Key result
Lowering the IFG cutoff to 5.6 mmol/L increases diabetes prediction sensitivity by ~24% but reduces specificity.
Why the study?
The effect of lowering the fasting plasma glucose threshold for impaired fasting glucose on its prevalence and the associated risk of developing diabetes in Koreans needed to be evaluated.
Does lowering the fasting plasma glucose diagnostic threshold for impaired fasting glucose from 6.1 mmol/L to 5.6 mmol/L improve the prediction of new-onset type 2 diabetes in Korean adults?
Cohort (n=7,211)
No
Does lowering the fasting plasma glucose diagnostic threshold for impaired fasting glucose from 6.1 mmol/L to 5.6 mmol/L improve the prediction of new-onset type 2 diabetes in Korean adults?
Answers are grounded in this paper and cite their sources.
Lowering the diagnostic threshold for impaired fasting glucose to 5.6 mmol/L substantially increases IFG prevalence in Koreans while improving sensitivity for predicting 2-year incident diabetes, supporting the 2003 ADA criteria.
PURPOSE: The aim of this study was to evaluate the effect of lowering the fasting plasma glucose (FPG) criteria for impaired fasting glucose (IFG) on the prevalence of IFG and the risk for the development of diabetes associated with IFG in Koreans. MATERIALS AND METHODS: A total of 7,211 subjects who had normal glucose tolerance (NGT) or IFG were recruited. Subjects were evaluated at baseline and after two years follow up. Clinical data including total cholesterol, FPG and blood pressure were examined. RESULTS: Lowering the criteria for IFG from 6.1 mmol/L (110 mg/dL) to 5.6 mmol/L (100 mg/dL) increased the prevalence of IFG from 6.6% (494 subjects) to 24.4% (1829 subjects). After the 2 years follow up period, 91 subjects (1.3%) developed diabetes. Twenty one (0.3%) subjects developed diabetes among 5,382 NGT subjects and 70 (3.8%) subjects developed diabetes among 1,829 IFG (5.6-7.0 mmol/L) subjects. Lowering the IFG threshold from 6.1 mmol/L to 5.6 mmol/L resulted in a 18.4% decrease in specificity and 23.9% increase in sensitivity for predicting diabetes. The baseline FPG for predicting the development of diabetes after 2 years at a point on the receiver operating characteristic curve that was closest to the ideal 100% sensitivity and 100% specificity was 5.7 mmol/L (103 mg/dL). CONCLUSION: Lowering the FPG criterion of IFG should have benefits in predicting new onset type 2 diabetes mellitus in Koreans. The economic and health benefits of applying the new IFG criteria should be evaluated in future studies.
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Kim et al. (2008) conducted a cohort in Normal glucose tolerance or impaired fasting glucose (n=7,211). Impaired fasting glucose defined by lowered ADA threshold (5.6-7.0 mmol/L or 100-125 mg/dL) vs. Normal glucose tolerance (<5.6 mmol/L) or old IFG threshold (6.1-7.0 mmol/L) was evaluated on Development of incident type 2 diabetes mellitus (FPG ≥7.0 mmol/L or prior diagnosis) after 2 years. Lowering the IFG threshold from 6.1 to 5.6 mmol/L increased IFG prevalence from 6.6% to 24.4% and increased sensitivity for predicting 2-year diabetes by 23.9% while decreasing specificity by 18.4%.
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