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

Desempenho de perus de corte alimentados com níveis crescentes de aflatoxinas, com ou sem adição de adsorvente Turkey performance fed with increasing aflatoxins levels, with or without adsorvent inclusion

Este trabalho foi realizado durante o verão de 1995/96 com o objetivo de determinar o nível de aflatoxinas (AFL) capaz de causar prejuízos no desempenho de perus de corte criados sob condições ambientais de baixo desafio, bem como avaliar a eficácia da adição de bentonita sódica natural (BSN) como um adsorvente. Foram utilizados 1008 perus de corte, alojados em 84 boxes seguindo um delineamento experimental de blocos casualizados com 14 tratamentos distribuídos em um arranjo fatorial 7x2, sendo 7 níveis de adição de AFL, (0, 10, 50, 100, 500, 1000 e 2000ppb) e 2 níveis de adição de BSN (0 e 0,5%). Aos 21 dias de idade, as aves alimentadas com as dietas sem adição de BSN mostraram uma redução significativa (P<0,05) no ganho de peso (GP) e no consumo de ração (CR) com níveis de AFL iguais ou superiores a 500ppb, enquanto que aves alimentadas com as dietas com 0,5% de BSN mostraram redução significativa (P<0,05) no GP e CR apenas à partir de 1000ppb de AFL. Estes mesmos resultados foram observados aos 40 dias de idade, entretanto aos 70 dias ocorreu uma redução significativa (P<0,05) no GP e CR das aves à partir de 500ppb de AFL, com ou sem adição de BSN, demonstrando um efeito cumulativo desta micotoxina. Em geral, em todos os níveis de adição de AFL que ocorreu redução significativa no GP e CR das aves, esta foi cerca de 15 a 20% menor nos grupos alimentados com 0,5% de BSN. A conversão alimentar (CA) das aves foi menos afetada pelos níveis de AFL dietéticos, embora tenha existido uma tendência de piora na CA com altos níveis de AFL, em todas as idades. Aflatoxinas tiveram um grande efeito sobre a taxa de mortalidade (%MOR), sendo que já aos 21 dias a %MOR verificada nos lotes que receberam 1000 e 2000ppb de AFL, sem BSN, foi de 15,3 e 72,2%, respectivamente. Antes de completar 40 dias de experimento, 100% das aves alimentados com dietas contendo 2000 ppb de AFL, sem e com BSN, morreram. A adição de 0,5% BSN proporcionou uma redução média de 35% na %MOR em comparação aves alimentadas com dietas sem BSN. Com base nos resultados pode ser concluído que AFL são extremamente deletérias aos perus e que a adição de 0,5% de BSN na ração protege parcialmente os perus dos efeitos negativos desta micotoxina.<br>This experiment was carried out in the 1995/96 summer to determine the aflatoxin (AFL) levels ability to decrease turkey performance raised under excellent environmental conditions and also to avaluate a natural sodium bentonite (NSB) efficiency as an adsorbent. One thousand and eight poults were housed in 84 floor pens following a randomized complete block design with 14 treatments arranged in a 7x2 factorial, with 7 AFL levels (0, 10, 50, 100, 500, 1000 and 2000ppb) and 2 NSB levels (0 and 0.5%). At 21 days of age the birds fed without NSB showed body weight gain (BWG) and feed intake (FI) reduction (P<0.05) from 500ppb or more of AFL, whereas the birds fed with NSB showed BWG and FI reduction (P<0.05) only from 1000ppb or more of AFL. These same results were observed at 40 days of age, but at 70 days, the BWG and FI reduction was statistically significant (P<0.05) from 500ppb or more of AFL, with or without NSB inclusion. In general, birds fed with NSB had about 15 to 20% less BWG and FI reduction than birds fed without NSB. The feed conversion (FC) was less affected by AFL levels, although it worsened with increasing AFL levels. AFL have greatly affected the mortality rate. At 21 days of age the birds fed with 1000 and 2000pbb of AFL have already presented 15.3 and 72.2% of mortality, respectively and until 40 days all birds fed with 2000ppb of AFL died. However there was a benefic effect of NSB inclusion. Based on theses results can be concluded that AFL are highly deleterious for turkey and that NSB can partialy protect the birds from AFL negativo effects