PURPOSE: The evaluations of color vision sensitivity in children with type I diabetes mellitus without retinopathy. MATERIAL AND METHOD: We examined 96 young patients. They was divided into three groups: I: 35 children from 7 to 16 years old with insulin-dependent diabetes mellitus duration of 1-8 years, II: 30 children with type I diabetes lasting more then 8 years, III--31 non-diabetic subjects as a control-matched for age and sex, without visual or systemic symptoms. The examinations of colour vision sensitivity were done with the IF-2AII-color Anomaloscope. In all cases were tested the dynamic blue-green equation of Moreland and two variables were determined: setting (matching) range (SR), calculated mid point (matching mid point) (CMP). RESULTS: In the blue-green equation setting range (SR) was significantly (p < 0.01) enlarged in the II group (diabetes mellitus duration > 8 years) and calculated mid point (CMP) was shifted but no significant. The results indicate a diminution of the colour discriminating sensitivity in the short wavelength half of the visible spectrum and diminution of the blue cone sensitivity in early diabetic retinopathy. CONCLUSIONS: Blue-green colour vision testing with the anomaloscope may serve as an additional test in the diagnosis of early diabetic retinopathy in children without vascular changes at the eye fundus.

Di Yi Jun Yi Da Xue Xue Bao. 2003 Aug;23(8):868-9
Value of glutamic acid decarboxylase autoantibody detection for early diagnosis of latent autoimmune diabetes in adults
Huang YY, Huang P, Lou HL.
Department of Geriatrics, First People's Hospital of Guangzhou, Guangzhou 510055, China.

OBJECTIVE: To study the diagnostic values of detection of glutamic acid decarboxylase antibody (GAD-Ab) for latent autoimmune diabetes in adults (LADA). METHOD: The clinical characteristics, body mass index (BMI), serum C-peptide levels, and HbAIC were compared between the 12 type 2 diabetic patients positive and 86 negative for GAD-Ab. RESULTS: The mean age, BMI, fasting and postprandial 2 h C-peptide levels in GAD-Ab-positive group were lower than those of GAD-Ab-negative group. The frequency of insulin use and prevalence of ketosis were higher in GAD-Ab-positive group than in GAD-Ab-negative group. CONCLUSIONS: The diagnosis of LADA can be established according to GAD-Ab-positivity, clinical characteristics and islet function. Patients with LADA should receive insulin therapy as early as possible to protect the residue islet B cells, reduce the occurrence of ketosis, and prevent diabetic complications of the eye, kidney and nerves.

Pol Arch Med Wewn. 2001 Sep;106(3):793-800.
Insulinemia--a marker of early diagnosis and control of efficacy of treatment of type II diabetes
Szybinski Z, Szurkowska M.
Katedra i Klinika Endokrynologii Collegium Medicum Uniwersytet Jagiellonski w Krakowie.

Metabolic Syndrome X defined by Reaven is caused by peripheral insuline receptor resistance, leads to hyperinsulinemia regarded as a cause of secondary dyslipidemia, hypertension, hemostatic disturbances, atherosclerosis and insulin as a growth factor takes part in carcinogenesis. Depending on a contribution of the primary risk factors of type 2 Diabetes Mellitus (2-DM) mainly genetic factors and obesity--an independent cause of insulin receptor resistance--glucose intolerance and 2-DM may overlap the Syndrome X. The aims of these studies were to determine in cross-sectional investigation a plasma insulin concentration in subjects aged over 35 years and to assess the clinical usefulness of insulinemia in early diagnosis of diabetes type 2. Investigations were carried out in Krakow town's district with 200,000 inhabitants, out of those 3060 randomly selected subjects (1720 females and 1340 males aged over 35 years) took part in the Polish Multicenter Study on Diabetes Epidemiology (PMSDE) with protocol and methods previously presented. Glucose concentration was determine by enzymatic method, insuline in plasma by IRMA method using ready kits produced by the Swierk-Poland. Logistic multiple regression model was used to estimate the effect of risk factors on the development of glucose intolerance, Chi square test, Fisher test and Mann-Whitney test were used for statistical analysis by means of statistical package BMPD. Fasting insulinemia in persons with normal glucose tolerance and body weight (BMI < 25 and glycemia < 6.1 mmol/l) in subpopulation aged over 35 years was 5.73 (SD = 3.99) in men and 7.05 (SD = 4.67) microU/ml in women. These values were positively correlated with BMI and at the range 25-30 and > 30 increased by 50 and 100% responsively and in 2-nd h in OGTT by five-times. In the persons with glucose intolerance and new-diagnosed 2-DM insulinemia increased 2-3 fold depending on BMI, and gender. In the subgroup with 2-DM and BMI > 30, insulinemia in 2 h-OGTT treated values 152 (SD = 90) in women and 112 (SD = 83.4) microU/ml in men. Obesity and insulinemia in 2 h-OGTT in multiple analysis have been identified as a strong predictors and risk factors of impaired glucose intolerance (IGT) 2-DM fasting insulinemia may be useful as an indicator of the peripheric insulin receptor resistance. The results lead to the conclusions that determination of the plasma insulin concentration may be useful in early diagnosis of IGT and diabetes type 2, and should be monitored in the course of non-pharmacological and pharmacological treatment 2-DM. One of the main goals in the course of treatment of obesity and early phases of the 2-DM should be normalization or at least reduction of hyperinsulinemia. Insulinemia may be regarded also as an important criterion for selection of the oral antidiabetic drugs.

