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Abstract
Background
The criteria for the diagnosis of diabetes mellitus have been modified by the American Diabetes Association (ADA) in 1997. The ADA proposed that the diagnosis of diabetes be defined by a fasting plasma glucose (FPG) of 7.0 mmol/L. Disagreement has been reported between criteria based on FPG and postchallenge 2-h plasma glucose (2-h PG). The aim of the present study is to assess the FPG criteria as the diagnostic screening test for diabetes in Korean middle-aged adults in comparison to the 2-h PG criteria.
Methods
Randomly selected 1,731 subjects (679 men and 1,052 women) aged 40~70 years (mean age: 58.4 ± 7.89 years) without previously diagnosed diabetes completed 75 g oral glucose tolerance test (OGTT). We assessed the prevalence of diabetes mellitus and the level of agreement (κ statistics) according to the different diagnostic glucose categories.
Results
The frequency of newly diagnosed diabetes was 2.7% (n = 51) using the FPG criteria only; 6.4% (n = 120) using the 2-h PG criteria only; and 6.9% (n = 130) using concentrations of ≥ 7.0 mmol/L for FPG or ≥ 11.1 mmol/L for 2-h PG. Of the 120 subjects with diabetes by the 2-h PG criteria, 65.8% (n = 79) were not diagnosed with diabetes according to FPG concentration. The level of agreement between two diagnostic criteria was low (κ = 0.268). The receiver operating characterstic (ROC) curve analysis determined FPG of 5.6 mmol/L to yield optimal sensitivity and specificity corresponding to 2-h PG 11.1 mmol/L.
Conclusion
The findings in this study demonstrate that the discordance between the FPG and 2-h PG criteria in the diagnosis of diabetes in Korean middle-aged adults is large. We suggest that IFG group (FPG 5.6~6.9 mmol/L) were performed 75 g OGTT for diagnosing diabetes mellitus in Korean middle-aged adults.
Figures and Tables
Fig. 1
Receiver operator characteristic (ROC) curve for fasting plasma glucose predicting 2 hr plasma glucose of 11.1 mmol/L. Diagonal segments are produced by ties.
Table 1
Clinical characteristics of study subjects with respect to sex
Data are means ± SD. BMI, body mass index; DBP, diastolic blood pressure; HDLc, high density lipoprotein cholesterol; LDLc, low density lipoprotein cholesterol; SBP, systolic blood pressure; 2-h insulin, 75 g 2 h post load insulin; 2-h PG, 75 g 2 h post load glucose; TC, total cholesterol; WC, waist circumference.
Table 2
Clinical characteristics of study subjects with respect to age
Data are means ± SD. BMI, body mass index; DBP, diastolic blood pressure; F, female; HDL, high density lipoprotein cholesterol; LDL, low density lipoprotein cholesterol; M, male; SBP, systolic blood pressure; 2-h insulin, 75 g 2 h post load insulin; 2-h PG, 75 g 2 h post load glucose; TC, total cholesterol; WC, waist circumference.
Table 3
Distribution of study subjects without previously diagnosed diabetes, according to fasting and 2-h glucose criteria
Table 4
Concordance between FPG and 2-h PG criteria for diagnosis of diabetes mellitus with respect to age
Table 5
Concordance between FPG and 2-h PG criteria for diagnosis of diabetes mellitus with respect to sex and BMI
Table 6
Optimal fasting plasma glucose cutoff points corresponding to a 2-h plasma glucose concentration 11.1 mmol/L, according to sex, age and BMI
Table 7
Comparison of cardiovascular risk factors in impaired glucose tolerance and impaired fasting glucose subgroup
*P < 0.05, for different from NGT/NFG. †P < 0.05, for different from IGT/NFG. ‡P < 0.05, for different from NGT/IFG. Data are means ± SD. BMI, body mass index; DBP, diastolic blood pressure; F, female; HDL, high density lipoprotein cholesterol; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; LDL, low density lipoprotein cholesterol; M, male; NGT, normal glucose tolerance; NFG, normal fasting glucose; SBP, systolic blood pressure; 2-h insulin, 75 g 2 h post load insulin; 2-h PG, 75 g 2 h post load glucose; TC, total cholesterol; WC, waist circumference.
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