Spotlight on screening

New data on who to screen for diabetes and how to screen them were offered by a few studies published in the past month.

Women who have survived breast cancer appear to have an elevated risk of developing diabetes, according to a study in the December 2012 Diabetologia. Researchers compared the incidence of diabetes among more than 25,000 Canadian women 55 and over who were treated for breast cancer between 1996 and 2008 and more than 120,000 age-matched controls. Breast cancer patients had a slight increase in diabetes starting two years after diagnosis, which grew to a 20% higher risk by 10 years, leading study authors to conclude that “greater diabetes screening and prevention strategies among breast cancer survivors may be warranted.”

Physicians may also want to keep a closer eye on women who undergo menopause at a relatively young age. A different study, which compared more than 3,000 postmenopausal women with type 2 diabetes to more than 4,000 controls, found that women who went through menopause before age 40 were 32% more likely to develop diabetes than those who had it at ages 50 to 54. A trend toward higher risk was also seen in women who experienced menopause between ages 40 and 44. A shorter reproductive life span was also associated with higher diabetes risk, according to the study, which was published online by Diabetes Care on Dec. 10.

Adult-onset autoimmune diabetes is more likely in patients who are leaner, female and younger according to a recent European study, published Dec. 17 by Diabetes Care. More than 6,000 relatively newly diagnosed (within five years) diabetic patients were tested for GAD antibodies (GADA) and antibodies to insulinoma-associated antigen-2 and zinc-transporter 8. Almost 9% of the patients were found to have GADA and another 0.9% had one of the other types. Patients with the antibodies tended to be younger, leaner and female, but researchers concluded that these patients are generally clinically indistinguishable from patients with type 2 diabetes at diagnosis and can only be certainly identified by antibody screening.

What is the best method to measure a waist circumference? Researchers measured the waists of almost 2,000 Taiwanese subjects two ways: at the superior border of the iliac crest (as recommended by the National Cholesterol Education Program Third Adult Treatment Panel) and midway between the lowest ribs and the iliac crest (as recommended by World Health Organization and International Diabetes Federation). The latter measure was more strongly correlated with visceral fat area especially in women and more strongly correlated with blood pressure, cholesterol, plasma glucose and C-reactive protein. The study authors conclude that the midway technique is a better method to identify central obesity, particularly in women. Their results were published online by Diabetes Care on Dec. 28.