American Diabetes Association calls for testing all those over 45

BMJ 1997; 315 doi: (Published 05 July 1997) Cite this as: BMJ 1997;315:7
  1. Norra Macready
  1. California

    Everyone older than 45 should be tested for diabetes, an expert committee of the American Diabetes Association recommended last week. It also advised that diabetes should be diagnosed at a fasting plasma glucose concentration of 7.0 mmol/l (126 mg/dl) instead of 7.8 mmol/l (140 mg/dl), the previous cutoff point. These announcements came during the association's 57th annual scientific sessions in Boston.

    The committee based its recommendations on a two year review of more than 15 years' research. According to the chairman, James Gavin III: “We now have conclusive data from population based research that show that serious complications of diabetes begin earlier than previously thought. A value of 126 mg/dl on the … fasting plasma glucose test, confirmed by repeat testing on a different day, is a wake up call to patients and healthcare professionals that diabetes is present and cannot be ignored.”

    Members warned that eight million of the estimated 16 million Americans with diabetes remain undiagnosed. “These new guidelines will help us identify at least two million of these patients,” said Sherman Holvey, clinical professor of medicine at the University of California, Los Angeles School of Medicine. “The earlier we can confirm the presence of diabetes, the faster we can get people into treatment and minimise or avoid the devastating consequences of this disease.” The World Health Organisation plans to adopt similar recommendations.

    The committee also advised that insulin dependent and non-insulin dependent diabetes should now be called type 1 and type 2 diabetes. It was suggested that adopting these terms would remove the current anomaly of having so-called non-insulin dependent patients receiving insulin treatment.

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