TY - JOUR
T1 - Relation between fasting glucose and retinopathy for diagnosis of diabetes
T2 - three population-based cross-sectional studies
AU - Wong, Tien Y.
AU - Liew, Gerald
AU - Tapp, Robyn J.
AU - Schmidt, Maria Inês
AU - Wang, Jie Jin
AU - Mitchell, Paul
AU - Klein, Ronald
AU - Klein, Barbara EK
AU - Zimmet, Paul
AU - Shaw, Jonathan
N1 - Funding Information:
The Blue Mountains Eye Study is supported by the Australian National Health & Medical Research Council, ACT, Australia (NHMRC grant numbers 153948, 302068, 211069). The Multi-Ethnic Study of Atherosclerosis study is supported by contracts N01-HC-95159 through N01-HC-95165, and N01-HC-95169 from the National Heart, Lung, and Blood Institute, MD, USA. Additional support was provided by NIH grant HL69979-03 (RK, TYW). RJT is supported by a Sidney Sax fellowship from the National Health and Medical Research Council of Australia (grant number 334173). The AusDiab study is supported by an Australian National Health and Medical Research Council, ACT, Australia (NHMRC grant 233200). The AusDiab study has received financial and in-kind support from the Australian Government Department of Health and Ageing, Abbott Australasia, Alphapharm, AstraZeneca, Aventis Pharma, Bio-Rad Laboratories, Bristol-Myers Squibb, City Health Centre Diabetes Service Canberra, Department of Health and Community Services Northern Territory, Department of Health and Human Services Tasmania, Department of Health New South Wales, Department of Health Western Australia, Department of Human Services South Australia, Department of Human Services Victoria, Diabetes Australia, Diabetes Australia Northern Territory, Eli Lilly Australia, Estate of the Late Edward Wilson, GlaxoSmithKline, Highpoint Shopping Centre, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian and EH Flack Trust, Menzies Research Institute, Merck Sharp and Dohme, Multiplex, Novartis Pharmaceuticals, Novo Nordisk Pharmaceuticals, Pfizer Pty Ltd, Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital Sydney, and Sanofi-Synthelabo. The authors thank the other investigators, the staff, and the participants of the Blue Mountains Eye Study, the Australian Diabetes, Obesity and Lifestyle Study, and the Multi-Ethnic Study of Atherosclerosis for their valuable contributions.
PY - 2008
Y1 - 2008
N2 - Background: The WHO and American Diabetes Association criteria for diagnosing diabetes mellitus assume the presence of a glycaemic threshold with high sensitivity for identifying retinopathy. However, this assumption is based on data from three previous studies that had important limitations in detecting retinopathy. We aimed to provide updated data for the relation between fasting plasma glucose (FPG) and retinopathy, and to assess the diagnostic accuracy of current FPG thresholds in identifying both prevalent and incident retinopathy. Methods: We examined the data from three cross-sectional adult populations: those in the Blue Mountains Eye Study (BMES, Australia, n=3162), the Australian Diabetes, Obesity and Lifestyle Study (AusDiab, Australia, n=2182), and the Multi-Ethnic Study of Atherosclerosis (MESA, USA, n=6079). Retinopathy was diagnosed from multiple retinal photographs of each eye, and graded according to the modified Airlie House Classification system. Plasma glucose concentrations were measured from fasting venous blood samples. Findings: The overall prevalence of retinopathy was 11·5% in BMES (95% CI 10·4-12·6%), 9·6% in AusDiab (8·4-10·9), and 15·8% in MESA (14·9-16·7). However, we found inconsistent evidence of a uniform glycaemic threshold for prevalent and incident retinopathy, with analyses suggesting a continuous relation. The widely used diabetes FPG cutoff of 7·0 mmol/L or higher had sensitivity less than 40% (range 14·8-39·1) for detecting retinopathy, with specificity between 80·8% and 95·8%. The area under receiver operating characteristic curves for FPG and retinopathy was low and ranged from 0·56 to 0·61. Interpretation: We saw no evidence of a clear and consistent glycaemic threshold for the presence or incidence of retinopathy across different populations. The current FPG cutoff of 7·0 mmol/L used to diagnose diabetes did not accurately identify people with and without retinopathy. These findings suggest that the criteria for diagnosing diabetes could need reassessment.
AB - Background: The WHO and American Diabetes Association criteria for diagnosing diabetes mellitus assume the presence of a glycaemic threshold with high sensitivity for identifying retinopathy. However, this assumption is based on data from three previous studies that had important limitations in detecting retinopathy. We aimed to provide updated data for the relation between fasting plasma glucose (FPG) and retinopathy, and to assess the diagnostic accuracy of current FPG thresholds in identifying both prevalent and incident retinopathy. Methods: We examined the data from three cross-sectional adult populations: those in the Blue Mountains Eye Study (BMES, Australia, n=3162), the Australian Diabetes, Obesity and Lifestyle Study (AusDiab, Australia, n=2182), and the Multi-Ethnic Study of Atherosclerosis (MESA, USA, n=6079). Retinopathy was diagnosed from multiple retinal photographs of each eye, and graded according to the modified Airlie House Classification system. Plasma glucose concentrations were measured from fasting venous blood samples. Findings: The overall prevalence of retinopathy was 11·5% in BMES (95% CI 10·4-12·6%), 9·6% in AusDiab (8·4-10·9), and 15·8% in MESA (14·9-16·7). However, we found inconsistent evidence of a uniform glycaemic threshold for prevalent and incident retinopathy, with analyses suggesting a continuous relation. The widely used diabetes FPG cutoff of 7·0 mmol/L or higher had sensitivity less than 40% (range 14·8-39·1) for detecting retinopathy, with specificity between 80·8% and 95·8%. The area under receiver operating characteristic curves for FPG and retinopathy was low and ranged from 0·56 to 0·61. Interpretation: We saw no evidence of a clear and consistent glycaemic threshold for the presence or incidence of retinopathy across different populations. The current FPG cutoff of 7·0 mmol/L used to diagnose diabetes did not accurately identify people with and without retinopathy. These findings suggest that the criteria for diagnosing diabetes could need reassessment.
UR - https://www.scopus.com/pages/publications/39649088467
U2 - 10.1016/S0140-6736(08)60343-8
DO - 10.1016/S0140-6736(08)60343-8
M3 - Article
C2 - 18313502
AN - SCOPUS:39649088467
SN - 0140-6736
VL - 371
SP - 736
EP - 743
JO - The Lancet
JF - The Lancet
IS - 9614
ER -