Studies on Diagnosis and Complications of Type 2 Diabetes in Taiwan

• Main Authors: Yun-Ju Lai, 賴韻如
• Other Authors: Pesus Chou
• Format: Others
• Language: en_US
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/39270561805851281536

博士 === 國立陽明大學 === 公共衛生研究所 === 103 === Abstract Part I: Comparison of fasting plasma glucose and glycated hemoglobin A1c for diagnosing diabetes in a Taiwanese population. Background: The purposes of this study were to examine the impact of using hemoglobin A1c (A1C) as a diagnostic criterion for (pre)diabetes and to determine the appropriate A1C cutoff value in a Taiwanese population. Methods: We used a dataset from the Clinical Informatics Research &; Development Center of Taichung Veteran General Hospital. Fasting plasma glucose (FPG) and A1C test results were obtained from outpatient laboratory reports produced from 1 January 2011 to 30 April 2012. A total of 4,920 blood tests were analyzed. For each potential A1C cutoff value, the sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristic curve (AUC) were calculated at FPG levels of 100 and 126 mg/dl. Two-sample t- and χ² tests were used to compare differences in characteristics between individuals matching the definitions of diabetes set by the American Diabetes Association (ADA) in 2009 and 2010. Results: Among the 4920 study subjects, 580 people had an FPG < 126 mg/dl and an A1C ≥ 6.5%. After the diagnostic criterion of A1C percentage was applied, the numbers of patients with normoglycemia and prediabetes decreased, whereas the number of diabetic patients increased. For FPG levels of 100 and 126 mg/dl, the A1C cutoff points were 5.95% and 6.35%, respectively. Conclusions: More patients were diagnosed with diabetes when A1C was added as a diagnostic criterion. A1C thresholds of 5.95% and 6.35% were highly specific for prediabetes and diabetes, respectively, in Taiwanese adults. Part II: Incidence and risk factors of lower extremity amputations in people with type 2 diabetes in Taiwan, 2001-2010. Background: Diabetic patients have an increased risk of lower extremity amputations (LEAs). The present study served to analyze LEA incidence in patients with type 2 diabetes mellitus (T2DM) in Taiwan from 2001 to 2010, and determine LEA risk factors. Methods: Data from the Taiwan National Health Insurance Research Database (NHIRD) collected between 1 January 2001 and 31 December 2010 were analyzed. First, we calculated LEA incidence in the diabetic population. Subsequently, patients with newly onset type 2 diabetes during the study period were selected, and the Cox proportional hazards model was used to identify factors associated with LEA. The characteristics of patients that underwent major and multiple amputations were also analyzed. Results: From 2001 to 2010, a total of 1,588 non-traumatic LEAs were performed among the study subjects; 776 (48.9%) were minor and 812 (51.1%) were major LEAs. LEA incidence decreased from 3.08 to 1.65 per 1,000 person-years. Factors associated with LEA included peripheral arterial occlusive disease (PAOD) (hazard ratio (HR): 4.134, 95% CI: 2.72-6.29), diabetic neuropathy (HR: 2.34, 1.62-3.38), diabetic retinopathy (HR: 2.07, 1.12-3.82), heart failure (HR: 2.13, 1.45-3.15), male gender (HR: 1.64, 1.24-2.18), and adult onset diabetes (HR: 1.02, 1.01-1.04). Patients with a history of stroke were more likely to undergo a major and multiple amputations (P < 0.001 and P < 0.01, respectively). Conclusions: LEA incidence in the Taiwan diabetic population decreased in the study period. Results indicated efforts to improve diabetic care should be supported and sustainable, especially for those at high risk.