DIAGNOSING DIABETES-MELLITUS - DO WE NEED NEW CRITERIA

The current classification and diagnostic criteria for diabetes mellit us were introduced by the United States National Data Group in 1979 an d endorsed by the World Health Organization in 1980, with modification s in 1985 and 1994. The criteria, chosen to reflect the risk of compli cations, were the synthesis of considerable thought and expertise and represented a consensus which, it was hoped, would prove helpful to al l those involved with diabetes practising clinician, research scientis t and epidemiologist alike. The inconvenience, variability and non-phy siological nature of the oral glucose tolerance test (OGTT) are well-r ecognised. In spite of these limitations the 2-h post-load plasma gluc ose has remained the standard against which all other tests have been evaluated. This article reviews the original justification for the OGT T, and in the light of more recent epidemiological research seeks to p lace the current diagnostic criteria for diabetes into a pathophysiolo gical, diagnostic and prognostic perspective.