Comparison of the effect of plasma glucose concentrations on microvascular disease between Pima Indian youths and adults.
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.
Krakoff
J
J
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
Hanson
R L
RL
Kobes
S
S
Knowler
W C
WC
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
D015415:Biomarkers; D001786:Blood Glucose