Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact

<div><p>Background</p><p>Incidental hepatocellular carcinoma (iHCC) is a histological finding after liver transplantation (LT) which relevance has been scarcely studied.</p><p>Aims</p><p>to describe the histopathological features of iHCC and to determine its prognostic impact in terms of tumor recurrence and overall survival.</p><p>Methods</p><p>Observational study including 451 consecutive adult LT patients (2000–2013). Patients aged<18, retransplanted or with early postoperative death were excluded. Median follow-up after LT was 58 months. Multiple Cox’s regression was used to assess the prognostic impact of iHCC on tumor recurrence and mortality while controlling for potential confounders.</p><p>Results</p><p>141 patients had known HCC before LT (31.3%). Among the remaining 310 patients, the prevalence of iHCC was 8.7% (n = 27). In the explanted liver, 36.2% of patients with known HCC and 25.9% of patients with iHCC trespassed Milan criteria (<i>p</i> = 0.30). Patients with known and iHCC had similar rates of multinodular disease (50.4% vs 55.6%; <i>p</i> = 0.62), macrovascular invasion (6.5% vs 3.7%; <i>p</i> = 0.58), microvascular invasion (12.9% vs 14.8%; <i>p</i> = 0.76) and moderate-poor tumor differentiation (53.9% vs 70.4%; <i>p</i> = 0.09). In the multivariate analysis, iHCC and known HCC had identical recurrence-free survival after controlling for histological features (RR = 1.06, 95%CI 0.36–3.14; <i>p</i> = 0.90). Cumulative 5-year overall survival rates were similar between patients with known and iHCC (65% vs 52.8% respectively; log rank <i>p</i> = 0.44), but significantly inferior as compared with patients without HCC (77.8%) (<i>p</i> = 0.002 and <i>p</i> = 0.007 respectively). Indeed, in the overall cohort, iHCC was an independent predictor of mortality (RR = 3.02; 95%CI 1.62–5.65; <i>p</i> = 0.001).</p><p>Conclusion</p><p>The risk of tumor recurrence after LT is similar in patients with iHCC and known HCC. A close imaging surveillance is strongly recommended for patients awaiting LT in order to detect HCC prior to LT, thus allowing for an adequate selection of candidates, prioritization and indication of bridging therapies.</p></div

Multivariate Cox’s regression showing independent predictors of recurrence-free survival after liver transplantation.

<p>Multivariate Cox’s regression showing independent predictors of recurrence-free survival after liver transplantation.</p

Survival curves showing overall survival of patients with incidental hepatocellular carcinoma (n = 27), as compared with patients with previously known hepatocellular carcinoma (n = 141), and patients without hepatocellular carcinoma (n = 283).

<p>Survival curves showing overall survival of patients with incidental hepatocellular carcinoma (n = 27), as compared with patients with previously known hepatocellular carcinoma (n = 141), and patients without hepatocellular carcinoma (n = 283).</p

Clinical characteristics of 451 consecutive patients who received a liver transplantation between January 2000 to April 2013.

<p>Patients were stratified into previously known hepatocellular carcinoma (kHCC, n = 141), incidental hepatocellular carcinoma (iHCC, n = 27), and patients without hepatocellular carcinoma (nHCC, n = 283). Continuous variables are presented as mean ± standard deviation (median and interquartile range for asymmetric distributions). Categorical variables are displayed as n (%). Statistically significant findings are highlighted in bold.</p

Histological features of hepatocellullar carcinoma in the explanted liver.

<p>Patients were stratified into previously known hepatocellular carcinoma (kHCC, n = 141) and incidental hepatocellular carcinoma (iHCC, n = 27). Descriptive values are displayed as median (interquartile range) or N (%). Statistically significant findings are highlighted in bold.</p

Multivariate Cox’s regression showing independent predictors of overall survival after liver transplantation.

<p>Multivariate Cox’s regression showing independent predictors of overall survival after liver transplantation.</p

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

International audienceAbstract Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance