Comparison of the current WHO and new ADA criteria for the diagnosis of diabetes mellitus in three ethnic groups in the UK

The American Diabetes Association have recommended that the fasting plasma glucose level for the diagnosis of diabetes is lowered and that this becomes the main diagnostic test. We have used population-based data from three ethnic groups in Newcastle upon Tyne to examine the implications of this change. Data were available on 824 European (25–74 years), 375 Chinese (25–64 years), and 680 South Asian (25–74 years) subjects. All subjects apart from those reporting a prior diagnosis of diabetes underwent a standard 75 g oral glucose tolerance test (WHO criteria) which included the measurement of fasting glucose. The prevalence of diabetes was higher in all three ethnic groups using the new ADA criteria compared to the WHO criteria: 7.1 % vs 4.8 % in Europeans; 6.2 % vs 4.7 % in Chinese; and 21.4 % vs 20.1 % in South Asians. There was much variation in individuals categorized by the ADA and WHO criteria. Agreement between the two for the diagnosis of previously unknown diabetes was only moderate (kappa statistics 0.42 to 0.59). Thus in the populations studied the new criteria would increase the prevalence of diabetes in addition to classifying some individuals diabetic by current criteria as non-diabetic. It should be stressed however that diagnosis of the individual should not be based on a single test.     

WHO及美国糖尿病学会糖尿病诊断标准在老年人群中应用的分析和评估

目的　探讨 1985年WHO与 1997年美国糖尿病学会 (ADA)糖尿病 (DM)诊断标准在老年人群应用中的敏感性及特异性 ,确定在老年人群中诊断DM的理想空腹血糖 (FPG)切点。方法对在北京地区居住 5年以上的老年人群体检时进行口服葡萄糖耐量试验 (OGTT)的 12 0 4人 ,分别根据WHO标准与ADA标准划分不同血糖水平的人群 ,分析其分布的异同 ,并以OGTT 2h血糖 (2hPG)≥ 11.1mmol/L为DM诊断标准 ,分析ADA(FPG)≥ 7.0mmol/L的标准诊断DM的敏感性及特异性变化情况 ,并确定在老年人群中应用FPG诊断DM的理想切点。结果　按WHO标准 (2hPG)诊断DM的患病率为 16 .2 8% ,按ADA标准 (FPG)诊断DM的患病率为 3.16 %。ADA标准制定的FPG 7.0mmol/L所得出的诊断DM的敏感度为 15 .3% ,特异度为 99.2 %。WHO与ADA两项标准均诊断DM的符合率仅为 15 .3% ,糖耐量低减 (IGT)与空腹血糖异常 (IFG)的一致性仅为 4 .5 %。老年人群诊断DM的理想FPG切点为 5 .5mmol/L ,其受性别、年龄、BMI和有否高血压的影响。结论　WHO标准和ADA标准在本人群中缺乏一致性 ,以ADA(FPG)标准诊断老年人群DM时 ,在很大程度上不能替代WHO(2hPG)诊断标准。对 5 .5mmol/L≤FPG <7.0mmol/L老年人群应建议行OGTT检查。     

Association of impaired glucose homeostasis with preclinical carotid atherosclerosis in women: Impact of the new American Diabetes Association criteria.

The aim of this study was to determine whether impaired glucose regulation, defined according to the new American Diabetes Association (ADA) criteria, is associated with early signs of carotid atherosclerosis. We examined 310 clinically healthy women from southern Italy, aged 30 to 69 years, recruited for a prospective study, currently ongoing, on the etiology of cardiovascular disease and cancer in the female population (Progetto Atena). All subjects underwent cardiovascular risk factor assessment and high resolution B-mode ultrasound to measure intima-media thickness (IMT) of common carotid arteries and carotid bifurcations. At the time of our survey, fasting glucose levels > or = 7.0 mmol/L had already been found in 7 women, 17 participants were diagnosed on that occasion as having new diabetes, 38 had impaired fasting glucose (IFG), and the remaining 248 presented normal fasting glucose values (NFG). Diabetic women showed a worse cardiovascular risk profile, with higher values of triglycerides, body mass index, and diastolic blood pressure than either normoglycemic or IFG subjects. The frequency of atherosclerotic plaques (IMT > 1.2 mm) increased as glucose homeostasis worsened. In multivariate logistic regression analyses, only diabetes mellitus was associated with a significantly increased risk of carotid atherosclerosis (odds ratio [OR], 11.5; 95% confidence interval [CI], 1.4 to 92.7). Our findings suggest a definite association between diabetes mellitus, as defined by the new ADA diagnostic criteria and early carotid structural changes. Furthermore, the condition of IFG does not seem to identify subjects at significantly increased atherosclerotic risk.     

