Who Should Set the Standards for Diagnosing Diabetes?
Nov. 16, 1999 (Cleveland) -- Just two years after the American Diabetes Association (ADA) published new, simpler standards for diagnosing diabetes and classifying it in terms of its severity, researchers are saying that the simpler approach doesn't go far enough to identify people at risk of death from diabetes complications. In three articles published in a recent issue of the British medical journal The Lancet, the researchers call for returning to earlier standards developed by the World Health Organization (WHO).
One of the problems with the ADA standards, say the researchers, is that only fastingblood glucose (sugar) levels are tested -- no oral test is given to confirm abnormally high levels. This means that people at risk for serious complications from diabetes mellitus, such as heart disease and stroke, could be "missed," one of the researchers tells WebMD.
According to the ADA criteria, a fasting glucose measurement -- taken about eight hours after eating -- of 126 mg/dL or more merits a diagnosis of diabetes without the need for an oral glucose tolerance test. When used, the oral test involves taking blood samples two hours after the patient drinks a special glucose solution. The WHO standards for making a diabetes diagnosis are a fasting glucose concentration of 140 mg/dL or more and a blood glucose level of at least 200 mg/dL after oral testing.
"The ideal situation is to get both measurements done ... but if you have to choose one because you can't afford blood-drawing twice, the two-hour glucose tolerance test is preferable," says Jaakko Tuomilehto, MD, a researcher for the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study. Tuomilehto is with the National Public Health Institute in Helsinki, Finland.
The results from a second study -- the Cardiovascular Health Study, conducted in the United States -- provide further evidence that the ADA criteria may not go far enough, says researcher Joshua I. Barzilay, MD, of Kaiser Permanente of Georgia. Barzilay says the ADA criteria were developed based on the typical diabetes complications -- eye and kidney problems -- and don't address the other major health problems that can develop. "You have to understand that the ADA developed the criteria based on microvascular disease -- eye and kidney problems -- but macrovascular [or large blood vessel] disease is where one sees the big complications of diabetes in western societies," Barzilay tells WebMD. He agrees with Tuomilehto that an oral glucose tolerance test is preferable if only one test can be done.
Who Should Set the Standards for Diagnosing Diabetes?
Nov. 16, 1999 (Cleveland) -- Just two years after the American Diabetes Association (ADA) published new, simpler standards for diagnosing diabetes and classifying it in terms of its severity, researchers are saying that the simpler approach doesn't go far enough to identify people at risk of death from diabetes complications. In three articles published in a recent issue of the British medical journal The Lancet, the researchers call for returning to earlier standards developed by the World Health Organization (WHO).
One of the problems with the ADA standards, say the researchers, is that only fastingblood glucose (sugar) levels are tested -- no oral test is given to confirm abnormally high levels. This means that people at risk for serious complications from diabetes mellitus, such as heart disease and stroke, could be "missed," one of the researchers tells WebMD.
According to the ADA criteria, a fasting glucose measurement -- taken about eight hours after eating -- of 126 mg/dL or more merits a diagnosis of diabetes without the need for an oral glucose tolerance test. When used, the oral test involves taking blood samples two hours after the patient drinks a special glucose solution. The WHO standards for making a diabetes diagnosis are a fasting glucose concentration of 140 mg/dL or more and a blood glucose level of at least 200 mg/dL after oral testing.
"The ideal situation is to get both measurements done ... but if you have to choose one because you can't afford blood-drawing twice, the two-hour glucose tolerance test is preferable," says Jaakko Tuomilehto, MD, a researcher for the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study. Tuomilehto is with the National Public Health Institute in Helsinki, Finland.
The results from a second study -- the Cardiovascular Health Study, conducted in the United States -- provide further evidence that the ADA criteria may not go far enough, says researcher Joshua I. Barzilay, MD, of Kaiser Permanente of Georgia. Barzilay says the ADA criteria were developed based on the typical diabetes complications -- eye and kidney problems -- and don't address the other major health problems that can develop. "You have to understand that the ADA developed the criteria based on microvascular disease -- eye and kidney problems -- but macrovascular [or large blood vessel] disease is where one sees the big complications of diabetes in western societies," Barzilay tells WebMD. He agrees with Tuomilehto that an oral glucose tolerance test is preferable if only one test can be done.
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