The Prevelance of Diabetes Mellitus and Prediabetes by Oral Glucose Tolerance Test in Risk Population Applying to a Tertiary Hospital

Öz

Aim: Diabetes mellitus is an increasingly public health problem all over the world, due to the frequency and problems it creates. We aimed to investigate the prevalence of prediabetes and diabetes mellitus in individuals with no known history of diabetes and risk factors for Oral Glucose Tolerance Test (OGTT).

Material and Methods: The proportion of diabetic and prediabetic (impaired fasting glycemia, impaired glucose tolerance) cases was determined by performing OGTT on those who applied to a tertiary care hospital and had a risk factor for diabetes mellitus. The age, sex, fasting blood glucose, OGTT 2nd hour blood glucose and glycosylated hemoglobin (A1C) values of the cases were determined and differences according to sex were investigated. Comparisons were made according to glycemic subgroups.

Results: Glucose tolerance was normal in 187 cases (36.5%) with risk factor by oral glucose tolerance test. New diabetes was diagnosed in 48 (9.4%) cases. Together Impaired Fasting Glycemia (IFG) and Impaired Glucose Tolerance (IGT) were detected in 79 cases (15.4%). IFG in 150 cases (29.3%), and IGT 48 cases (9.4%). Men’s age, fasting blood glucose, OGTT 2nd hour glucose and A1C averages and diabetes mellitus ratio were significantly higher than women (p<0.05). Mean averages of diabetic and prediabetic patients, fasting blood glucose, OGTT 2nd hour blood glucose and A1C averages were significantly higher than normal group (<0.05). Meanwhile, the female sex ratio was significantly higher in normal glucose tolerant and prediabetics, while the male sex ratio was higher in diabetics.

Conclusion: OGTT is a stand-alone test for the diagnosis of diabetes mellitus and prediabetes. The prevalence of prediabetes, a risk factor for diabetes, can be detected at high levels in society and varies according to sex.

Anahtar Kelimeler

• Oral glucose tolerance test,Prediabetes,Diabetes mellitus

Üçüncü Basamak Bir Hastaneye Başvuran Riskli Popülasyonda Oral Glukoz Tolerans Testi ile Diabetes Mellitus ve Prediyabet Prevalansının Tespiti

Öz

Amaç: Diabetes mellitus, sıklığı ve yarattığı sorunlar nedeniyle tüm dünyada önemi gittikçe artan toplumsal bir sağlık sorunudur. Burada bilinen diyabet hikayesi olmayan ve Oral Glukoz Tolerans Testi (OGTT) yapılacak risk faktörlü bireylerde prediyabet ve diabetes mellitus prevalansının araştırılmasını amaçladık.

Gereç ve Yöntemler: Üçüncü basamak bir hastaneye başvuran ve diabetes mellitus açısından risk faktörü bulunduran bireylere OGTT yapılarak diyabetik ve prediyabetik (bozulmuş açlık glisemisi, bozulmuş glukoz toleransı) olguların oranı belirlendi. Olguların yaş, cinsiyet, açlık kan glukozu, OGTT 2.saat kan glukozu ve glikozile hemoglobin (A1C) değerleri belirlenerek cinsiyete göre farklılıklar araştırıldı. Glisemik tablo alt gruplarına göre karşılaştırmalar yapıldı.

Bulgular: Oral glukoz tolerans testi ile risk faktörü bulunduran 187 olguda (%36,5) glukoz toleransı normal bulundu. Yeni diyabet tanısı 48 (% 9.4) olguda saptandı. Ayrıca 150 olguda (%29,3) Bozulmuş Açlık Glukozu (BAG), 48’inde (%9.4) Bozulmuş Glukoz Toleransı (BGT) ve 79’unda (%15.4) BAG ve BGT birlikteliği tespit edildi. Erkeklerin yaş, açlık kan glukozu, OGTT 2. saat glukozu ve A1C ortalamaları ile diabetes mellitus oranı kadınlara göre anlamlı olarak yüksekti (p<0.05). Diyabetik ve prediyabetiklerin yaş ortalamaları, açlık kan glukozu, OGTT 2. saat kan glukozu ile A1C ortalamaları anlamlı olarak yüksekti (p<0.05). Bu arada normal glukoz toleranslı ve prediyabetikler içerisinde kadın cinsiyet oranı belirgin yüksek iken diyabetiklerde erkek cinsiyet oranı daha yüksek bulundu.

Sonuç: Diabetes mellitus ve prediyabet tanısı için OGTT tek başına önerilen bir testtir. Diyabet için risk faktörü pediyabet prevalansı toplumda yüksek ve cinsiyete göre farklılıklar göstermektedir. Oral glukoz tolerans testi yapılmış riskli gruplarda diabetes mellitus tanı prevalansımız toplumumuza ait bildirilenlere benzer oranda görünmektedir.

