Comparison of WHO and ADA criteria for diagnosis of glucose status in adults

The aim was to compare the 1997 American Diabetes Association (ADA) and 1985 and 1998 World Health Organisation (WHO) criteria for the diagnosis of diabetes and impaired glucose tolerance (IGT) by ethnicity and cardiovascular risk factors. We analysed the oral glucose tolerance tests carried out in a cross-sectional survey of 5816 New Zealand workers aged 22-78 years (4211 men, 1605 women) carried out between 1988 and 1990. Prevalence of diabetes was similar using ADA (3.1%) compared with the 1998 WHO criteria (3.0%). The overall prevalence rate of diabetes using the 1985 WHO criteria was only 1.5%. The prevalence rate of impaired fasting glucose (IFG) was the lowest in Europeans (7.3%) and highest in Asians (15.0%). The overall weighted kappa for agreement between the 1997 ADA and 1998 WHO criteria was moderate (0.59), but varied between ethnic groups. Cardiovascular disease (CVD) risk factors were approximately more adverse across groups with IFG, normal (ADA)/IGT (WHO), IFG/IGT and diabetes compared with normal subjects. Compared to those with IFG, participants with the normal (ADA)/IGT (WHO) criteria differed in fasting and 2-h glucose, diastolic blood pressure, and urinary albumin levels, and the proportions of males and number with hypertension, but had a significantly adverse pattern of CVD risk factors compared to those with normal glycaemia. The 1988 WHO criteria using the OGTT provides additional information for classifying various categories of glucose intolerance that is not captured using the 1997 ADA fasting glucose criteria alone.     

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 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.     

Application of the new ADA criteria for the diagnosis of diabetes to population studies in sub-Saharan Africa. American diabetes association.

AIMS: To examine the implications for epidemiological studies of the American Diabetes Association (ADA) recommendation that the fasting blood glucose at a lowered level becomes the main diagnostic test for diabetes on cross-sectional-based data from sub-Saharan Africa. METHODS: Data from 11 surveys conducted in rural, peri-urban and urban Cameroon (n = 1804), South Africa (n = 3799) and Tanzania (n = 10013) which measured fasting (ADA criteria) and 2-h blood glucose concentrations during a standard 75 g OGTT (old WHO criteria) were analysed. RESULTS: The prevalence of diabetes was higher in eight of the 11 surveys when applying the new ADA compared to the old WHO criteria. With the exception of one population (Mara, Tanzania) the absolute difference in prevalence between the two classifications tended to be small (< 2%). There was considerable variation in the categorization of individuals using the ADA and old WHO criteria. The level of agreement between the two ranged from fair to good (Kappa statistic 0.17-0.86). The prevalence of impaired fasting glycaemia (IFG) was lower than that of impaired glucose tolerance (IGT) in 10 of the surveys and the agreement between the two was fair, < or = 0.26 in all the surveys. CONCLUSIONS: Although the use of the new ADA fasting criteria for prevalence surveys is an attractive and practical option, particularly in Africa, further information is required on the characteristics and prognosis of individuals classified as IFG or diabetic by the fasting criteria, prior to wide adoption of the ADA criteria. Ideally measurement of both fasting and two low glucose concentrations should remain the standard for epidemiological studies.     

Comparing the ADA 1997 and the WHO 1999 criteria: Prevalence of Diabetes in India Study

