Effects of changing diagnostic criteria on the risk of developing diabetes

• Published in: Diabetes care Vol. 21; no. 9; pp. 1408 - 1413
• Main Authors: S F Dinneen, D Maldonado, 3rd, C L Leibson, G G Klee, H Li, L J Melton, 3rd, R A Rizza
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-09-1998
• Subjects: Adult; Biological and medical sciences; Blood Glucose - analysis; Clinical medicine; Cohort Studies; Diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Diabetes. Impaired glucose tolerance; Diagnostic Services - standards; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Glucose; Glucose Tolerance Test; Humans; Incidence; Laboratories; Magnetic tape; Medical records; Medical sciences; Middle Aged; Plasma; Research design; Risk Factors; United States; North America; America; United States > US; Minnesota; Endocrinopathy; Human; Disease development; Fasting; Diabetes mellitus; Adult; Boundary value; Diagnosis; Predictive factor; Comparative study; Glycemia
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.21.9.1408

Effects of changing diagnostic criteria on the risk of developing diabetes.
S F Dinneen ,
D Maldonado, 3rd ,
C L Leibson ,
G G Klee ,
H Li ,
L J Melton, 3rd and
R A Rizza
Division of Endocrinology and Metabolism, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. [e-mail]
Abstract
OBJECTIVE: The American Diabetes Association (ADA) has recommended that the fasting plasma glucose (FPG) level used to diagnose
diabetes be changed from 7.8 mmol/l (the level recommended by the National Diabetes Data Group [NDDG] in 1979) to 7.0 mmol/l.
We examined the impact of this change on rates of progression to overt diabetes from different levels of FPG. RESEARCH DESIGN
AND METHODS: Using the laboratory database of Mayo Clinic, we assembled a cohort of 8,098 nondiabetic Olmsted County residents
40 years of age or older on 1 July 1983. Subjects were followed for a median of 9 years. RESULTS: Among 7,567 individuals
with follow-up FPG data, 778 (10.3%) progressed to ADA diabetes and 513 (6.8%; P < 0.0001) progressed to NDDG diabetes. The
risk of developing ADA diabetes was 7, 19, and 39% for individuals with initial FPG values in the ranges of <5.6, 5.6-6.0,
and 6.1-6.9 mmol/l, respectively. For progression to NDDG diabetes, the respective risks were 3, 11, and 25%. A clear gradient
of risk was observed within the "normal" range of FPG (<5.6 mmol/l). Among the 793 individuals who developed ADA diabetes,
222 (29%) developed NDDG diabetes simultaneously and 291 (37%) developed NDDG diabetes later. In all FPG subgroups, progression
to ADA diabetes occurred approximately 7 years sooner than progression to NDDG diabetes. CONCLUSIONS: The baseline level of
FPG is a major predictor of an individual's risk of developing diabetes. The proposed change in the diagnostic criteria for
diabetes will lead to earlier diagnosis among individuals who are destined to develop the disease.