Bimodal Glucose Distribution As A Determinant Of Diagnostic Threshold

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The 2 h cut-point originates from the shape of the distribution of 2 h glucose in various populations and the shape of the risk curve relating 2 h glucose to the microvascular complications of diabetes. In certain high risk populations, 11.1 mmol/l was found to the point separating two components of the bimodal population distribution of 2 h PG values16,17,18. In addition, in several studies, the prevalence of diabetes-related microvascular disease was found to sharply increase above 2 h PG levels of around 11.1 mmol/l and similarly at fasting plasma glucose levels of 7.8 mmol/l19.

Based on the chosen 2 h PG thresholds of 11.1 mmol/l and 7.8 mmol/l FPG, an enormous body of clinical and epidemiological data was then collected. Newer data in lower risk populations did not demonstrate bimodality. In these populations, glucose values were more normally distributed, making it difficult to identify a threshold separating those individuals who are at substantially increased risk for some adverse outcomes caused by diabetes from those who are not20,21. It has been suggested that the phenomenon of bimodality is only apparent in certain high prevelance populations because of statistical power22.

Table 2.3 contains the results of various studies which are cited to have blood glucose values following a bimodal distribution and the antimodal cut-points within those populations. It is evident from these studies that the cut-points

Table 2.3. Antimodal cut-points of FPG and/or 2 h PG distributions in different populations.





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