Diagnostic Criteria for Diabetes Mellitus and Prediabetes

Abstract

Recent estimates indicate there were 171 million people in the world with diabetes in the year 2000 and this is projected to increase to 366 million by 2030 Diabetes is a condition primarily defined by the level of hyperglycaemia giving rise to risk of microvascular damage (retinopathy, nephropathy and neuropathy). It is associated with reduced life expectancy, significant morbidity due to specific diabetes related microvascular complications, increased risk of macrovascular complications (ischaemic heart disease, stroke and peripheral vascular disease), and diminished quality of life. The American Diabetes Association (ADA) estimated the national costs of diabetes in the USA for 2002 to be $US 132 billion, increasing to $US 192 billion in 2020.
Since 1965 the World Health Organization (WHO) has published guidelines for the diagnosis and classification of diabetes. These were last reviewed in 1998 and were published as the guidelines for the Definition, Diagnosis and Classification of Diabetes Mellitus3. Since then more information relevant to the diagnosis of diabetes has become available. In addition, in 2003, the ADA reviewed its diagnostic criteria4. While the criteria for the diagnosis of diabetes and Impaired Glucose Tolerance (IGT) remained unchanged, the ADA recommended lowering the threshold for Impaired Fasting Glucose (IFG) from 6.1mmol/l (110mg/dl) to 5.6mmol/l (100mg/dl)4. In view of these developments WHO and the International Diabetes Federation (IDF) decided that it was timely to review its existing guidelines for the definition and diagnosis of diabetes and intermediate hyperglycaemia.