For those who are interested you may find this article very enlightening with regards to the Diabetic Screening Product. It was published in the Medical Post.
MAKING GLUCOSE TOLERANCE TESTING TOLERABLE
Canadian diabetes researchers are experimenting with a new type of test meal that may replace the syrupy drink used in standard oral glucose tolerance testing.
The diabetes screening product (DSP), as it is being called ,consists of five wafers made of oats and canola oil and flavored with honey and cinnamon. It is being developed by researchers at the University of Toronto and CEAPRO INC. in Edmonton.
"We've heard at this conference how diabetes is approaching international epidemic proportions, and the number of people with diabetes around the world is likely to double in the next 15 to 20 years," said Dr. Thomas Wolever, associate professor in the department of nutritional sciences at the University of Toronto.
"If we're going to do something about trying to lessen this terrific burden, we may need to do more in terms of screening and diagnosis," he told colleagues here at the annual meeting of the Canadian Diabetes Association (CDA).
While the merits of mass screening for diabetes are still debated, new guidelines from the CDA call for screening of all individuals over 45 years of age every three years; more often and earlier for those with risk factors for the disease.
The guidelines call for the use of a fasting plasma glucose test, Dr. Wolever pointed out.
"However, I still think a glucose tolerance test or a two-hour postprandial glucose screen can be useful."
Despite the lower glucose levels considered diagnostic of diabetes, he said, 30% to 40% of those with diabetes will be missed by the fasting test that would be caught based on the two-hour challenge.
The gold standard for diagnosis has been the 75g load oral glucose tolerance test (OGTT), Internationally accepted as a method for diagnosis of diabetes. It is more sensitive and specific than either fasting plasma glucose or measures of hemoglobin A1C, he said.
"However, it's not widely used, and many people dislike it because it's perceived by physicians as a complex and difficult test, it's unpalatable and an unphysiologic load, and it's recognized to be highly variable in its results from day to day." Dr. Wolever said.
They hypothesized if patients could be provided a more physiologic load as a meal, some of these difficulties might be overcome, resulting in a more reproducible test.
The DSP consists of five wafers and contains 350 calories from 50g of glycemic carbohydrates--41g of starch and 9g of sugars. "We managed to be relatively low in sugars, and it's also meant to be relatively low in fat."
About 30% of energy is from fat in the wagers and 12% from protein.
At the CDA meeting here, Dr. Wolever presented a multicentre study of the wafers compared to the standard OGTT in four different populations of subjects: lean nondiabetics, obese nondiabetics, subjects with impaired glucose tolerance (IGT) and diabetics.
Study centres included the Universities of Toronto, Montreal, British Columbia, Calgary and Alberta.
Each subject about 10 in each group, was studied on eight occasions after a 10 to 12 hour overnight fast, in four blocks consisting of either the OGTT or the DSP in random order.
As their measure of variation they calculated the standard deviation among the four results of each test.
"In the range of impaired glucose tolerance, which is actually critical borderline range between normal and diabetes, the OGTT was SIGNIFICANTLY LESS CONSISTENT day to day in the result it gave than the DSP," Dr. Wolever said in an interview.
They found almost 50% less variability from test to test with the DSP than the OGTT in diagnosing glucose intolerance.
"For people with impaired glucose tolerance, use of the solid standardized test may be a better more precise test for their glucose intolerance than the classic GTT, he concluded.
"We can't say it's better than the OGTT but it's an indication that it may be, and it was more palatable certainly, and caused less symptoms," particularly nausea, he said.
The investigators are undertaking a study of the product in screening for gestational diabetes mellitus, where glucose tolerance among pregnant women can be very important. |
