Relationships of fasting and postload glucose levels to sex and alcohol consumption - Are American Diabetes Association criteria biased against detection of diabetes in women?

OBJECTIVE - To compare, in men and women, the prevalence of undiagnosed typ e 2 diabetes assessed using criteria from the American Diabetes Association (ADA) and the World Health Organization (WHO) and to investigate risk fact ors associated with fasting and 2-h postload plasma glucose. RESEARCH DESIGN AND METHODS - Data from two companion surveys of Europeans, South Asians, and Afro-Caribbeans in west London were used. A total of 4,3 67 men and women aged 40-64 years who were not known to have diabetes under went an oral glucose tolerance test after an overnight fast. The prevalence of undiagnosed diabetes was estimated using the ADA (fasting plasma glucos e greater than or equal to 7.0 mmol/l) and WHO (2-h postload glucose greate r than or equal to 11.1 mmol/l) criteria for epidemiologic studies. The ass ociation of body fat and usual alcohol intake with plasma glucose and diabe tes prevalence was assessed. RESULTS - Compared with the WHO criterion, the ADA criterion gave a higher prevalence of diabetes in men (6.4 vs. 4.7%) but a lower prevalence in wome n (3.3 vs. 4.2%). In Afro-Caribbeans, the sex difference in diabetes preval ence was reversed. Women had significantly lower fasting glucose than men d espite higher 2-h glucose levels. Alcohol intake was positively associated with fasting glucose in men and women but not with 2-h glucose levels. CONCLUSIONS - The new ADA criterion, based on fasting glucose alone, does n ot take account of sex differences in metabolic response to fasting or poss ible artifactual effects on fasting glucose. With the ADA criterion, alcoho l intake was a significant risk factor for diabetes in our study population ; this was not the case with the WHO criterion.