Friday, December 24, 2021

Handgrip Strength as a Predictor for Prediabetes

The commonly accepted definition of prediabetes, in general, is as follows: prediabetes is when an individual has abnormally high blood glucose, but the blood glucose is not high enough to be called diabetes. Prediabetes may affect the body in many ways. For example, according to a recent study done in India, prediabetes is associated with unwanted changes in handgrip strength. And a change in handgrip strength may come before the prediabetes. Indeed, one study, looking at subjects in Japan, indicates that handgrip strength could be an independent predictor of prediabetes.

In the India study, 200 subjects were examined. One hundred of the subjects had prediabetes and 100 had normal blood glucose. The researchers measured the handgrip strength of all subjects.

After crunching the data, the researchers found that the handgrip strength was approximately 12% less for the subjects with prediabetes compared to the subjects who had normal blood glucose.  So, handgrip strength decreased with prediabetes.

In the Japanese study, mentioned above, decreasing handgrip strength was shown to be a possible predictor of prediabetes. In the study, the researchers investigated 1075 subjects who had no prediabetes or diabetes. The researchers measured the handgrip strength of the subjects to obtain baseline measurements.  And the researchers used the handgrip strength measurements to calculate the relative handgrip strength. The relative handgrip strength is defined as "absolute handgrip strength (kg) divided by BMI (reported as kg/BMI)."

After two years of follow-up, the researchers concluded "that lower baseline relative handgrip strength predicted a higher risk of prediabetes incidence among the participants." The researchers stated that "relative handgrip strength predicted a lower and significant risk of prediabetes incidence among individuals with normal weight" as defined by a BMI between 18.4 and 25.

Therefore, handgrip strength measurements could be taken in healthcare settings. Those individuals who have low handgrip strength measurements could be examined for other indicators of prediabetes. And for those with prediabetes or a high risk for diabetes, appropriate interventions could be made.

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Tuesday, December 21, 2021

HbA1c Plus FPG May be Superior to FPG Alone in Predicting Diabetes

FPG (fasting plasma glucose), HbA1c, and the OGTT (oral glucose tolerance test) are typically used to determine if someone has prediabetes or diabetes. Indeed, all three measures are employed by the National Diabetes Prevention Program (National DPP) to determine eligibility for the National DPP. So, these blood based tests are important. A recent study focused on HbA1c and FPG to see if the combination of HbA1c plus FPG was a better predictor of  diabetes than FPG. And the researchers indicated that the combination of elevated HbA1c plus elevated Impaired FPG was superior to elevated FPG alone in predicting a progression to diabetes.

The OGTT is considered by some to be the gold standard for diagnosing diabetes and prediabetes. However, it is not always practical to perform the test, and results are not always reproducible. Therefore, while the OGTT may be more accurate in predicting prediabetes than the HbA1c test in some cases, the HbA1c test is widely used since it is more practical and it is considered to be a valid test.

In the above mentioned HbA1c-FPG related study, a meta analysis considered 3011 patients with prediabetes or elevated glucose levels. The researchers concluded that patients with a combination of  elevated FPG and elevated HbA1c had the highest risk of diabetes. And that "Using HbA1c in combination with FPG could identify subgroups of people with IFG [impaired fasting glucose] at highest risk of progression to DM."

While more research is always needed to better predict the progression from prediabetes to diabetes, using the available results of recent studies is a way to create better criteria for determining Diabetes Prevention Program eligibility.

Healthcare providers should pay attention to this study and other studies related to predicting the progression from prediabetes to diabetes. If we can improve our predictive capabilities, this will lead to more bang for the buck, since we will be able to pinpoint and treat the patients who are more likely to progress to diabetes and increase healthcare cost.

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