title: Lowering the criterion for impaired fasting glucose: impact on disease prevalence and associated risk of diabetes and ischemic heart disease.
abstract: OBJECTIVE
  To determine the effect of lowering the fasting plasma glucose (FPG) criterion for impaired fasting glucose (IFG) on the prevalence of IFG, the risks of diabetes, and cardiovascular disease (CVD) associated with IFG.
  
  
  METHODS
  Three studies were used: 1). the 1998 National Health Survey (NHS98), a randomly selected cross-sectional sample of 4723 subjects; 2). the Singapore Impaired Glucose Tolerance (IGT) Follow-up Study, a cohort study comprising 295 IGT and 292 normal glucose tolerance subjects (frequency matched for age, sex, and ethnic group) followed up from 1992 to 2000; and 3). the Singapore CVD Cohort Study, comprising 5920 subjects from three cross-sectional studies in whom the first ischemic heart disease (IHD) event was identified through linkage to registry databases. Risk of diabetes (Singapore IGT Follow-up study) was estimated using logistic regression adjusted for age, sex, and ethnicity. Risk of IHD (Singapore CVD cohort) was estimated using stratified (by study, from which data were derived) Cox's proportional hazards models adjusted for age, sex, and ethnicity.
  
  
  RESULTS
  Lowering the criterion for diagnosing IFG to 5.6 mmol/l increased the prevalence of IFG from 9.5 to 32.3% in the NHS98. The lower cutoff identified more subjects at risk of diabetes and IHD, but the relative risk was lower than that for IGT.
  
  
  CONCLUSIONS
  Greater efforts to identify those with IGT, or a group at similar risk of diabetes and CVD, may be a more efficient public health measure than lowering the FPG criterion for diagnosing IFG.
authors.affiliation: Department of Endocrinology, Singapore General Hospital, Singapore. eshyong@pacific.net.sg
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Su Yen
authors.initials: SY
authors.lastname: Goh
authors.forename: Jeannette J M
authors.initials: JJ
authors.lastname: Lee
authors.forename: Moh-Sim
authors.initials: MS
authors.lastname: Wong
authors.forename: Derrick
authors.initials: D
authors.lastname: Heng
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hughes
authors.forename: Suok Kai
authors.initials: SK
authors.lastname: Chew
authors.forename: Jeffery
authors.initials: J
authors.lastname: Cutter
authors.forename: William
authors.initials: W
authors.lastname: Chew
authors.forename: Ken
authors.initials: K
authors.lastname: Gu
authors.forename: Kee Seng
authors.initials: KS
authors.lastname: Chia
authors.forename: Chee Eng
authors.initials: CE
authors.lastname: Tan
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D003430:Cross-Sectional Studies; D005215:Fasting; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D001786:Blood Glucose