Oral glucose tolerance t

Abnormal glucose metabolism leading to hyperglycaemia defines the disease of diabetes mellitus, but hyperglycaemia exists on a continuum. The levels of fasting glucose (at or above 7mmol/l) and HbA1c (at or above 48 mmol/mol or %) that are used to define the diagnosis of diabetes are chosen because they are the levels associated with the diabetes specific complication of diabetic retinopathy. Levels of glucose below these diagnostic values but above “normal” levels (. fasting glucose between 6-/l and HbA1c of 42-48 mmol/mol or 6-%) have been defined to indicate people who are at increased risk of developing type 2 diabetes. Levels of fasting glucose below 6mmol/l and HbA1c levels below 42 mmol/mol (6%) are defined as within the normal range. Successful management of diabetes with lifestyle and/or medication or transplant or bariatric surgery may result in glucose levels below those diagnostic of diabetes but, hitherto, it has not been clarified as to whether this should be termed good diabetes control, remission, resolution or cure?

A result in one RCT comprising 206 patients aged 65 or older (mean baseline HgbA1c of %) receiving either 50 or 100 mg/d of Sitagliptin was shown to reduce HbA1c by % (combined result of both doses). [30] A combined result of 5 RCTs enlisting a total of 279 patients aged 65 or older (mean baseline HbA1c of 8%) receiving 5 mg/d of Saxagliptin was shown to reduce HbA1c by %. [31] A combined result of 5 RCTs enlisting a total of 238 patients aged 65 or older (mean baseline HbA1c of %) receiving 100 mg/d of Vildagliptin was shown to reduce HbA1c by %. [32] Another set of 6 combined RCTs involving Alogliptin (not yet approved, might be released in 2012) was shown to reduce HbA1c by % in 455 patients aged 65 or older who received or 25 mg/d of the medication. [33]

“Like everything, its an individual decision and whatever a woman decides should be respected. I believe very little information is provided to women prior to booking at GTT – which means women are not having the opportunity to make an informed decision. For me personally, I will only consent to that which is required due to medical indication – necessary intervention. This is not only during labour/birth but also pertains to all tests in pregnancy or after. If there is a genuine medical NEED for a test or intervention, I expect to have this discussed with me in order to come to a decision and a plan of action. But there rarely is medical indication for these tests. And the criteria has been widened to catch more women, which means that women are being treated for diabetes who perhaps shouldn’t be…. High risk clinics and status has serious implications on how your pregnancy, labour, birth, and post natal care is managed and it completely kills any limited choice you may have on place of birth. All these factors contributed to why I chose to abstain from the GTT and all other tests where no medical indication”

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  • Citation tools Download this article to citation manager Yudkin John S , Montori Victor M . The epidemic of pre-diabetes: the medicine and the politics BMJ 2014; 349 :g4485
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    Oral glucose tolerance t

    oral glucose tolerance t

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  • Citation tools Download this article to citation manager Yudkin John S , Montori Victor M . The epidemic of pre-diabetes: the medicine and the politics BMJ 2014; 349 :g4485
    • BibTeX (win & mac) Download
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