Comparison of Fasting and 2-Hour Glucose and HbA1c Levels for Diagnosing Diabetes: Diagnostic criteria and performance revisited

作者：Michael Maurice Engelgau, Theodore J. Thompson, William H. Herman, James P. Boyle, Ronald E. Aubert, Susan J Kenny, Ahmed Badran, E.S. Sous, Mohamed A Ali · 发表于：Diabetes Care · 年份：1997 · DOI：10.2337/diacare.20.5.785 · 被引用次数：329 · 研究领域：Diabetes, Cardiovascular Risks, and Lipoproteins、Diabetes Treatment and Management、Diabetes Management and Research

OBJECTIVE: Nearly two decades ago, the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) Expert Committee on Diabetes Mellitus published diagnostic criteria for diabetes. We undertook this study to compare the performance of three glycemic measures for diagnosing diabetes and to evaluate the performance of the WHO criteria. RESEARCH DESIGN AND METHODS: In a cross-sectional population-based sample of 1,018 Egyptians > or = 20 years of age, fasting and 2-h glucose and HbA1c levels were measured, and diabetic retinopathy was assessed by retinal photograph. Evidence for bimodal distributions was examined for each glycemic measure by fitting models for the mixture of two distributions using maximum likelihood estimates. Sensitivity and specificity for cutpoints of each glycemic measure were calculated by defining the true diabetes state (gold standard) as 1) the upper (diabetic) component of the fitted bimodal distribution for each glycemic measure, and 2) the presence of diabetic retinopathy. Receiver operating characteristic (ROC) curves were constructed to determine the performance of the glycemic measures in detecting diabetes as defined by diabetic retinopathy. RESULTS: In the total population, the point of intersection of the lower and upper components that minimized misclassification for the fasting and 2-h glucose and HbA1c were 7.2 mmol/l (129 mg/dl), 11.5 mmol/l (207 mg/dl), and 6.7%, respectively. When diabetic retinopathy was used to define di...