Dysglycemia often missed despite treatment for other metabolic abnormalities
medwireNews: Almost two in every five patients receiving treatment for hypertension or dyslipidemia have undetected dysglycemia, shows an analysis of the EUROASPIRE IV registry.
The 2395 patients in the study had no history of cardiovascular disease and had no known diabetes, despite taking medications to lower blood pressure and/or cholesterol. Yet 20% proved to have impaired glucose tolerance and 19% had type 2 diabetes, meaning 39% of patients had some form of dysglycemia.
Bahira Shahim (Karolinska University Hospital, Stockholm, Sweden) and study co-authors note that trials of population-based diabetes screening have shown limited benefit, but stress that this “does not reflect the benefit of screening for dysglycaemia in a population at higher risk due to already diagnosed risk factors.”
The team found that the fasting plasma glucose (FPG) test detected 80% of all new type 2 diabetes cases; the addition of glycated hemoglobin results detected 90%, whereas adding an oral glucose tolerance test (OGTT) detected 92% of cases.
Although no single test detected all patients with dysglycemia, the researchers note that FPG detected 87% of OGTT-detected type 2 diabetes cases, as well as identifying patients with prediabetic dysglycemia, including the majority of those detected as having impaired glucose tolerance by OGTT.
“A pragmatic strategy, decreasing the demand for an OGTT by 21%, would be to screen all patients with FPG followed by OGTT in patients with [impaired fasting glucose],” they write in Cardiovascular Diabetology.
The team had hoped that use of the Finnish Diabetes Risk Score (FINDRISC) questionnaire would reduce the need for blood glucose tests by identifying people unlikely to have dysglycemia. But although the proportion of people with dysglycemia rose with higher FINDRISC category, 20% of people even in the lowest risk category had abnormal glucose metabolism, making the tool unsuitable for this purpose.
Shahim et al note that the questionnaire was developed in people from the general population, which could explain why it failed to accurately discriminate risk in the higher-risk population from EUROASPIRE IV.
And beyond the difficulties of initial screening for dysglycemia, they also highlight the “important goal” of finding a simple means to identify patients with dysglycemia who are at high risk for developing diabetes and cardiovascular disease and may benefit from more targeted preventive treatment.
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