predictive equation based on age, sex,
BMI, postprandial time, and capillary
plasma glucose levels to assess the likeli-
hood of previously undiagnosed diabetes.
The equation was 65% sensitive and 96%
specific. In validation testing, the equa-
tion was 62% sensitive and 96% specific.
Predictive equations rarely perform as
well with new data as with the data with
which they were developed because dur-
ing development, the equation maximizes
the probability of predicting the values in
the original dataset. When testing an
equation, the important factor is the size
of the decrement in performance. The rel-
atively small decrement in sensitivity and
unchanged specificity suggest that the
equation has both external validity and
generalizability (21).
A decision regarding acceptable levels
of sensitivity and specificity involves
weighting the consequences of leaving
cases undetected (false negatives) and
classifying healthy individuals as abnor-
mal (false positives) (22,23). Like the
ADA-recommended plasma glucose cut
point of 160 mg/dl, the logistic equation
provided high specificity (96%) (Table 3).
Compared with the ADA-recommended
cut point of 160 mg/dl, the logistic equa-
tion improved sensitivity (44 and 63%,
respectively) (Table 3). Compared with
the plasma glucose cut point of 120 mg/dl,
the logistic equation improved specificity
(77 and 96%, respectively) but was less
sensitive (76 and 63%, respectively) (Table
3).
Highly specific screening tests mini-
mize the number of false-positive results
but increase the number of false-negative
results. They are preferable if the failure to
Figure 1—ROC curve. Points on the ROC
curve represent the probability levels generated
from the logistic regression analysis that was
used to select the optimal cut point. A probabil-
ity value of 0.20 provided a sensitivity of 65%
and a specificity of 96%. Sensitivity and speci-
ficity of risk factors for the prediction of previ-
ously undiagnosed diabetes based on FPG
Ն126 mg/dl and/or 2-h PG Ն200 mg/dl were
estimated using the multiple regression model
described in the text, in which FPG and/or 2-h
PG were modeled as a function of age, random
plasma glucose, postprandial time, sex, and
BMI. Screening tests that discriminate well be-
tween diabetic and nondiabetic individuals ag-
gregate toward the upper left corner of the ROC
curve. The area under the curve quantifies how
well the screening test correctly distinguishes a
diabetic from a nondiabetic individual; the
greater the area under the curve, the better the
performance of the screening test. A diagonal
reference line (area under the curve ϭ 0.50)
defines points where a test is no better than
chance in identifying individuals with diabetes.
Table 2—Maximum likelihood estimates of logistic regression function
Variable
Estimated regression
coefficient Estimated SE Wald
2 P
Estimated
odds ratio
95% CI for
odds ratio
Intercept Ϫ10.0382 Ϯ0.8123 — 0.0001 — —
Age (years) 0.0331 Ϯ0.009 12.7 0.0004 1.39* 1.16–1.67*
Plasma glucose (mg/dl) 0.0308 Ϯ0.003 101.6 0.0001 1.36* 1.28–1.44*
Postprandial time (0–8 h) 0.2500 Ϯ0.625 16.0 0.0001 1.28† 1.13–1.45
Sex (F) 0.5620 Ϯ0.277 4.1 0.04 1.75 1.02–3.02
BMI (kg/m2
) 0.0346 Ϯ0.014 5.8 0.02 1.04† 1.01–1.07
* Estimated odds ratios and 95% CIs for 10-unit increase; †estimated odds ratios and 95% CIs for 1-unit increase
Tabaei and Herman
DIABETES CARE, VOLUME 25, NUMBER 11, NOVEMBER 2002 2001
4. make an early diagnosis and initiate treat-
ment does not have dire health conse-
quences, if a disease is uncommon in the
population, and if false-positive results
can harm the subject physically, emotion-
ally, or financially. Type 2 diabetes is of-
ten slowly progressive and is not
associated with complications in the short
term. Individuals with initial false-
negative screening tests will be identified
as abnormal on rescreening, particularly
if they have progressive glucose intoler-
ance. In addition, undiagnosed diabetes is
uncommon: in a representative sample of
the U.S. population 40–74 years of age,
undiagnosed diabetes, defined by FPG
Ն140 mg/dl or 2-h PG Ն200, was present
in only 6.7% (24). False-positive screen-
ing tests require further diagnostic tests
that are inconvenient, expensive, and
time-consuming. For these reasons, we
believe that the predictive equation,
which is highly specific, is preferable to a
static glucose cut point of 120 mg/dl,
which is much less specific. We also be-
lieve that the predictive equation is pref-
erable to a static glucose cut point of 160
mg/dl because, given comparable high
specificity, it is much more sensitive.
PPV and OAPR are measures of the
performance of a diagnostic test that de-
pend on the prevalence of the disease in
the screened population and on the sen-
sitivity and specificity of the test
(22,25,26). However, unlike sensitivity
and specificity, they are not properties of
the screening test itself, but of its applica-
tion. The multivariate predictive equation
provided a PPV of 64% and an OAPR of
1.75. These results were better than those
obtained with all static plasma glucose cut
points Ͻ180 mg/dl and indicate that
among those with a positive test, 64% ac-
tually have diabetes (true positives), and
the odds of having a true-positive test re-
sult are 1.75 times greater than the odds
of having a false-positive result (Table 3).
Tests with an OAPR Ͻ1 identify fewer
true positives than false positives.
In summary, by incorporating rele-
vant risk factor data, the predictive equa-
tion performs better in the general
population than any single glucose cut
point. The multivariate equation can be
implemented with a number of inexpen-
sive, programmable, handheld calcula-
tors. We programmed the formula and
coefficients presented in RESEARCH DESIGN
AND METHODS into a TI-83 graphic and sci-
entific calculator (Texas Instruments,
Dallas, TX). To obtain a probability value,
the user enters the values for age (years),
capillary plasma glucose (mg/dl), post-
prandial time (0 to Ն8 h), BMI (kg/m2
),
and sex (0 ϭ male and 1 ϭ female). The
calculator prompts the user by displaying
the coefficient for the variable that should
be entered next. The result displayed is
the calculated probability that a subject
has previously undiagnosed diabetes (a
number between 0.0 and 1.0). The pro-
gramming is available on request. Using
this device and a glucose meter, a health
care professional can perform a quick
point-of-care assessment of the probabil-
ity of undiagnosed diabetes in either a
public health or clinical setting.
Acknowledgments— This work was sup-
ported by the U.S. Agency for International
Development and the Egyptian Ministry of
Health under PASA (Participating Agency Ser-
vice Agreement) 236-0102-P-HI-1013-00, the
Michigan Diabetes Research and Training
Center under grant DK-20572, and the Cen-
ters for Disease Control and Prevention.
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