Summary
The frequency distributions of both the fasting and two-hour post-load plasma glucose levels were bimodal in the Pima Indian population aged 25 years and over. The hyperglycaemic component of this distribution represents those with diabetes mellitus, as some 30 percent of this group had evidence of the specific vascular complications of the disease, whereas these abnormalities were virtually absent in those with lower glucose levels. The bimodal characteristics of the frequency distributions were utilized to define optimal criteria to separate those with and without diabetes. The sensitivity and specificity of these criteria for fasting and two-hour glucose levels were compared and were found to be similar. The fasting glucose determination, however, was more reproducible and stable, as well as being easier to obtain, indicating that it is the better measurement for diagnostic purposes. The optimal level for diagnosis of 7.5 mmol/l (136 mg/dl) for the fasting glucose and the equivalent two-hour value of 14 mmol/l (250 mg/dl), were higher than many previously recommended diagnostic levels. Nevertheless, there was no evidence that subjects with lower levels were at appreciable risk of developing the specific complications of diabetes. Subjects with impaired glucose tolerance (IGT), but without fasting hyperglycaemia, shouldnot be diagnosed as having diabetes mellitus.
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John, H. J.: Glucose tolerance and its value in diagnosis. J. Metab. Res.1, 497–548 (1922)
Mayer, J.H., Womack, C. R.: Glucose tolerance 1. A comparison of four types of diagnostic tests in 103 control subjects and 26 patients with diabetes. Am. J. Med. Sci.219, 161–173 (1950)
Fajans, S. S., Conn, J. W.: The early recognition of diabetes mellitus. Ann. N.Y. Acad. Sci.82, 208–218 (1959)
Sharp, C. L., Butterfield, W. J. H., Keen, H.: Diabetes survey in Bedford 1962. Proc. R. Soc. Med.57, 193–202 (1964)
U.S. Public Health Service: Glucose tolerance in adults, United States 1960–62. Publication 1000, Series II, No. 2. Washington: U.S. Government Printing Office 1964
Hayner, N. S., Kjelsberg, M. D., Epstein, F. H., Francis, T.: Carbohydrate tolerance and diabetes in a total community, Tecumseh, Michigan. Diabetes14, 413–423 (1965)
Siperstein, M. D.: The glucose tolerance test: A pitfall in the diagnosis of diabetes mellitus. Adv. Intern. Med.20, 297–323 (1975)
Jarrett, R. J., Keen, H.: Hyperglycaemia and diabetes mellitus. Lancet1976 II, 1009–1012
O'Sullivan, J.B., Mahan, C.M.: Prospective study of 352 young patients with chemical diabetes. N. Engl. J. Med.278, 1038–1041 (1968)
Birmingham Working Party. Five year follow-up report on the Birmingham diabetes survey of 1962. Br. Med. J.1970 III, 301–305
Walker, J. B.: Ten year follow-up of diabetes in an English community. In: Diabetes epidemiology in Europe. Gutshe, H., Holler, H. D. (Ed.), pp. 2–7. Stuttgart: Georg Thieme 1975
Carlstrom, S., Lundquist, A., Lundquist, I., Norden, A., et al.: Borderline glucose tolerance not followed by overt diabetes. Acta Med. Scand.189, 415 (1971)
Hamman, R. F., Bennett, P. H., Miller, M.: Incidence of diabetes among Pima Indians. Adv. Metab. Disord.9, 49–63 (1978)
Keen, H., Rose, G., Pyke, D. A., Boyns, D., Chlouverakis, C., Mistry, S.: Blood-sugar and arterial disease. Lancet1965 II, 505–508
Epstein, F. H., Ostrander, L. D., Johnson, B. C., Payne, M.W., Hayner, N. S., Kelly, J.B., Francis, T., Jr.: Epidemiological studies of cardiovascular disease in a total community-Tecumseh, Michigan. Ann. Intern. Med.62, 1170–1187 (1965)
Bennett, P. H., Burch, T. A., Miller, M.: Diabetes mellitus in American (Pima) Indians. Lancet1971 II, 125–128
Rushforth, N.B., Bennett, P.H., Steinberg, A.G., Burch, T. A., Miller, M.: Diabetes in the Pima Indians: Evidence of bimodality in glucose tolerance distributions. Diabetes20, 756–765 (1971)
Dorf, A., Ballintine, E. J., Bennett, P. H., Miller, M.: Retinopathy in Pima Indians; Relationship to glucose level, duration of diabetes, age at diagnosis of diabetes, and age at examination in a population with a high prevalence of diabetes mellitus. Diabetes25, 554–560 (1976)
Kamenetzky, S., Bennett, P.H., Dippe, S., Miller, M., LeCompte, P. M.: A clinical and histologic study of diabetic nephropathy in the Pima Indians. Diabetes23, 61–68 (1974)
Bennett, P. H., Rushforth, N. B., Miller, M., LeCompte, P. M.: Epidemiologic studies in diabetes in the Pima Indians. Recent Prog. Horm. Res.32, 333–376 (1976)
Shevky, N. C., Stafford, D. D.: A clinical method for the estimation of protein in urine and other body fluids. Arch. Intern. Med.32, 222–225 (1923)
Steinberg, A. G., Rushforth, N.B., Bennett, P.H., Burch, T. A., Miller, M.: On the genetics of diabetes mellitus. In: The pathogenesis of diabetes mellitus, Cerasi, E., Luft, R. (Ed.), pp. 237–264, Nobel Symposium 13. New York: John Wiley and Sons 1970
Rushforth, N. B., Bennett, P. H., Steinberg, A. G., Miller, M.: Comparison of the value of the two- and one-hour glucose levels of the oral GTT in the diagnosis of diabetes in Pima Indians. Diabetes24, 538–546 (1975)
Mosenthal, H. O., Barry, E.: Criteria for an interpretation of normal glucose tolerance tests. Ann. Intern. Med.33, 1175–1194 (1950)
Zimmet, P., Taft, P., Guinea, A., Guthrie, W., Thoma, K.: The high prevalence of diabetes mellitus on a Central Pacific Island. Diabetologia13, 111–115 (1977)
Zimmet, P., Whitehouse, S.: Bimodality of fasting and twohour glucose tolerance distributions in a micronesian population. Diabetes27, 793–800 (1978)
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Rushforth, N.B., Miller, M. & Bennett, P.H. Fasting and two-hour post-load glucose levels for the diagnosis of diabetes. Diabetologia 16, 373–379 (1979). https://doi.org/10.1007/BF01223157
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DOI: https://doi.org/10.1007/BF01223157