Reduced prevalence of diabetes according to 1997 American Diabetes Association criteria

Aims/hypothesis. We examined the prevalence of diabetes and investigated th e characteristics of subjects diagnosed by the American Diabetes Associatio n and the World Health Organization criteria. Methods. A total of 1235 Japanese-Americans living in Hawaii and Los Angele s was studied. Of the subjects 114 were classified as previously diagnosed as having diabetes. A 75-g glucose tolerance test was given to the rest of the subjects. Results. When abnormal glucose tolerance was diagnosed by the American Diab etes Association criteria, it was possible to identify only 40% of diabetic subjects who had not been previously diagnosed compared with the current W orld Health Organization criteria based on a glucose tolerance test. In add ition, the subjects identified by the American Diabetes Association criteri a had higher glucose concentrations and had less insulin secretory capacity and they were in need of intensive treatment for diabetes. On the other ha nd, the subjects not diagnosed by the American Diabetes Association criteri a alone were those whose glucose tolerance would be more likely to improve with lifestyle modification. Conclusion/interpretation, It might be better to use the fasting plasma glu cose criterion advocated by the American Diabetes Association in combinatio n with a glucose tolerance test after taking a detailed medical history. To reduce the number of subjects requiring the glucose tolerance test, priori ty should be given to subjects with impaired fasting glucose (6.1 less than or equal to fasting plasma glucose <7.0 mmol/l).