Comparison of WHO and ADA criteria for diagnosis of glucose status in adults

Abstract

The aim was to compare the 1997 American Diabetes Association (ADA) and 1985 and 1998 World Health Organisation (WHO) criteria for the diagnosis of diabetes and impaired glucose tolerance (IGT) by ethnicity and cardiovascular risk factors. We analysed the oral glucose tolerance tests carried out in a cross-sectional survey of 5816 New Zealand workers aged 22–78 years (4211 men, 1605 women) carried out between 1988 and 1990. Prevalence of diabetes was similar using ADA (3.1%) compared with the 1998 WHO criteria (3.0%). The overall prevalence rate of diabetes using the 1985 WHO criteria was only 1.5%. The prevalence rate of impaired fasting glucose (IFG) was the lowest in Europeans (7.3%) and highest in Asians (15.0%). The overall weighted κ for agreement between the 1997 ADA and 1998 WHO criteria was moderate (0.59), but varied between ethnic groups. Cardiovascular disease (CVD) risk factors were approximately more adverse across groups with IFG, normal (ADA)/IGT (WHO), IFG/IGT and diabetes compared with normal subjects. Compared to those with IFG, participants with the normal (ADA)/IGT (WHO) criteria differed in fasting and 2-h glucose, diastolic blood pressure, and urinary albumin levels, and the proportions of males and number with hypertension, but had a significantly adverse pattern of CVD risk factors compared to those with normal glycaemia. The 1988 WHO criteria using the OGTT provides additional information for classifying various categories of glucose intolerance that is not captured using the 1997 ADA fasting glucose criteria alone.