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Item
#15
Fasting
Glucose Seen as Inadequate in Screening for Cardiovascular Risk
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.
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Fact:
Few
people with diabetes surveyed could name important methods to
reduce their risk of heart attack or stroke, such as taking
prescription medications (18 percent), lowering cholesterol (8
percent), quitting smoking (7 percent), reducing blood pressure (5
percent) and taking aspirin (1 percent).
Fact:
In addition to managing weight and increasing physical
activity, the treatment of high blood pressure and cholesterol,
smoking cessation, taking aspirin, and the use of prescription
medications such as angiotensin-converting enzyme (ACE) inhibitors
have been shown to reduce the risk of heart attack and stroke in
people with diabetes. Efforts are needed to increase awareness of
these potentially life-saving measures
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