Comparison of the diagnostic criteria for diabetes mellitus, WHO-1985, ADA-1997 and WHO-1999 in the adult population of Asturias (Spain)

• Published in: Diabetic medicine Vol. 20; no. 11; pp. 904 - 908
• Main Authors: Botas, P., Delgado, E., Castaño, G., Díaz de Greñu, C., Prieto, J., Díaz-Cadórniga, F. J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2003; Blackwell
• Subjects: 2-h oral glucose tolerance test; Adult; Biological and medical sciences; Blood Glucose - analysis; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; diagnostic criteria; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Glucose Tolerance Test; Humans; Mass Screening - methods; Medical sciences; Middle Aged; Practice Guidelines as Topic - standards; Prevalence; screening; Sensitivity and Specificity; Societies, Medical; Spain - epidemiology; Type 2 diabetes mellitus; United States; World Health Organization; Europe; Spain; United States; Endocrinopathy; Human; Type 2 diabetes; diagnostic criteria; screening; Oral administration; 2-h oral glucose tolerance test; Glucose tolerance test; Type 2 diabetes mellitus; Medical screening; Epidemiology; Adult; Diagnosis; Comparative study
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1046/j.1464-5491.2003.01006.x

Aims  To estimate the prevalence of diabetes mellitus with three diagnostic criteria (WHO‐1985 and 1999 and ADA‐1997), evaluate their concordance and analyse the sensitivity and specificity of the different screening strategies for diabetes. Methods  A cross‐sectional population study with two‐step sampling. One thousand and 34 people were selected randomly. A 75‐g oral glucose tolerance test (OGTT) was performed and venous blood samples were obtained fasting and at 2 h. Results  The prevalence of known Type 2 diabetes mellitus (DM‐2) is 4%[95% confidence interval (CI) 2.8, 5.1]. By WHO‐1985 criteria the prevalence of unknown DM‐2 is 5.9% (4.5, 7.4); by ADA‐1997 criteria 3.5% (2.5, 4.6) and by WHO‐1999 criteria 7.3% (5.8, 8.8). Diagnostic overlap and statistical concordance (coefficient K) are WHO‐1985/ADA‐1997 29.3%, K = 0.42; WHO‐1985/WHO‐1999 80%, K = 0.88; ADA‐1997/WHO‐1999 48%, K = 0.63. If only fasting glucose was used (following ADA‐1997), 36.3% of those with diabetes (2‐h glucose ≥ 11.1 mmol/l) would be diagnosed. If OGTT was performed (i) in those with a fasting glucose between 6.1 mmol/l and 6.9 mmol/l (9.8% of the population) we would diagnose 66.6%, and (ii) in all those between 5.7 mmol/l and 6.9 mmol/l (18.9% of the population) 81.8% would be diagnosed. Conclusions  The ADA criteria decrease the prevalence of DM in the adult population of Asturias by 2.4% and concordance with the classical criteria (WHO‐1985) was only 29.3%. Using fasting glucose only (ADA‐1997) diagnoses 36.3% of those with diabetes. The recent recommendations of the WHO‐1999 increases this to 66.6%. To improve the diagnostic strategy for diabetes and detect up to 81.8% of patients, we propose the use of OGTT for all those with a fasting glucose between 5.7 mmol/l and 6.9 mmol/l.