WHO与美国糖尿病学会糖尿病诊断标准异同的探讨

目的　探讨WHO与美国糖尿病学会 (ADA)糖尿病 (DM )诊断标准的异同及可能的原因。方法　对大庆地区 9832人糖尿病普查中做口服葡萄糖耐量试验 (OGTT)的 10 6 9人 ,分别以WHO与ADA诊断标准划分不同的血糖水平人群。分析人群分布的异同 ,并以Pearson相关分析探讨两种诊断标准的血糖异常人群不相符的原因。结果　WHO与ADA标准检出糖尿病患者分别为2 0 2例及 2 5 3例 ,与WHO标准比较 ,ADA标准诊断的DM符合率为 78.7% ,血糖正常人群符合率为 72 .3 % ,WHO检出的糖耐量低减 (IGT)人群中仅有 41.6 %被ADA判定为空腹血糖升高 (IFG) ,在空腹血浆葡萄糖 (FPG) <5 .83mmol/L的IGT及DM人群中 ,FPG均与 2小时血糖 (PG2h)不相关 ;在FPG≥ 5 .83mmol/L的人群中 ,FPG与PG2h相关。结论　ADA糖尿病诊断标准并非WHO诊断标准的替代物。WHO之IGT与ADA之IFG人群差异很大 ,以空腹血糖为标准找出与IGT完全相同的人群是不可能的     

Comparison of National Diabetes Data Group and World Health Organization criteria for detecting gestational diabetes mellitus

Summary We compared the criteria for diagnosis of gestational diabetes mellitus (GDM) of the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) and studied the outcomes of pregnancy. A 50-g glucose screening test and 75-g oral glucose tolerance test (OGTT) were scheduled for 709 pregnant women in the same week between the 24th and 28th week of pregnancy. Blood glucose was measured 1 h after the 50-g glucose screening test and if found to be 7.8 mmol/l or more, a 100-g OGTT was scheduled within 7 days after a 75-g OGTT. The prevalence of GDM was found to be 1.4% (10/709) and 15.7% (111/709) by NDDG and WHO criteria (2 h 7.8 mmol/l), respectively. Using NDDG criteria, all the GDM patients had abnormal 75-g OGTT by WHO criteria. NDDG and WHO criteria were significantly different when compared with normal OGTT by each criteria for age, BMI, pregnancy-induced hypertension, Caesarian delivery, macrosomia and neonatal hypoglycaemia. Of 14 women with macrosomic infants 6 had an abnormal WHO test while only 3 of 14 had an abnormal NDDG test. These findings suggest that WHO criteria GDM patients had significantly worse outcomes of pregnancy and fewer perinatal complications were missed than with the more cumbersome NDDG criteria, and no case of GDM as diagnosed by NDDG criteria was missed.Abbreviations GDM Gestational diabetes mellitus - NDDG National Diabetes Data Group - WHO World Health Organization - OGTT oral glucose tolerance test - BMI body mass index     

Comparison of diagnostic criteria of the metabolic syndrome in 3 ethnic groups of Canada

