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A reassessment of fasting plasma glucose concentrations in population screening for diabetes mellitus in a community of northern European ancestry: the Wadena City Health Study

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Abstract

In current clinical and research practice, the determination of diabetic status depends largely on plasma glucose levels 2 h after the ingestion of a standard 75-g glucose load, the oral glucose tolerance test (OGTT). The OGTT, however, remains inconvenient, not highly reproducible, and costly, especially for large-scale studies and population screening tests. Fasting plasma glucose (FPG) determinations are convenient, reliable, and valid measures of glucose intolerance, but the currently prescribed cut-off point of 140 mg/dl (7.8 mM) lacks sensitivity. We evaluated the reliability and validity of fasting plasma glucose (FPG) values compared with other measures of hyperglycemia for a diagnosis of diabetes in a populationbased study of carbohydrate metabolism in Wadena, Minnesota, a community of predominantly northern European ancestry. As a part of this effort, a random sample of Wadena adults, stratified by age and gender, plus all known, previously diagnosed diabetics participated in 2 days of baseline testing and were followed prospectively and retested 5 years later. Cross-sectional analyses of baseline data are presented in this article. Diabetic status was ascertained by administering a standard OGTT according to National Diabetes Data Group (NDDG) specifications. Sensitivity and specificity levels obtained when using a FPG cut-off point of 6.4 mM were 95.2% and 97.4%, respectively. In study subjects with no known diagnosis of diabetes, the FPG cut-off point of 6.4 mM performed reasonably well with a sensitivity and specificity of 67.7% and 97.4%, respectively. A receiver operating characteristic (ROC) curve analysis showed that FPG consistently performed better than glycosylated hemoglobin in distinguishing diabetic from non-diabetic subjects. FPG concentrations accurately and reliably discriminate diabetic from non-diabetic individuals in a population-based study of Caucasians of northern European ancestry.

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Authors and Affiliations

  1. Chronic Disease and Environmental Epidemiology Section, Minnesota Department of Health, University of Minnesota, Minneapolis, Minnesota, USA

    J. P. Clements & L. R. French

  2. Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA

    J. R. Boen

  3. Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota, USA

    J. M. Sprafka

  4. Biomedical Frontiers, Inc., University of Minnesota, Minneapolis, Minnesota, USA

    B. Hedlund

  5. Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA

    F. C. Goetz

Authors
  1. J. P. Clements
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  2. L. R. French
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  3. J. R. Boen
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  4. J. M. Sprafka
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  5. B. Hedlund
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  6. F. C. Goetz
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Clements, J.P., French, L.R., Boen, J.R. et al. A reassessment of fasting plasma glucose concentrations in population screening for diabetes mellitus in a community of northern European ancestry: the Wadena City Health Study. Acta Diabetol 31, 187–192 (1994). https://doi.org/10.1007/BF00571949

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  • DOI: https://doi.org/10.1007/BF00571949

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