BMJ 1999;318:531 ( 20 February )

Letters

New diagnostic criteria for diabetes mellitus

    New criteria result in fewer cases in older adults
    Subjects with impaired glucose tolerance but normal fasting values will not be identified
    Prevalence is reduced using these criteria rather than 1985 WHO criteria
    A way of identifying all those at risk of long term complications of diabetes is still needed
    The reanalysis by the DECODE Study Group needs to be reanalysed
    Authors' reply

New criteria result in fewer cases in older adults

The first 150 words of the full text of this article appear below.

EDITOR---The DECODE Study Group's paper on the implications of the American Diabetes Association's (ADA) recent changes in diagnostic criteria for diabetes mellitus raises several issues.1

The World Health Organisation's definition of diabetes that was used in the American report included both fasting glucose concentrations and concentrations 2 hours after a glucose load.2 In the DECODE paper, however, WHO criteria were defined by the glucose concentration after challenge alone. This difference in definition of the WHO criteria may help to explain why changes in prevalence estimates of diabetes presented in the DECODE paper differ from findings in the American report. A reanalysis of data using consistent definitions would be desirable.

More important questions stem from the DECODE Study Group's finding that the prevalence of diabetes in older adults will increase substantially with the ADA criteria. We believe that the opposite is likely to happen. Most people who have fasting glucose . . . [Full text of this article]
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Relevant Article

Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data
DECODE Study Group
BMJ 1998 317: 371-375. [Abstract] [Full Text] [PDF]

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