The American Diabetes Association and World Health Organization Classifications for Diabetes
Their impact on diabetes prevalence and total and cardiovascular disease mortality in elderly Japanese-American men
- Beatriz L. Rodriguez, MD, PHD1,
- Robert D. Abbott, PHD2,
- Wilfred Fujimoto, MD3,
- Beth Waitzfelder1,
- Randi Chen, MS1,
- Kamal Masaki, MD1,
- Irwin Schatz, MD1,
- Helen Petrovitch, MD1,
- Webster Ross, MD4,
- Katsuhiko Yano, MD1,
- Patricia L. Blanchette, MD1 and
- J. David Curb, MD1
- 1Division of Clinical Epidemiology and the Departments of Geriatric Medicine and Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, the Pacific Health Research Institute and the Kuakini Medical Center, Honolulu, Hawaii
- 2Division of Biostatistics and Epidemiology, University of Virginia School of Medicine, Charlottesville, Virginia
- 3Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington
- 4Department of Veterans Affairs, Honolulu, Hawaii
Abstract
OBJECTIVE—To compare the prevalence of diabetes according to the American Diabetes Association (ADA) and World Health Organization (WHO) classifications in a sample of elderly Japanese-American men; to examine the association with total and cardiovascular mortality by diabetes status using both classifications; and to determine whether the fasting or 2-h glucose measurement is a stronger predictor of adverse outcomes.
RESEARCH DESIGN AND METHODS—Examinations given from 1991 to 1993 in the Honolulu Heart Program were used as baseline for these analyses. Subjects were 71–93 years of age at that time and were followed for total and cardiovascular disease mortality for up to 7 years.
RESULTS—A total of ∼66% of individuals who had diabetes by WHO criteria were missed when the ADA definition was used. The relative risks of total and cardiovascular mortality for those with versus those without diabetes were similar for both definitions; however, when fasting and postload glucose measures were analyzed as continuous variables, the 2-h measurement was a superior predictor and was independent of fasting glucose. In contrast, fasting glucose was not an independent predictor of these outcomes in the presence of the 2-h measurement.
CONCLUSIONS—The prevalence of glucose metabolism abnormalities was very high among elderly Japanese-American men. The WHO classification was superior to the ADA classification in identification of subjects at high risk for adverse outcomes. Therefore, we conclude that the 2-h glucose measurement is valuable and should be retained in epidemiologic studies.
- ADA, American Diabetes Association
- OGTT, oral glucose tolerance test
- RR, relative risk
- WHO, World Health Organization
Footnotes
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Address correspondence and reprint requests to Beatriz L. Rodriguez, MD, PhD, Pacific Health Research Institute, 846 S. Hotel St, Suite 306, Honolulu, HI 96813. E-mail: beatriz{at}phri.hawaii-health.com.
Received for publication 26 October 2001 and accepted in revised form 12 March 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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