Screening for diabetes mellitus – a two‐step approach in individuals with impaired fasting glucose improves detection of those at risk of complications

SUMMARY Aims  To compare the new American Diabetes Association (ADA) fasting plasma glucose (FPG) criteria to the 1985 World Health Organization (WHO) 2‐h post glucose (2hPG) criteria when used for screening of those with no prior history of diabetes mellitus.Methods  The study included 3407 subjects without a history of diabetes in whom both FPG and 2hPG were available from the 1992 Singapore National Health Survey. The agreement (κ) between FPG and 2hPG for the diagnosis of DM was assessed. The optimal cut‐off of FPG for the detection of individuals with 2hPG ≥ 11.1 mmol/l was determined by receiver–operating characteristics analysis.Results  The prevalence of diabetes diagnosed by FPG alone was 7.3% compared to 8.4% diagnosed by 2hPG. The prevalence of impaired fasting glucose was 8.0%. FPG and 2hPG showed moderate agreement(κ = 0.646, 95% confidence interval 0.584–0.708). Age, ethnic group and obesity did not affect the degree of agreement. Of those with 2hPG ≥ 11.1 mmol/l, 40.8% had FPG in the non‐diabetic range while 24.8% of those with FG ≥ 7.0 mmol/l had 2hPG in the non‐diabetic range. The optimal FPG for the detection of 2hPG ≥ 11.1 mmol/l was 6.1 mmol/l. Oral glucose tol