Br J Nutr. 2000 Dec;84 Suppl 2:S177-81.
Early diagnosis, early treatment and the new diagnostic criteria of diabetes mellitus.
Kuzuya T.
JA Shioya General Hospital, Yaita, Tocjigi, Japan.

The main purpose of treating diabetes is to prevent chronic complications. Strict glycemic control is known to suppress the occurrence and progression of these complications. The test for plasma glucose is essential to identify diabetic patients, as mild hyperglycemia without symptoms can be a risk factor for complications. The new classification and diagnostic criteria for diabetes were proposed by the American Diabetes Association (ADA), WHO and Japan Diabetes Society (JDS) between 1997 and 1999. Diabetes is classified into four etiological categories; type 1, type 2, diabetes due to other specific mechanisms or conditions, and gestational diabetes. Another classification system according to the degree of metabolic abnormality has also been adopted. For diagnosis of diabetes, the JDS Committee classified the glycemic state into three categories based on fasting plasma glucose (FPG) and 2-h plasma glucose in the 75 g oral glucose tolerance test (2hPG); normal type (FPG <110 and 2hPG <140 mg/dl), diabetic type (FPG > or =126 and/or 2hPG > or =200 mg/dl), and borderline type (neither normal nor diabetic type). The borderline type corresponds to the sum of impaired fasting glycemia (IFG) and impaired glucose tolerance (IGT) based on ADA and WHO. Using the JDS criteria, diabetes is diagnosed when hyperglycemia of 'diabetic type' is confirmed on two or more occasions. ADA recommends the use of FPG alone for the diagnosis of diabetes, but findings from both Japan and Europe indicate that many diabetic subjects would be classified as non-diabetic solely on the FPG test. JDS recommends the use of the glucose tolerance test when the elevation of FPG is mild. Keeping glycemia near-normal by periodic monitoring of glycemic parameters and by appropriate treatment would prevent or reduce the diabetic complications in patients to a minimum.

Eur J Obstet Gynecol Reprod Biol. 2003 Jul 1;109(1):41-4.
Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications.
Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R.
Department of Obstetrics and Gynaecology, University Hospital of Puerto Real, Carretera Nacional IV, KM 665, 11150 Puerto Real, Cadiz, Spain.

OBJETIVE: To test the hypothesis that an early diagnosis of gestational diabetes mellitus (GDM) could avoid some diabetes-related complications. STUDY DESIGN: We compared the rates of pregnancy complications commonly related to diabetes between 189 (later screening group) and 235 (earlier screening group) women with GDM diagnosed before and after adding an universal glucose tolerance screening performed in the first antenatal visit to the traditional screening performed at 24-28 weeks of gestation. RESULTS: Women in the later screening group were likely to have hydramnios (12.7 versus 2.1%, P<0.0001) and preterm deliveries (11.8 versus 5.5%; P=0.03). All cases of preterm premature rupture of membranes and fetal anomalies took place in the later screening group (P=0.03, P=0.007, respectively). Statistical analysis was performed using the Student's t-test, Mann-Whitney's U-test, Fisher's exact test and chi2-test. Statistical significance was set at 95% level (P<0.05). CONCLUSIONS: Early glucose tolerance screening could avoid some diabetes-related complications in women with gestational diabetes. However, further studies are needed to know if it should be done in all pregnant women or only in those with a high risk of developing diabetes.

