Bimodality of fasting and two-hour glucose tolerance distributions in a Micronesian population

Zimmet, Paul; Whitehouse, S.

doi:10.2337/diabetes.27.8.793

Cited by 55 publications

(34 citation statements)

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“…However, the estimated cut points were inconsistent between countries, especially for 2-h plasma glucose when participants with known diabetes were included. Comparing these results with those of earlier studies, we found that the overall cut point for FPG was somewhat lower (2,3,8,9), whereas the cut point for 2-h plasma glucose was well in line (1)(2)(3)5,8,10,11,13), except for the studies of South African Indians (9) and Western Samoans (12), which produced lower cut points for 2-h plasma glucose.…”

Section: -Distribution Of Fpg In Korea (A) and Nauru (B) And 2-h Plassupporting

confidence: 56%

“…The variance of the two components in the mixture model may differ. In that case, simulation results have shown that the limiting function for the likelihood ratio test is bounded by 2 distributions with 4 and 6 degrees of freedom (d.f.) (17).…”

Section: Methodsmentioning

confidence: 99%

“…imodality in glucose distribution has been reported in a number of populations with a high prevalence of diabetes, including the American Pima Indians (1) and the Micronesian population of Nauru (2). This observation was an important component in defining the 1980 World Health Organization (WHO) diagnostic criteria for diabetes together with thresholds for diabetes-specific microvascular complications such as retinopathy.…”

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confidence: 99%

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Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Vistisen

Colagiuri²,

Borch‐Johnsen³

2009

Diabetes Care

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OBJECTIVE -Bimodality in the distribution of glucose has been used to define the cut point for the diagnosis of diabetes. Previous studies on bimodality have primarily been in populations with a high prevalence of type 2 diabetes, including one study in a white Caucasian population. All studies included participants with known diabetes. The aim of this study was to assess whether a bimodal structure is a general phenomenon in fasting plasma glucose (FPG) and 2-h plasma glucose that is useful for deriving a common cut point for diabetes in populations of different origin, both including and excluding known diabetes. RESEARCH DESIGN AND METHODS -The Evaluation of Screening and EarlyDetection Strategies for Type 2 Diabetes and Impaired Glucose Tolerance (DETECT-2) project is an international collaboration pooling surveys from all continents. These studies include surveys in which plasma glucose was measured during an oral glucose tolerance test; in total, 43 studies (135,383 participants) from 27 countries were included. A mixture of two normal distributions was fitted to plasma glucose levels, and a cut point for normal glycemia was estimated as their intersection. In populations with a biologically meaningful cut point, bimodality was tested for significance.RESULTS -Distributions of FPG and 2-h plasma glucose did not, in general, produce bimodal structures useful for deriving cut points for diabetes. When present, the cut points produced were inconsistent over geographical regions.CONCLUSIONS -Deriving cut points for normal glycemia from distributions of FPG and 2-h plasma glucose does not appear to be suitable for defining diagnostic cut points for diabetes. Diabetes Care 32:397-403, 2009

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Section: -Distribution Of Fpg In Korea (A) and Nauru (B) And 2-h Plassupporting

confidence: 56%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Vistisen

Colagiuri²,

Borch‐Johnsen³

2009

Diabetes Care

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“…It was recognized in the 1970s that some populations with a high prevalence of diabetes, such as the Pima Indians and the Micronesian population of Nauru, demonstrate a bimodal distribution of glucose levels [45,46]. With such a distribution, the intersect of the two curves can be used to provide an indication of the level at which individuals should be classified as either having or not having diabetes.…”

Section: Diagnosing Diabetesmentioning

confidence: 99%

Current controversies in the use of haemoglobin A_1c

Hare

Shaw

Zimmet

2012

Journal of Internal Medicine

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Abstract. Hare MJL, Shaw JE, Zimmet PZ (Baker IDI Heart and Diabetes Institute, Melbourne, Vic.; and Monash University, Melbourne, Vic.; Australia). Current controversies in the use of haemoglobin A 1c (Review). J Intern Med 2012;271: 227-236.Haemoglobin A 1c (HbA 1c ) has recently been adopted by the World Health Organization into its recommended criteria for diabetes diagnosis. Much debate continues regarding the relative benefits and potential disadvantages surrounding the use of HbA 1c for this purpose. There is a lack of consensus as to whether this alteration to the definition of diabetes is a step forward or whether it could add further confusion and ambiguity to the debate on the method and criteria for the diagnosis of this globally important disease. This review provides a comprehensive overview of the current issues surrounding how HbA 1c is measured and reported; and of the evidence for and against its use in diagnosis.

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“…Bimodality of fasting and 2-h post-load plasma glucose distributions have been demonstrated in both populations [52][53][54]. The cut-off plasma glucose values between the two modes were: fasting approximately 140 mg/dl (7.8 mmol/l) and 2 h approximately 200 mg/dl (11.1 mmol/1) respectively.…”

Section: Other Facets Of Epidemiological Studiesmentioning

confidence: 99%

Type 2 (non-insulin-dependent) diabetes ? An epidemiological overview

1982

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Summary.Despite the use of a wide range of different methodologies and diagnostic criteria, epidemiological studies have shown that Type 2 (non-insulindependent) diabetes has a global distribution and its prevalence varies from country to country, in different ethnic groups in the same country, and between the same ethnic group undergoing internal or external migration. Rural-urban and migration studies indicate that change towards a 'Westernized' lifestyle is associated with a dramatic increase in the prevalence rates for Type 2 diabetes. Between populations, comparisons are confounded by a wide range of different ascertainment rates, survey methodologies, and diagnostic criteria for diabetes. However, low prevalence rates for Type 2 diabetes are seen in Eskimos and populations of the Far East, while the highest are seen in American Indians, urbanized Pacific Island populations, and migrant Asian Indians. Available evidence suggests that these latter groups have a genetic susceptibility to Type 2 diabetes ('diabetes genotype') and that the disease is unmasked by environmental factors. There appears to be a spectrum of interaction between genetic and environmental factors -in certain populations the genetic role may be more important than environmental, or vice versa. Epidemiological studies, apart from their value in population screenings and case-finding, have contributed to the new classification and diagnostic criteria for diabetes and our understanding of risk factors and host characteristics in the aetiology of Type 2 diabetes.

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Bimodality of fasting and two-hour glucose tolerance distributions in a Micronesian population

Cited by 55 publications

References 0 publications

Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Current controversies in the use of haemoglobin A_1c

Type 2 (non-insulin-dependent) diabetes ? An epidemiological overview

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Bimodality of fasting and two-hour glucose tolerance distributions in a Micronesian population

Cited by 55 publications

References 0 publications

Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Bimodal Distribution of Glucose Is Not Universally Useful for Diagnosing Diabetes

Current controversies in the use of haemoglobin A1c

Type 2 (non-insulin-dependent) diabetes ? An epidemiological overview

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Product

Resources

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Current controversies in the use of haemoglobin A_1c