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Diabetes criteria may change in the wake of studies
Posted
9-6-99 Minneapolis. Two new studies criticizing American Diabetes Association guidelines for diagnosing diabetes have prompted the agency to reevaluate its criteria. The studies, published in the Aug. 21 issue of Lancet, found that the association's revised 1997 guidelines are less effective than World Health Organization (WHO) criteria for detecting elderly people at increased risk for the heart complications of diabetes. According to a study of more than 25,000 men and women ages 30 and older, the American Diabetes Association guidelines missed about 30 percent of people classified as diabetic by WHO standards. Bruce Zimmerman, MD, an endocrinologist at the Mayo Clinic in Minneapolis and president of the association, called the studies "flawed" and "not helpful." "The authors of these studies took a negative, attacking approach rather than a positive approach of trying to find a better diagnostic level for diabetes," Zimmerman said. Nevertheless, the association plans to analyze the results of the studies to see whether the current guidelines need revision, Zimmerman said. Yet he faulted the studies for failing to repeat the WHO glucose tolerance test, even though previous studies found the test produced high numbers of false positive results on the first try. Joshua Barzilay, MD, the author of one of the Lancet studies, admitted the WHO test sometimes produces questionable results. But Barzilay noted that his study and the Finnish study-a composite of eight separate European studies-came to the same conclusions independently. "When you have several independent studies saying the same thing, the results become more convincing," said Barzilay, an endocrinologist at Kaiser Permanente in Tucker, Ga. Barzilay plans to begin a study in November to determine the precise measure of blood sugar that best indicates the danger of cardiovascular disease. "If we're going to attack both diabetes and its complications, we have to have better ways of identifying people earlier so that we might be able to take preventive measures," he said.
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