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Clinical impact of borderline and undiagnosed diabetes mellitus in patients with coronary artery disease

      The prevalence of type 2 diabetes continues to increase in developed countries.

      Diabetes Statistics. National Diabetes Information Clearinghouse. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, NIH publication 1999:99–3926.

      ,
      • Burke J.P.
      • Williams K.
      • Gaskill S.P.
      • Hazuda H.P.
      • Haffner S.M.
      • Stern M.P.
      Rapid rise in the incidence of type 2 diabetes from 1987 to 1996 results from the San Antonio Heart Study.
      This indicates the expanding importance of diabetes as a cause of morbidity and mortality. Recent studies also have shown a widespreading of unrecognized and untreated diabetes mellitus in general populations.

      Diabetes Statistics. National Diabetes Information Clearinghouse. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, NIH publication 1999:99–3926.

      ,
      • Oswald G.A.
      • Corcoran S.
      • Yudkin J.S.
      Prevalence and risks of hyperglycaemia and undiagnosed diabetes in patients with acute myocardial infarction.
      ,
      • Madsen J.K.
      • Haunsoe S.
      • Helquist S.
      • Hommel E.
      • Malthe I.
      • Pedersen N.T.
      • Sengelov H.
      • Ronnow-Jessen D.
      • Telmer S.
      • Parving H.H.
      Prevalence of hyperglycaemia and undiagnosed diabetes mellitus in patients with acute myocardial infarction.
      ,
      • Behar S.
      • Boyko V.
      • Benderly M.
      • Mandelzweig L.
      • Graff E.
      • Reicher-Reiss H.
      • Schneider H.
      • Shotan A.
      • Balkin J.
      • Brunner D.
      • Goldbourt U.
      BIP Study Group
      Asymptomatic hyperglycemia in coronary heart disease frequency and associated lipid and lipoprotein levels in the Bezafibrate Infarction Prevention (BIP) register.
      However, data regarding the prevalence of undiagnosed diabetes in so-called “well-characterized” coronary patients are scarce. In 1997, the American Diabetes Association (ADA) adopted new criteria for detection of diabetes.
      American Diabetes Association
      Report of the expert committees on the diagnosis and classification of diabetes mellitus.
      The major changes in comparison with World Health Organization (WHO) criteria

      World Health Organization Expert Committee on Diabetes Mellitus. Second Report. Series No. 646. Geneva: WHO, 1980.

      are establishing a fasting blood glucose (FBG) ≥126 mg/dl instead of 140 mg/dl for the diagnosis, and the suggestion that oral glucose tolerance tests are not needed in routine practice for the diagnosis of diabetes. The major purpose of the ADA criteria was to help resolve the problem of undiagnosed diabetes using more aggressive and simple screening. These modifications were justified on the basis of the incidence and prevalence of diabetic retinopathy without analysis of their implications on mortality. The application of the ADA criteria on American, Asian, European, and other populations induced changes in the prevalence of diabetes ranging from a reduction of 4% to an increase of 13%.

      DECODE Study Group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. DECODE Study Group on behalf of the European Diabetes Epidemiology Study Group. Br Med J 1998;317:371–375.

      ,
      • Harris M.I.
      • Flegal K.M.
      • Cowie C.C.
      • Eberhardt M.S.
      • Goldstein D.E.
      • Little R.R.
      • Wiedmeyer H.M.
      • Byrd-Holt D.D.
      Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey 1988–1994.
      ,
      • Li C.L.
      • Tsai S.T.
      • Chou P.
      Comparison of the results between two diagnostic criteria by ADA and WHO among subjects with FPG 5.6–7.8 mmol/l in Kin-Hu and Kin-Chen, Kinmen, 1991–1994.
      Whether WHO or ADA criteria can better identify persons at risk for increased mortality in different populations as well as long-term prognosis of the newly recognized borderline diabetic person with FBG 126 to 139 mg/dl are unknown.
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