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Undiagnosed diabetes has worse profiles of cardiovascular and metabolic markers than known diabetes

Ohara C, Murata　A, Inoue  M,　Inoue K.

Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine

Introduction

We examined cardiovascular and metabolic risk factors in individuals with undiagnosed (unknown and newly diagnosed) diabetes using new diagnostic criteria to compare with individuals with known diabetes.

Methods

From a voluntary health checkup program database (from 1998 to 2006) with a total of 97,385 records, we used the data of 34,303 persons who attended the checkup program for the first time. New diabetes was diagnosed both at a fasting plasma glucose (FPG) of >= 7.0 mmol/L and hemoglobin A1c (HbA1c) >= 6.5%(NSGP) using JDS criteria, and was compared with known diabetes for cardiovascular and metabolic risk factors.

Results

From the sample, we retrieved 913 (2.7%) and 744 (2.2%) persons with known and undiagnosed diabetes, respectively. Among the 913 with known diabetes, 493 (54.0%) met the new criteria for diabetes. There was no significant difference in sex distribution between the two groups. After controlling for age and sex, subjects with undiagnosed diabetes had higher FPG (mean ± SD; 9.6 ± 2.5 vs. 8.0 ± 2.4 mmol/l, p < 0.001), HbA1c (7.8 ± 1.7 vs. 6.9 ± 1.7%, p < 0.001), body mass index (24.9 ± 3.6 vs. 23.9 ± 3.1, p < 0.001), systolic/diastolic blood pressure (136.1 ± 18.7 vs. 131.1 ± 17.4 mmHg, p < 0.001 / 81.8 ± 11.3 vs. 78.0 ± 10.2 mmHg, p < 0.001), and serum levels of liver enzymes (alanine aminotransferase (median; 27 vs. 22 IU/l, p < 0.001) and gamma-glutamyl transpeptidase (median; 36 vs. 25 IU/l, p < 0.001)) and lipids (total cholesterol (215.7 ± 38.7 vs. 202.1 ± 34.4 mmHg, p < 0.001) and triglycerides (median; 1.56 vs. 1.34 mmol/l, p < 0.001)) than those with known diabetes. In general, these differences were more prominent in younger ages (< 50 years) than in older ages (>= 50 years). Some marker levels among subjects with undiagnosed diabetes were matched to those among subjects with known diabetes with poor control (HbA1c >= 7.0%).

Conclusion

Persons with undiagnosed diabetes have worse profiles of cardiovascular and metabolic predictors than those with known diabetes. Undiagnosed diabetes should also be recognized as a condition with these risks.

Keywords

Epidemiology, undiagnosed/known diabetes, cardiovascular disease, metabolic syndrome, fasting plasma glucose, hemoglobin A1c

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