The Evaluation And Comparison Of Three Ways In Screening For Type 2 Diabetes And Impaired Glucose Tolerance

[Background]In recent years, the prevalence of type 2 diabetes (T2DM) has a dramatically increased trend in China, the latest survey results of Chinese Diabetes showed that the prevalence of T2DM in urban adults has been 9.7%, thus the number of T2DM has reached 92.4 million, at the same time, the prevalence of pre-diabetes came up to 15% and impaired glucose tolerance (IGT) changed into diabetes in a certain percentage each year. Patients with T2DM mostly had non-specific symptoms in its early stage, so it often been ignored, an average of 9 to 12 years of preclinical before clinical diagnosis, then a lot of patients would be omission diagnosed.50% of new diagnosed T2DM had complication, so it affecting people's physical and mental health seriously. A large number of undiagnosed patients, high complication rate once diagnosed, multiple cardiovascular risk factors has existed in IGT phase which make screening more and more important, and some large studies have shown that the changing of IGT to DM can be delayed significantly through lifestyle or drug intervention. As a result, we can early detect, treat timely and prevent the occurrence and development of T2DM through screening. Nevertheless, the strategy for diabetes screening in asymptomatic individuals is still in the air. [Objective]1. To explore the screening cut-off points of fasting blood glucose, diabetes risk score and glycosylated hemoglobin which is suitable for community residents in Guangzhou.2. To evaluate and compare the effect of fasting blood glucose, diabetes risk score, glycosylated hemoglobin in screening for type 2 diabetes and impaired glucose tolerance results.[Methods]Using SPSS13.0, chose 500 cases from 5000 inhabitants aged more than 45 years and had no diabetes randomly from Jiangnanzhong Street, Haizhu District, in Guangzhou,42 of whom refused to be investigated, therefore the total number was 458. We took the fasting blood glucose, collected medical history, conducted body measurement, and filled in diabetes risk score. Took the oral glucose tolerance test and glycated hemoglobin, blood lipids a week later. Then divided all the OGTT subjects into NGT group, IGT group, T2DM group according to the 1999 WHO diagnostic criteria on type 2 diabetes and IFG, IGT.We selected Onetouch * SureStep glucometer which made in Johnson & Johnson from the United States. GOD-PAP method was adopted to detect venous glucose, Oxidase method was adopted to detect TG, cholesterol oxidative enzymic method to detect TC, Enzyme-colorimetric method to detect HDL-C and homogeneous enzyme-colorimetric method to detect LDL-C,HPLC method to detect HbAlc. We measured blood pressure, height, weight, calculated body mass index (BMI) and waist-hip ratio (WHR) in all subjects.[Results]We have screened 223 patients with NGT included 103 males and 120 females; 151 patients with IGT included 64 males and 87 females; 78 T2DM with 36 males and 42 females. The IFG group was excluded for its sample size was too small (6 cases).1. The Basic conditions in the three groupsThe comparison of basic conditions in NGT, IGT, T2DM groups:age, systolic blood pressure, pulse pressure, BMI, waist, WHR, diabetes risk score were all upward from NGT to IGT, T2DM groups. The T2DM group's diastolic blood pressure is lower than IGT group but higher than NGT group.As follows:Age:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=14.952, P=0.000); T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). There is no statistic difference between T2DM group and IGT group (P=0.359);BMI:There is difference between IGT group, T2DM group, NGT group, the statistic difference is significant (F=15.122, P=0.000), T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). There is no statistic difference between T2DM group and IGT group (P=0.321);Waist:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=28.164, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). T2DM group are higher than IGT group, the statistic difference is significant (P=0.006);WHR:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F= 32.249, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). T2DM group are higher than IGT group, the statistic difference is significant (P=0.000);Risk score:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=105.609, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). T2DM group are higher than IGT group, the statistic difference is significant (P=0.006);Systolic blood pressure:There is difference between IGT group, T2DM group, NGT group, the statistic difference is significant (F= 13.898, P=0.000). T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). There is no statistic difference between T2DM group and IGT group (P=0.081);Pulse