This random multistage cross-sectional population survey was undertaken to determine the prevalence of type 2 diabetes mellitus (DM) in subjects aged 25 years and above in India. The study was carried out in 77 centres (42 urban and 35 rural) to reflect the size and heterogeneity of the Indian population. 18,363 (9008 male and 9355 female) subjects were studied. 10,617 (5379 males and 5238 females) were from urban areas and 7746 (3629 males and 4117 females) from rural areas. Blood samples were taken after a fast of 10-12 and 2 h after 75 g of oral glucose. Subjects were categorized as having impaired fasting glycemia (IFG) or DM using the 1997 ADA or having impaired glucose tolerance (IGT) or DM using the 1999 WHO criteria. The age- and gender-standardized prevalence rate for DM using the ADA criteria was 3.6% whilst that using the WHO criteria was 4.3% (P < 0.001). The respective standardized prevalence of DM, using the two criteria was, 4.7 and 5.6%, respectively (P < 0.001) in the urban Indian population and 2.0 and 2.7% (P < 0.02) in the rural Indian population. Using the WHO criteria, 581 subjects were newly diagnosed whilst the ADA criteria newly diagnosed 437 subjects. The respective numbers for the urban population were 425 and 323, and for the rural population were 146 and 114, respectively. The ADA criteria could diagnose 75.2, 76.0 and 73.0% of the subjects who had DM as per the WHO criteria. Of 739 Indian subjects who had IFG, 106 (14.3%) were diagnosed as having DM by the WHO criteria whilst 505 (68.3%) had values compatible with a diagnosis of IGT. Of the 536 urban subjects with IFG, 74 (13.8%) had DM and 350 (65.3%) had IGT using the WHO criteria. Of the 302 rural subjects with IFG, 32 (15.8%) had DM and 155 (76.3%) had IGT using the WHO criteria. 505 (49.9%) of 1012 Indian subjects with IGT as per the WHO criteria had IFG. 350 (47.7%) of 733 urban subjects and 155 (55.5%) of 279 rural subjects with IGT had values compatible with IFG as per the ADA criteria. Type 2 diabetes is a major health problem is India. The use of the ADA criteria would underestimate the prevalence of DM by not diagnosing subjects showing a poor response to a glucose challenge. This along with the discrepancies between subjects showing IGF or IGT could be a challenge to any prevention program.     

Impact of the new American Diabetes Association and World Health Organisation diagnostic criteria for diabetes on subjects from three ethnic groups living in the UK

BACKGROUND AND AIM: The American Diabetes Association (ADA) recommends basing diabetes diagnosis on a fasting plasma glucose (FPG) of > or = 7.0 mmol/L and impaired fasting glucose (IFG) on 6.1 < or = FPG < 7.0 mmol/L. The new World Health Organisation (WHO) recommendations also adopt this FPG cut-off, but retain the oral glucose tolerance test (OGTT) where possible and the intermediate group of impaired glucose tolerance (IGT) in addition to IFG. We compare the effect of the new ADA and WHO diagnostic criteria in three ethnic groups. METHODS AND RESULTS: Three hundred and eighty whites, 340 South Asians and 347 subjects of African descent, aged 40-59 years and not known to have diabetes, were identified through South London general practices. Inevitably, the prevalence of new diabetes was lower under ADA than under WHO criteria (including post-load levels) for all three groups, falling from 5.7% overall to 3.3% (fall 2.4% 95% CI 1.6% to 3.6%). The largest fall was for South Asians from 9.1% to 5.0% (fall 4.1% 95% CI 2.2% to 6.8%). The prevalence of impaired glucose homeostasis under ADA criteria (IFG) was substantially less than under WHO criteria (IFG + IGT). Under WHO criteria, including a glucose tolerance test, there was marked variation by ethnic group in diabetes prevalence (p < 0.001) and IGT (p < 0.0001), both were most prevalent amongst South Asians. Under ADA criteria, (or new WHO criteria without OGTT) diabetes prevalence still differed significantly between groups (p < 0.01), but there was no difference in IFG prevalence (p = 0.43). CONCLUSIONS: Subjects with IGT but normal FPG are at greater risk of coronary heart disease. The new ADA definition fails to identify substantial numbers of such subjects, particularly among South Asians. Our study supports the retention of the OGTT in the new WHO criteria, particularly for South Asians.     

Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans.

AIMS: This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. METHODS: This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist-hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (kappa statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. RESULTS: The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted kappa = 0.228 men, weighted kappa = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. CONCLUSIONS: Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.     

Diagnosis of diabetes mellitus and intermediate glucose abnormalities in obese patients based on ADA (1997) and WHO (1985) criteria.

