Revisiting the oral glucose tolerance test criterion for the diagnosis of diabetes |
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Authors: | Dr Mayer B Davidson MD David L Schriger MD MPH Anne L Peters MD Brett Lorber MPH |
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Institution: | (1) the Charles R. Drew University of Medicine and Science, Los Angeles, Calif;(2) Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, Calif;(3) Department of Emergency Medicine, University of California, Los Angeles School of Medicine, Los Angeles, Calif;(4) Clinical Trials Unit, 1731 East 120th St., 90059 Los Angeles, CA |
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Abstract: | OBJECTIVE: The Expert Committee on the Diagnosis and Classification of Diabetes retained the 2-hour glucose concentration on an oral
glucose tolerance test of ≥11.1 mmol/L (200 mg/dL) as a criterion to diagnose diabetes. Since glycated hemoglobin levels have
emerged as the best measure of long-term glycemia and an important predictor of microvascular and neuropathic complications,
we evaluated the distribution of hemoglobin A1C (Hb A1C) levels in individuals who had undergone an oral glucose tolerance
test to determine how well 2-hour values could identify those with normal versus increased Hb A1C levels.
DESIGN: A cross-sectional analysis of 2 large data sets was performed. We cross-tabulated 2-hour glucose concentrations on an oral
glucose tolerance test separated into 4 intervals (<7.8 mmol/L 140 mg/dL], 7.8–11.0 mmol/L 140–199 mg/dL], 11.1–13.3 mmol/L
200–239 mg/dL], and ≥13.3 mmol/L 240 mg/dL]) with Hb A1C levels separated into 3 intervals (normal; <1% above the upper
limit of normal; and greater than or equal to the upper limit of normal +1%).
RESULTS: Approximately two thirds of patients in both data sets with 2-hour glucose concentrations of 11.1 to 13.3 mmol/L (200–239
mg/dL) had normal Hb A1C levels. In contrast, 60% to 80% of patients in both data sets with 2-hour glucose concentrations
≥13.3 mmol/L (240 mg/dL) had elevated Hb A1C levels.
CONCLUSION: Since Hb A1C levels are the best measures presently available that reflect long-term glycemia, we conclude that the 2-hour
glucose concentration criterion on an oral glucose tolerance test for the diagnosis of diabetes should be raised from ≥11.1
mmol/L (200 mg/dL) to ≥13.3 mmol/L (240 mg/dL) to remain faithful to the concept that diagnostic concentrations of glucose
should predict the subsequent development of specific diabetic complications (e.g., retinopathy).
Presented at the American Diabetes Association meeting, San Diego, Calif, June 1999. |
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Keywords: | oral glucose tolerance test glycated hemoglobin Hb A1C diagnosis of diabetes |
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