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Fasting Plasma Glucose Cutoff for Diagnosis of Diabetes in a Japanese Population

Departments of Environmental Medicine (Y.D., M.K., K.Y., T.N., H.A., J.H. Y.T., Y.K.) and Medicine and Clinical Science (Y.D., M.K., T.N., M.I., H.A., J.H. Y.T., M.I., Y.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan

Address all correspondence and requests for reprints to: Yasufumi Doi, M.D., Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail: doi{at}intmed2.med.kyushu-u.ac.jp.

Objective: We examined the relationship between fasting plasma glucose (FPG) and 2-h post-load glucose (PG) levels, and the optimal FPG cutoff level to correspond to a 2-h PG of 11.1 mmol/liter, the gold standard diagnostic criterion, in a general Japanese population.

Design: Cross-sectional study populations of 2421 subjects in 1988 and 2698 subjects in 2002, aged 40–79 yr and without antidiabetic medication, were tested with an oral glucose tolerance test. The relationship between FPG and 2-h PG was investigated by various regression models and a receiver operating characteristic curve.

Results: The best-fit model for the relationship between FPG and 2-h PG was a quadratic regression model. The FPG cutoff levels corresponding to the 2-h PG of 11.1 mmol/liter by this model were 6.2 mmol/liter in 1988 and 6.3 mmol/liter in 2002. In the combined populations, the FPG cutoff point was 6.3 mmol/liter; the sensitivity and specificity of this cutoff point for detecting a 2-h PG of 11.1 mmol/liter were 75.2 and 88.6%, respectively. The receiver operating characteristic curve analysis confirmed that the corresponding FPG point was 6.2 mmol/liter in both the 1988 and 2002 populations. In a stratified analysis, the FPG cutoff level increased with increasing body mass index levels; however, even in subjects with body mass index more than or equal to 30 kg/m², the FPG cutoff level was lower than 7.0 mmol/liter.

Conclusions: Our findings suggest that the FPG cutoff level corresponding to the 2-h PG of 11.1 mmol/liter in the general Japanese population is lower than the current diagnostic criterion.