Harris T J, Cook D G, Wicks P D, Cappuccio F P
Department of General Practice and Primary Care, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
Nutr Metab Cardiovasc Dis. 2000 Dec;10(6):305-9.
The American Diabetes Association (ADA) recommends basing diabetes diagnosis on a fasting plasma glucose (FPG) of > or = 7.0 mmol/L and impaired fasting glucose (IFG) on 6.1 < or = FPG < 7.0 mmol/L. The new World Health Organisation (WHO) recommendations also adopt this FPG cut-off, but retain the oral glucose tolerance test (OGTT) where possible and the intermediate group of impaired glucose tolerance (IGT) in addition to IFG. We compare the effect of the new ADA and WHO diagnostic criteria in three ethnic groups.
Three hundred and eighty whites, 340 South Asians and 347 subjects of African descent, aged 40-59 years and not known to have diabetes, were identified through South London general practices. Inevitably, the prevalence of new diabetes was lower under ADA than under WHO criteria (including post-load levels) for all three groups, falling from 5.7% overall to 3.3% (fall 2.4% 95% CI 1.6% to 3.6%). The largest fall was for South Asians from 9.1% to 5.0% (fall 4.1% 95% CI 2.2% to 6.8%). The prevalence of impaired glucose homeostasis under ADA criteria (IFG) was substantially less than under WHO criteria (IFG + IGT). Under WHO criteria, including a glucose tolerance test, there was marked variation by ethnic group in diabetes prevalence (p < 0.001) and IGT (p < 0.0001), both were most prevalent amongst South Asians. Under ADA criteria, (or new WHO criteria without OGTT) diabetes prevalence still differed significantly between groups (p < 0.01), but there was no difference in IFG prevalence (p = 0.43).
Subjects with IGT but normal FPG are at greater risk of coronary heart disease. The new ADA definition fails to identify substantial numbers of such subjects, particularly among South Asians. Our study supports the retention of the OGTT in the new WHO criteria, particularly for South Asians.
美国糖尿病协会（ADA）建议将空腹血糖（FPG）≥7.0 mmol/L作为糖尿病诊断标准，空腹血糖受损（IFG）的标准为6.1≤FPG＜7.0 mmol/L。世界卫生组织（WHO）的新建议也采用了这一FPG临界值，但尽可能保留口服葡萄糖耐量试验（OGTT），并除IFG外还保留糖耐量受损（IGT）这一中间组。我们比较了新的ADA和WHO诊断标准对三个种族群体的影响。
通过伦敦南部的全科医疗诊所确定了380名白人、340名南亚人和347名非洲裔受试者，年龄在40 - 59岁之间，此前未被诊断患有糖尿病。不可避免地，对于所有三个群体，ADA标准下新诊断糖尿病的患病率低于WHO标准（包括负荷后血糖水平），总体患病率从5.7%降至3.3%（下降2.4%，95%置信区间为1.6%至3.6%）。下降幅度最大的是南亚人，从9.1%降至5.0%（下降4.1%，95%置信区间为2.2%至6.8%）。ADA标准下（IFG）糖代谢异常的患病率显著低于WHO标准（IFG + IGT）。按照WHO标准，包括葡萄糖耐量试验，糖尿病患病率（p＜0.001）和IGT患病率（p＜0.0001）在不同种族群体中存在显著差异，两者在南亚人中最为普遍。按照ADA标准（或不进行OGTT的新WHO标准），各群体之间糖尿病患病率仍存在显著差异（p＜0.01），但IFG患病率无差异（p = 0.43）。
IGT但FPG正常的受试者患冠心病的风险更高。新的ADA定义未能识别出大量此类受试者，尤其是在南亚人中。我们的研究支持在新的WHO标准中保留OGTT试验，特别是对于南亚人。
