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Skin autofluorescence based decision tree in detection of impaired glucose tolerance and diabetes.

Smit AJ, Smit JM, Botterblom GJ, Mulder DJ - PLoS ONE (2013)

Bottom Line: With SAF-DM, FP were reduced to 18, FN to 16 (5 with DM) (S 82%; SP 89%).Using HbA1c-defined DM-IGT/suspicion ≥6%/42 mmol/mol, SAF-DM scored 33 FP, 24 FN (4 DM) (S76%; SP72%), FPG 29 FP, 41 FN (S71%; SP80%).SAF-DM is superior to FPG and non-inferior to HbA1c to detect diabetes/IGT in intermediate-risk persons.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University Medical Center Groningen, and University of Groningen, Groningen, The Netherlands. a.j.smit@umcg.nl

ABSTRACT

Aim: Diabetes (DM) and impaired glucose tolerance (IGT) detection are conventionally based on glycemic criteria. Skin autofluorescence (SAF) is a noninvasive proxy of tissue accumulation of advanced glycation endproducts (AGE) which are considered to be a carrier of glycometabolic memory. We compared SAF and a SAF-based decision tree (SAF-DM) with fasting plasma glucose (FPG) and HbA1c, and additionally with the Finnish Diabetes Risk Score (FINDRISC) questionnaire±FPG for detection of oral glucose tolerance test (OGTT)- or HbA1c-defined IGT and diabetes in intermediate risk persons.

Methods: Participants had ≥1 metabolic syndrome criteria. They underwent an OGTT, HbA1c, SAF and FINDRISC, in adition to SAF-DM which includes SAF, age, BMI, and conditional questions on DM family history, antihypertensives, renal or cardiovascular disease events (CVE).

Results: 218 persons, age 56 yr, 128M/90F, 97 with previous CVE, participated. With OGTT 28 had DM, 46 IGT, 41 impaired fasting glucose, 103 normal glucose tolerance. SAF alone revealed 23 false positives (FP), 34 false negatives (FN) (sensitivity (S) 68%; specificity (SP) 86%). With SAF-DM, FP were reduced to 18, FN to 16 (5 with DM) (S 82%; SP 89%). HbA1c scored 48 FP, 18 FN (S 80%; SP 75%). Using HbA1c-defined DM-IGT/suspicion ≥6%/42 mmol/mol, SAF-DM scored 33 FP, 24 FN (4 DM) (S76%; SP72%), FPG 29 FP, 41 FN (S71%; SP80%). FINDRISC≥10 points as detection of HbA1c-based diabetes/suspicion scored 79 FP, 23 FN (S 69%; SP 45%).

Conclusion: SAF-DM is superior to FPG and non-inferior to HbA1c to detect diabetes/IGT in intermediate-risk persons. SAF-DM's value for diabetes/IGT screening is further supported by its established performance in predicting diabetic complications.

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Sensitivity and specificity of skin AF alone, skin AF based decision tree (SAF-DM), FPG, HbA1c and FINDRISC for correct classification of diabetes/IGT versus normal, using OGTT based WHO criteria, or for DM/suspicion DM using HbA1c based IEC 2009 criteria.
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pone-0065592-g002: Sensitivity and specificity of skin AF alone, skin AF based decision tree (SAF-DM), FPG, HbA1c and FINDRISC for correct classification of diabetes/IGT versus normal, using OGTT based WHO criteria, or for DM/suspicion DM using HbA1c based IEC 2009 criteria.

Mentions: Part of these results are also shown, for the decision tree (SAF-DM) in comparison with FPG, HbA1c and FINDRISC, in table 2 and figures 2.


Skin autofluorescence based decision tree in detection of impaired glucose tolerance and diabetes.

Smit AJ, Smit JM, Botterblom GJ, Mulder DJ - PLoS ONE (2013)

Sensitivity and specificity of skin AF alone, skin AF based decision tree (SAF-DM), FPG, HbA1c and FINDRISC for correct classification of diabetes/IGT versus normal, using OGTT based WHO criteria, or for DM/suspicion DM using HbA1c based IEC 2009 criteria.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672176&req=5

pone-0065592-g002: Sensitivity and specificity of skin AF alone, skin AF based decision tree (SAF-DM), FPG, HbA1c and FINDRISC for correct classification of diabetes/IGT versus normal, using OGTT based WHO criteria, or for DM/suspicion DM using HbA1c based IEC 2009 criteria.
Mentions: Part of these results are also shown, for the decision tree (SAF-DM) in comparison with FPG, HbA1c and FINDRISC, in table 2 and figures 2.

Bottom Line: With SAF-DM, FP were reduced to 18, FN to 16 (5 with DM) (S 82%; SP 89%).Using HbA1c-defined DM-IGT/suspicion ≥6%/42 mmol/mol, SAF-DM scored 33 FP, 24 FN (4 DM) (S76%; SP72%), FPG 29 FP, 41 FN (S71%; SP80%).SAF-DM is superior to FPG and non-inferior to HbA1c to detect diabetes/IGT in intermediate-risk persons.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University Medical Center Groningen, and University of Groningen, Groningen, The Netherlands. a.j.smit@umcg.nl

ABSTRACT

Aim: Diabetes (DM) and impaired glucose tolerance (IGT) detection are conventionally based on glycemic criteria. Skin autofluorescence (SAF) is a noninvasive proxy of tissue accumulation of advanced glycation endproducts (AGE) which are considered to be a carrier of glycometabolic memory. We compared SAF and a SAF-based decision tree (SAF-DM) with fasting plasma glucose (FPG) and HbA1c, and additionally with the Finnish Diabetes Risk Score (FINDRISC) questionnaire±FPG for detection of oral glucose tolerance test (OGTT)- or HbA1c-defined IGT and diabetes in intermediate risk persons.

Methods: Participants had ≥1 metabolic syndrome criteria. They underwent an OGTT, HbA1c, SAF and FINDRISC, in adition to SAF-DM which includes SAF, age, BMI, and conditional questions on DM family history, antihypertensives, renal or cardiovascular disease events (CVE).

Results: 218 persons, age 56 yr, 128M/90F, 97 with previous CVE, participated. With OGTT 28 had DM, 46 IGT, 41 impaired fasting glucose, 103 normal glucose tolerance. SAF alone revealed 23 false positives (FP), 34 false negatives (FN) (sensitivity (S) 68%; specificity (SP) 86%). With SAF-DM, FP were reduced to 18, FN to 16 (5 with DM) (S 82%; SP 89%). HbA1c scored 48 FP, 18 FN (S 80%; SP 75%). Using HbA1c-defined DM-IGT/suspicion ≥6%/42 mmol/mol, SAF-DM scored 33 FP, 24 FN (4 DM) (S76%; SP72%), FPG 29 FP, 41 FN (S71%; SP80%). FINDRISC≥10 points as detection of HbA1c-based diabetes/suspicion scored 79 FP, 23 FN (S 69%; SP 45%).

Conclusion: SAF-DM is superior to FPG and non-inferior to HbA1c to detect diabetes/IGT in intermediate-risk persons. SAF-DM's value for diabetes/IGT screening is further supported by its established performance in predicting diabetic complications.

Show MeSH
Related in: MedlinePlus