AIM: To assess the accuracy of the 1997 ADA criteria for diagnosing diabetes mellitus and related glucose disturbances in comparison with the reference WHO 1985 criteria in obese subjects. PATIENTS AND METHODS: In 286 men and 881 women, 15-84 years of age, with obesity (body mass index (BMI) > or = 30 kg/m2), an oral glucose tolerance test (OGTT) was carried out according to WHO standard. Patients were classified into three categories of glucose tolerance using WHO 1985 (Normal Glucose Tolerance (NGT), Impaired Glucose Tolerance (IGT) and Diabetes Mellitus (DM)) and ADA (Normal Fasting Glucose (NFG), Impaired Fasting Glucose (IFG) and DM) criteria. Prevalence of each category was compared and agreement between the two classifications was assessed. The relation between fasting plasma glucose value and diabetes, as diagnosed by WHO 1985 criteria, was studied using various regression models, cumulative frequency curves, Finch method and ROC curve. RESULTS: Compared with WHO 1985, ADA criteria strongly underestimated the prevalence rate of diabetes (3.7% vs. 10.6%) and intermediate glucose abnormalities (6.0% vs. 22.4%). Agreement between the two classifications was poor (kappa = 0.23). Moreover, many patients defined as glucose-intolerant by the WHO 1985 criteria were shifted to a more favourable metabolic status by ADA criteria. Thus, ADA criteria failed to detect 69% of WHO diabetic patients and 89% with IGT were considered as normal. According to the method, cut-off value of fasting blood glucose for detecting WHO 1985-diagnosed diabetes varied widely, from 5.3 to 6.3 mmol/l and none was satisfactory because of poor sensitivity and positive predictive value. CONCLUSION: The ADA criteria do not appear to be a good substitute for those of the WHO 1985 at identifying diabetes and intermediate glucose abnormalities in an obese population. Since it appears impossible to determine a reliable cut-off value for fasting blood glucose to identify diabetic obese subjects with sufficient sensitivity, our results justify the retention of the OGTT in clinical practice or for epidemiological studies.     

Potential impact of a change in the diagnostic criteria for diabetes mellitus on the prevalence of abnormal glucose tolerance in a local community at risk of diabetes: impact of new diagnostic criteria for diabetes mellitus.

AIMS: To compare the prevalence of diabetes and abnormal glucose metabolism using conventional and suggested new WHO and new ADA criteria in a group of people with symptoms of diabetes. METHODS: We examined retrospectively the results of 154 consecutive OGTTs in such patients performed using capillary whole blood. RESULTS: With the 1985 WHO criteria. Forty-four point eight per cent of subjects (69 subjects, with 95% confidence intervals, 37-52.6%) had diabetes, 47.8% (33 subjects, 36-59.6%) had a normal fasting glucose, 31.2% (48 subjects, 23.9-38.5%) had impaired glucose tolerance (IGT) and 76% (117 subjects, 69.3-82.7%) had abnormal glucose tolerance. Applying the ADA criteria (fasting capillary whole blood only), 33.1% (51 subjects, 25.7-40.5%) had diabetes (a 26% relative reduction) and 11% (17 subjects, 6.1-15.9%) IFG, with 44.1% (68 subjects, 36.3-51.9%) having abnormal glucose metabolism (a 42% relative reduction). If the proposed 1998 WHO criteria were used, the number with diabetes increase to 48% (74 subjects, 40.1-55.9%) a 7.2% increase on the old criteria. 27.9% (43 subjects, 20.8-35%) had IGT, so the number with some degree of abnormal glucose metabolism remains unchanged. Use of the ADA criteria, considering only the fasting glucose as suggested, will result in a significant reduction in the diagnosis of diabetes and those with abnormal glucose metabolism.     

Diagnostic criteria for diabetes mellitus and other categories of glucose intolerance: 1997 criteria by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (ADA), 1998 WHO consultation criteria, and 1985 WHO criteria. World Health Organization.

To compare 1997 ADA diagnostic criteria for diabetes mellitus and other categories of glucose intolerance/1998 WHO Consultation criteria versus 1985 WHO criteria, we analyzed data from a 75-g oral glucose tolerance test (OGTT) performed on 1051 high-risk subjects without medical history of diabetes at Diabetes Screening Clinic, Ramathibodi Hospital, Thailand. There were 372 males and 679 females, aged (mean +/- S.D.) = 50.3 +/- 12.55 years, BMI = 25.62 +/- 4.39 kg/m2. If fasting plasma glucose (FPG) was used as recently recommended then 54.1, 20.4, and 25.5% of cases were classified as normal, impaired fasting glucose (IFG), and diabetic, respectively. In diagnosing diabetes using a full OGTT based on the 1985 WHO criteria as the reference test, FPG > or = 7 mmol/l had a sensitivity of 57.7%, specificity of 97.4%, positive predictive value of 94.0%, and negative predictive value of 76.4%; 53.7% of subjects with IFG had 2-h plasma glucose > or = 11.1 mmol/l. The 1997 ADA/1998 WHO Consultation criteria and 1985 WHO criteria for a full OGTT yield similar overall results. FPG ( > or = 7 mmol/l) was not sensitive for diagnosing diabetes. Moreover, about half of the subjects with IFG were actually diabetic. Therefore, OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance.     

