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Item
#4
Fasting
Glucose 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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News Flash:
According to
an article in the Feb. 25 issue of Archives of Internal Medicine;
In examining 270 patients visits, medication was prescribed or
changed at only 38% of visits, despite documented high blood
pressure for at least six months before the most recent visit.
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