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PLoS One. 2019 Jul 19;14(7):e0219964. doi: 10.1371/journal.pone.0219964. eCollection 2019.

Random plasma glucose predicts the diagnosis of diabetes.

Author information

1
Atlanta VA Health Care System, Decatur, Georgia, United States of America.
2
Department of Medicine, Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia, United States of America.
3
MAVERIC VA Boston Healthcare System, Boston, Massachusetts, United States of America.
4
VA Eastern Colorado Healthcare System, Aurora, Colorado, United States of America.
5
Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America.
6
Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
7
Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
8
Department of Medicine, Department of General Aging, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
9
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.
10
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
11
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America.

Abstract

AIMS/HYPOTHESIS:

Early recognition of those at high risk for diabetes as well as diabetes itself can permit preventive management, but many Americans with diabetes are undiagnosed. We sought to determine whether routinely available outpatient random plasma glucose (RPG) would be useful to facilitate the diagnosis of diabetes.

METHODS:

Retrospective cohort study of 942,446 U.S. Veterans without diagnosed diabetes, ≥3 RPG in a baseline year, and ≥1 primary care visit/year during 5-year follow-up. The primary outcome was incident diabetes (defined by diagnostic codes and outpatient prescription of a diabetes drug).

RESULTS:

Over 5 years, 94,599 were diagnosed with diabetes [DIAB] while 847,847 were not [NONDIAB]. Baseline demographics of DIAB and NONDIAB were clinically similar, except DIAB had higher BMI (32 vs. 28 kg/m2) and RPG (150 vs. 107 mg/dl), and were more likely to have Black race (18% vs. 15%), all p<0.001. ROC area for prediction of DIAB diagnosis within 1 year by demographic factors was 0.701, and 0.708 with addition of SBP, non-HDL cholesterol, and smoking. These were significantly less than that for prediction by baseline RPG alone (≥2 RPGs at/above a given level, ROC 0.878, p<0.001), which improved slightly when other factors were added (ROC 0.900, p<0.001). Having ≥2 RPGs ≥115 mg/dl had specificity 77% and sensitivity 87%, and ≥2 RPGs ≥130 mg/dl had specificity 93% and sensitivity 59%. For predicting diagnosis within 3 and 5 years by RPG alone, ROC was reduced but remained substantial (ROC 0.839 and 0.803, respectively).

CONCLUSIONS:

RPG levels below the diabetes "diagnostic" range (≥200 mg/dl) provide good discrimination for follow-up diagnosis. Use of such levels-obtained opportunistically, during outpatient visits-could signal the need for further testing, allow preventive intervention in high risk individuals before onset of disease, and lead to earlier identification of diabetes.

Conflict of interest statement

The authors read the journal’s policy, and the authors of this manuscript have the following competing interests: MKR, PWFW and LSP declare the competing interests of receiving funding from the NIH and the VA. LRS, CNF, and SR declare the competing interests of receiving funding from the NIH. LSP declares the following competing interests: he has served on Scientific Advisory Boards for Janssen, and the Profil Institute for Clinical Research; has/had research support from the NIH, the VA, Merck, Amylin, Eli Lilly, Novo Nordisk, Sanofi, PhaseBio, Roche, Abbvie, Vascular Pharmaceuticals, Janssen, Glaxo SmithKline, Pfizer, and the Cystic Fibrosis Foundation; and is co-founder, Officer, Board member, and stockholder of DIASYST, Inc. YH, SR, JLV, KC, and DG have declared that no competing interests exist. There are no patents, products in development, or marketed products to declare. Though there are ethical and legal restrictions imposed on sharing the data underlying this study, the reported competing interests do not alter the authors’ adherence to all PLOS ONE policies on sharing data and materials.

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