Diagnostic Criteria For Diabetes Mellitus

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Prior to 1979, various criteria existed, and there was no consensus on how to diagnose diabetes (33). In 1979, the National Diabetes Data Group developed guidelines for diagnosing diabetes mellitus and impaired glucose tolerance, which were adopted by the American Diabetes Association in 1993 (33). According to these guidelines, diabetes was diagnosed when: 1) there was unequivocal elevation of plasma glucose (> 200 mg/dl [11.1 mmol/l]) and presence of classic symptoms of diabetes including polydipsia, polyuria, polyphagia, and weight loss; 2) fasting plasma glucose > 140 mg/dl (7.8 mmol/l) on two occasions; 3) fasting plasma glucose less than 104 mg/dl and two OGTTs with the two-hour plasma glucose > to 200 mg/dl and one intervening value > 200 mg/dl after a 75-gram glucose load (33).

Impaired glucose tolerance was defined by fasting plasma glucose less than 140 mg/dl and two-hour plasma > 140 mg/dl, and less than 200 mg/dl with one intervening value > 200 mg/dl after a 75-gram glucose load (33). The 1985 World Health Organization criteria use the fasting and two-hour values only, with fasting glucose > to 140 mg/dl or two-hour glucose > 200 mg/dl (33, 34). The 1997 American Diabetes Association criteria require fasting plasma glucose > to 126 mg/dl (34).

An International Expert Committee, established in May 1995, working under the auspices of the American Diabetes Association, published new recommendations in 2000 (23), as shown in Table 9.3. They stipulate that the diagnosis of diabetes mellitus should include one of these three criteria, namely classic symptoms of diabetes plus casual (casual defined as any time of day without regard to time since last meal) plasma glucose concentration > 200 mg/dl; fasting (no caloric intake for at least eight hours) plasma glucose > 126 mg/dl (7.0 mmol/l); or two-hour plasma glucose > 200 mg/dl during an OGTT using a glucose load containing the equivalent of 75 grams anhydrous glucose dissolved in water (23).

This expert committee defined: fasting plasma glucose < 110 mg/dl (6.1 mmol/l) as normal fasting glucose; fasting plasma glucose > 110 mg/dl (6.1 mmol/l) and < 126 mg/dl (7.0 mmol/l) as impaired fasting glucose; and fasting plasma glucose > 126 mg/dl (7.0 mmol/l) as provisional diagnosis of diabetes (23). When OGTT is performed, a two-hour postload glucose < 140 mg/dl (7.8 mmol/l) is normal glucose

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