The metabolic syndrome (MetS) is a cluster of metabolic abnormalities in which visceral obesity is a prominent feature. Although a matter of debate, the MetS essentially represents “at risk obesity.” The purpose of this study was to compare the various definitions of MetS, with a special focus on abdominal obesity, and to explore sex and ethnic differences in the prevalence and nature of this syndrome in 3 ethnic groups residing in the Canadian province of Québec. The study population included adult participants of 3 cross-sectional health surveys conducted in southern Québec, James Bay, and Nunavik between 1990 and 1992. A total of 2613 adults (18-74 years old) were included: 1417 Quebecers, 817 Indian Crees, and 379 Inuit. The prevalence of MetS varied by definitions, and the highest agreement was observed between the National Cholesterol Education Program-Adult Treatment Panel III and the International Diabetes Federation (79%). Most women (25%), regardless of ethnic origin, presented with a “triad” profile characterized by high waist circumference, elevated triglycerides, and low high-density lipoprotein, whereas 20% of men had the “deadly quartet” of high blood pressure with the triad mentioned above. Furthermore, our results highlight an obvious difference in the impact of the increased abdominal obesity on metabolic parameters such as insulin resistance measured by the homeostasis model assessment according to ethnic origin (P < .001). These 3 unique population-based samples suggest that abdominal obesity does not have a similar deleterious impact according to ethnicity, suggesting the need for an ethnic-based MetS definition.     

Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain

Aims/hypothesis This study was carried out to determine the impact of American Diabetes Association (ADA) 2000 criteria for the diagnosis of gestational diabetes mellitus (GDM) in the Spanish population.Methods Pregnant women were assigned to one of four categories: negative screenees, false-positive screenees, ADA-only-GDM (untreated) and GDM according to National Diabetes Data Group (NDDG) criteria (treated). Fetal macrosomia and Caesarean section were defined as primary outcomes, with seven additional secondary outcomes.Results Of 9,270 pregnant women screened for GDM, 819 (8.8%) met NDDG criteria. If the threshold for defining GDM had been lowered to ADA criteria, an additional 2.8% of women would have been defined as having the condition (relative increase of 31.8%). Maternal characteristics of women with ADA-only-GDM were between those of false-positive screenees and women with NDDG-GDM. The risk of diabetes-associated complications was slightly elevated in the individuals who would have been classified as abnormal only after the adoption of ADA criteria. In addition, the ADA-only-GDM contribution to morbidity was lower than that of other variables, especially BMI.Conclusions/interpretation Use of the ADA criteria to identify GDM would result in a 31.8% increase in prevalence compared with NDDG criteria. However, as the contribution of these additionally diagnosed cases to adverse GDM outcomes is not substantial, a change in diagnostic criteria is not warranted in our setting.     

ADA及WHO糖尿病诊断标准在中国人中检出率的变化及迁移

目的　比较美国糖尿病协会１９９７年修订的糖尿病诊断标准［ＡＤＡ（１９９７）］和世界卫生组织糖尿病诊断标准［ＷＨＯ（１９８０～１９８５）］在中国人中检出率的变化及迁移。方法　对９０６例研究对象实施７５ｇ 口服葡萄糖耐量试验（ＯＧＴＴ）。结果　ＡＤＡ（１９９７）空腹血糖（ＦＰＧ）标准较ＷＨＯ（１９８０～１９８５）标准敏感性提高１１．１５％ ,并使近１／５的糖尿病（ＤＭ）患者可免于ＯＧＴＴ而被确诊,但仍有近半数经ＷＨＯ（１９８０～１９８５）标准诊断的ＤＭ 患者被ＡＤＡ（１９９７）ＦＰＧ标准诊断为空腹血糖损害（ＩＦＧ）或正常空腹血糖者（ＮＦＧ）。结论　对用ＡＤＡ（１９９７）ＦＰＧ标准诊断为ＩＦＧ及ＮＦＧ,尤其是存在糖尿病高危因素者,有必要进行ＯＧＴＴ２小时血糖核查,以避免漏诊     

Impact of the 1997 American Diabetes Association criteria on classification of glucose intolerance among Kuwaitis below 50 years of age

Type 2 (non-insulin-dependent) diabetes is emerging as a leading chronic non-communicable disease among the adult Kuwaiti population. Based on the World Health Organization and similar reports the projected estimates for subjects suffering from type 2 diabetes by the years 2000 and 2010 show a striking tendency to high rates of the disease in our area. We report the prevalence rates of glucose intolerance among a relatively young adult Kuwaiti population below 50 years of age and the effect of implementing the recent 1997 American Diabetes Association diagnostic criteria on the frequency of type 2 diabetes, impaired glucose tolerance and impaired fasting glucose among this group. The overall prevalence rate for the three categories of glucose intolerance reached as high as 15.8% (95% CI, 14.2 to 17.4). Age, though all subjects were below 50 years, parental history of type 2 diabetes, diastolic blood pressure and serum triglycerides were found to be significant associated risk factors for the development of type 2 diabetes. Obesity was an apparent significant factor associated with the three forms of glucose intolerance (p < 0.001). Obesity and physical inactivity were documented in both non-diabetic and more so in diabetic Kuwaiti adults, which should form the basis of any immediate intervention programme. An integrated approach to the prevention of the described critical risk factors associated with type 2 diabetes is highly recommended in Kuwait. Research, focused on genetics of type 2 diabetes in the highly susceptible Kuwaiti population, should be planned. Received: 18 December 1998 / Accepted in revised form: 14 June 1999     

