Comparison of the effect of plasma glucose concentrations on microvasculardisease between Pima Indian youths and adults

OBJECTIVE - To examine whether the current adult guidelines for diagnosis o f diabetes are applicable to youth (age <20 years). RESEARCH DESIGN AND METHODS - We analyzed fasting plasma glucose (FPG) and 2-h plasma glucose (PG) in two groups of Pima Indians, youths aged 5-19 yea rs and adults aged 20-34 years, in relation to the incidence of microvascul ar disease when subjects were reexamined at ages 25-39 (youths) and 40-54 ( adults). Microvascular disease was defined as retinopathy or a urine protei n-to-creatinine ratio <greater than or equal to>0.5 g. RESULTS - An increase in the incidence of microvascular disease occurred at nearly the same level of glycemia in both groups. For youths, this increas e occurred at FPG similar to7.1 mmol/l and 2-h PG similar to 10.0 mmol/l; f or adults, this increase occurred at FPG similar to7.5 mmol/l and 2-h PG si milar to 10.3 mmol/l. Sensitivity of the adult diagnostic guidelines of FPG greater than or equal to7.0 mmol/l and 2-h PG greater than or equal to 11. 1 mmol/l for the detection of microvascular disease was much lower (with hi gher specificity) in youths than in adults. Receiver operating characterist ics (ROC) curve areas were lower for FPG and 2-h PG for youths, suggesting that microvascular disease was less strongly predicted by baseline glucose. CONCLUSION - The current adult guidelines for diagnosis of diabetes are app licable to youth, as they identify a population at high risk of microvascul ar complications.