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Counterpoint: Impaired Fasting Glucose: The Case Against the New American Diabetes Association Guidelines

¹ Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands
² INSERM U258, Villejuif, France

Address correspondence to Jacqueline M. Dekker, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands. E-mail: jm.dekker@vumc.nl

The first 300 words of the full text of this article appear below.

Definitions of diabetes and impaired fasting glucose

The clinical symptoms of type 2 diabetes were described in 1500 BC (1). Until today, diabetes in clinical practice is still often diagnosed when patients present with symptoms. With increasing knowledge of the pathophysiology of the disease, the diagnosis of diabetes was based on the presence of hyperglycemia. Since 1979, internationally accepted definitions and diagnostic cut points for diabetes have been available (Table 1) (2–4). The initial cut points were based on the sharp increase of the prevalence of microvascular disease with increasing glucose. Diagnostic cut points were based on fasting glucose, as well as on glucose concentration 2 h after a 75-g oral glucose tolerance test (OGTT). The OGTT further allowed the identification of a category termed "impaired glucose tolerance" (IGT), which infers a very high risk of diabetes. The OGTT, however, turned out to be problematic in clinical practice, as it is little used. It has become a measure that is mainly used in clinical research. Therefore, in 1997, the American Diabetes Association (ADA) introduced a new definition that no longer required an OGTT (3). The cut point of fasting glucose was lowered with the expectation that most of the subjects with diabetic postload glucose levels would be captured with this lower cut point. In addition, a new category with high risk of diabetes was introduced, termed "impaired fasting glucose" (IFG), again with the expectation that most subjects with IGT would also have IFG.

The prevalence of IFG

IFG and risk of diabetes

IFG and risk of all-cause and CVD mortality

Public health implications

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