American Diabetes Association 60th Scientific Sessions, 2000: glucose tolerance, diabetes and cancer, glycemic control, monitoring, and related topics.

Abstract

This is the sixth in a continuing series of articles on the American Diabetes Association (ADA) 60th Scientific Sessions held in San Antonio, TX, in June 2000. It covers topics related to use of fasting versus 2-h glucose for diagnosis of diabetes, diabetes and cancer, glycemic control, monitoring, and hypoglycemia. ### Postload Glycemia in the Diagnosis of Diabetes At a symposium on diagnostic criteria for diabetes James Gavin, Chevy Chase, MD, discussed the dilemma that fasting and post–glucose load glucose levels are differently regulated and that diagnosis based on the two criteria therefore define somewhat different populations. The use of fasting glucose has several advantages. It is more convenient to perform and limits a missed diagnosis of diabetes. Gavin noted that microvascular complications begin to occur above a fasting glucose of 126 mg/dl. A concern, however, is that more than half of patients with diabetes diagnosed by a glucose tolerance test have a fasting glucose below 126 mg/dl. Given new data showing that the fasting glucose level is less predictive of cardiovascular disease (CVD) risk than postchallenge glucose level, Gavin concluded that “fundamentally, we are back at ‘square one’ in asking ‘What is diabetes?’” Daniel Porte, San Diego, CA, noted that “cause and effect is not necessary when we see associations,” an important caveat in the new emphasis on glucose tolerance testing and postchallenge glycemia for diabetes diagnosis. Jaakko Tuomilehto, Helsinki, Finland, reviewed data from the Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) Study of 18,048 men and 7,316 women aged 30 years or older followed for an average of 7 years after glucose tolerance testing, addressing the question of whether fasting glucose or 2-h postload glucose better predicts mortality (1) There were a total of 1,836 deaths. The World Health Organization (WHO) criteria for diabetes, based mainly on 2-h glucose >200 mg/dl, and the …