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CLINICAL RESEARCH: DIABETES AND CARDIOVASCULAR DISEASE

Comparison of the 1997 and 2003 American Diabetes Association Classification of Impaired Fasting Glucose

Impact on Prevalence of Impaired Fasting Glucose, Coronary Heart Disease Risk Factors, and Coronary Heart Disease in a Community-Based Medical Practice

Sun H. Kim, MD^_*,1,_*, Lubna Chunawala, MS, Randolph Linde, MD and Gerald M. Reaven, MD^_*

^_* Department of Medicine, Stanford University School of Medicine, Stanford, California
Department of Medicine, Palo Alto Medical Foundation, Palo Alto, California.

Manuscript received November 23, 2005; revised manuscript received March 6, 2006, accepted March 16, 2006.

^_* Reprint requests and correspondence: Dr. Sun H. Kim, Stanford University Medical Center, 300 Pasteur Drive, Room S025, Stanford, California 94305-5103. (Email: sunhkim{at}stanford.edu).

OBJECTIVES: The goals of this study were to assess the effect of the 2003 American Diabetes Association definition of impaired fasting glucose (IFG) on prevalence of IFG, coronary heart disease (CHD) risk factors, and CHD compared with the 1997 IFG definition.

BACKGROUND: Although IFG is viewed as increasing CHD risk, this association is unclear and has not been well studied after changing the IFG criterion, especially in a clinical practice setting.

METHODS: This was a cross-sectional evaluation of 8,295 members (3,763 men and 4,532 women) of a community medical center who were between the ages of 30 and 69 years, without a history of diabetes mellitus, and who had available measurements of fasting plasma glucose and lipid concentrations within the past 2 years. The prevalence of IFG, CHD risk factors, and CHD with the 1997 and 2003 IFG definition was compared.

RESULTS: The prevalence of IFG increased from 8% to 35% with the 2003 criterion. Individuals with glucose of 100 to 109 mg/dl had lower prevalence of most CHD risk factors (hypertension, triglyceride 150 mg/dl, high-density lipoprotein cholesterol <40 mg/dl, meeting 2 components of the metabolic syndrome criteria, CHD risk 10% by Framingham score) compared with individuals with glucose 110 to 125 mg/dl. Individuals identified with the 2003 IFG definition did not have an increase in known CHD when adjusted for covariates (odds ratio 1.4 [95% confidence interval (CI) 0.7 to 2.3] vs. 3.2 [95% CI 1.8 to 5.9]).

CONCLUSIONS: One-third of the population has IFG with the 2003 definition, yet many of these individuals do not have increased prevalence of CHD risk factors or CHD.

Abbreviations and Acronyms   ADA = American Diabetes Association   BMI = body mass index   CHD = coronary heart disease   CI = confidence interval   HDL-C = high-density lipoprotein-cholesterol   IFG = impaired fasting glucose   LDL-C = low-density lipoprotein-cholesterol   OR = odds ratio

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