Acta Ophthalmol Scand. 1996 Apr;74(2):166-70.
The importance of early diagnosis of treatable diabetic retinopathy for the four-year visual outcome in older-onset diabetes mellitus.
Agardh E, Agardh CD, Hansson-Lundblad C, Cavallin-Sjoberg U.
Department of Ophthalmology, University Hospital, Lund, Sweden.

The four-year visual outcome was retrospectively studied in patients with older-onset diabetes mellitus and diabetic retinopathy in need of laser treatment. Visual acuity in 53 patients examined by ophthalmologists who referred the patients for an evaluation of retinopathy before laser treatment, was compared to that of 47 patients examined by ophthalmologists who also performed the photocoagulation. The number of eyes that became blind (visual acuity < or = 6/60) during the four-year period was higher (23/90 vs 9/91; p < 0.01) among referred patients, whereas the number of retinal examinations per patient during the three-year period prior to laser treatment did not differ between the two groups. Among referred patients, 13% had not been ophthalmologically examined before the treatment-requiring retinopathy was found. Corresponding figure for those examined at the laser centre was 23%. Severe macular oedema in regularly examined patients was more common among referred patients (9/30 vs 1/32; p < 0.01). The results indicate that screening for diabetic retinopathy in older-onset diabetes was not performed satisfactorily. In addition, laser treatment was delayed in older-onset diabetic patients controlled by ophthalmologists who referred patients for photocoagulation, resulting in an increased incidence of legally blind eyes. The study also stresses the importance of carrying out knowledge of when and how to diagnose early sight-threatening diabetic retinopathy to ophthalmologists referring patients for laser treatment.

Diabet Med. 1993 Mar;10(2):167-73.
A model for early diagnosis of type 2 diabetes mellitus in primary health care.
Andersson DK, Lundblad E, Svardsudd K.
Primary Health Care Centre, Laxa, Sweden.

The aim of the study was to determine the feasibility of conducting a case-finding programme for Type 2 diabetes mellitus in primary health care and to see whether random urinary glucose or random capillary blood glucose testing is the most suitable instrument for the early detection of Type 2 diabetes. Residents in the community of Laxa aged 35-64 years were subjected to testing during 1983-1987; those aged 65-79 were included from July 1985 and onwards. The urinary glucose testing was considered positive if a urinary dipstick was not unequivocally negative. The random blood glucose test was regarded as positive when > or = 8.0 mmol l-1. A diagnosis of Type 2 diabetes made within a follow-up period of 3 years from the initial examination was regarded as a positive outcome. Random blood glucose testing was performed on 3268 persons which was close to 85% of the eligible population. Urinary glucose tests were missing in 67 subjects. The random blood glucose test was positive in 220 persons and the urinalysis in 42 persons. A total of 234 individuals had a positive test, out of which 66 new diabetic cases were found. Sixty-four of these were detected by the random blood glucose testing and 20 by the urinalysis. The sensitivity for the random blood glucose and urinary glucose testing was 73 and 23%, the specificity was 95 and 99%, the positive predictive value 29 and 48%, and the negative predictive value 99 and 98%, respectively.

Zhonghua Nei Ke Za Zhi. 1989 Jul;28(7):407-9, 443-4.
Evaluation of glycated hemoglobin in the early diagnosis of diabetes mellitus
Qiu WS.

Although oral glucose tolerance test (OGTT) has been the key examination in early diagnosis of diabetes mellitus, but it still has some problems. It may be affected by some physiological or pathological changes and also requires frequent blood sampling. We investigated the usefulness of measuring the level of glycated hemoglobin (GHb) or HbA1 and HbA1c in screening or early diagnosis of diabetes mellitus. OGTT was performed and fasting levels of HbA1 and HbA1c were measured in 168 subjects. According to the diagnostic criteria of WHO for 75g OGTT, 31 subjects were classified as normal, 35 as having impaired glucose tolerance test (IGT) and 102 as diabetics. The method used for determination of HbA1 and HbA1c was high pressure liquid chromatography (HPLC). The total discovery rate for GHb in diabetic patients was 87%. In patients with fasting level of plasma glucose (FPG) greater than or equal to 8 mmol/L the discovery rate was 100%, while in those with level of FPG less than or equal to 7.94 mmol/L the rate was 80%. Thus, GHb is very useful in screening and early diagnosis of NIDDM (type II), especially diabetes mellitus of the elderly.