Research article

Diagnostic criteria for diabetes revisited: making use of combined criteria

Ali Parappil¹ , Suhail AR Doi^2,3 and Kamal AS Al-Shoumer^2,3

¹Division of Medicine, Jahra Hospital, Kuwait

²Division of Endocrinology and metabolic medicine, Faculty of Medicine, Kuwait

³Mubarak Al-Kabeer Hospital, Jabriya, Kuwait

author email corresponding author email

BMC Endocrine Disorders 2002, 2:1doi:10.1186/1472-6823-2-1

Published:	1 February 2002

Abstract

Background

Existing cut-offs for fasting plasma glucose (FPG) and post-load glucose (2hPG) criteria are not equivalent in the diagnosis of diabetes and glucose intolerance. Adjusting cut-offs of single measurements have not helped so we undertook this project to see if they could be complementary.

Methods

We performed oral glucose tolerance tests and mean levels of hemoglobin A1c (HbA1c) measurements on 43 patients referred to a diabetes clinic for possible diabetes. Results of single and combined use of the FPG and 2hPG criteria were evaluated against the levels of HbA1c and results re-interpreted in the light of existing reports in the literature.

Results

Our results confirm that the FPG and the 2hPG, being specific and sensitive respectively for the presence of glucose intolerance or diabetes, are not equivalent. They are shown to be indeed complementary and a re-definition of diagnostic criteria based on their combined use is proposed.

Conclusions

We conclude that altering single measurement cut-offs for the diagnosis of diabetes and altered glucose tolerance will not result in better outcomes. We present the case for a combined criteria in the diagnosis and definition of diabetes with a FPG≥7 mmol/L AND 2-hour glucose ≥7.8 mmol/L being used to define diabetes while a FPG<7 mmol/L AND 2-hour glucose <7.8 mmol/L being used to define normality. Discordant values will define impaired glucose tolerance (IGT). This proposal requires prospective evaluation in a large cohort.