Просмотр полной версии : Эндокринология

Эндокринология

Обновленная формулировка критериев "Метаболического синдрома" от Международной федерации диабета (апрель 2005):

The metabolic syndrome, which includes diabetes or prediabetes, abdominal obesity, unfavorable lipid profile and hypertension, triples the risk of myocardial infarction or stroke and doubles mortality from these conditions. It also increases the risk of developing type 2 diabetes, if not already present, fivefold. Recent data from Australia and the U.S. suggest that up to one quarter of the adult population may have the metabolic syndrome.

The new diagnostic criteria are
central obesity, defined as waist equal to or more than 94 cm for males and 80 cm for females in Europids, and ethnic-specific levels in Chinese, Japanese and South Asians;
together with two of the following:
raised triglycerides of at least 1.7 mmol/L or 150 mg/dL;
low HDL-cholesterol, defined as less than 1.04 mmol/L (40 mg/dL) in males and less than 1.29 mmol/L (50 mg/dL) in females;
raised blood pressure of at least 130/85 mm Hg;
fasting hyperglycemia, defined as glucose equal to or greater than 5.6 mmol/L (100mg/dL) or previous diagnosis of diabetes or impaired glucose tolerance.

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Рациональный базис для создания новых критериев:

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__________________
Искренне,
Вадим Валерьевич.

обновить

От Яны Студенцовой

The ‘Edmonton’ Protocol
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Ресурсы для специалистов и пациентов по диабету

Диабет в Великобритании
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University of Massachusetts
Diabetes Division
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It's a New Day In Diabetes
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Ассоциация пациентов с заболеваниями гипофиза ( Великобритания)
The Pituitary Foundation
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THYROID DISEASE MANAGER © offers an up-to-date analysis of thyrotoxicosis, hypothyroidism, thyroid nodules and cancer, thyroiditis, and all aspects of human thyroid disease and thyroid physiology. [Ссылки могут видеть только зарегистрированные и активированные пользователи]

THE OFFICIAL WEB SITE FOR THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS
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Журнал Diabetes Care
Есть раздел Clinical Practice Recommendations

Menopause

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Clinical Endocrinology
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Beata Bartes, член ТFI ( международная ассоциация пациентов с заболеваниями щитовидной железы)
является автором бюллетеня "Vivre sans Thyroide"
(для пациентов с гипотирозом, в том числе оперированных по поводу рака щитовидиной железы)
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Эта женщина, сама перенесшая тироидэктомию по поводу рака, высоко оценивает также форум
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Брошюры для пациентов с заболеваниями Щ.З.

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the Society for Behavioral Neuroendocrinology

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Вышел новый номер Th. Internftional (В. Фадеев по секрету признался. что уже начал переводить), но я в качестве анонса.
Номер посвящен т.н.TSH-receptor disoders (я очень люблю такие интеллектуально яркие идеи), и описывает 8 клинических фенотипов различных мутаций этого рецептора.
А здесь эта информация потому, что есть база данных (comprehensive & up-to-date, по заверению авторов) по нашему родному, из почтенного семейства G-связанных
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A systematic review of drug therapy for Graves’ hyperthyroidism [Ссылки могут видеть только зарегистрированные и активированные пользователи]

Subclinical Thyroid Disease
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Management of postpartum thyrotoxicosis.
Current Opinion in Endocrinology & Diabetes. 12(6):471-476, December 2005.
Azizi, Fereidoun a; Braverman, Lewis E b
Abstract:
Purpose of review: In the months following delivery, thyrotoxicosis occurs frequently. The timely recognition of the etiology and proper clinical management is important and improves the quality of life of both mother and her child. This article reviews recent literature defining the proper diagnosis and management of postpartum thyrotoxicosis.

