Diabetes detection in Australian general practice: a comparison of diagnostic criteria.
OBJECTIVE
To study the influence of different diagnostic criteria on the prevalence of diabetes mellitus and characteristics of those diagnosed.


METHODS
Retrospective analysis of data from the general-practice-based Australian Diabetes Screening Study (January 1994 to June 1995).


METHODS
5911 people with no previous diagnosis of diabetes, two or more symptoms or risk factors for diabetes, a random venous plasma glucose (PG) level > 5.5 mmol/L and a subsequent oral glucose tolerance test (OGTT) result.


METHODS
Prevalence of undiagnosed diabetes based on each of three sets of criteria: 1997 criteria of the American Diabetes Association (ADA), 1996 two-step screening strategy of the Australian Diabetes Society (ADS) (modified according to ADA recommendations about lowered diagnostic fasting PG level), and 1999 definition of the World Health Organization (WHO).


RESULTS
Prevalence estimates for undiagnosed diabetes using the American (ADA), Australian (ADS) and WHO criteria (95% CI) were 9.4% (8.7%-10.1%), 16.0% (15.3%-16.7%) and 18.1% (17.1%-19.1%), respectively. People diagnosed with diabetes by fasting PG level (common to all sets of criteria) were more likely to be male and younger than those diagnosed only by 2 h glucose challenge PG level (Australian and WHO criteria only). The Australian (ADS) stepwise screening strategy detected 88% of those who met the WHO criteria for diabetes, including about three-quarters of those with isolated post-challenge hyperglycaemia.


CONCLUSIONS
The WHO criteria (which include an OGTT result) are preferable to the American (ADA) criteria (which rely totally on fasting PG level), as the latter underestimated the prevalence of undiagnosed diabetes by almost a half. The Australian (ADS) strategy identified most of those diagnosed with diabetes by WHO criteria.
Hilton
Deborah J
DJ
CVD Prevention Unit, Baker Medical Research Institute, Melbourne, VIC.
O'Rourke
Peter K
PK
Welborn
Timothy A
TA
Reid
Christopher M
CM
D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014944:World Health Organization
D001786:Blood Glucose