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Issue 93 Item 15 Fasting Glucose Seen as Inadequate in Screening for Cardiovascu

Fasting blood glucose (FBG) testing alone misses 2/3’s of those with cardiovascular risk factors.  There is little agreement between impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) among patients at high risk for diabetes, researchers in Taiwan report. Fasting glucose testing alone would miss two-thirds of those with cardiovascular risk factors, they estimate.

Dr. Pesus Chou, of National Yang-Ming University, Taipei, Taiwan, and colleagues used a two-step screening strategy to compare metabolic risk profiles between patients with IFG and those with IGT.

The investigators first identified 1855 subjects without a previous diagnosis of diabetes had a fasting plasma glucose of between 5.6 (100mg/dl) and 7.8 mmol/L (140mg/dl). These patients were then asked to undergo an oral glucose tolerance test (OGTT), which was completed by 1456 patients.

As reported in n the January issue of the Journal of Clinical Epidemiology, the researchers observed agreement between IFG and IGT in only 20.8% of the patients.

Those with isolated IFG did not have clinical features associated with cardiovascular risk profiles. However, men with IGT had high body mass index (BMI), waist-to-hip ratio, triglycerides, and systolic blood pressure. Women with IGT had high BMI, triglycerides, diastolic blood pressure, and low HDL cholesterol.

"If the definition of IFG alone had been used for glucose intolerance screening, about 66.6% of subjects with IGT (i.e., isolated IGT with 2-hr glucose impairment and a normal fasting state) who had cardiovascular risk profiles would have been undetected," the authors write.

They say their findings indicate that "the second step of OGTT screening may be essential in screening subjects for risk of cardiovascular disease."

J Clin Epidemiol 2002;55:19-24.