Wahl P W, Savage P J, Psaty B M, Orchard T J, Robbins J A, Tracy R P
Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, USA.
Lancet. 1998 Sep 26;352(9133):1012-5. doi: 10.1016/S0140-6736(98)04055-0.
We aimed to compare the prevalence of abnormal glucose tolerance identified by the 1985 WHO and the 1997 American Diabetes Association (ADA) diagnostic categories based on information collected in the Cardiovascular Health Study, an epidemiological study of elderly people.
We measured glucose concentrations during fasting and 2 h after a 75 g oral glucose-tolerance test in participants aged 65-100 years in the Cardiovascular Health Study. From a 1989 cohort, we analysed the glucose measurements of 4515 individuals without a previous diagnosis of diabetes and of 262 additional measurements from an African-American cohort recruited in 1992-93.
In the 1989 cohort, the prevalence of untreated diabetes with ADA diagnostic fasting criteria was 7.7% versus a prevalence of 14.8% by the WHO criteria. In the African-American cohort, the prevalence of untreated diabetes was 2.7% with ADA criteria and 11.8% with WHO criteria. 3509 (77.7%) of the 4515 participants in the 1989 cohort had normal glucose concentrations according to ADA fasting criteria, compared with 2401 (53.2%) according to WHO criteria. In the African-American cohort, the corresponding numbers were 239 (91.2%) versus 153 (58.4%). All differences in prevalence of abnormal glucose tolerance between ADA and WHO classifications were significant (p<0.0001).
Among elderly individuals, there was a significant difference in the prevalence of diabetes identified by the WHO diagnostic criteria based on oral glucose-tolerance test and the ADA fasting criteria. Consequently, many individuals currently classified as non-diabetic according to ADA criteria would previously have had a diagnosis of diabetes according to WHO criteria. Longitudinal studies are needed to assess the value of the criteria in the identification of individuals at increased risk of diabetes-associated chronic complications.
基于心血管健康研究（一项针对老年人的流行病学研究）收集的信息，我们旨在比较根据1985年世界卫生组织（WHO）和1997年美国糖尿病协会（ADA）诊断类别所确定的糖耐量异常的患病率。
在心血管健康研究中，我们测量了65至100岁参与者在空腹及75克口服葡萄糖耐量试验后2小时的血糖浓度。从1989年的队列中，我们分析了4515名既往未诊断为糖尿病个体的血糖测量值，以及1992 - 1993年招募的非裔美国人队列中的另外262次测量值。
在1989年的队列中，按照ADA诊断空腹标准，未治疗糖尿病的患病率为7.7%，而按照WHO标准则为14.8%。在非裔美国人队列中，按照ADA标准未治疗糖尿病的患病率为2.7%，按照WHO标准为11.8%。根据ADA空腹标准，1989年队列中的4515名参与者中有3509名（77.7%）血糖浓度正常，而按照WHO标准这一数字为2401名（53.2%）。在非裔美国人队列中，相应数字分别为239名（91.2%）和153名（58.4%）。ADA和WHO分类之间糖耐量异常患病率的所有差异均具有统计学意义（p<0.0001）。
在老年人中，基于口服葡萄糖耐量试验的WHO诊断标准与ADA空腹标准所确定的糖尿病患病率存在显著差异。因此，许多目前按照ADA标准被分类为非糖尿病的个体，按照WHO标准以前会被诊断为糖尿病。需要进行纵向研究以评估这些标准在识别糖尿病相关慢性并发症风险增加个体方面的价值。
