BMJ. 1998 Aug 8;317(7155):371-5. doi: 10.1136/bmj.317.7155.371.
To evaluate the impact of the revised diagnostic criteria for diabetes mellitus adopted by the American Diabetes Association on prevalence of diabetes and on classification of patients. For epidemiological purposes the American criteria use a fasting plasma glucose concentration >=7.0 mmol/l in contrast with the current World Health Organisation criteria of 2 hour glucose concentration >=11.1 mmol/l.
Data were collected from 13 populations and three occupational based studies from eight European countries. All studies used a 75 g oral glucose tolerance test to measure fasting and 2 hour glucose concentrations.
17 881 men; 8309 women; age range 17-92 years.
Classification of diabetes according to both sets of criteria.
The application of the American criteria on European populations induced changes in prevalence of diabetes ranging from a reduction of 4.0% to an increase of 13.2%. A total of 1517 previously undiagnosed individuals had diabetes according to either the WHO or the American criteria. Among 1044 with diabetes according to American criteria, only 45% had 2 hour values fulfilling the WHO criteria. The risk of disagreement of classification decreased with increasing body mass index (P<0.00001) and increasing age (P<0.0001); the impact of sex was not significant (P=0.08).
This shift in strategy from using 2 hour to fasting plasma glucose will cause an increase in the prevalence of diabetes in some European populations. A high degree of disagreement in the classification was observed between the two recommendations. Prospective data are needed to evaluate whether the WHO or the American criteria best identify individuals at risk of developing microvascular complications and cardiovascular disease. Wider implementation of revised diagnostic criteria should await prospective data.
评估美国糖尿病协会采用的修订版糖尿病诊断标准对糖尿病患病率及患者分类的影响。出于流行病学目的，美国的标准采用空腹血糖浓度≥7.0 mmol/L，而目前世界卫生组织的标准是2小时血糖浓度≥11.1 mmol/L。
数据收集自8个欧洲国家的13个人群和3项基于职业的研究。所有研究均采用75克口服葡萄糖耐量试验来测量空腹及2小时血糖浓度。
17881名男性；8309名女性；年龄范围17 - 92岁。
根据两套标准对糖尿病进行分类。
将美国标准应用于欧洲人群导致糖尿病患病率的变化幅度从降低4.0%至增加13.2%。共有1517名之前未被诊断出的个体根据世界卫生组织或美国标准患有糖尿病。在根据美国标准诊断为糖尿病的1044人中，只有45%的人2小时血糖值符合世界卫生组织标准。分类不一致的风险随着体重指数的增加（P<0.00001）和年龄的增加（P<0.0001）而降低；性别影响不显著（P = 0.08）。
从使用2小时血糖到空腹血糖这种策略转变将导致部分欧洲人群中糖尿病患病率上升。观察到这两项标准在分类上存在高度不一致。需要前瞻性数据来评估世界卫生组织或美国标准哪一个能更好地识别有发生微血管并发症和心血管疾病风险的个体。修订后的诊断标准的更广泛应用应等待前瞻性数据。
