Nic Crook

Point-of-care testing as a tool for screening for diabetes and pre-diabetes.

Aim  To determine the utility of finger‐prick point‐of‐care testing (POCT) of blood glucose for the detection of dysglycaemia.

Low prevalence of retinopathy, but high prevalence of nephropathy among Maori with newly diagnosed diabetes-Te Wai o Rona: Diabetes Prevention Strategy.

AIMS/HYPOTHESIS To describe the prevalence of retinopathy and microalbuminuria at diagnosis of diabetes in a predominantly Maori study population. METHODS Biomedical assessment including photographic retinal examination was undertaken among 157 (68.9% of eligible) members of Maori families (3.3% non-Maori) diagnosed with diabetes during a community screening programme (n=5240) as part of a diabetes prevention strategy. RESULTS Mean HbA1c of those with newly diagnosed diabetes was 7.8+/-1.5% with 34.4% having an HbA1c >/=8.0%. Retinopathy was present in 3 (1.7%) subjects, cataracts in 3.2%, microalbuminuria in 29.6% and albuminuria in 7.7%. After adjusting for covariates, only smoking was a risk factor for microalbuminuria/proteinuria (current and former smokers: increased 3.81(1.32-11.0) and 3.67(1.30-10.4) fold, respectively). CONCLUSIONS The prevalence of retinopathy at diagnosis was lower than in previous studies, yet that of microalbuminuria/proteinuria remained high. The retinopathy data suggest that case detection for diabetes in the community may be improving, but that other strategies among those at risk of diabetes, including those promoting smoking cessation, will be needed to reduce the risk of renal disease among Maori with diabetes.

Optimal waist cutpoint for screening for dysglycaemia and metabolic risk: evidence from a Maori cohort

We sought to identify the sex-specific cut-off in waist circumference which best identifies those with metabolic abnormalities consistent with the metabolic syndrome (MS) among Maori, the indigenous people of New Zealand of Polynesian origin. In 3816 self-identified Maori (2742 women, 1344 men) a 75 g oral glucose tolerance test, fasting lipid, anthropometric and blood pressure measurements were made. MS components were defined by Adult Treatment Panel (ATP) III criteria. Waist cut-off was defined using receiver operating characteristic (ROC) curve analysis to define the presence of at least two of the other MS components ( > or = 2MS). Prevalence of > or = 2MS was high (42.1 %). In males and females, waist was as good, or better, a predictor of > or = 2MS (area under ROC 0.73 women, 0.68 men) as waist:hip ratio (0.66, 0.67), BMI (0.72, 0.68) or percentage body fat (0.70, 0.68). The prediction of dysglycaemia using anthropometric variables followed a similar pattern to > or = 2MS. Waist circumference to predict > or = 2MS or dysglycaemia in Maori women and men was 98 cm and 103 cm. Applying this cut-off to the International Diabetes Federation (IDF) criteria would identify 27.8 % (34.0 % males, 25.5 % females) with the MS with an OR for > or = 2MS (adjusted for sex, smoking and age) of 3.5 (95 % CI 3.1, 4.0). Age >48 years, smoking and being male increased the odds of the MS. These waist cut-offs should be considered in both clinical practice and to optimise the definition of the MS for Maori. The validity of these criteria in other Polynesian groups should be confirmed.

Relationships between a walk test, body size and metabolic risk among a New Zealand Māori community

Abstract Aims: Programmes to prevent or delay chronic disease incorporate promotion of physical activity, particularly walking. The objective of this study was to test the associations of the ability to walk quickly with measures of adiposity and metabolic risk including dysglycaemia. Subjects and methods: Participants (3209), without known diabetes, in a lifestyle trial undertook a 4-minute walk test (4MWT) following measurements of fasting lipids, 75 g oral glucose tolerance test, anthropometry and blood pressure. Lower socio-economic status was defined by possession of a ‘community services card’ (CSC). Dysglycaemia (diabetes, impaired glucose tolerance and impaired fasting glucose) and metabolic syndrome (MS) were defined by WHO and ATPIII criteria, respectively. Results: Controlling for age, length of the walk-course and height, distance walked during the 4MWT decreased linearly (p < 0.001) with increasing waist, body mass index, %fat mass and MS risk. On average those with dysglycaemia walked 15.2 (95% CI 9.3, 20.8) m less than ‘normal’ participants independent of gender. In the best-fit regression model, distance walked was associated with reduced distances walked 1.3 (1.2, 1.5) m/year of age, 0.9 (0.8, 1.1) m/kg fat, 15.7 (11.2, 19.5) m with a CSC and 8.0 (5.8,10.2) m if currently smoking. Each additional MS factor was associated with a reduction of the distance walked by 6.6 (4.6, 8.6) m. Conclusion: Increasing numbers of MS components are associated with slower walking. The 4MWT is an easy assessment of functional limitation, which may have use in guiding intervention.

Diabetes among Māori women with self‐reported past gestational diabetes mellitus in a New Zealand Māori community

Gestational diabetes mellitus (GDM) is a risk factor for subsequent development of type 2 diabetes mellitus (T2DM). We have investigated the extent of this risk among Māori women without known diabetes.