Glucose Abnormalities in Urban Hispanics: diagnosis, prevalence, risk predictive value, and association with metabolic syndrome and high blood pressure

The objective is to study the prevalence of glucose abnormalities (GA), their association with metabolic syndrome(MS), and the screening value of fasting plasma glucose (FPG) and insulin in detecting impaired glucose tolerance (IGT) and diabetes mellitus (DM), were determined in an unselected sample of apparently healthy Urban- Hispanics.OGGT was conducted in 592 subjects. GA were found in 34% of subjects, defined as impaired fasting glucose (IFG) (13.3%), IGT (6.9%), combined IFG+IGT (7.8%) and type2-DM (6.5%). FPG of 5.6-6.9mmol/l diagnostic of IFG missed 47.1% of subjects with IGT, and FPG >7.0mmol/l missed 53.9% of DM. GA were associated with abdominal obesity, hypertriglyceridemia, hyperinsulinemia, hypertension and MS. Prevalence of MS was greater in DM=IFG+IGT>IGT=IFG> controls. Post-load hyperinsulinemia and hyperglycemia was higher in IGT than in IFG; whereas HOMA-IR was higher in IFG. Indices of insulin secretion were markedly reduced in DM, IFG-IGT and IGT. In summary: currently recommended FPG thresholds detect only half of subjects with GA. Diagnosis of GA must include both, fasting and 2-hr postload glucose levels. Presence of fasting and post-load hyperglycemia-hyperinsulinemia in one individual mayexplain the increased risk in combined IFG-IGT and in DM. Because of its high prevalence, silent course, and associated increased risk, full-scale screening programs and aggressive management of GA must be implemented.