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Diagnostic thresholds for diabetes: the association of retinopathy and albuminuria with glycaemia.
Diabetes Res Clin Pract. 2006 Sep; 73(3):315-21.DR

Abstract

AIM

We examined the association of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) and HbA1c with retinopathy and microalbuminuria using both deciles of glycaemia and change point models, to validate current diagnostic criteria for diabetes and to identify therapeutic thresholds for glycaemic control.

METHODS

The Australian Diabetes Obesity and Lifestyle study (AusDiab), conducted in 1999-2000, included adults aged > or =25 years from 42 randomly selected areas of Australia. Retinopathy and albuminuria were assessed in participants identified as having diabetes (based on self report and oral glucose tolerance test), impaired fasting glucose, impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,182 participants with retinal photographs and 2,389 with urinary albumin/creatinine results.

RESULTS

The prevalence of retinopathy in the first 8 deciles of FPG and HbA1c and the first 9 deciles of 2hPG were 7.2, 6.6, and 6.3%, respectively and showed no variation with increasing glucose or HbA1c. Above these levels, the prevalence rose markedly to 18.6% in the top 2 deciles of FPG, 21.3% in the top 2 deciles of HbA1c and 10.9% in the top decile of 2hPG. The thresholds for increasing prevalence of retinopathy were 7.1 mmol/l for FPG, 6.1% for HbA1c and 13.1 mmol/l for 2hPG. The prevalence of microalbuminuria rose gradually across deciles of each glycaemic measure. Thresholds were less clear than for retinopathy, but were seen at a FPG of 7.2 mmol/l and HbA1c of 6.1%, with no evidence of a threshold effect for 2hPG.

CONCLUSIONS

The prevalence of retinopathy rose dramatically in the highest deciles of each glycaemic measure, while for microalbuminuria the increase of prevalence was more gradual. The FPG values corresponded well with the WHO diagnostic cut-point for diabetes, however the 2hPG value did not. HbA1c thresholds were similar for both retinopathy and microalbuminuria and compared well to values shown in other studies. These results support current targets for FPG and HbA1c in preventing microvascular complications.

Authors+Show Affiliations

International Diabetes Institute, Melbourne, Australia. Robyn.Tapp@med.monash.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16644057

Citation

Tapp, R J., et al. "Diagnostic Thresholds for Diabetes: the Association of Retinopathy and Albuminuria With Glycaemia." Diabetes Research and Clinical Practice, vol. 73, no. 3, 2006, pp. 315-21.
Tapp RJ, Zimmet PZ, Harper CA, et al. Diagnostic thresholds for diabetes: the association of retinopathy and albuminuria with glycaemia. Diabetes Res Clin Pract. 2006;73(3):315-21.
Tapp, R. J., Zimmet, P. Z., Harper, C. A., de Courten, M. P., McCarty, D. J., Balkau, B., Taylor, H. R., Welborn, T. A., & Shaw, J. E. (2006). Diagnostic thresholds for diabetes: the association of retinopathy and albuminuria with glycaemia. Diabetes Research and Clinical Practice, 73(3), 315-21.
Tapp RJ, et al. Diagnostic Thresholds for Diabetes: the Association of Retinopathy and Albuminuria With Glycaemia. Diabetes Res Clin Pract. 2006;73(3):315-21. PubMed PMID: 16644057.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic thresholds for diabetes: the association of retinopathy and albuminuria with glycaemia. AU - Tapp,R J, AU - Zimmet,P Z, AU - Harper,C A, AU - de Courten,M P, AU - McCarty,D J, AU - Balkau,B, AU - Taylor,H R, AU - Welborn,T A, AU - Shaw,J E, AU - ,, Y1 - 2006/04/27/ PY - 2005/11/01/received PY - 2006/02/20/accepted PY - 2006/4/29/pubmed PY - 2007/1/9/medline PY - 2006/4/29/entrez SP - 315 EP - 21 JF - Diabetes research and clinical practice JO - Diabetes Res Clin Pract VL - 73 IS - 3 N2 - AIM: We examined the association of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) and HbA1c with retinopathy and microalbuminuria using both deciles of glycaemia and change point models, to validate current diagnostic criteria for diabetes and to identify therapeutic thresholds for glycaemic control. METHODS: The Australian Diabetes Obesity and Lifestyle study (AusDiab), conducted in 1999-2000, included adults aged > or =25 years from 42 randomly selected areas of Australia. Retinopathy and albuminuria were assessed in participants identified as having diabetes (based on self report and oral glucose tolerance test), impaired fasting glucose, impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,182 participants with retinal photographs and 2,389 with urinary albumin/creatinine results. RESULTS: The prevalence of retinopathy in the first 8 deciles of FPG and HbA1c and the first 9 deciles of 2hPG were 7.2, 6.6, and 6.3%, respectively and showed no variation with increasing glucose or HbA1c. Above these levels, the prevalence rose markedly to 18.6% in the top 2 deciles of FPG, 21.3% in the top 2 deciles of HbA1c and 10.9% in the top decile of 2hPG. The thresholds for increasing prevalence of retinopathy were 7.1 mmol/l for FPG, 6.1% for HbA1c and 13.1 mmol/l for 2hPG. The prevalence of microalbuminuria rose gradually across deciles of each glycaemic measure. Thresholds were less clear than for retinopathy, but were seen at a FPG of 7.2 mmol/l and HbA1c of 6.1%, with no evidence of a threshold effect for 2hPG. CONCLUSIONS: The prevalence of retinopathy rose dramatically in the highest deciles of each glycaemic measure, while for microalbuminuria the increase of prevalence was more gradual. The FPG values corresponded well with the WHO diagnostic cut-point for diabetes, however the 2hPG value did not. HbA1c thresholds were similar for both retinopathy and microalbuminuria and compared well to values shown in other studies. These results support current targets for FPG and HbA1c in preventing microvascular complications. SN - 0168-8227 UR - https://www.unboundmedicine.com/medline/citation/16644057/Diagnostic_thresholds_for_diabetes:_the_association_of_retinopathy_and_albuminuria_with_glycaemia_ DB - PRIME DP - Unbound Medicine ER -