Comparison of the results between two diagnostic criteria by ADA and WHO among subjects with FPG 5.6-7.8 mmol/l in Kin-Hu and Kin-Chen, Kinmen, 1991-94.

The objective of this study was to compare the results between two diagnostic criteria by ADA (1997) and WHO (1985) among those with fasting plasma glucose (FPG) level 5.6-7.8 mmol/l from a community-based survey in Kin-Hu and Kin-Chen, Kinmen conducted in 1991-94. According to official household registry, 10,797 residents aged over 30 were eligible for screening. 7580 had completed FPG screening and 1855 with FPG 5.6-7.8 mmol/l were invited to receive a 75-g oral glucose tolerance test (OGTT). 78.5% (1456/1855) had completed OGTT. The prevalence of impaired fasting glucose (IFG, by ADA) was 15.7%; the prevalence of impaired glucose tolerance (IGT, by WHO) was 22.7%; the prevalence of undiagnosed diabetes was 7.4% by ADA criteria and 10.9% by WHO criteria. It should be noticed that, among subjects with FPG 5.6-7.8 mmol/l, 50.3% of individuals with undiagnosed diabetes and 67.6% of individuals with IGT by WHO criteria would be missed by ADA criteria. Based on the above findings, the two-step screening strategy using FPG as the first line screening and OGTT for high-risk group (FPG 5.6-7.8 mmol/l) only was recommended in epidemiological study and case finding in consideration of feasibility and validity.     

Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemia.

AIMS: To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance. METHODS: Men (1223) and women (1370) aged 45-64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register. RESULTS: During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72-0.82) than for fasting glucose (0.65, 0.58-0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4-6.2) than for isolated IFG (2.3, 0.9-5.7) as compared with subjects with neither IFG nor IGT. CONCLUSION: Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention.     

Creating a pandemic of prediabetes: the proposed new diagnostic criteria for impaired fasting glycaemia

Aims/hypothesis In November 2003 the American Diabetes Association expert committee on the diagnosis and classification of diabetes mellitus suggested a revision of the diagnostic criteria for IFG, lowering the diagnostic threshold from 6.1 to 5.6 mmol/l. The aim of the present study was to evaluate the consequences of this change with respect to: (i) the prevalence of IFG in five different countries; (ii) the concordance between IFG and IGT (classification of individuals); and (iii) the cardiovascular risk profile of these groups. Finally we discuss the likelihood that intervention for cardiovascular risk and prevention strategies developed for individuals with IGT are applicable to subjects with IFG.Methods The first part of the study is based on the population-based Danish Inter99 study, where 6265 individuals, aged 30 to 60 years and without previously diagnosed diabetes, underwent an oral glucose tolerance test. The second part is based on the DETECT-2 project, in which studies from China, India, France and USA were used to analyse the impact of the proposed revision of the diagnostic criteria in different ethnic groups.Results The proposed change in diagnostic criteria would increase the prevalence of IFG in Denmark from 11.8 to 37.6%. The proposed IFG category would identify 60.0% of all subjects with IGT compared to 29.2% with the old criteria, but among individuals with the new IFG category only 18.5% would also have IGT. Individuals with isolated IFG had lower insulin levels and a lower cardiovascular risk profile with the proposed criteria compared with the current WHO criteria. Data from the DETECT-2 study confirmed the marked increase in the prevalence of IFG, and the estimated number of individuals in the age range 40 to 64 years with IFG in urban India, urban China and the USA would increase by 78%, 135% and 193% respectively.Conclusions/interpretation The proposed revised diagnostic criteria will lead to a dramatic increase in the prevalence of IFG, but the concordance rate between IFG and IGT remains low. This new IFG group will have a more favourable cardiovascular risk profile than the current IFG group as defined by the WHO. This seriously questions whether the existing intervention strategies are applicable to the new category of individuals with IFG.Abbreviations ADA American Diabetes Association - FPG fasting plasma glucose - NHANES III Third National Health and Nutrition Survey - WHO World Health Organization     

Relative role of insulin resistance and beta-cell dysfunction in the progression to type 2 diabetes--The Kinmen Study

