Rijkelijkhuizen Josina M, Nijpels Giel, Heine Robert J, Bouter Lex M, Stehouwer Coen D A, Dekker Jacqueline M
EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands.
Diabetes Care. 2007 Feb;30(2):332-6. doi: 10.2337/dc06-1238.
To optimize identification of future diabetic patients, the American Diabetes Association (ADA) introduced criteria for impaired fasting glucose (IFG) in 1997 (IFG 6.1 mmol/l [IFG6.1]) and lowered the threshold from 6.1 to 5.6 mmol/l (IFG5.6) in 2003. Our aim was to assess the consequences of lowering the IFG cutoff on the risk of cardiovascular disease (CVD) mortality and to evaluate whether this risk is explained by a conversion to type 2 diabetes within 6.4 years.
In a population-based cohort, the Hoorn Study, plasma glucose was determined in 1989 and 1996 (n = 1,428). Subjects were classified in 1989 according to 1997 and 2003 ADA criteria. Subjects with IFG in 1989 were further classified according to diabetes status in 1996. Hazard ratios for CVD mortality (n = 81) in the period 1996-2005 were adjusted for age and sex.
Subjects with IFG6.1, but not IFG5.6, had a significantly higher CVD mortality risk than normal fasting glucose (NFG) subjects. Subjects who converted from IFG to diabetes (IFG6.1: 42%; IFG5.6: 21%) had a more than twofold risk of CVD mortality (IFG6.1: 2.47 [1.17-5.19]; IFG5.6: 2.14 [1.12-4.10]) than subjects with NFG. IFG subjects who did not develop diabetes did not have significantly higher CVD mortality risks (IFG6.1: 1.50 [0.72-3.15]; IFG5.6: 1.15 [0.69-1.93]).
The lower cutoff for IFG (ADA 2003 criteria) results in a category of IFG that no longer represents a high-risk state of CVD. Furthermore, only subjects who convert from IFG to diabetes have a high risk of CVD mortality.
为优化对未来糖尿病患者的识别，美国糖尿病协会（ADA）于1997年引入了空腹血糖受损（IFG）标准（IFG 6.1 mmol/l [IFG6.1]），并于2003年将阈值从6.1 mmol/l降至5.6 mmol/l（IFG5.6）。我们的目的是评估降低IFG临界值对心血管疾病（CVD）死亡率风险的影响，并评估这种风险是否可由6.4年内转变为2型糖尿病来解释。
在一项基于人群的队列研究——霍恩研究中，于1989年和1996年测定了血浆葡萄糖（n = 1428）。1989年根据1997年和2003年ADA标准对受试者进行分类。1989年患有IFG的受试者根据1996年的糖尿病状态进一步分类。对1996 - 2005年期间CVD死亡率（n = 81）的风险比按年龄和性别进行了调整。
IFG6.1的受试者，但不是IFG5.6的受试者，其CVD死亡风险显著高于空腹血糖正常（NFG）的受试者。从IFG转变为糖尿病的受试者（IFG6.1：42%；IFG5.6：21%）的CVD死亡风险（IFG6.1：2.47 [1.17 - 5.19]；IFG5.6：2.14 [1.12 - 4.10]）是NFG受试者的两倍多。未发展为糖尿病的IFG受试者的CVD死亡风险没有显著升高（IFG6.1：1.50 [0.72 - 3.15]；IFG5.6：1.15 [0.69 - 1.93]）。
IFG的较低临界值（ADA 2003标准）导致了一类不再代表CVD高风险状态的IFG。此外，只有从IFG转变为糖尿病的受试者才有较高的CVD死亡风险。