Impact of the American Diabetes Association diagnosis criteria on high-risk Spanish population. IGT Research Group. Impaired glucose tolerance

To research into the impact of the new American Diabetes Association (ADA) diagnostic criteria on high risk Spanish population, two cross-sectional studies involving seven primary health care centers in Catalonia (Spain) were revised. Individuals aged > 40 years with any major risk factor for diabetes were screened according to the World Health Organization (WHO) rules using a 75 g oral glucose tolerance test to measure fasting plasma glucose (FPG) and 2 h plasma glucose. The changes on diabetes prevalence and on epidemiological characteristics were evaluated applying the ADA criteria on the basis of FPG alone. A total of 970 individuals, 453 males (46.7%), mean age 59 years and mean body mass index (BMI) 30.6 kg/m2 were screened. Among the 459 diabetic subjects according to either the WHO or the ADA criteria, 314 (68.4%) were classified as having diabetes with respect to both sets of criteria (WHO and ADA). The overlap between impaired glucose tolerance (WHO) and impaired fasting glucose (ADA) diagnoses was 20.7%. Using the ADA criteria results in a decrease of the prevalence of diabetes by 1.5% (95% confidence interval (CI) = -2.2 to -0.8%). No changes in the diabetic phenotype (age, sex and BMI) were found. Impaired fasting glucose prevalence was 18.4% (95% CI = 16-21%). Overall concordance in terms of crude and weighted kappa-value was only acceptable (kappa = 0.51 and kappa = 0.61, respectively). To apply the new ADA diagnostic criteria on high risk Spanish population evidenced a decrease on diabetes prevalence. Nevertheless, the change of criteria undervalued the risk of postprandial hyperglycaemia related to impaired glucose tolerance.     

Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria

Aims/hypothesis  

New diagnostic criteria for gestational diabetes mellitus (GDM) have recently been published. We wished to evaluate what impact these new criteria would have on GDM prevalence and outcomes in a predominantly European population.     

Association of diabetes mellitus using old and new diagnostic criteria with incidence of new coronary events in older men and women

A prospective study investigated in 952 men (mean age 79 years) and in 2,014 women (mean age 81 years), the association of diabetes mellitus using the old and new diagnostic criteria with the incidence of new coronary events. At 40-month follow-up for men and 44-month follow-up for women, whether the old or the new criteria for diagnosing diabetes mellitus were used, diabetes mellitus was significantly associated with the incidence of new coronary events (p <0.0001) in older men and women.     

Comparison of ADA 1997 and WHO 1985 criteria for diabetes in south Indians--the Chennai Urban Population Study. American Diabetes Association.

AIMS: To compare the American Diabetes Association (ADA) fasting criteria and World Health Organization (WHO) 2-h criteria for diabetes in an urban south Indian population. METHODS: Subjects were drawn from the Chennai Urban Population Study. Of the 1001 subjects studied, 52 (5.2%) were diagnosed as having diabetes according to WHO 2-h criteria and 32 (3.2%) according to the ADA fasting criteria. RESULTS: Twenty-five (48%) of the subjects diagnosed with diabetes by the WHO 2-h criteria were not classified as having diabetes by the ADA fasting criteria. Similarly, of the 78 subjects (7.8%) classified as having impaired glucose tolerance (IGT), only eight (10.3%) had impaired fasting glucose (IFG) according to the ADA fasting criteria. The overall agreement between the WHO 2-h criteria and ADA fasting criteria was poor (kappa = 0.40). CONCLUSIONS: Use of the ADA fasting criteria results in a lower prevalence rates of diabetes in this lean urban south Indian population.