Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans

Kyung Mook Choi, Juneyoung Lee, D. R. Kim, S. K. Kim, D. H. Shin, Nan Hee Kim, I. B. Park, D. S. Choi, Sei-Hyun Baik

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Abstract

Aims: This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. Methods: This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist-hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (κ statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. Results: The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted κ = 0.228 men, weighted κ = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. Conclusions: Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.

Original languageEnglish
Pages (from-to)853-857
Number of pages5
JournalDiabetic Medicine
Volume19
Issue number10
DOIs
Publication statusPublished - 2002 Oct 29

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Fasting
Glucose Intolerance
Glucose
Body Mass Index
Waist-Hip Ratio
Glucose Tolerance Test
Blood Pressure
Korea
Hyperglycemia
Triglycerides
Cross-Sectional Studies
Cholesterol
Insulin
Lipids
Population

Keywords

  • ADA fasting criteria
  • Diabetes
  • Korean
  • Oral glucose tolerance test
  • WHO 2-h criteria

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans. / Choi, Kyung Mook; Lee, Juneyoung; Kim, D. R.; Kim, S. K.; Shin, D. H.; Kim, Nan Hee; Park, I. B.; Choi, D. S.; Baik, Sei-Hyun.

In: Diabetic Medicine, Vol. 19, No. 10, 29.10.2002, p. 853-857.

Research output: Contribution to journalArticle

Choi, Kyung Mook ; Lee, Juneyoung ; Kim, D. R. ; Kim, S. K. ; Shin, D. H. ; Kim, Nan Hee ; Park, I. B. ; Choi, D. S. ; Baik, Sei-Hyun. / Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans. In: Diabetic Medicine. 2002 ; Vol. 19, No. 10. pp. 853-857.
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AU - Kim, Nan Hee

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AU - Choi, D. S.

AU - Baik, Sei-Hyun

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N2 - Aims: This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. Methods: This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist-hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (κ statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. Results: The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted κ = 0.228 men, weighted κ = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. Conclusions: Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.

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