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Comparison of ADA and WHO screening methods for diabetes mellitus in obese patients
Author(s) -
Mannucci E.,
Bardini G.,
Ognibene A.,
Rotella C. M.
Publication year - 1999
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.1999.00116.x
Subject(s) - medicine , impaired glucose tolerance , diabetes mellitus , endocrinology , impaired fasting glucose , body mass index , glucose tolerance test , insulin resistance
Summary Aims To compare the performance of fasting glycaemia (FG) and oral glucose tolerance testing (OGTT) in screening for diabetes mellitus in obese patients. Methods A consecutive series of 528 (445 female, 83 male) obese (body mass index > 30 kg/m 2 ) outpatients, aged 45.2 ± 14.3 years, was studied with FG and OGTT. The association of categories of glucose tolerance (diabetes and impaired glucose tolerance (IGT)) and fasting glycaemia (diabetes and impaired fasting glucose (IFG)) with hypertension and hyperlipidaemia were also assessed. Results Prevalence of diabetes and IGT were 20.1 and 22.9%, respectively. FG (> 7 mmol/l) had a sensitivity of 56.7%. Using FG > 6.1 mmol/l, and OGTT in those above the threshold, the sensitivity for diabetes would have been 89.6%, with a positive predictive value of 59.0%, but 68.8% of cases of IGT would not have been detected. Patients with impaired fasting glucose (FG of 6.1–7.0 mmol/l) showed lower insulin sensitivity and impaired β cell function, and a weaker association to hypertriglyceridaemia, when compared to IGT. Conclusion FG > 7.0 mmol/l does not show a sufficient sensitivity for the screening of diabetes in obese patients. FG > 6.1 mmol/l has a satisfactory sensitivity for diabetes, but not for IGT. IFG has different pathophysiological features than IGT and cannot be assumed to have the same prognostic value of IGT.