Korean J Intern Med.  2000 Jan;15(1):37-41.

Comparison of glucose tolerance categories in the Korean population according to World Health Organization and American Diabetes Association diagnostic criteria

• Park KS
• Shin CS
• Park YS
• Park DJ
• Koh JJ
• Kim SY
• Lee HK

Abstract

OBJECTIVES
To compare the prevalence and metabolic profiles of glucose tolerance categories according to World Health Organization(WHO) and 1997 American Diabetes Association(ADA) fasting criteria for the diagnosis of diabetes mellitus and impaired glucose metabolism in the Korean population. METHODS: 2251 subjects without previous history of diabetes, who participated in the Yonchon diabetes epidemiology survey in 1993, were classified according to both criteria. The prevalence of glucose tolerance categories and the agreement across all categories of glucose tolerance were calculated. Metabolic characteristics of different glucose tolerance categories were compared. RESULTS: The prevalence of diabetes and impaired fasting glucose(IFG) according to ADA fasting criteria was similar to those of diabetes and impaired glucose tolerance(IGT) according to WHO criteria, respectively. However, 35.5+ACU- of the subjects who were diagnosed as diabetes by WHO criteria were reclassified as either IFG or normal fasting glucose (NFG), and 38.5+ACU- of diabetic patients according to ADA fasting criteria were IGT or normal glucose tolerance (NGT) by WHO criteria. Only 31.3+ACU- of IGT subjects remained as IFG and 62.1+ACU- were reclassified as NFG. Similarly, 69.4+ACU- of IFG subjects were NGT by WHO criteria. The agreement between the two criteria was poor (K +AD0- 0.31). Discordant diabetes groups had higher WHR, systolic and diastolic blood pressure, cholesterol and triglyceride levels than concordant non-diabetes group. Non-diabetes(WHO)/diabetes(ADA) group had higher WHR than diabetes (WHO)/non-diabetes(ADA) group. There were no differences in other metabolic characteristics between the two discordant diabetes groups. IGT/NFG and NGT/IFG group showed higher BMI, WHR, systolic and diastolic blood pressure, cholesterol and triglyceride levels than NGT/NFG group. Metabolic characteristics of IGT/NFG group were not different from those of NGT/IFG group except IGT/NFG subjects were older than NGT/IFG subjects. CONCLUSION: The agreement between WHO and ADA fasting criteria was poor. ADA fasting criteria can detect new diabetic patients and subjects with impaired glucose metabolism who are not classified as diabetes or IGT by WHO criteria. However, a substantial number of subjects, who may have increased cardiovascular risk and/or increased risk for the development of diabetes and its complication, will be missed when using ADA fasting criteria.

Keyword

diagnosis; diabetes mellitus; impaired glucose tolerance; impaired fasting glucose; fasting plasma glucose

MeSH Terms

Adult
Aged
Blood Glucose/analysis+ACo-
Comparative Study
Diabetes Mellitus/metabolism
Diabetes Mellitus/epidemiology+ACo-
Diabetes Mellitus/diagnosis+ACo-
Female
Glucose Tolerance Test
Human
Korea/epidemiology
Male
Middle Age
Population Surveillance
Prevalence
Probability
Reproducibility of Results
Sensitivity and Specificity
United States
Voluntary Health Agencies
World Health Organization