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Fasting Plasma Glucose in the Screening for Type 2 Diabetes in Morbidly Obese Subjects

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Abstract

Background

Higher mortality rates among morbidly obese (BMI of ≥40 or ≥35 kg/m2 with weight-related comorbidities) subjects are mainly explained by comorbidities such as type 2 diabetes. As bariatric surgery ameliorates diabetes, obese diabetic subjects will receive great benefits from bariatric surgery. Screening for diabetes prior to surgical referral is therefore crucial.

Methods

We studied 1,253 consecutively recruited (2005–2008) morbidly obese subjects (67% women). Among subjects without known diabetes, 70% (670/961) performed an oral glucose tolerance test (OGTT). Screen-detected diabetes was defined as fasting plasma glucose (fPG) ≥7.0 mmol/l and/or 2-h glucose concentration (2hPG) ≥ 11.1 mmol/l.

Results

Within the study population, 31% had diabetes, of which 8% were screen-detected. Eighty percent of those with screen-detected diabetes were diagnosed by fPG. In subjects with nondiabetic fPG concentrations, elevating the fPG cutoff value from 5.2 mmol/l to the World Health Organization’s (WHO’s) recommended value of 6.1 mmol/l reduced the percentage of the population needing an OGTT considerably (78–23%), but only slightly reduced the sensitivity of fPG in detecting a diabetic 2hPG concentration (100–77%). Only 7% of the patients with fPG between 6.1 and 6.9 mmol/l had a diabetic 2hPG concentration. Following the WHO’s recommendations, we found that 95% of all subjects with unknown diabetes were identified.

Conclusions

Fasting glucose identified four out of five morbidly obese subjects with unknown diabetes. A supplemental OGTT in selected persons identified the majority of the remaining diabetic cases.

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Acknowledgments

We thank Hanne Aspaas and Berit Mossing Bjørkås for their assistance with sampling and logistics; Anne Grete Kildal, Tove Alstad, Liv Haugen Sveva, and Anne Syrdalen for their participation in data collection; and the Novo Nordisk A/S, South-Eastern Norway Regional Health Authority and Vestfold Hospital Trust for donating unrestricted educational grants to Dag Hofsø.

Conflict of Interest

No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Morbid Obesity Center, Vestfold Hospital Trust, Post box 2168, 3103, Tønsberg, Norway

    Dag Hofsø, Jo Røislien & Jøran Hjelmesæth

  2. Department of Medicine, Rikshospitalet University Hospital, Oslo, Norway

    Trond Jenssen

  3. Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway

    Trond Jenssen

  4. Department of Clinical Chemistry, Vestfold Hospital Trust, Tønsberg, Norway

    Helle Hager

  5. Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

    Jo Røislien

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  1. Dag Hofsø
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  2. Trond Jenssen
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Correspondence to Dag Hofsø.

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Hofsø, D., Jenssen, T., Hager, H. et al. Fasting Plasma Glucose in the Screening for Type 2 Diabetes in Morbidly Obese Subjects. OBES SURG 20, 302–307 (2010). https://doi.org/10.1007/s11695-009-0022-5

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  • DOI: https://doi.org/10.1007/s11695-009-0022-5

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