Anahtar Kelimeler

• Oral glukoz tolerans testi,Prediyabet,Diabetes mellitus

Kaynakça

1. 1. American Diabetes Association. 2.Classification and Diagnosis of Diabetes. Diabetes Care. 2017;40(Suppl 1):S11-S24.
2. 2. American Diabetes Association. 1.Promoting Health and Reducing Disparities in Populations. Diabetes Care. 2017;40(Suppl 1):S6-S10.
3. 3. World Health Organization. Diabetes Action Now. Switzerland,2004 (Accessed date 08.11.2017, http://www.who.int/diabetes/actionnow/booklet/en/)
4. 4. İnternational Dabetes Federation. Diabetes Atlas. 6thedition, 2013. (Accessed date 08.11.2017, http://www.idf.org/diabetesatlas).
5. 5. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, Bastar I, Tütüncü Y, Sargin M, Dinççag N, Karsidag K, Kalaça S, Ozcan C, King H. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care.2002;25(9):1551-6.
6. 6. Satman I,Ömer B,Tutuncu Y,Kalaca S,Gedik S,Dinccag N,Karsıdag K,Genc S,Telci A,Canbaz B,Turker F,Yılmaz T,Cakır B,Tuomiletho j;TURDEP –II Study Group.Twelveyear trends in the prevalance and risk factors of diabetets and prediabetes in Turkısh adults. Eur J Epidemiol. 2013;28(2):169-80.
7. 7. Türkiye Endokrinoloji ve Metabolizma Derneği. Diabetes Mellitus ve Komplikasyonlarının Tanı,Tedavi ve İzlem Kılavuzu, Ankara, Miki Matbaacılık San. ve Tic. Ltd. Şti. 2017. (Erişim tarihi 08.11.2017 http://turkendokrin.org/files/ DIYABET2017_web.pdf).
8. 8. World Healt Organization. Diabetes Mellitus: Report of a who Study Group Geneva. Teac Rep Ser No 727,1985. (Accessed Date 08.11.2017 http://apps.who.int/iris/bitstream/10665/39592/1/WHO_TRS_727.pdf).

9. 9. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003; 26:S5-S20.
10. 10. Christensen DL, Witte DR, Kaduka L, et al. Moving to A1Cbased diagnosis of diabetes as a different impact on prevalence in different ethnic groups. Diabetes Care 2010; 33:580-582.
11. 11. Kaiser A, Vollenweider P, Waeber G, Waeber G, Marques- Vidal P. Prevalence, awareness and treatment of type 2 diabetes mellitus in Switzerland: the CoLaus study.Diabet Med. 2012;29(2):190-7.
12. 12. Morimoto A Nushimura R Tajima N. trend in the epidemiology of patients w,th diabetes in Japan. Jpn Med Assoc J. 2010; 53:36-40.
13. 13. Ylihärsilä H1, Lindström J, Eriksson JG, Jousilahti P, Valle TT, Sundvall J, Tuomilehto J. Prevalence of diabetes and impaired glucose regulation in 45- to 64-year-old individuals in three areas of Finland. Diabet Med. 2005;22(1):88-91.
14. 14. Consequences of the new diagnostic criteria for diabetes in older men and women. DECODEStudy (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) Diabetes Care. 1999;22(10):1667-71.
15. 15. Selvin E, Steffes MW, Ballantyne CM, Hoogeveen RC, Coresh J, Brancati FL. Racial differences in glycemic markers: a crosssectional analysis of community-based data. Ann Intern Med. 2011;154(5):303-9.
16. 16. NCD Risk Factor Collaboration (NCD-RisC). Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 populationbased studies with 331,288 participants. Lancet Diabetes Endocrinol. 2015;3(8):624-37.
17. 17. Kengne AP, Erasmus RT, Levitt NS, Matsha TE. Alternative indices of glucose homeostasis as biochemical diagnostic tests for abnormal glucose tolerance in an African setting. Prim Care Diabetes. 2017;11(2):119-131.
18. 18. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J; China National Diabetes and Metabolic Disorders Study Groups. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(12):1090-101.
19. 19. Huang XB, Tang WW, Liu Y, Hu R, Ouyang LY, Liu JX, Li XJ, Yi YJ, Wang TD, Zhao SP. Prevalence of diabetes and unrecognized diabetes in hypertensive patients aged 40 to 79 years in southwest China.PLoSOne. 2017;12(2):e0170250.
20. 20-Echouffo-Tcheugui JB, Mayige M, Ogbera AO, Sobngwi E, Kengne AP. Screening for hyperglycemia in the developing world: rationale, challenges and opportunities. Diabetes Res Clin Pract. 2012;98(2):199-208.
21. 21. Gu P, Jiang W, Cheng M, Lu B, Shao J, Du H, Jiang S.Glucose metabolism in outpatients with new-onset hypertension in Chinese Han population. Clin Exp Hypertens. 2012;34(7):474- 81.
22. 22. Barrett-Connor E, Ferrara A. Isolated postchallenge hyperglycemia and the risk of fatalcardiovasculardisease in olderwomenand men. TheRanchoBernardoStudy. DiabetesCare. 1998;21(8):1236-9.