This study compared the relative role of insulin resistance and beta-cell dysfunction (both assessed using the HOMA method) with glucose intolerance conditions in the progression to type 2 diabetes among a high risk group of subjects with fasting plasma glucose (FPG) 5.6-7.0 mmol/l in Kinmen, Taiwan. Data were collected during a continuing prospective study (1998-99) of a group of Taiwanese subjects at high-risk of developing type 2 diabetes who had fasting hyperglycemia (5.6-7.0 mmol/l) and exhibited 2-h postload glucose concentrations <11.1 mmol/l from 1992-94 to 1995-96. Among 644 non-diabetic subjects at baseline, 79.8% (514/644) had at least one follow-up examination. There were 107 new cases of diabetes diagnosed by 1999 WHO criteria in 2918.7 person-years of follow-up. The incidence rate was 3.67%/year (107/2918.7). After adjustment for other possible associative variables, including gender, age, BMI, waist circumference, insulin resistance, and beta-cell dysfunction, Cox's hazard model showed that those individuals with isolated IFG (impaired fasting glucose) and those individuals with isolated IGT (2-h glucose impairment) exhibited similar risk of developing diabetes. Those individuals with isolated IFG and isolated IGT showed a comparable impairment of basal or hepatic insulin sensitivity, but those individuals with isolated IFG had a greater beta-cell dysfunction by the HOMA method.     

Reduced attenuation of bone resorption after oral glucose in type 2 diabetes

Objective  To investigate the effect of oral glucose on bone resorption and osteoprotegerin (OPG) in subjects with varying degrees of glucose tolerance.
Design and Patients  In a cross-sectional study, 163 postmenopausal women aged 50–88 years without previous history of diabetes, impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) were recruited. All subjects underwent a 75-g oral glucose tolerance test (OGTT) and were then classified as having normal glucose tolerance (NGT), IFG, IGT or diabetes according to American Diabetes Association (ADA) criteria.
Measurements  Plasma glucose, serum insulin, C-terminal telopeptide of type I collagen (CTX-I) and OPG were measured.
Results  Fasting insulin levels increased progressively from subjects with NGT, IFG/IGT to diabetes. After adjusted for age and body mass index (BMI), there was no significant difference in fasting CTX-I and OPG levels across the various degrees of glucose tolerance. After oral glucose, there was a significant decrease in serum CTX-I and OPG ( P <  0·001) except for serum OPG in diabetic subjects. In addition, the percentages of change from baseline for both serum CTX-I and OPG were significantly less in diabetic subjects when compared to those in NGT subjects (–40·9% and 0·6% for diabetes and –50·2% and –10·6% for NGT, respectively).
Conclusions  Oral glucose intake causes suppression of serum CTX-I and OPG in postmenopausal women. The effect is attenuated in women with type 2 diabetes.     

The utility of fasting glucose for detection of prediabetes

Treatment of prediabetes attenuates progression to type 2 diabetes mellitus. The American Diabetes Association (ADA) previously defined prediabetes as either impaired fasting glucose (IFG) = 6.1 to 6.9 mmol/L (110-125 mg/dL) and/or impaired glucose tolerance (IGT) (2-hour postload glucose of 7.8-11.0 mmol/L [140-199 mg/dL]). For practical reasons, fasting plasma glucose (FPG) is commonly used for diabetes screening. Recently, the ADA lowered the fasting glucose threshold value for IFG from 110 to 100 mg/dL. Our objective was to determine the utility of FPG alone for detecting prediabetes in African Americans. Oral glucose tolerance test (OGTT) data from a cohort of 304 young adult African American men and women were examined. We calculated prediabetes prevalence using the previous ADA criteria and examined the effect of lowering the IFG threshold value for IFG to 100 mg/dL. The prediabetes prevalence in this cohort using the previous ADA criteria was 20.4% (n = 62). Of the 62 cases, 8 had IFG, 45 had IGT, and 9 had IFG together with IGT. Fasting plasma glucose testing alone detected 17 (27.4%) prediabetic cases, whereas a complete OGTT detected 54 (87.1%). Lowering the IFG threshold value to FPG = 100 mg/dL identified 13 of the 45 IGT-only cases. However, this lower IFG threshold increased prediabetes prevalence in the overall cohort from 20.4% to 31.9%. In conclusion, in young adult African Americans, an ethnic group at high risk for developing diabetes, FPG testing alone may be inadequate for diagnosing prediabetes. Until alternative strategies are identified, an OGTT is presently the best method for detecting the prediabetic condition in these high-risk patients.     

