HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Social Bookmarking                What's this?

Follow-up Report on the Diagnosis of Diabetes Mellitus

Reprinted with permission from Diabetes Care 26:3160–3167, 2003

The first 300 words of the full text of this article appear below.

In 1997, an International Expert Committee was convened to reexamine the classification and diagnostic criteria of diabetes, which were based on the 1979 publication of the National Diabetes Data Group¹ and subsequent WHO study group.² As a result of its deliberations, the Committee recommended several changes to the diagnostic criteria for diabetes and for lesser degrees of impaired glucose regulation (IFG/IGT).³ The following were the major changes or issues addressed.

1) The use of a fasting plasma glucose (FPG) test for the diagnosis of diabetes was recommended, and the cut point separating diabetes from nondiabetes was lowered from FPG 140 mg/dl (7.8 mmol/l) to 126 mg/dl (7.0 mmol/l). (All glycemic values represent venous plasma.) This change was based on data that showed an increase in prevalence and incidence of diabetic retinopathy beginning at approximately an FPG of 126 mg/dl, as well as on the desire to reduce the discrepancy that existed in the number of cases detected by the FPG cut point of 140 mg/dl and the 2-h value in the OGTT (2-h plasma glucose [2-h PG]) of 200 mg/dl (11.1 mmol/l).

2) Normal FPG was defined as < 110 mg/dl (6.1 mmol/l).

3) The use of HbA_1c (A1C) as a diagnostic test for diabetes was not recommended. The primary reason for this decision was a lack of standardized methodology resulting in varying nondiabetic reference ranges among laboratories.

4) Although the OGTT (which consists of an FPG and 2-h PG value) was recognized as a valid way to diagnose diabetes, the use of the test for diagnostic purposes in clinical practice was discouraged for several reasons (e.g., inconvenience, less reproducibility, greater cost). The diagnostic category of impaired glucose tolerance (IGT) was retained to describe people whose FPG was < 126 mg/dl but whose 2-h PG after . . . [Full Text of this Article]

Question 1: Should the cut point of FPG 126 mg/dl ( 7.0 mmol/l) or the cut point for the 2-h PG of 200 mg/dl (11.1 mmol/l) for the diagnosis of diabetes, or both, be changed?

Question 2: Should the lower limit for IFG be reduced from 110 mg/dl?

Question 3: Should the HbA_1c (A1C) level be included as a criterion for the diagnosis of diabetes?

Question 4: What is the value of the 2-h PG in addition to the FPG?

How does the FPG or 2-h OGTT relate to the condition to be detected?

What are their relative advantages and disadvantages?

What other features are related to either test?

Is there a "lost opportunity" by doing one test versus the other?

Is it possible to identify people likely to have IFG/IGT using other characteristics?

Conclusions

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?