Lowering the Criterion for Impaired Fasting Glucose

Impact on disease prevalence and associated risk of diabetes and ischemic heart disease

  1. E. Shyong Tai, MB, CHB12,
  2. Su Yen Goh, MB, BS1,
  3. Jeannette J.M. Lee, MB, BS2,
  4. Moh-Sim Wong, MB, BS3,
  5. Derrick Heng, MB, BS45,
  6. Kenneth Hughes, PHD6,
  7. Suok Kai Chew, MSC4,
  8. Jeffery Cutter, MSC4,
  9. William Chew, MB, BS3,
  10. Ken Gu, PHD5,
  11. Kee Seng Chia, MD2 and
  12. Chee Eng Tan, PHD12
  1. 1Department of Endocrinology, Singapore General Hospital, Singapore
  2. 2NUS-GIS Centre for Molecular Epidemiology, National University of Singapore, Singapore
  3. 3Department of Medicine, Alexandra Hospital, Singapore
  4. 4Epidemiology and Disease Control Division, Ministry of Health, Singapore
  5. 5Clinical Trials and Epidemiology Unit, National Medical Research Council, Singapore
  6. 6Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore
  1. Address correspondence and reprint requests to Dr. E. Shyong Tai, Department of Endocrinology, Block 6 level 6, Room B35, Singapore General Hospital, Outram Road, Singapore 169608, Republic of Singapore. E-mail: eshyong{at}pacific.net.sg

Abstract

OBJECTIVE—To determine the effect of lowering the fasting plasma glucose (FPG) criterion for impaired fasting glucose (IFG) on the prevalence of IFG, the risks of diabetes, and cardiovascular disease (CVD) associated with IFG.

RESEARCH DESIGN AND METHODS—Three studies were used: 1) the 1998 National Health Survey (NHS98), a randomly selected cross-sectional sample of 4,723 subjects; 2) the Singapore Impaired Glucose Tolerance (IGT) Follow-up Study, a cohort study comprising 295 IGT and 292 normal glucose tolerance subjects (frequency matched for age, sex, and ethnic group) followed up from 1992 to 2000; and 3) the Singapore CVD Cohort Study, comprising 5,920 subjects from three cross-sectional studies in whom the first ischemic heart disease (IHD) event was identified through linkage to registry databases. Risk of diabetes (Singapore IGT Follow-up study) was estimated using logistic regression adjusted for age, sex, and ethnicity. Risk of IHD (Singapore CVD cohort) was estimated using stratified (by study, from which data were derived) Cox’s proportional hazards models adjusted for age, sex, and ethnicity.

RESULTS—Lowering the criterion for diagnosing IFG to 5.6 mmol/l increased the prevalence of IFG from 9.5 to 32.3% in the NHS98. The lower cutoff identified more subjects at risk of diabetes and IHD, but the relative risk was lower than that for IGT.

CONCLUSIONS—Greater efforts to identify those with IGT, or a group at similar risk of diabetes and CVD, may be a more efficient public health measure than lowering the FPG criterion for diagnosing IFG.

Footnotes

  • Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted March 26, 2004.
    • Received October 4, 2003.
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This Article

  1. doi: 10.2337/diacare.27.7.1728 Diabetes Care July 2004 vol. 27 no. 7 1728-1734
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