Abstract
Many studies have been performed to compare WHO and ADA criteria for detection of diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of Tehran, Iran. Materials and Methods: Subjects were chosen from among 15005 urban individuals, 3 years old and over, selected by cluster random sampling in the cross-sectional phase of a longitudinal study conducted in the east of Tehran; there were 3870 men and 5359 women aged 20 years and over. Those with known diabetes were excluded. Blood samples were taken after 12-14 hours overnight fast and 2 hours post 75gr glucose taken orally. Prevalence of glucose tolerance categories and the level of agreement (? statistic) were obtained using WHO and ADA criteria. Results: Based on WHO criteria 6.0% (0.95 CI, 5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impaired fasting glucose); p<0.05 and <0.001 for diabetes and IGT, respectively and 7355 (84%) had concordance with both criteria. Among 7105 normal subjects classified according to WHO criteria, 153 (2.2%) had IFG or diabetes by ADA, whereas from 8068 normal subjects according to ADA criteria, 1116 (13.8%) had IGT or diabetes based on WHO criteria. The level of agreement (? statistic) between the two criteria was 35% (p<0.001). Sensitivity and specificity of ADA criteria were 45.5 and 100%, respectively, considering WHO as the gold standard. Conclusion: Our data shows a low level of agreement between WHO and ADA diagnostic criteria for detection of diabetes. Patients with unknown diabetes, glucose disorders are detected more frequently using WHO criteria.
Keywords
Diabetes mellitus Impaired glucose tolerance Impaired fasting glucose WHO criteria ADA criteria Tehran Lipid and Glucose Study
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