1379-P: Detection of Type 2 Diabetes—Evidence from a Pilot Screening Study in Denmark
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Introduction & Objective: Early detection of type 2 diabetes mellitus (T2DM) increases the quality of life and the life expectancy of individuals with T2DM and reduces societal health care costs. The aim of the study is to evaluate the efficiency of targeted and free screening using at-home self-sampling A1c tests for early detection of T2DM. Methods: In October 2022 to June 2023, the Danish Diabetes Association mailed free capillary at-home self-sampling A1c tests to 8,000 randomly selected individuals aged 50 to 75 years, who had not had their A1c measured within the past two years. The Clinical Laboratory Information Register, including all laboratory measurements covering hospitals and GPs, was used to identify the population. Results: 3,040 individuals, 38%, returned a blood sample. This is in line with screening studies for other diseases in Denmark. The participation rate was 3.8 %-points higher for women than for men and approximately U-shaped across age for both sexes with the highest participation rate among the 50-year-olds. The age-adjusted share of participants with A1c of 42-47 mmol/mol was 11%, equivalent to the estimated share of individuals with unknown prediabetes in the Danish population aged 50-75 years. The age-adjusted share of the participants with A1c ≥48 mmol/mol was 1.2% for women and 2.5% for men. It is slightly lower than the estimated shares of individuals with unknown T2DM, 1.6% for women and 2.7% for men. Further, individuals between 50-59 years of age constituted 51% of the participants with A1c ≥48 mmol/mol compared to 40% of the population, when diagnosed by the Danish Health Care System (DHCS). Similarly, the median A1c was 52 mmol/mol among the participants with A1c ≥48 mmol/mol compared to a median A1c of 60 mmol/mol in the population, when diagnosed with T2DM by the DHCS. Conclusion: The pilot screening study for at-home self-sampling prove highly efficient in detecting individuals with A1c ≥48 mmol/mol earlier compared to individuals in the same age group diagnosed by the DHCS. Disclosure N. Cayuelas Mateu: Research Support; Novo Nordisk A/S, Bayer Inc., Boehringer-Ingelheim, Sanofi, AstraZeneca, Abbott, Abbott Diagnostics. P. Rossing: Other Relationship; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Gilead Sciences, Inc., Novo Nordisk, Eli Lilly and Company, Novartis AG, Abbott Diagnostics. K.P. Neergaard: None. T. Thybo: Research Support; Novo Nordisk A/S, Bayer Inc., Boehringer-Ingelheim, Sanofi, AstraZeneca, Abbott, Abbott Diagnostics.Keywords:
Prediabetes
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Aim: To investigate the effect of oral consumption of engineered mesoporous silica particles, SiPore15®, on long-term blood glucose levels and other metabolic parameters in individuals with prediabetes and newly diagnosed Type 2 diabetes. Method: An open-label, single-arm, multicenter trial was conducted in which SiPore15 was consumed three times daily for 12 weeks. Hemoglobin A1c (HbA1c, primary end point) and an array of metabolic parameters were measured at baseline and throughout the trial. Result: SiPore15 treatment significantly reduced HbA1c by a clinically meaningful degree and improved several disease-associated parameters with minimal side effects. Conclusion: The results from this study demonstrate the potential use of SiPore15 as a treatment for prediabetes that may also delay or prevent the onset of Type 2 diabetes.
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Mortality in type 2 diabetes, is determined not only by classical complications, but also by comorbidities, and is linked to hyperglycaemia and apparent even in prediabetes. We aimed to comprehensively investigate, in a population-based cohort, health burden defined as the presence of comorbidities in addition to classical complications and cardiometabolic risk factors, in not only type 2 diabetes but also prediabetes. Such population-based study has not been performed previously. Extensive phenotyping was performed in 3,410 participants of the population-based Maastricht Study (15.0% prediabetes and 28.6% type 2 diabetes) to assess presence of 17 comorbidities, six classical complications, and ten cardiometabolic risk factors. These were added up into individual and combined sum scores and categorized. Group differences were studied with multinomial regression analyses adjusted for age and sex. Individuals with type 2 diabetes and prediabetes, as compared to normal glucose metabolism (NGM), had greater comorbidities, classical complications, cardiometabolic risk factors and combined sum scores (comorbidities sum score ≥ 3: frequencies (95% CI) 61.5% (57.6;65.4) and 41.2% (36.5;45.9) vs. 25.4% (23.5;27.4), p-trend < 0.001; classical complications ≥ 2 (26.6% (23.1;30.1; P < 0.001 vs. NGM) and 10.1% (7.8;12.7; P = 0.065 vs NGM) vs. 8.0% (6.9;9.3)); cardiometabolic risk factors ≥ 6 (39.7% (35.9;43.4) and 28.5% (24.5;32.6) vs. 14.0% (12.5;15.6); p-trend < 0.001); combined ≥ 8 (66.6% (62.7;70.5) and 48.4% (43.7;53.1) vs. 26.0%(24.1;28.0), p-trend < 0.001). Type 2 diabetes and prediabetes health burden was comparable to respectively 32 and 14 years of ageing. Our population-based study shows, independently of age and sex, a considerable health burden in both type 2 diabetes and prediabetes, which to a substantial extent can be attributed to comorbidities in addition to classical complications and cardiometabolic risk factors. Our findings emphasize the necessity of comorbidities' awareness in (pre)diabetes and for determining the exact role of hyperglycaemia in the occurrence of comorbidities.
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The article discusses the pathogenesis, methods of diagnosis, prevention, and treatment of insulin resistance, prediabetes, and type 2 diabetes. According to international recommendations, the first-line therapy for type 2 diabetes is metformin and lifestyle modification (correction of excess weight, regular physical activity), which have shown high effectiveness in large-scale clinical studies.
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Different prediabetic states precede overt type 2 diabetes. Prediabetes also carries an increased cardiovascular risk per seand may be divided into fasting hyperglycemia, impaired glucose tolerance and intermediate hyperglycemia. Mixed forms of these are very common. Prediabetes develops insidiously for many years and usually produces no symptoms until very late. It is possible to prevent prediabetes from progressing to manifest type 2 diabetes and it can also be made to revert to normoglycemia. The importance of lifestyle interventions, pharmacological treatment, surgical treatment and community efforts is discussed.
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