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Diabetes has been linked to a number of other conditions including hypertension, obesity, dislipidaemia and coronary heart disease, and also to environmental factors such as physical activity and nutrition. To complicate the picture further, several genetic factors are thought to play a significant role in the predisposition to diabetes and its complications. With so many factors involved in the aetiology of this disease or disease group, it is not surprising that a single biomedical test, such as blood glucose, has not produced a definitive and precise threshold for diagnosis or prediction of the disease and its complications. As discussed above, throughout the history of diabetes classification various methods and cut-off values were employed as diagnostic of diabetes until the desire to conduct international comparisons encouraged the development of standardised diagnostic criteria. Such an approach has obvious merits for epidemiological studies, but can present the clinician with difficulties when considering individual patients.

Both the ADA14 and WHO13 recommended the following changes to the criteria which were used since 1985 (Table 2.2):

• The fasting plasma glucose (FPG) threshold for the diabetes category was lowered from 7.8 to 7.0 mmol/l.

• Impaired fasting glycaemia (FPG 6.1-6.9 mmol/l) was introduced as a new category of intermediate glucose metabolism (named impaired fasting glucose by the ADA). The term IFG was originally coined by Charles et al.15 with a fasting plasma glucose level between 6.1 mmol/l and <7.8 mmol/l. The ADA, and subsequently the WHO, altered the upper end to correspond to the new lower diagnostic criteria for diabetes. The fasting glucose concentration of 6.1 mmol/l has been chosen as the upper limit of 'normal'.

Table 2.2. Values for diagnosis* of diabetes and other categories of hyperglycaemia

Glucose concentration, mmol/l

Plasma Whole blood

Glucose concentration, mmol/l

Plasma Whole blood

Table 2.2. Values for diagnosis* of diabetes and other categories of hyperglycaemia

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