Impaired fasting glucose and impaired glucose tolerance - lack of agreement between the two categories in a North Indian population

This study was carried out to determine the relationship between impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in a North Indian population. The data in 5083 subjects studied earlier was reanalyzed by applying new WHO diagnostic criteria. Reanalysis revealed that 305 (6.0%) subjects had diabetes mellitus (198 on the basis of fasting plasma glucose of > or =7.0 mmol/l (> or =126 mg/dl) and an additional 107 based on a 2-h glucose tolerance test), 381 (7.5%) had IFG and 361 (7.1%) had IGT. Of these 361 subjects with IGT, only 99 (27.4%) had impaired fasting glucose whereas 262 (72.6%) had normal fasting glucose of <6.1 mmol/l (<110 mg/dl). Of 381 subjects with IFG, 99 (26%) had IGT where as 282 (74%) had normal 2-hr glucose. We conclude that there is a poor correlation between IGT and IFG.     

Value and significance of new diagnostic criteria of diabetes mellitus in older people

In 1998, the World Health Organization (WHO) accepted the diagnostic criteria proposed in 1997 by the American Diabetes Association (ADA) and confirmed that, independent of age, the fasting plasma glucose (FPG) level from and above 126mg/dl in the morning should be considered as diabetic, while subjects with FPG 110-125mg/dl have an impaired fasting glucose (IFG), compared with the normal fasting glucose (NFG) level (up to 110mg/dl). In a pool of 4492 elderly people (65-84 years), we assessed the significance and meaning of these new diagnostic criteria of diabetes. A 5-year follow-up was carried out, during which out of 4492 elderly subjects, 2750 were re-examined. As regards the diagnosis, we applied both the criteria of WHO (1985, 1998). At our first observation (1992), 13.1% were diabetic in the elderly group, if applying the WHO (1985) criteria, and 15.1% applying the ADA-WHO definitions. When re-analyzing the subjects with FPG of 126-139mg/dl after 5 years, it became evident that the diagnosis of diabetes is not stable in this group, because 50.7% of them displayed FPG<126mg/dl (14.5% IFG; 36.2% even NFG). It means that the significance of FPG and the conditions of diabetes are different in the elderly, as compared with the younger adults. Furthermore, the oral glucose tolerance test (OGTT) of 60 elderly subjects in the age range of 71-80 years, admitted in our day hospital, were considered. Among the subjects with an FPG 126-140mg/dl, the OGTT was of diabetic type in 90%, while among IFG and NFG subjects, it was in 50 and 10%, respectively. In conclusion, in elderly subjects with FPG of 126-140mg/dl, the diagnosis of diabetes is not stable and requires further confirmation.     

Prevalence of latent autoimmune diabetes of adults (LADA) in Southern Spain

OBJECTIVE: To study the prevalence of diabetes mellitus and islet autoantibodies in an adult population from Southern Spain. RESEARCH AND METHODS: A cross-sectional study in Southern Spain of 1226 people, age 18-65 years. Clinical data were obtained and a blood sample taken to measure autoantibodies (glutamic acid decarboxylase antibodies (GADAb), tyrosine phosphatase antibodies (IA2Ab), and insulin antibodies (IAA)). An oral glucose tolerance test (OGTT) was also given to 982 of the subjects. RESULTS: The overall prevalence of diabetes mellitus according to the WHO 1979 criteria was 10.9% and according to the ADA 1997 criteria it was 14.7% (8.8% were unaware of their diabetes). The prevalence of impaired fasting glucose (IFG) was 12.4% and of impaired glucose tolerance (IGT) 11.5%. The prevalence of GADAb+ in the general population was 0.9% and in the diabetic population 3.7%. There were no significant differences between groups in the prevalence of IA2Ab or IAA (both were 0.8% in the general population). Of the three autoantibodies studied, only GADAb were significantly different in the diabetic population (P=0.0006). CONCLUSIONS: The prevalence of Type 2 diabetes and LADA are high in the south of Spain.     

Impaired fasting glucose and impaired glucose tolerance in urban population in India.

AIMS: To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics. METHODS: Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged > or = 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2-h blood glucose (2hBG; 75-g glucose load) values. Subjects with known diabetes were excluded. RESULTS: Age-standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (chi2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose-intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated. CONCLUSIONS: Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.