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￭ S-345 ￭
Impact Factors on Discordance between HbA1c & Fasting Plasma Glucose Criteria for Diabetes Screening
Devision of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University Hospital
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Bo Bae Kim, Jin Hwa Kim
Background & Aims: As the prevalence of diabetes increases,there is an increasing need to identify diabetes earlier and more efficiently. The objective was to evaluate the agreement between HbA1c and FPG based criteria for screening of diabetes in an asymptomatic Korean population and identify independent factors associated with discordance. Methods: This study was based on the data from the Korea National Health and Nutrition Examination Survey in 2011. This survey is a cross-sectional and nationally representative study. Individuals previously diagnosed with diabetes or hypertension, and those treated with lipid lowering agents were excluded.After these exclusions, 4,110 individuals were included in this study. Results: The percentages of individuals newly diagnosed with diabetes were 3.6% (148/4,110) using either the HbA1c criterion or the FPG criterion. Moderate agreement existed between the HbA1c and FPG diagnoses (kappa index=0.693).To identify factors associated with discordance, multivariate logistic regression analysis was performed. The results showed that a BMI≥25 kg/m2, waist circumference ≥90 cm(male);
80 cm(female), and an age of 60-69 years, or ≥70 years were the only variables independently associated with discordance. Conclusion: Our results indicated that significant discordance exists between the HbA1c and FPG based diagnostic criteria for diabetes in older or obese adults.
We suggest that the use of the HbA1c or FPG level as diagnostic screening tools for diabetes should be individualized based on the characteristics of the Korean population.
￭ S-346 ￭
Case of ketosis prone type 2 diabetes associated with chorea-ballism localized on left arm
Department of Internal Medicine, College of Medicine, Inje University, Busan, South Korea
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Si Hyeong Lee, Dong Woo Lee, Yun Mi Kim, Tae Kyoon Kim, Min Jeong Kwon, Soon Hee Lee, Jeong Hyun Park
Ketosis prone type 2 diabetes (KPD) is manifested by presentation with diabetic ketoacidosis (DKA) or unprovoked ketosis due to severe beta cell dysfunction at diagnosis. Hyperglycemic chorea-ballism is predominantly observed in older type 2 diabetic patients, non-ketotic hyperglycemia and is associated with contralateral striatal hyperintensities (i.e., putamen, caudate) on both brain CT and MRI. Hyperglycemic chorea-ballism is rare in type 1 diabetes and DKA. The pathophysiology and exact cause of hyperglycemic chorea-ballism is poorly understood. A 60-year-old woman was admitted with nausea and severe involuntary movement of left arm began a week ago. She had no medical history except hypertension diagnosed three years ago. At admission, blood pressure was 120/70 mmHg and respiration rate was 24 times per minute. Height was 160 cm, weight was 60 kg, and body mass index was 23.4 kg/m2. Choreic movement of negative and positive myoclonus on left arm was observed. Laboratory findings showed pH 7.38, actual bicarbonate 24.1 mEq/L, anion gap 18, Hb 13.3 g/dL, glucose 816 mg/L, BUN 34 mg/dL, Cr 1.38 mg/dL, Na 128 mEq/L, K 5.3 mEq/L, Cl 86 mEq/L, CRP 0.49 mg/dL, C-peptide 1.65 ng/mL, keton 3.9 mEq/L, HbA1c 12.7%, anti GAD Ab 0.22 U/mL, islet cell Ab negative, insulin Ab 4 U/mL, and urine ketone body +++100 mg/dL. pH and bicarbonate were not low level but, ketosis was in progress and anion gap increased more than 10. It was thought that she was admitted to our hospital before acidosis was proceeding further. She was diagnosed with KPD based on the clinical course and laboratory results. Brain MRI showed no abnormal signal change in brain parenchyma. She was treated with saline fluid and insulin. When serum glucose was maintained at less than 200 mg/dL, involuntary movement of left arm disappeared. We report a case of ketosis prone diabetes associated with chorea-ballism localized on left arm without contralateral striatal hyperintensities on brain MRI.
