title: Comparison of the effect of plasma glucose concentrations on microvascular disease between Pima Indian youths and adults.
abstract: OBJECTIVE
  To examine whether the current adult guidelines for diagnosis of diabetes are applicable to youth (age <20 years).
  
  
  METHODS
  We analyzed fasting plasma glucose (FPG) and 2-h plasma glucose (PG) in two groups of Pima Indians, youths aged 5-19 years and adults aged 20-34 years, in relation to the incidence of microvascular disease when subjects were reexamined at ages 25-39 (youths) and 40-54 (adults). Microvascular disease was defined as retinopathy or a urine protein-to-creatinine ratio > or =0.5 g.
  
  
  RESULTS
  An increase in the incidence of microvascular disease occurred at nearly the same level of glycemia in both groups. For youths, this increase occurred at FPG approximately 7.3 mmol/l and 2-h PG approximately 10.0 mmol/l; for adults, this increase occurred at FPG approximately 7.5 mmol/l and 2-h PG approximately 10.3 mmol/l. Sensitivity of the adult diagnostic guidelines of FPG > or =7.0 mmol/l and 2-h PG > or =11.1 mmol/l for the detection of microvascular disease was much lower (with higher specificity) in youths than in adults. Receiver operating characteristics (ROC) curve areas were lower for FPG and 2-h PG for youths, suggesting that microvascular disease was less strongly predicted by baseline glucose.
  
  
  CONCLUSIONS
  The current adult guidelines for diagnosis of diabetes are applicable to youth, as they identify a population at high risk of microvascular complications.
authors.affiliation: National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, 1550 E. Indian School Road, Phoenix, AZ 85014, USA. jkrakoff@mail.nih.gov
authors.forename: J
authors.initials: J
authors.lastname: Krakoff
authors.forename: R L
authors.initials: RL
authors.lastname: Hanson
authors.forename: S
authors.initials: S
authors.lastname: Kobes
authors.forename: W C
authors.initials: WC
authors.lastname: Knowler
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001130:Arizona / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000503:physiopathology*; D015994:Incidence; D007198:Indians, North American; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose