WHO and ADA criteria for the diagnosis of diabetes mellitus in relation to body mass index. Insulin sensitivity and secretion in resulting subcategories of glucose tolerance

Abstract

OBJECTIVE:To determine the influence of body mass index (BMI) on agreement between the American Diabetes Association (ADA) and the new World Health Organization diagnostic criteria for the diagnosis of diabetes mellitus and to investigate the metabolic profile of the resulting subcategories. DESIGN: Cross-sectional study SUBJECTS: A total of 3018 subjects with no previous history of diabetes and fasting glucose < 7.8 mmol=l, with a wide range of BMIs. MEASUREMENTS: (1) Prevalence of impaired glucose regulation (IGR) and diabetes (DM) according to ADA and WHO diagnostic criteria; (2) basal and post-load insulin sensitivity and secretion, calculated on the basis of data derived from an oral glucose tolerance test (OGTT). RESULTS: The diagnosis according to the two classifications was concordant in 2490 subjects, discordant in 528 (452 were identified as impaired glucose tolerance (IGT) and 76 as DM only by means of OGTT). The disagreement increased with increasing BMI, being as high as 25.3% in subjects with BMI ! 35 kg=m 2 . Subjects with isolated fasting hyperglycaemia were mainly characterised by reduced insulin sensitivity and secretion in the basal state, but normal first-phase insulin secretion and moderately reduced insulin sensitivity after glucose challenge. Subjects with isolated 2 h hyperglycaemia were mainly characterised by normal basal insulin secretion and by a marked insulin resistance associated with a blunted first-phase insulin secretion after the glucose load. CONCLUSIONS:The disagreement between ADA and WHO classifications is particularly relevant in obesity, making OGTT mandatory in these subjects. Different pathogenic mechanisms are involved in isolated fasting or post-load hyperglycaemia, possibly related to a different site of insulin resistance (hepatic vs peripheral), and=or to a different disregulation of insulin secretion (basal vs post-load). A correct identification of the underlying mechanism(s) is the rationale for future studies to detect the effectiveness of different pharmacological or behavioural approaches.

Diagnostic Strategies to Detect Glucose Intolerance in a Multiethnic Population

“…This is consistent with the observations of other comparisons of the ADA to WHO criteria. For example, the 10 most recent studies we identified in which the ADA criteria were compared with other criteria, the sensitivity ranged from as low as 31% in a an obese French population to as high as 79% in Canarian Caucasians (13,14,(25)(26)(27)(28)(29)(30)(31)(32) (Table 6). We identified two cut-off values (fasting plasma glucose Ն5.7 mmol/l and an HbA 1c Ն5.9%) that minimize the number of false positives and false negatives.…”

Fasting Serum Lipid and Dehydroepiandrosterone Sulfate as Important Metabolites for Detecting Isolated Postchallenge Diabetes: Serum Metabolomics via Ultra-High-Performance LC-MS

“…There are different pathogenic mechanisms underlying IPD and T2DM (FPG Ն126 mg/dL [Ն7.0 mmol/L] and 2-h PG Ն200 mg/dL [Ն11.1 mmol/L]) (17 ). IPD is characterized by increased peripheral insulin resistance and reduced first-phase insulin secretion, and T2DM by progressive increase in peripheral and hepatic insulin resistance and reduced basal and first-phase insulin secretion (17 ), signifying that T2DM is a more serious metabolic disturbance than IPD. We detected higher insulin concentrations in T2DM than IPD cases (Table 1), which may be the basis for more serious disorders of lipid, steroid hormone, and glucose metabolism in these patients.…”

The Effect of a Silybin-Vitamin E-Phospholipid Complex on Nonalcoholic Fatty Liver Disease: A Pilot Study

“…(2) Liver US and plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ -glutamyl transpeptidase (γ -GT), blood glucose, and insulin were determined using commercial kits. Insulin resistance was calculated by the HOMA test [32]. Adverse events were evaluated from the questionnaire, which reported signs and symptoms graded from mild to severe, possible association of symptoms with the treatment, the method used for resolution, and the necessity to stop the treatment.…”