[Detecting impaired glucose tolerance based on medical decision making].
Impaired glucose tolerance (IGT) is recognized as a preclinical state of diabetes mellitus (DM), and therefore its detection is important in terms of preventive medicine. It is, however, difficult to perform an oral glucose tolerance test (OGTT) during usual health examinations due to time constraints. This study aims to establish an appropriate procedure for detecting IGT without OGTT. Subjects were 422 males who had annual health examinations and who did not have DM. The measurement of serum fructosamine (FRA) and glycosylated hemoglobin (HbA1C), and a 75-gram oral glucose tolerance test were conducted simultaneously. IGT cases were determined as those subjects whose glucose value after two hours of oral glucose administration was 140 mg/dl or above. Ninety-four persons were classified as having IGT with this criterion. Receiver operating characteristics (ROC) analysis and logistic regression analysis were conducted to determine the most appropriate procedure for the detection of IGT. The following results were obtained: 1. ROC analysis indicated that suitable cut-off values for FPG, HbA1C, and FRA were 100 mg/dl, 5.3%, 240 mumol/l respectively. 2. The following logistic function showed suitable diagnostic capability among the several combinations of medical tests: Y = 1/(1 + e-R); R = 0.027 x age + 0.035 x (body index [%]) + 0.074 x FPG [mg/dl] + 0.198 x HbA1C [%] - 11.286. When IGT was defined as a level of logistic function equal to 0.2 or above, the logistic function showed a sensitivity value of 0.755 and specificity value of 0.753.
Takahashi
E
E
Department of Preventive Medicine and Public Health, School of Medicine, Keio University.
Yoshida
K
K
Kondo
T
T
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003937:Diagnosis, Differential; D019270:Fructosamine; D018149:Glucose Intolerance / Q000175:diagnosis*; D005951:Glucose Tolerance Test; D006454:Hemoglobins / Q000032:analysis; D006595:Hexosamines / Q000097:blood; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D006454:Hemoglobins; D006595:Hexosamines; D019270:Fructosamine