How do we diagnose diabetes and measure blood glucose control? View 1 (diagnosing) A clinical basis for the diagnosis of diabetes

W 1979 roku ustalono kryteria rozpoznawania cukrzycy na podstawie stężenia glukozy we krwi oraz wyników doustnego testu tolerancji glukozy (OGTT, oral glucose tolerance test), które wiążą się z rozwojem retinopatii. Od tego czasu ukazały się wyniki 5 badań o długim okresie obserwacji, w których wykazano, że praktycznie nie dochodzi do rozwoju retinopatii i mikroalbuminurii, jeśli stężenie HbA1c utrzymuje się poniżej wartości 7% (norma 6%). U około 60% osób z osoczowym stężeniem glukozy na czczo (FPG, fasting plasma glucose) wynoszącym 126-139 mg/dl i u 70% osób ze stężeniem glukozy 200-239 mg/dl po 2 godzinach OGTT stężenie HbA1c jest prawidłowe, a u 30% wartość ta mieści się w granicach 6-7%. Artykuł ten stanowi propozycję alternatywnego podejścia do zagadnienia rozpoznawania cukrzycy, z wykorzystaniem pomiaru zarówno FPG, jak i wartości HbA1c.In 1979, criteria for the diagnosis of diabetes were selected based on levels of glycemia on the oral glucose tolerance test (OGTT) that were associated with the subsequent development of retinopapthy. Since then, five long-term studies have demonstrated that when HbA1c levels are maintained below 7% (normal 6%), development of retinopathy and microalbuminuria is practically nil. Approximately 60% of people with fasting plasma glucose (FPG) concentrations of 126–139 mg/dl and 70% of those with 2-h values on the OGTT of 200–239 mg/dl have normal HbA1c levels, with another third having values between 6 and 7%. This article offers an alternative approach to diagnosis using both FPG and HbA1c values

The Reality of Type 2 Diabetes Prevention

Efforts to reduce the burden of type 2 diabetes include attempts to prevent or delay the onset of the disease. Landmark clinical trials have shown that lifestyle modification programs focused on weight loss can delay the onset of type 2 diabetes in subjects at high risk of developing the disease. Building on this knowledge, many community-based studies have attempted to replicate the trial results and, simultaneously, payers have begun to cover diabetes prevention services. This article focuses on the evidence supporting the premise that community prevention efforts will be successful. Unfortunately, no study has shown that diabetes can be delayed or prevented in a community setting, and efforts to replicate the weight loss achieved in the trials have been mostly disappointing. Furthermore, both the clinical trials and the community-based prevention studies have not shown a beneficial effect on any diabetes-related clinical outcome. While the goal of diabetes prevention is extremely important, the absence of any persuasive evidence for the effectiveness of community programs calls into question whether the use of public funds or national prevention initiatives should be supported at this time

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes

T he epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity have made the effective treatment of hyperglycemia a top priority.1-3 While the management of hyperglycemia, the hallmark metabolic abnormality associated with type 2 diabetes, has historically taken center stage in the treatment of diabetes, therapies directed at other coincident features, such as dyslipidemia, hypertension, hypercoagulability, obesity, and insulin resistance, have also been a major focus of research and therapy. Maintaining glycemic levels as close to the nondiabetic range as possible has been demonstrated to have a powerful beneficial effect on diabetes-specific microvascular complications, including retinopathy, nephropathy, and neuropathy, in the setting of type 1 diabetes;4,5 in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce microvascular complications.6-8 Intensive glycemic management resulting in lower A1C levels has also been shown to have a beneficial effect on cardiovascular disease (CVD) complications in type 1 diabetes;9,10 however, current studies have failed to demonstrate a beneficial effect of intensive diabetes therapy on CVD in type 2 diabetes.11-13 The development of new classes of blood glucose-lowering medications to supplement the older therapies, such as lifestyle-directed interventions, insulin, sulfonylureas, and metformin, has increased the number of treatment options available for type 2 diabetes. Whether used alone or in combination with other blood glucose-lowering interventions, the increased number of choices available to practitioners and patients has heightened uncertainty regarding the most appropriate means of treating this widespread disease.14 Although numerous reviews on the management of type 2 diabetes have been published in recent years,15-17 practitioners are often left without a clear pathway of therapy to follow. We developed the following consensus approach to the management

Diagnostic criteria for diabetes revisited: making use of combined criteria

BACKGROUND: Existing cut-offs for fasting plasma glucose (FPG) and post-load glucose (2hPG) criteria are not equivalent in the diagnosis of diabetes and glucose intolerance. Adjusting cut-offs of single measurements have not helped so we undertook this project to see if they could be complementary. METHODS: We performed oral glucose tolerance tests and mean levels of hemoglobin A1c (HbA1c) measurements on 43 patients referred to a diabetes clinic for possible diabetes. Results of single and combined use of the FPG and 2hPG criteria were evaluated against the levels of HbA1c and results re-interpreted in the light of existing reports in the literature. RESULTS: Our results confirm that the FPG and the 2hPG, being specific and sensitive respectively for the presence of glucose intolerance or diabetes, are not equivalent. They are shown to be indeed complementary and a re-definition of diagnostic criteria based on their combined use is proposed. CONCLUSIONS: We conclude that altering single measurement cut-offs for the diagnosis of diabetes and altered glucose tolerance will not result in better outcomes. We present the case for a combined criteria in the diagnosis and definition of diabetes with a FPG≥7 mmol/L AND 2-hour glucose ≥7.8 mmol/L being used to define diabetes while a FPG<7 mmol/L AND 2-hour glucose <7.8 mmol/L being used to define normality. Discordant values will define impaired glucose tolerance (IGT). This proposal requires prospective evaluation in a large cohort

Cosmological neutrinos

The current status of neutrino cosmology is reviewed, from the question of neutrino decoupling and the presence of sterile neutrinos to the effects of neutrinos on the cosmic microwave background and large scale structure. Particular emphasis is put on cosmological neutrino mass measurements.Comment: 21 pages, 4 figures, review for NJP focus issue on neutrino

Measurements of Higgs boson production and couplings in diboson final states with the ATLAS detector at the LHC

Measurements are presented of production properties and couplings of the recently discovered Higgs boson using the decays into boson pairs, H →γ γ, H → Z Z∗ →4l and H →W W∗ →lνlν. The results are based on the complete pp collision data sample recorded by the ATLAS experiment at the CERN Large Hadron Collider at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV, corresponding to an integrated luminosity of about 25 fb−1. Evidence for Higgs boson production through vector-boson fusion is reported. Results of combined fits probing Higgs boson couplings to fermions and bosons, as well as anomalous contributions to loop-induced production and decay modes, are presented. All measurements are consistent with expectations for the Standard Model Higgs boson