Recent findings: During pregnancy, a variety of immune changes in systemic immune responses and localized mechanisms for protection of the placenta occur. Following delivery, there is exacerbation of immune reactivity, and during this period, autoimmune thyroid disorders may begin, recur, or exacerbate. Graves' disease and postpartum thyroiditis are two major causes of thyrotoxicosis during the postpartum period. Increased thyroidal uptake, high thyroxine/triiodothyronine ratio, and positive thyrotropin receptor-stimulating antibody results could differentiate Graves' disease from postpartum thyroiditis. The patient's thyrotoxic phase of postpartum thyroiditis lasts a few weeks and does not require treatment. Antithyroid drugs are the mainstay of treatment for postpartum Graves' disease. Many investigations have concluded that both methimazole and propylthiouracil do not cause any alterations in thyroid function and the physical and mental development of infants breast-fed by lactating hyperthyroid mothers.

Summary: Both methimazole and propylthiouracil could be safely administered in moderately high doses during lactation. It is now clear that treatment of breastfeeding thyrotoxic mothers using antithyroid medication has no detrimental effects on the thyroid function and physical and intellectual development of their children.

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Endotext.org is the web-based source of information on endocrine disease directed to physicians around the world caring for patients with these problems.

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American Association of Clinical Endocrinologists

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Endocrine Surgical Procedures

Обновленные рекомендации American Diabetes Association (январь 2006 года).
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Web site The Hormone Foundation - [Ссылки могут видеть только зарегистрированные и активированные пользователи]

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American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules.

ENEA (The European Neuroendocrinology Association) весьма активизировала свою деятельность (это я как уже многолетний член этой асоциации напоминаю).
Вот информация о будущих конгрессах и новых ассоциациях (из письма нашего президента, самого A.Grossman - пользуюсь случаем подчеркнуть его необыкновенную человеческую милоту и простоту.

Итак, что у нас в этом году -19-22 июня Питтсбург, США - международный конгресс по нейроэндокринологии

Annual Meeting (ENDO) - ежегодный анонс конференций
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архив абстрактов прошлых конференций

Интересно и заманчиво! Аж облизываюсь! :)

The European Neuroendocrine Association was founded in the early 1980's to promote, assist and integrate neuroendocrinology in all its aspects, both basic and clinical, throughout the European continent. Visit the Society online at [Ссылки могут видеть только зарегистрированные и активированные пользователи]




The British Society for Neuroendrocrinology aims to promote research into the interplay between the endocrine and nervous systems that control so many important body processes. The Society's homepage is at [Ссылки могут видеть только зарегистрированные и активированные пользователи]




The International Neuroendocrine Federation aims to promote the development of research and education in basic and clinical neuroendocrinology, to disseminate scientific information in this and related fields, to arrange for publication of information aimed at the advance of the field, to facilitate the exchange of ideas among scientists of all nations and to attract young investigators to the field. Visit the Society online at [Ссылки могут видеть только зарегистрированные и активированные пользователи]

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Журнал European Thyroid Association
доступны полнотекстовые лекции

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Androgen therapy in women: an Endocrine Society clinical practice guideline.


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Menopause and hormone therapy (HT): collaborative decision-making and management.

Журнал "Оценка медицинских технологий"
Health Technol Assess. 2007 Mar;11(7):1-256.

Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis.

Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M.

WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UK.

