Harris M I, Eastman R C, Cowie C C, Flegal K M, Eberhardt M S
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892, USA.
Diabetes Care. 1997 Dec;20(12):1859-62. doi: 10.2337/diacare.20.12.1859.
To compare the 1997 American Diabetes Association (ADA) and the 1980-1985 World Health Organization (WHO) diagnostic criteria in categorization of the diabetes diagnostic status of adults in the U.S.
Analyses are based on a probability sample of the U.S. population age 40-74 years in the 1988-1994 Third National Health and Nutrition Examination Survey (NHANES III). People with diabetes diagnosed before the survey were identified by questionnaire. For 2,844 people without diagnosed diabetes, fasting plasma glucose was obtained after an overnight 9 to < 24-h fast, HbA1c was measured, and a 2-h oral glucose tolerance test was administered.
Prevalence of diagnosed diabetes in this age-group is 7.9%. Prevalence of undiagnosed diabetes is 4.4% by ADA criteria and 6.4% by WHO criteria. The net change of -2.0% occurs because 1.0% are classified as having undiagnosed diabetes by ADA criteria but have impaired or normal glucose tolerance by WHO criteria, and 3.0% are classified as having impaired fasting glucose or normal fasting glucose by ADA criteria but have undiagnosed diabetes by WHO criteria. Prevalence of impaired fasting glucose is 10.1% (ADA), compared with 15.6% for impaired glucose tolerance (WHO). For those with undiagnosed diabetes by ADA criteria, 62.1% are above the normal range for HbA1c compared with 47.1% by WHO criteria. Mean HbA1c is 7.07% for undiagnosed diabetes by ADA criteria and 6.58% by WHO criteria.
The number of people with undiagnosed diabetes by ADA criteria is lower than that by WHO criteria. However, those individuals classified by ADA criteria are more hyperglycemic, with higher HbA1c values and a greater proportion of values above the normal range. This fact, together with the simplicity of obtaining a fasting plasma glucose value, may result in the detection of a greater proportion of people with undiagnosed diabetes in clinical practice using the new ADA diagnostic criteria.
比较1997年美国糖尿病协会（ADA）和1980 - 1985年世界卫生组织（WHO）的诊断标准对美国成年人糖尿病诊断状况的分类。
分析基于1988 - 1994年第三次全国健康与营养检查调查（NHANES III）中40 - 74岁美国人群的概率样本。通过问卷确定调查前被诊断为糖尿病的人群。对于2844名未被诊断为糖尿病的人，经过9至<24小时的空腹后获取空腹血糖，测量糖化血红蛋白（HbA1c），并进行2小时口服葡萄糖耐量试验。
该年龄组中已诊断糖尿病的患病率为7.9%。按照ADA标准，未诊断糖尿病的患病率为4.4%；按照WHO标准，未诊断糖尿病的患病率为6.4%。出现-2.0%的净变化是因为1.0%的人按照ADA标准被归类为患有未诊断糖尿病，但按照WHO标准其葡萄糖耐量受损或正常；3.0%的人按照ADA标准被归类为空腹血糖受损或空腹血糖正常，但按照WHO标准患有未诊断糖尿病。空腹血糖受损的患病率为10.1%（ADA），相比之下，葡萄糖耐量受损的患病率为15.6%（WHO）。对于按照ADA标准患有未诊断糖尿病的人，62.1%的糖化血红蛋白高于正常范围，而按照WHO标准这一比例为47.1%。按照ADA标准，未诊断糖尿病患者的平均糖化血红蛋白为7.07%，按照WHO标准为6.58%。
按照ADA标准未诊断糖尿病的人数低于按照WHO标准的人数。然而，按照ADA标准分类的个体血糖更高，糖化血红蛋白值更高，且高于正常范围的比例更大。这一事实，再加上获取空腹血糖值的简便性，可能导致在临床实践中使用新的ADA诊断标准检测出更大比例的未诊断糖尿病患者。
