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Random Plasma Glucose in Serendipitous Screening for Glucose Intolerance: Screening for Impaired Glucose Tolerance Study 2

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Abstract

Background

With positive results from diabetes prevention studies, there is interest in convenient ways to incorporate screening for glucose intolerance into routine care and to limit the need for fasting diagnostic tests.

Objective

The aim of this study is to determine whether random plasma glucose (RPG) could be used to screen for glucose intolerance.

Design

This is a cross-sectional study.

Participants

The participants of this study include a voluntary sample of 990 adults not known to have diabetes.

Measurements

RPG was measured, and each subject had a 75-g oral glucose tolerance test several weeks later. Glucose intolerance targets included diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose110 (IFG110; fasting glucose, 110–125 mg/dl, and 2 h glucose < 140 mg/dl). Screening performance was measured by area under receiver operating characteristic curves (AROC).

Results

Mean age was 48 years, and body mass index (BMI) was 30.4 kg/m2; 66% were women, and 52% were black; 5.1% had previously unrecognized diabetes, and 24.0% had any “high-risk” glucose intolerance (diabetes or IGT or IFG110). The AROC was 0.80 (95% CI 0.74–0.86) for RPG to identify diabetes and 0.72 (0.68–0.75) to identify any glucose intolerance, both highly significant (p < 0.001). Screening performance was generally consistent at different times of the day, regardless of meal status, and across a range of risk factors such as age, BMI, high density lipoprotein cholesterol, triglycerides, and blood pressure.

Conclusions

RPG values should be considered by health care providers to be an opportunistic initial screening test and used to prompt further evaluation of patients at risk of glucose intolerance. Such “serendipitous screening” could help to identify unrecognized diabetes and prediabetes.

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Abbreviations

ARIC:

Atherosclerosis Risk in Communities

NHANES-III:

National Health and Nutrition Examination Survey III

AGT110 :

any glucose intolerance110 (dysglycemia)

T2DM:

type 2 diabetes mellitus

ROC:

receiver-operating-characteristic

AROC:

area under the ROC curve

IGT:

impaired glucose tolerance

IFG:

impaired fasting glucose

IFG110 or IFG110–125 :

IFG with fasting plasma glucose 110–125 mg/dl

Dysglycemia:

type 2 diabetes or IGT or IFG110

WHO:

World Health Organization

NCEP:

National Cholesterol Education Program

HDL:

high density lipoprotein

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Acknowledgment

This work was supported in part by DK07298, DK062668, RR017643, DK066204, and RR00039. We thank Jane Caudle, Jack Kaufman, Eileen Osinski, Elizabeth Barrera, Jade Irving, and Aisha Bobcombe for their assistance. Portions of this work were presented at the Scientific Sessions of the American Diabetes Association in Washington, DC (2006).

Conflict of interest Statement

None disclosed.

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Author notes

  1. Paul Kolm PhD & William S. Weintraub MD

    Present address: Christiana Care Health System, Newark, DE, USA

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, GA, USA

    David C. Ziemer MD, Mary K. Rhee MD, MS, Rincy M. Varughese MS, Circe W. Tsui BBA & Lawrence S. Phillips MD

  2. Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Paul Kolm PhD, Jovonne K. Foster MS, William S. Weintraub MD & Viola Vaccarino MD, PhD

  3. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA

    David D. Koch PhD

  4. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Jennifer G. Twombly MD, PhD & K. M. Venkat Narayan MD, MPH, MBA

  5. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    K. M. Venkat Narayan MD, MPH, MBA

  6. VA Medical Center, Atlanta, GA, USA

    Lawrence S. Phillips MD

  7. Division of Endocrinology, Emory University, Atlanta, GA, USA

    Lawrence S. Phillips MD

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  1. David C. Ziemer MD
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Correspondence to Lawrence S. Phillips MD.

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Ziemer, D.C., Kolm, P., Foster, J.K. et al. Random Plasma Glucose in Serendipitous Screening for Glucose Intolerance: Screening for Impaired Glucose Tolerance Study 2. J GEN INTERN MED 23, 528–535 (2008). https://doi.org/10.1007/s11606-008-0524-1

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