Is There a Clear Threshold for Fasting Plasma Glucose That Differentiates Between Those With and Without Neuropathy and Chronic Kidney Disease?: The Singapore Prospective Study Program
Open Access
- 30 April 2009
- journal article
- research article
- Published by Oxford University Press (OUP) in American Journal of Epidemiology
- Vol. 169 (12), 1454-1462
- https://doi.org/10.1093/aje/kwp076
Abstract
Recent studies suggest that no distinct glycemic threshold consistently differentiates individuals with or without retinopathy. The authors sought to determine whether the same was true for other microvascular complications. They studied 5,094 participants with fasting plasma glucose values and concurrent microvascular complications from 4 previous cross-sectional surveys carried out in Singapore (1982–1998) who attended a follow-up examination in 2004–2007. Peripheral neuropathy was diagnosed based on abnormal responses to a 10-g monofilament or neurothesiometer test. Chronic kidney disease was defined in various ways by using albuminuria (urine albumin:creatinine ratio >30 μg/mg) and estimated glomerular filtration rate, alone and in combination. Prevalence of peripheral neuropathy was 7.5%. For chronic kidney disease, prevalence of albuminuria only was 10.5%, estimated glomerular filtration rate of 2 only was 4.1%, and both was 2.1%. Prevalence of peripheral neuropathy and chronic kidney disease gradually increased in relation to fasting plasma glucose, beginning at levels below the existing diagnostic threshold for diabetes mellitus of 7.0 mmol/L (126 mg/dL). For chronic kidney disease, these associations persisted after adjustment for age, gender, ethnic group, and hypertension. Current diagnostic thresholds for diabetes mellitus have limited sensitivity for identifying individuals with these microvascular complications. Ascertaining these individuals may require development and application of novel screening strategies.Keywords
This publication has 23 references indexed in Scilit:
- Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studiesThe Lancet, 2008
- Prevalence of Polyneuropathy in Pre-Diabetes and Diabetes Is Associated With Abdominal Obesity and MacroangiopathyDiabetes Care, 2008
- Impaired Glucose Tolerance and NeuropathyThe Neurologist, 2008
- Lifestyle Intervention for Pre-Diabetic NeuropathyDiabetes Care, 2006
- Predictive Performance of the Modification of Diet in Renal Disease and Cockcroft-Gault Equations for Estimating Renal FunctionJournal of the American Society of Nephrology, 2005
- A comparison of urinary albumin excretion rate and microalbuminuria in various glucose tolerance subjectsDiabetic Medicine, 2005
- Global and societal implications of the diabetes epidemicNature, 2001
- The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years.Diabetes Care, 1999
- The Prediction of Diabetic Neuropathic Foot Ulceration Using Vibration Perception Thresholds: A prospective studyDiabetes Care, 1994
- Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. II. Differences in risk factor levels.Journal of Epidemiology and Community Health, 1990