TITLE

Macrovascular Risk and Diagnostic Criteria for Type 2 Diabetes

AUTHOR(S)
Jesudason, David R.; Dunstan, Kerrie; Dunstan, Kerri; Leong, Darryl; Wittert, Gary A.
PUB. DATE
February 2003
SOURCE
Diabetes Care;Feb2003, Vol. 26 Issue 2, p485
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE — The use of fasting plasma glucose (FPG) level ≥ 7.0 mmol/l leads to underdiagnosis of type 2 diabetes compared with the oral glucose tolerance test (OGTT). The OGTT is of limited use for population screening. Most of the increase in cardiovascular risk in relation to increasing blood glucose occurs before the threshold at which the diagnosis of type 2 diabetes is made. The aim of this study was to evaluate the use of HbA[sub 1c] and FPG as predictors of type 2 diabetes and cardiovascular risk and, accordingly, to develop a rational approach to screening for abnormalities of glucose tolerance. RESEARCH DESIGN AND METHODS — OGTT and measurement of HbA[sub 1c] and FPG levels were performed in 505 subjects screened for type 2 diabetes. Anthropomorphic measurements were obtained. A cardiovascular risk factor questionnaire was completed. RESULTS — The subjects were aged 19-88 years (mean 53.8). The incidence of type 2 diabetes was 10.4% based on the OGTT and 4% based on an FPG level ≥7.0 mmol/l. Using high-performance liquid, chromatography (HPLC), HbA[sub 1c] of <4.7 and ≥6.2% predicted with certainty the absence or presence of type 2 diabetes as defined by the OGTT. The corresponding cutoffs were <5.0 and ≥6.8% for HbA[sub 1c] (DCA2000 HPLC device; Bayer Diagnostics, Mulgrave, Australia) and <4.7 and ≥6.4 mmol/1 for FPG. However, 75-85% of subjects in each case had intermediate values, which were therefore nondiagnostic. Cardiovascular risk increased at least 2.2 times at an HbA[sub 1c] level ≥ 6.2 % (by HPLC), 1.8-2.2 times at an HbA[sub 1c] level of 5.6-6.1% (by HPLC), 2 times at an FPG level ≥6.4 mmol/l, and 1.7-1.9 times at an FPG level of 5.6-6.3 mmol/l. CONCLUSIONS — Measurement of FPG and HbA[sub 1c] levels will diagnose or exclude type 2 diabetes with certainty in a minority (15 %) of people. There is a continuous relationship between FPG and HbA[sub 1c] and cardiovascular risk. Accordingly, we...
ACCESSION #
9067424

 

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