Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans
Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans
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DOI：
10.1046/j.1464-5491.2002.00783.x
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发表时间：
2002-10-01
影响因子：
3.5
通讯作者：
Baik, SH
中科院分区：
文献类型：
--
作者：
Choi, KM;Lee, J;Baik, SH
目的 本研究采用世界卫生组织 (WHO) 和美国糖尿病协会 (ADA) 标准，比较韩国老年人群中不同类别葡萄糖耐量的患病率和心血管危险因素。 方法 本研究纳入 1456 名 60 岁以上的非糖尿病受试者，这些受试者选自 1999 年在韩国首尔进行的一项横断面研究。检查空腹和攻击后 2 小时血浆葡萄糖、胰岛素水平、体重指数 (BMI)、腰臀比 (WHR)、血压和血脂情况。使用 WHO 2 小时标准和 ADA 禁食标准获得了葡萄糖耐量类别的患病率和一致性水平（kappa 统计）。对几个一致和不一致的糖耐量组之间的心血管危险因素进行了比较。结果按WHO 2小时标准和ADA空腹标准定义的老年男性新诊断糖尿病的患病率分别为11.8%和4.8%。根据世界卫生组织 2 小时标准，老年女性的这一比例为 8.1%，根据 ADA 禁食标准，这一比例为 3.1%。根据 WHO 标准，糖耐量受损 (IGT) 的患病率也高于根据 ADA 标准的空腹血糖受损 (IFG) 患病率（男性为 23.5%，男性为 10.0%，女性为 23.7%，女性为 7.5%）。 ADA 禁食标准与 WHO 2 小时标准之间的一致性程度较低（男性加权 kappa = 0.228，女性加权 kappa = 0.301）。根据 ADA 禁食标准和 WHO 2 小时标准，一致的糖尿病女性显示出比一致的正常受试者更高的 BMI、腰臀比、舒张压、总胆固醇和甘油三酯水平。然而，除了 BMI 之外，孤立的攻击后高血糖 (IPH) 女性组与一致的正常女性组没有显着差异。 结论 我们的结果清楚地表明，在韩国老年人中，1997 年 ADA 禁食标准对于诊断糖尿病的敏感性低于基于口服葡萄糖耐量试验 (OGTT) 的 WHO 标准。此外，ADA 和 WHO 标准之间不同类别的葡萄糖耐量的一致性较差；因此，OGTT 仍然是诊断糖尿病和对各种类型的葡萄糖不耐症进行分类的有价值的测试，特别是对于韩国老年人来说。
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 (kappa 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 kappa = 0.228 men, weighted kappa = 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.