pressure:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=13.813, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000, P=0.012). T2DM group are higher than IGT group, the statistic difference is significant (P=0.020);Diastolic blood pressure:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=3.262, P=0.039).IGT group are higher than NGT group, the statistic difference is significant (P=0.015). There is no statistic difference between T2DM group and NGT group (P=0.094); There is no statistic difference between T2DM group and IGT group (P=0.078);2. The detection indicators in the three groups:Comparison of detection indicators in NGT, IGT, T2DM groups:TG, CHOL were all increased from NGT to IGT, T2DM, But HDL-C decreased from NGT to IGT, T2DM.AS follow:FBG:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=52.275, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). T2DM group are higher than IGT group, the statistic difference is significant (P=0.000);HbAlc:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=35.704, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000, P=0.001). T2DM group are higher than IGT group, the statistic difference is significant (P=0.000);FPG:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=51.164, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). T2DM group are higher than IGT group, the statistic difference is significant (P=0.000);2h-PG:There is difference between IGT group, T2DM group and NGT group, the statistic difference is significant (F=496.762, P=0.000).T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.000). T2DM group are higher than IGT group, the statistic difference is significant (P=0.000);TG:There is difference between IGT group, T2DM group, NGT group, the statistic difference is significant (F=9.284, P=0.000). T2DM group, IGT group are higher than NGT group, the statistic difference is significant (P=0.001, P=0.018). There is no statistic difference between T2DM group and IGT group (P=0.139);CHOL:There is no statistic difference between IGT group, T2DM group and NGT group (F=2.154, P=0.117);HDL-C:There is difference between IGT group, T2DM group, NGT group, the statistic difference is significant (F=6.596, P=0.002). T2DM group is lower than NGT group, the statistic difference is significant (P=0.000). There is no statistic difference between T2DM group and IGT group (P=0.052). There is no statistic difference between IGT group and NGT group (P=0.064);LDL-C:There is no statistic difference between IGT group, T2DM group and NGT group (F=1.881, P=0.155).3. The choice of FBG, HbAlc, DRS cut-off points for T2DM and IGT screening.We selected the the value corresponding the largest Youden index as the cut point. As a result, the optimal cut-point of FBG, DRS, HbAlc related to T2DM diagnosed by OGTT were 5.6mmol/L,9score,5.8% respectively. The optimal cut-point of FBG, DRS, HbAlc related to T2DM or IGT diagnosed by OGTT were 5.8mmol/L,9score,5.9% respectively.4. The comparison of screening effect in FBG, HbAlc, DRS and joint test.Comparing of the three methods, the lager the area under the curve the more efficient of the method. When screening for T2DM, The results of area under the curve were HbAlc(0.847)>FBG(0.840)>DRS(0.782) which showed the screening accuracy of HbAlc was higher.When screening for T2DM and IGT, the results of area under the curve was DRS(0.822)>FBG(0.731)>HbAlc(0.697) which showed the screening accuracy of DRS was higher. The joint test could improve the screening efficiency. For easier, cheaper and more efficient, we choose three-stage for screening T2DM, which was filled in DRS firstly, if DRS>9 take FBG secondly, if FBG≥5.6mmol/L take OGTT lastly. The results showed we lead to identification of 71.9% of cases of unknown diabetes and required the measurement of FBG in 46% of the patients and an OGTT test in 28%. Comparing with HbAlc which was the most efficient in the tow-stage strategy, the screening number had no difference, but the cost was decreased a lot.[Conclusions]1. The optimal cut-off points of FBG, DRS, HbAlc were each 5.6mmo/L,9,5.8% for screening T2DM, which was suitable for community residents in Guangzhou.2. The optimal cut-off points of FBG, DRS, HbAlc was each 5.8mmo/L,9,5.9% for screening T2DM and IGT, which was suitable for community residents in Guangzhou.3. The most efficient two-stage method was HbAlc≥5.8% for screening T2DM, but it only fit for outpatient screening. The three-stage method which was filled in DRS firstly, if DRS>9 take FBG secondly, if FBG>5.6mmol/L take OGTT lastly was suitable for large-scale screening. It would decrease the cost a lot and ensure the screening number.4. The most efficient of two-stage method was DRS>9 for screening T2DM and IGT. It would decrease the cost a lot and ensure the screening number which was suitable for large-scale screening.