title: Fasting plasma glucose in the screening for type 2 diabetes in morbidly obese subjects.
abstract: BACKGROUND
  Higher mortality rates among morbidly obese (BMI of > or =40 or > or =35 kg/m2 with weight-related comorbidities) subjects are mainly explained by comorbidities such as type 2 diabetes. As bariatric surgery ameliorates diabetes, obese diabetic subjects will receive great benefits from bariatric surgery. Screening for diabetes prior to surgical referral is therefore crucial.
  
  
  METHODS
  We studied 1,253 consecutively recruited (2005-2008) morbidly obese subjects (67% women). Among subjects without known diabetes, 70% (670/961) performed an oral glucose tolerance test (OGTT). Screen-detected diabetes was defined as fasting plasma glucose (fPG) > or =7.0 mmol/l and/or 2-h glucose concentration (2hPG) > or = 11.1 mmol/l.
  
  
  RESULTS
  Within the study population, 31% had diabetes, of which 8% were screen-detected. Eighty percent of those with screen-detected diabetes were diagnosed by fPG. In subjects with nondiabetic fPG concentrations, elevating the fPG cutoff value from 5.2 mmol/l to the World Health Organization's (WHO's) recommended value of 6.1 mmol/l reduced the percentage of the population needing an OGTT considerably (78-23%), but only slightly reduced the sensitivity of fPG in detecting a diabetic 2hPG concentration (100-77%). Only 7% of the patients with fPG between 6.1 and 6.9 mmol/l had a diabetic 2hPG concentration. Following the WHO's recommendations, we found that 95% of all subjects with unknown diabetes were identified.
  
  
  CONCLUSIONS
  Fasting glucose identified four out of five morbidly obese subjects with unknown diabetes. A supplemental OGTT in selected persons identified the majority of the remaining diabetic cases.
authors: Morbid Obesity Center, Vestfold Hospital Trust, Post box 2168, 3103, Tønsberg, Norway. Dag.Hofso@siv.no
authors: Dag
authors: D
authors: Hofsø
authors: Trond
authors: T
authors: Jenssen
authors: Helle
authors: H
authors: Hager
authors: Jo
authors: J
authors: Røislien
authors: Jøran
authors: J
authors: Hjelmesaeth
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test / Q000592:standards; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000150:complications; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose