title: Bimodality in blood glucose distribution: is it universal?
abstract: OBJECTIVE
  Bimodality in blood glucose (BG) distribution has been demonstrated in several populations with a high prevalence of diabetes and obesity. However, other population studies had not found bimodality, thus casting doubt on its universality. We address this question in four ethnic populations-namely Malay, Chinese, Indian, and the indigenous people of Borneo.
  
  
  METHODS
  A national health survey was conducted in Malaysia in 1996. A total of 18,397 subjects aged > or =30 years had post-challenge BG measurements taken. To test whether BG was consistent with a bimodal distribution, we fitted unimodal normal and skewed distribution as well a mixture of two normal distributions to the data by age and ethnic groups.
  
  
  RESULTS
  Age-specific prevalence of diabetes varied from 1.3 to 26.3%. In all ethnic/age groups, the bimodal model fitted the log BG data better (likelihood ratio tests, all P values <0.001).
  
  
  CONCLUSIONS
  Bimodality in BG distribution is demonstrable even in populations with a very low prevalence of diabetes and obesity. Previous studies that found unimodality had failed to detect the second mode because of inadequate sample size, bias due to treatment of subjects with known diabetes, and inclusion of subjects with type 1 diabetes in the sample. Bimodality implies that diabetes is a distinct entity rather than an arbitrarily defined extreme end of a continuously distributed measurement.
authors.affiliation: Clinical Research Centre, Kuala Lumpur Hospital, Malaysia. limto@crc.gov.my
authors.forename: Teck-Onn
authors.initials: TO
authors.lastname: Lim
authors.forename: Rugayah
authors.initials: R
authors.lastname: Bakri
authors.forename: Zaki
authors.initials: Z
authors.lastname: Morad
authors.forename: Maimunah A
authors.initials: MA
authors.lastname: Hamid
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000453:epidemiology; D012016:Reference Values; D012727:Sex Characteristics
chemical_list: D001786:Blood Glucose