OBJECTIVES: To determine whether strategies can be devised for the assessment and treatment of glucocorticoid-induced osteoporosis (GIO).
DATA SOURCES: Electronic databases were searched up to October 2002.
REVIEW METHODS: A systematic review of interventions was undertaken of all randomised controlled trials in which fracture was measured as an outcome. Effectiveness was compared with effectiveness in postmenopausal osteoporosis. The risk of osteoporotic fractures at any given T-score for bone mineral density (BMD) was determined from published meta-analyses of the relationship between BMD and fracture risk. The risk of an osteoporotic fracture in the presence of a prior osteoporotic fracture was computed from a published meta-analysis of the relationship between the prior occurrence of fracture of each type and the risk of a future fracture of each type. The additional risk due to exposure to glucocorticoids was determined by meta-analysis of prospectively studied population-based cohorts. The consequences of fracture on mortality were assessed for each fracture type. Costs and utilities were determined for osteoporosis in the UK by updating systematic reviews of the literature. A model was prepared that comprised an individual patient-based approach that simulated whether or not events occurred in each subsequent year for each patient. Effectiveness was populated from a systematic review of interventions in GIO and postmenopausal osteoporosis. Treatments were given for 5 years using a 5-year offset time (in this context, offset time is the duration for which an effect on fracture persists after the treatment stops). The analytic framework was set at 10 years. Because of the many uncertainties, extensive sensitivity analysis was undertaken.
RESULTS: Evidence of anti-fracture efficacy was confined to a minority of agents used in the management of GIO. Only risedronate (a bisphosphonate) and calcidiol (vitamin D) were shown to have significant effects on vertebral fracture risk, but neither had significant effects on non-vertebral fracture risk. In further meta-analyses, the effects of bisphosphonates in GIO were compared with effects combining all available data for bisphosphonates in GIO and in postmenopausal osteoporosis. Since calcidiol is not licensed for use in the UK, cost-effectiveness analysis was confined to risedronate and to a pooled bisphosphonate effect. Analysis of cost-effectiveness of risedronate using the empirical data in GIO showed better cost-effectiveness with increasing age, but at no age did cost-effectiveness ratios fall below the threshold value of pound30,000 per quality-adjusted life-year gained. When account was taken of BMD, cost-effectiveness was confined to less than 10% of patients with very low T-scores for BMD. Assuming that bisphosphonate efficacy on fracture risk was comparable to that observed with bisphosphonates in postmenopausal osteoporosis, cost-effectiveness was shown in patients with a prior fracture. In patients with no prior fracture, cost-effectiveness was observed in individuals aged 75 years or more. In younger patients without a prior fracture, cost-effective scenarios were found contingent upon a T-score for BMD that was 2.0 SD or less.
CONCLUSIONS: Cost-effective scenarios for risedronate in the management of GIO were identified, but only at the extremes of age and T-score, such that less than 10% of patients aged 50 years or more would be eligible for treatment. Greater cost-effectiveness was observed assuming that the effects of bisphosphonate in GIO were similar to those observed in postmenopausal osteoporosis, an assumption tested by meta-analysis. An assessment algorithm is proposed based on age, the presence of a prior fragility fracture and BMD tests in individuals aged 50 years or more with no fracture. The conclusions derived are conservative, mainly because of the assumptions that were made in the absence of sufficient data. Thus, conclusions that treatment scenarios are cost-effective are reasonably secure. By contrast, scenarios shown not to be cost-effective are less secure. As information in these areas becomes available, the implications for cost-effectiveness of interventions should be reappraised. Health economic assessment based on probability of fracture is an important area for further research. Other areas for further research arise from gaps in empirical knowledge on utilities and side-effects that are amenable to primary research. Further secondary research is recommended to evaluate more closely the impact of all vertebral fractures (rather than clinically overt vertebral fractures) on cost-effectiveness and methods of monitoring treatment.

полный текст pdf
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Health Technol Assess. 2007 Feb;11(4):1-134.

The clinical effectiveness and cost-effectiveness of strontium ranelate for the prevention of osteoporotic fragility fractures in postmenopausal women.

Stevenson M, Davis S, Lloyd-Jones M, Beverley C.

School of Health and Related Research (ScHARR), University of Sheffield, UK.

OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of strontium ranelate for the prevention of osteoporotic fractures in postmenopausal women, at different levels of absolute fracture risk. This considers secondary prevention in women who have sustained a previous fracture and primary prevention in those women without a previous fracture, as women with osteoporosis are asymptomatic until a fracture is sustained.
DATA SOURCES: Major electronic bibliographic databases were searched in September 2004 and updated in March 2005.
REVIEW METHODS: A systematic review was carried out to determine clinical effectiveness using the major electronic bibliographic databases and handsearching reference lists of relevant articles and sponsor submissions. Data from selected studies were assessed and included in the meta-analyses, if appropriate. The model used to calculate cost-effectiveness ratios was an updated version of Sheffield Health Economic Model for Osteoporosis that was populated with absolute risk of fractures using an algorithm being developed for the World Health Organization and supplied in confidence to the authors. The model calculated the number of fractures that occur and provided as output data the costs associated with osteoporotic fractures, and the quality adjusted life-years (QALYs) accrued by a cohort of 100 osteoporotic women, with each fracture being detrimental to health and incurring a cost. When the costs of the intervention were included, the incremental cost compared with no treatment was calculated and divided by the gain in QALYs to calculate cost-effectiveness measures. Treatment with strontium ranelate was calculated against a no-treatment option to evaluate whether it could be given cost-effectively. An incremental analysis against alendronate was also conducted to estimate the cost-effectiveness of strontium ranelate relative to a current standard treatment. The cost-effectiveness of strategies for identifying and treating women without a prior fracture used the risk of fracture as an input to the cost-effectiveness model.
RESULTS: Three trials were identified. Pooled data from two studies indicate that strontium ranelate therapy is associated with a reduction in the risk of vertebral fracture [relative risk (RR) compared with placebo 0.60, 95% confidence interval (CI) 0.53 to 0.69, p < 0.001] and non-vertebral fracture (RR 0.84, 95% CI 0.73 to 0.97, p = 0.01). In general, strontium ranelate therapy did not seem to be associated with an increased risk of adverse events. However, the risk of one rare but serious adverse event, venous thromboembolism (including pulmonary embolism), was found to be significantly higher in patients receiving strontium ranelate compared with placebo (RR 1.42, 95% CI 1.02 to 1.98, p = 0.036). Some nervous system disorders, including mental impairment, disturbed consciousness, memory loss and seizures, were also more common in patients randomised to strontium ranelate. Strontium ranelate provided gains in QALYs compared with no treatment in women with sufficient calcium and vitamin D intakes. The size of the QALY gain for each intervention was strongly related to the absolute risk of fracture. From the algorithm used, it is seen that strontium ranelate can be used cost-effectively in women at relatively high risk of osteoporotic fracture. However, the results of the probabilistic sensitivity analysis, using efficacy data from randomised controlled trials, suggest that it is not as cost-effective as alendronate, a comparator intervention from the bisphosphonate class. The use of strontium ranelate in women without a prior fracture will be dependent on identification algorithms being produced in conjunction with the National Institute for Health and Clinical Excellence Osteoporosis Guidelines Development Group.
CONCLUSIONS: Strontium ranelate was shown to be clinically effective in the prevention of osteoporotic fractures. Scenarios have been found where strontium ranelate can be used cost-effectively, however given the probabilistic sensitivity analyses conducted, this intervention appears to be less cost-effective than the bisphosphonate alendronate. The evidence base for the efficacy of fracture prevention for strontium ranelate needs to be strengthened, particularly for hip fractures, where there is currently a non-significant reduction. If it were believed that the efficacy of strontium ranelate is dependent on either age or absolute risk, this would need to be proven. The evidence base on the T-score by age of the general female population needs to be strengthened, particularly in women over the age of 80 years. The prevalence of risk factors associated with fracture rates, over and above that provided by bone mineral density, also needs to be significantly strengthened to ensure that the estimated number of women that could be cost-effectively treated is accurate.

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a multidisciplinary consortium of clinicians (endocrinologists and ophthalmologists, clinical epidemiologists and radiologists) who have a special clinical and research interest in Graves' orbitopathy. Our aims are to develop standardised clinical assessment methods for evaluation of patients with Graves' orbitopathy

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2006 Canadian clinical practice guidelines on the management and
prevention of obesity in adults and children
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Diabetic Ketoacidosis
David E. Trachtenbarg, M.D., University of Illinois College of Medicine, Peoria, Illinois

Algorithm for the management of adults with diabetic ketoacidosis
Algorithm for the management of patients younger than 20 years with diabetic ketoacidosis

Management of Diabetes and Hyperglycemia in Hospitals
Diabetes Care 27:553-591, 2004
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Pediatric Endocrinology
Medical College of Georgia

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Endocrinology Update
Журнал
полнотекстовый свободный доступ в пдф.


