title: The American Diabetes Association and World Health Organization classifications for diabetes: their impact on diabetes prevalence and total and cardiovascular disease mortality in elderly Japanese-American men.
abstract: OBJECTIVE
  To compare the prevalence of diabetes according to the American Diabetes Association (ADA) and World Health Organization (WHO) classifications in a sample of elderly Japanese-American men; to examine the association with total and cardiovascular mortality by diabetes status using both classifications; and to determine whether the fasting or 2-h glucose measurement is a stronger predictor of adverse outcomes.
  
  
  METHODS
  Examinations given from 1991 to 1993 in the Honolulu Heart Program were used as baseline for these analyses. Subjects were 71-93 years of age at that time and were followed for total and cardiovascular disease mortality for up to 7 years.
  
  
  RESULTS
  A total of approximately 66% of individuals who had diabetes by WHO criteria were missed when the ADA definition was used. The relative risks of total and cardiovascular mortality for those with versus those without diabetes were similar for both definitions; however, when fasting and postload glucose measures were analyzed as continuous variables, the 2-h measurement was a superior predictor and was independent of fasting glucose. In contrast, fasting glucose was not an independent predictor of these outcomes in the presence of the 2-h measurement.
  
  
  CONCLUSIONS
  The prevalence of glucose metabolism abnormalities was very high among elderly Japanese-American men. The WHO classification was superior to the ADA classification in identification of subjects at high risk for adverse outcomes. Therefore, we conclude that the 2-h glucose measurement is valuable and should be retained in epidemiologic studies.
authors.affiliation: Division of Clinical Epidemiology and the Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Hawaii. beatriz@phri.hawaii-health.com
authors.forename: Beatriz L
authors.initials: BL
authors.lastname: Rodriguez
authors.forename: Robert D
authors.initials: RD
authors.lastname: Abbott
authors.forename: Wilfred
authors.initials: W
authors.lastname: Fujimoto
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.forename: Randi
authors.initials: R
authors.lastname: Chen
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
authors.forename: Irwin
authors.initials: I
authors.lastname: Schatz
authors.forename: Helen
authors.initials: H
authors.lastname: Petrovitch
authors.forename: Webster
authors.initials: W
authors.lastname: Ross
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yano
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Blanchette
authors.forename: J David
authors.initials: JD
authors.lastname: Curb
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality*; D003920:Diabetes Mellitus / Q000097:blood / Q000145:classification* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000401:mortality*; D006254:Hawaii; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D012955:Societies, Medical; D014481:United States; D014944:World Health Organization
chemical_list: D001786:Blood Glucose