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OBJECTIVE -- To create a simple prediction rule that could perform as well as the 2-h postchallenge plasma glucose (PCPG) test to predict those at risk for diabetes. We created a prediction rule in one sample and prospectively validated it for incident diabetes in a separate cohort. RESEARCH DESIGN AND METHODS -- A cross-sectional analysis with data from the Rancho Bernardo Study (age 67 ± 11 years) to derive a rule predicting abnormal PCPG ≥140 mg/dl, using demographic, clinical, and laboratory data of nondiabetic participants with fasting plasma glucose (FPG) < 126 mg/dl. Data from the Health, Aging and Body Composition study (age 74 ± 3 years) were used to prospectively validate this rule for incident diabetes and compare it with the predictive ability of the PCPG test. RESULTS -- Of 1,549 RBS participants, 514 (33%) had PCPG ≥140 mg/dl. Female sex, age, triglycerides, and FPG were most significantly associated with abnormal PCPG. Based on standardized β-coefficients, we allotted 1 point for female sex, triglycerides ≥150 mg/dl, or FPG 95-104 mg/dl. Age ≥70 years or FPG 105-115 mg/dl were given 2 points, and FPG 116-125 mg/dl received 3 points. In the validation cohort, this simple prediction rule was as good as the 2-h PCPG test for predicting incident diabetes (C-statistic: 0.71 for both). CONCLUSIONS -- Advanced age, female sex, FPG, and triglycerides were able to predict adults at risk for diabetes equally well as the 2-h PCPG test. Using this rule, clinicians may better identify older persons who should receive intensive lifestyle intervention to prevent type 2 diabetes. [ABSTRACT FROM AUTHOR]

Older white women with type 2 diabetes (DM) may have higher fracture rates despite higher weight and bone mineral density, though little information exists for men, blacks or those with impaired fasting glucose (IFG). The Cardiovascular Health Study (CHS) included 5888 white and black men and women, followed 10.1±3.9 years for health events including incident hip fractures (ICD-9 codes 820.xx). Participants with hip fracture concurrent to motor vehicle accidents (N=9, ICD-9 E810-E825) or pathologic fracture (N=8, ICD-9 733.1) or missing fasting glucose (FG; N=358) were excluded. In 5513 participants, 419 hip fractures occurred. DM was defined as hypoglycemic medication use or FG ≥126 mg/dl and IFG was defined as FG ≥ 100 and < 126 mg/dl. Of participants (mean age 72.8±5.6 years; 42.4% men; 16% black), 17% had DM and 39% had IFG at baseline. Participants with DM or IFG were more likely men (49% and 46% vs. 36%; p<0.001) and those with DM were more likely black (24% vs. 16%; p<0.001) than those with normal FG. Crude hip fracture rates (/1000 person-years) were 8.5 (95%CI: 7.4-9.6) for normal FG, 6.6 (95%CI: 5.6-7.7) for IFG, and 7.3 (95%CI: 5.7-9.5) for DM. In Cox regression models adjusted for gender, race, age, body mass index (BMI), DM was significantly related to hip fractures (HR=l.37; 95%CI: 1.01-1.85). IFG was not related to hip fracture (HR=0.92; 95%CI: 0.74-1.14). There were no interactions of race or gender with DM or IFG and women and men had similar HR. Clinical cardiovascular disease, creatinine ≥1.5 mg/dl in men and ≥1.3 mg/dl in women, and vision problems did not attenuate the HR. However, ankle-arm index <0.9 reduced the HR for DM [1.28 (0.94-1.75)] and was marginally related to hip fracture [1.31 (0.99-1.72)]. DM was independently associated with 37% higher hip fracture risk after adjusting for higher BMI in diabetic participants. Older diabetic adults, possibly those with subclinical peripheral vascular disease, may need to be targeted for tincture prevention. ADA-Funded Research [ABSTRACT FROM AUTHOR]