Endocrinology Update is a quarterly publication for physicians that highlights trends in endocrinology-related procedures and disease management strategies at Mayo Clinic.

To contact the Department of Endocrinology at Mayo Clinic for a referral or physician consultation, please call 800-313-5077. For an endocrine surgery consultation, please call 507-284-2166.

To subscribe to Endocrinology Update, please send an e-mail with your request to [Ссылки могут видеть только зарегистрированные и активированные пользователи].

KIM C, Kim H, Nam J, Cho M, et al.
Internet diabetic patient management using a short messaging service automatically produced by a knowledge matrix system.
Diabetes Care. 2007;.
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dding "value" to clinical practice guidelines
Can Fam Physician
Vol. 53, No. 8, August 2007, pp.1326 - 1327
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"Evidence-based medicine is not just a synopsis of research evidence.
Evidence-based medicine has been defined as "the integration of best research evidence with clinical expertise and patients' values." The third component of this definition, patients' values, has been further defined as "the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient." Guidelines created to aid in the development of CPGs suggest CPGs "should discuss the role of patient preferences for different courses of health care for those conditions or technologies in which patients' values and preferences may be important decision-making factors" and they should "...describe the role of patient preferences when a recommendation involves a substantial element of personal choice or values."

The authors "analyzed the current Canadian CPG documents for diabetes, dyslipidemias, hypertension, and osteoporosis to determine the degree to which they mentioned the importance of patients' values and preferences in therapeutic decisions. In addition, they assessed whether the CPGs acknowledged the importance of discussing risks and benefits with patients, and the degree to which they presented clinicians with the tools and data
that would enable them to engage patients in informed discussions about the benefits and harms of available therapeutic options. "

Clinical Practice

Gynecomastia
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G.D. Braunstein

Free full-text audio on beta.nejm.org

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по ссылке - полный текст

BMJ 2007;335:497 (8 September)

Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review.

Eurich DT, McAlister FA, Blackburn DF, Majumdar SR, Tsuyuki RT, Varney J, Johnson JA.
Institute of Health Economics, Edmonton, AB, Canada, T5J 3N4.

OBJECTIVE: To review the literature on the association between antidiabetic agents and morbidity and mortality in people with heart failure and diabetes.
DESIGN: Systematic review and meta-analysis of controlled studies (randomised trials or cohort studies) evaluating antidiabetic agents and outcomes (death and admission to hospital) in patients with heart failure and diabetes.
DATA SOURCES: Electronic databases, manual reference search, and contact with investigators.
REVIEW METHODS: Two reviewers independently extracted data. Risk estimates for specific treatments were abstracted and pooled estimates derived by meta-analysis where appropriate.
RESULTS: Eight studies were included. Three of four studies found that insulin use was associated with increased risk for all cause mortality (odds ratio 1.25, 95% confidence interval 1.03 to 1.51; 3.42, 1.40 to 8.37 in studies that did not adjust for diet and antidiabetic drugs; hazard ratio 1.66, 1.20 to 2.31; 0.96, 0.88 to 1.05 in the studies that did). Metformin was associated with significantly reduced all cause mortality in two studies (hazard ratio 0.86, 0.78 to 0.97) compared with other antidiabetic drugs and insulin; 0.70, 0.54 to 0.91 compared with sulfonylureas); a similar trend was seen in a third. Metformin was not associated with increased hospital admission for any cause or for heart failure specifically. In four studies, use of thiazolidinediones was associated with reduced all cause mortality (pooled odds ratio 0.83, 0.71 to 0.97, I2=52%, P=0.02). Thiazolidinediones were associated with increased risk of hospital admission for heart failure (pooled odds ratio 1.13 (1.04 to 1.22), I2=0%, P=0.004). The two studies of sulfonylureas had conflicting results, probably because of differences in comparator treatments. Important limitations were noted in all studies.
CONCLUSION: Metformin was the only antidiabetic agent not associated with harm in patients with heart failure and diabetes. It was associated with reduced all cause mortality in two of the three studies.

