Determining diabetes prevalence: a rational basis for the use of fasting plasma glucose concentrations?
The World Health Organization and the National Diabetes Data Group each recommend a diagnostic cut-off point for diabetes of 7.8 mmol l-1 for fasting plasma glucose concentrations as part of the diagnostic criteria for epidemiological studies. However, this cut-off has been shown to be insensitive compared with a screening test based on 2-h plasma glucose levels. In thirteen Pacific populations, from four ethnic groups (Asian Indian, Melanesian, Micronesian, and Polynesian), we have examined whether a different cut-off point for fasting plasma glucose would be more accurate for obtaining an estimate of the prevalence of diabetes when compared with 2-h levels. A fasting plasma glucose diagnostic cut-off of 7.0 mmol l-1 gave an estimate of prevalence not significantly different from that based on the 2-h plasma glucose in 12 of the 13 populations (mean difference 0.27, range -1.51 to +2.44,%). On the other hand, when a cut-off of 7.8 mmol l-1 for fasting plasma glucose was used, the resulting prevalence over-estimated the 2-h glucose prevalence in all populations (mean difference 1.91, range 0.14-5.80,%). Thus for Pacific populations, a fasting plasma glucose cut-off of 7.0 mmol l-1 provides estimates of prevalence that are equivalent to those based on 2-h plasma glucose levels. In epidemiological studies designed to estimate diabetes prevalence, we recommend use of a fasting plasma glucose cut-off of 7.0 mmol l-1 in preference to a detection level of 7.8 mmol l-1, if glucose loading is not possible.(ABSTRACT TRUNCATED AT 250 WORDS)
Finch
C F
CF
Lions-International Diabetes Institute, Melbourne, Australia.
Zimmet
P Z
PZ
Alberti
K G
KG
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005215:Fasting / Q000097:blood; D006801:Humans; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D015995:Prevalence; D014944:World Health Organization
D001786:Blood Glucose