03121nas a2200325 4500008004100000022001400041245008700055210006900142260001300211300001100224490000700235520222600242653000902468653002202477653001102499653001702510653002702527653001602554653001102570653001202581653000902593653001902602653003002621653003202651100001702683700001902700700002202719700001802741856003602759 1993 eng d a0002-861400aSerum fructosamine as a screening test for diabetes in the elderly: a pilot study.0 aSerum fructosamine as a screening test for diabetes in the elder c1993 Oct a1090-40 v413 a

OBJECTIVE: To determine the value of serum glycated protein, measured as serum fructosamine, as a screening test for diabetes in the elderly.

DESIGN: Cross-sectional pilot study.

SETTING: Ambulatory research clinic in university setting.

PATIENTS: One hundred fifty-seven consecutive community-dwelling participants in the Cardiovascular Health Study, average age 71.8 + 5 (mean +/- SD, range 65-88 years).

MEASUREMENTS: Serum fructosamine levels (first and second generation assay) were obtained. All subjects who did not have a diagnosis of diabetes were given a 75-g glucose tolerance test (GTT).

RESULTS: Twenty-six subjects (17%) (10 previously diagnosed, 16 undiagnosed and asymptomatic) had diabetes mellitus, and 38 subjects (24%) had impaired glucose tolerance by history or by the GTT (WHO criteria). Only the 16 asymptomatic diabetics were included in the analysis for the pilot study. There was a significant difference in the fasting fructosamine level between non-diabetics and asymptomatic diabetics for the first generation (2.06 +/- .21 vs 2.53 +/- .49 mMol/L, P < 0.0015) and second generation assay (221 +/- 27 vs 269 +/- 48 mMol/L, P < 0.0012). Receiver operator curves were constructed to evaluate the test characteristics of serum fructosamine. Using a point of > or = 2.3 mMol/L for the first-generation assay, the sensitivity to detect asymptomatic diabetes was 75%, specificity 83%, and positive predictive value 35%. To detect both diabetes and impaired glucose tolerance using a cutpoint of > or = 2.3 mMol/L, the sensitivity was 24%, specificity 95%, and positive predictive value 68%. Employing a cut point of 250 muMol/L for the second generation assay, the sensitivity to detect diabetes was 81%, specificity 87%, and positive predictive value 43%. However, to detect diabetes and glucose intolerance using the second generation assay, the sensitivity was 39% and specificity was 86%.

CONCLUSION: This study demonstrated that a single measurement of either first or second generation fructosamine showed promise as a screening test for diabetes, but not impaired glucose tolerance, in older people.

10aAged10aDiabetes Mellitus10aFemale10aFructosamine10aGlucose Tolerance Test10aHexosamines10aHumans10aInsulin10aMale10aPilot Projects10aPredictive Value of Tests10aSensitivity and Specificity1 aCefalu, W, T1 aEttinger, W, H1 aBell-Farrow, A, D1 aRushing, J, T uhttps://chs-nhlbi.org/node/144302895nas a2200361 4500008004100000022001400041245009200055210006900147260001300216300001100229490000700240520190600247653000902153653002202162653002002184653002802204653002102232653002102253653002102274653002802295653002202323653001102345653001102356653001902367653001702386653000902403653001502412653001702427100001602444700001802460700001902478856003602497 1995 eng d a0002-861400aHigh density lipoprotein cholesterol is associated with serum cortisol in older people.0 aHigh density lipoprotein cholesterol is associated with serum co c1995 Dec a1345-90 v433 a

OBJECTIVE: To determine the associations between serum cortisol and HDL cholesterol, other lipoprotein lipids and cardiovascular risk factors, carotid atherosclerosis, and clinical heart disease in older people.

DESIGN: A cross-sectional, observational, ancillary study of the Cardiovascular Health Study (CHS).

POPULATION: A total of 245 community-dwelling people, 65 to 89 years old, were recruited consecutively for a 2-month period from the CHS cohort in Forsyth County, North Carolina.

METHODS: Cortisol was measured by radioimmunoassay in serum collected between 7:00 and 10:00 AM after an overnight fast. Cortisol levels were correlated with lipoprotein lipids, insulin, glucose, body mass index, waist-hip ratio, prevalent coronary heart disease, hypertension, diabetes, and carotid atherosclerosis by B-mode ultrasound.

RESULTS: Serum cortisol was correlated negatively (r = -.24) with body mass index and waist-hip ratio (r = -.16) but was not related significantly to fasting insulin or glucose. Cortisol was not associated significantly with triglyceride and low density lipoprotein cholesterol but showed a positive correlation (r = .21) with high density lipoprotein cholesterol. The relationship between cortisol and high density lipoprotein cholesterol persisted after adjustment for gender, body mass index, waist-hip ratio, cigarette and alcohol use, triglyceride level, and diabetes. There was a trend toward a negative correlation between cortisol and measures of carotid atherosclerosis, but no significant relationship was indicated between cortisol and prevalent coronary heart disease, hypertension, or diabetes.

CONCLUSION: Endogenous glucocorticoid levels correlated with HDL cholesterol levels and may play a role in the physiologic regulation of high density lipoprotein levels in older people.

10aAged10aBody Constitution10aBody Mass Index10aCardiovascular Diseases10aCarotid Stenosis10aCholesterol, HDL10aCoronary Disease10aCross-Sectional Studies10aDiabetes Mellitus10aFemale10aHumans10aHydrocortisone10aHypertension10aMale10aPrevalence10aRisk Factors1 aVarma, V, K1 aRushing, J, T1 aEttinger, W, H uhttps://chs-nhlbi.org/node/1412