Association of Overweight With Increased Risk of Coronary Heart Disease Partly Independent of Blood Pressure and Cholesterol Levels: A Meta-analysis of 21 Cohort Studies Including More Than 300 000 Persons.

Bogers RP, Bemelmans WJ, Hoogenveen RT, Boshuizen HC, Woodward M, Knekt P, van Dam RM, Hu FB, Visscher TL, Menotti A, Thorpe RJ Jr, Jamrozik K, Calling S, Strand BH, Shipley MJ; for the BMI-CHD Collaboration Investigators.

Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands. [Ссылки могут видеть только зарегистрированные и активированные пользователи].

BACKGROUND: The extent to which moderate overweight (body mass index [BMI], 25.0-29.9 [calculated as weight in kilograms divided by height in meters squared]) and obesity (BMI, >/= 30.0) are associated with increased risk of coronary heart disease (CHD) through adverse effects on blood pressure and cholesterol levels is unclear, as is the risk of CHD that remains after these mediating effects are considered.
METHODS: Relative risks (RRs) of CHD associated with moderate overweight and obesity with and without adjustment for blood pressure and cholesterol concentrations were calculated by the members of a collaboration of prospective cohort studies of healthy, mainly white persons and pooled by means of random-effects models (RRs for categories of BMI in 14 cohorts and for continuous BMI in 21 cohorts; total N = 302 296).
RESULTS: A total of 18 000 CHD events occurred during follow-up. The age-, sex-, physical activity-, and smoking-adjusted RRs (95% confidence intervals) for moderate overweight and obesity compared with normal weight were 1.32 (1.24-1.40) and 1.81 (1.56-2.10), respectively. Additional adjustment for blood pressure and cholesterol levels reduced the RR to 1.17 (1.11-1.23) for moderate overweight and to 1.49 (1.32-1.67) for obesity. The RR associated with a 5-unit BMI increment was 1.29 (1.22-1.35) before and 1.16 (1.11-1.21) after adjustment for blood pressure and cholesterol levels.
CONCLUSIONS: Adverse effects of overweight on blood pressure and cholesterol levels could account for about 45% of the increased risk of CHD. Even for moderate overweight, there is a significant increased risk of CHD independent of these traditional risk factors, although confounding (eg, by dietary factors) cannot be completely ruled out.
PMID: 17846390 [PubMed - in process]

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Подборка видео для информирования пациентов от JoslinDiabetesCenter
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А вероятно такие плакатики можно сделать в детской поликлинике
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Diabetes symptoms

Endocrine Abstracts provides searchable abstracts of presentations at key conferences in endocrinology. It is also a permanent, citable record, freely available to all without access restrictions.
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A peer-reviewed transdisciplinary Journal covering Neuroendocrinology, Neuroscience, Neurophysiology, Neuropsychopharmacology, Psychoneuroimmunology, Reproductive Medicine, Chronobiology and Human Ethology for RAPID publication of Original Papers, Review Articles and State-of-the-art from basic research and clinical research.

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Клинические рекомендации от эндокринологического общества:
* Prevention and Treatment of Pediatric Obesity
* Primary Prevention of Cardiovascular Disease & Type 2 Diabetes in Patients at Metabolic Risk
* Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronsim
* The Diagnosis of Cushing's Syndrome
* Evaluation & Treatment of Hirsutism in Premenopausal Women
* Executive Summary: Management of Thyroid Dysfunction during Pregnancy & Postpartum
* Management of Thyroid Dysfunction during Pregnancy & Postpartum
* Androgen Therapy in Women
* Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes
* Evaluation and Treatment of Adult Growth Hormone Deficiency

