In message <[log in to unmask]>, Mohammad
Al-Jubouri <[log in to unmask]> writes
>Dear all
>
>GTT seems to be ever popular by GPs as our workload is
>increasing steadily.
>. Can we ignor these GTT findings and depend
>solely on a single fasting glucose measurement with
>all its inherant analytical, intraindividual and
>seasonal variability? can we restrict GTT only to
>those with a fasting glucose of 6.0 - 6.9 mmol/L which
>will reduce our workload to 130 GTTs only compared to
>a total of 518 GTTs? And finally I found only two
>thirds of 42 patients with a fasting glucose of 7.0 -
>7.9 mmol/L (WHO diabetic level)exhibiting diabetic
>curve and the remaining 1/3 showing IGT, which one to
>believe the fasting glucose or response to OGTT? All
>patients with a fasting glucose of =>8.0 mmol/L (25
>patients)exhibited a diabetic curve.
>
>Advice and comments are most welcome.
>
>Mohammad
>
It is important not to forget that the OGTT only is appropriate in
patients who have a had a normal Carbohydrate intake previously. I have
been misled by a patient who was unwell and had eaten little the
previous week who had a 2 hour level of 12.5 mmol/L.
However, I agree that the fasting level is not a good guide. I have
been sending an increasing number of my lipid clinic patients with
hyper-triglyceridaemia for a GTT, and finding some with very borderline
fasting levels (5.5 - 6.5) have frankly diabetic 2 hour levels. For
further discussion from a transatlantic perspective see the Guidelines
article in the March Clinical Chemistry.
--
Trevor Gray
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