Diabetic by FPG + GTT Diabetic by FPG Diabetics missed if no GTT

FIG. 3. Distributions for diagnosis of diabetes (D) made from FPG (5 7.0 mmol/l; x-axis) and from two-hour plasma glucose level following OGTT (511.1 mmol/l; y-axis) in the BLSA population.

We summarized 25 reports of studies that have computed the prevalence of diabetes in a population when both fasting glucose and the glucose tolerance test (GTT) were used (the WHO recommendation) in contrast to the prevalence when only the fasting level is considered (the ADA recommendation). A very high percentage (ranging from 11 to 80%) of the diagnosable diabetics are missed if the GTT is not considered.

When both tests are used, there are nine possible diagnostic categories since each test results in a classification of normal, impaired or diabetic. Figure 3 illustrates the distribution of test results from our BLSA population in men and women over 65 years. The percentage of subjects classified as diabetic when both tests are used is remarkably reduced when the fasting glucose alone is used: 65% of the men and 80% of the women would have been missed.

In other analyses, since the BLSA subjects are followed over many years with repeated testing, we could estimate that, on average, the diagnosis of diabetes can be established some 7 to 9 years earlier by glucose tolerance testing than by fasting glucose testing alone.

The result of our study is in agreement with many of the reported studies which show that the 1997 ADA diagnosis standards do not result in equal sensitivity for fasting and 2 h glucose levels, especially in older individuals. A disturbingly high percentage of older men and women will have to be informed either that they have diabetic or impaired test results. Although the use of fasting plasma glucose alone for diabetes diagnosis simplifies testing, the WHO criteria identify a much greater percentage of elderly subjects with diabetes or impaired glucose metabolism.

We will now provide a short summary on the effect of age on hepatic glucose production, glucose uptake and insulin secretion. This topic has been recently reviewed in detail, as previously noted, by Evans & Farrell (2001) and we will focus mainly on our own work using the clamp technique. The methodology of the technique has been previously reported (DeFronzo et al 1979) and its various uses reviewed (Elahi 1996). We will additionally review our data with respect to the insulinotropic effect of incretins and our preliminary data using these agents to stimulate insulin secretion and to regulate glucose homeostasis in type 2 diabetic individuals.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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