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Endocrinology


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Diabetes

Diabetes: cost of illness in Norway

Oddvar Solli 1, Trond Jenssen 2, 3, Ivar S Kristiansen 1, 4

1Department of Health Management and Health Economics, Oslo, Norway

2Rikshospitalet University Hospital, Oslo, Norway

3Institute of Clinical Medicine, Medical Faculty, University of Tromsø, Norway

4Institute of Public Health, University of Southern Denmark, Denmark

BMC Endocrine Disorders - Volume 10

doi:10.1186/1472-6823-10-15 - September 2010

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“….Diabetes mellitus places a considerable burden on patients in terms of morbidity and mortality and on society in terms of costs. Costs related to diabetes are expected to increase due to increasing prevalence of type 2 diabetes. The aim of this study was to estimate the health care costs attributable to type 1 and type 2 diabetes in Norway in 2005.

Methods

Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, medical equipment, nutrition guidance, physiotherapy, acupuncture, foot therapy and indirect costs were collected from national registers and responses to a survey of 584 patients with diabetes. The study was performed with a prevalence approach. Uncertainty was explored by means of bootstrapping.

Results

When hospital stays with diabetes as a secondary diagnosis were excluded, the total costs were €293 million, which represents about 1.4% of the total health care expenditure.
Pharmaceuticals accounted for €95 million (32%), disability pensions €48 million (16%), medical devices €40 million (14%) and hospital admissions €21 million (7%).



Patient expenditures for acupuncture, physiotherapy and foot therapy were many times higher than expenditure for nutritional guidance. Indirect costs (lost production from job absenteeism) accounted for €70.1 million (24% of the €293 million) and included sick leave (€16.7 million), disability support and disability pensions (€48.2 million) and other indirect costs (€5.3 million). If all diabetes related hospital stays are included (primary- and secondary diagnosis) total costs amounts to €535 million, about 2.6% of the total health care expenditure in Norway.

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Pass on HbA1c for Detecting Diabetes in Adolescents
HbA1c did not perform as well as traditional measures for diagnosing diabetes mellitus in high-risk adolescents.


In 2009, an international committee of diabetes experts recommended that glycosylated hemoglobin (HbA1c) replace fasting plasma glucose (FPG) and 2-hour plasma glucose levels for diagnosing diabetes mellitus in adolescents and adults. The committee and the American Diabetes Association (ADA) also recommend HbA1c testing for screening asymptomatic overweight and obese adolescents. However, the recommended HbA1c cutoffs were derived from data from adults. Therefore, investigators examined the accuracy of the recommended HbA1c cutoff value of 6.5% for diagnosis of diabetes in 1156 asymptomatic overweight and obese adolescents (age range, 12–18 years) who participated in the National Health and Nutritional Examination Surveys (NHANES 1999–2006).

Compared with an FPG cutoff value 126 mg/dL, the HbA1c cutoff of 6.5% had a sensitivity of 75.0% and a specificity of 99.9% for detecting diabetes mellitus in adolescents. However, only four adolescents had undiagnosed diabetes mellitus; this low prevalence resulted in a wide 95% confidence interval. Compared with an FPG cutoff value 100 and <125 mg/dL for detecting prediabetes, the sensitivity of the HbA1c cutoff value of 6.0% (and the ADA cutoff value of 5.7%) was very low (<5%).

Comment: Although use of glycosylated hemoglobin is appealing because the test does not require patients to be fasting, this study argues against using HbA1c for diagnosis of diabetes mellitus or prediabetes in adolescents. The authors acknowledge that their results were limited by the small number of adolescents with undiagnosed diabetes mellitus and the absence of repeat testing. Until we have more-definitive studies to guide us, I would stick with measuring fasting plasma glucose or 2-hour plasma glucose in adolescents.

— Alain Joffe, MD, MPH, FAAP

Published in Journal Watch Pediatrics and Adolescent Medicine July 13, 2011

Citation(s):
Lee JM et al. Diagnosis of diabetes using hemoglobin A1c: Should recommendations in adults be extrapolated to adolescents? J Pediatr 2011 Jun; 158:947.e3.