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Identification of Persons at High Risk for Type 2 Diabetes Mellitus: Do We Need the Oral Glucose Tolerance Test?

Michael P. Stern, MD; Ken Williams, MS; and Steven M. Haffner, MD, MPH
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From University of Texas Health Science Center at San Antonio, San Antonio, Texas.


Acknowledgment: The authors thank Dr. Agustin Escalante for providing helpful advice on the evaluation of ROC curves.

Grant Support: By the National Heart, Lung, and Blood Institute (grants RO1 HL24799 and RO1 HL36820).

Requests for Single Reprints: Michael P. Stern, MD, Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900; e-mail, stern@uthscsa.edu.

Current Author Addresses: Drs. Stern and Haffner and Mr. Williams: Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.

Author Contributions: Conception and design: M.P. Stern, S.M. Haffner.

Analysis and interpretation of the data: M.P. Stern, K. Williams, S.M. Haffner.

Drafting of the article: M.P. Stern, K. Williams.

Critical revision of the article for important intellectual content: M.P. Stern, K. Williams, S.M. Haffner.

Final approval of the article: M.P. Stern, K. Williams, S.M. Haffner.

Statistical expertise: K. Williams.

Obtaining of funding: M.P. Stern.

Administrative, technical, or logistic support: M.P. Stern.

Collection and assembly of data: M.P. Stern, S.M. Haffner.


Ann Intern Med. 2002;136(8):575-581. doi:10.7326/0003-4819-136-8-200204160-00006
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Of the 1838 Mexican Americans and 1166 non-Hispanic white persons without diabetes at the baseline examination, 208 Mexican Americans and 67 non-Hispanic whites developed type 2 diabetes in the 7.5-year follow-up period. Excluded from these tallies are 354 persons with diabetes at baseline, 192 whose diabetes status was indeterminate at baseline, and 132 whose diabetes status was indeterminate at follow-up. (Participants with indeterminate status had no evidence of diabetes but were missing values for at least one of the three study criteria for diabetes classification.) Of the 275 participants with incident diabetes, 221 were not receiving pharmacologic treatment for diabetes and were given a diagnosis exclusively on the basis of plasma glucose levels that met the WHO criteria (3). Of the 54 participants with confirmed pharmacologic treatment for diabetes, 45 also met one or both plasma glucose criteria for diabetes. Thus, only 9 incident cases of diabetes were diagnosed exclusively on the basis of medication history. The analyses presented here also exclude data on 101 persons with missing values for at least one predictor variable. Thus, our analyses are based on the data of 1791 Mexican Americans and 1112 non-Hispanic whites, of whom 204 Mexican Americans and 65 non-Hispanic whites developed diabetes.

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Figure.
Receiver-operating characteristic curves for the full multivariable model with 2-hour glucose value included, the clinical model with the 2-hour glucose measurement excluded, and the 2-hour glucose variable by itself.large circle

The location ( ) of impaired glucose tolerance (plasma glucose level ≥ 7.8 mm/L [≥ 140 mg/dL]) on the 2-hour glucose curve is indicated.

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Summary for Patients

Identifying People at High Risk for Type 2 Diabetes

The summary below is from the full report titled “Identification of Persons at High Risk for Type 2 Diabetes Mellitus: Do We Need the Oral Glucose Tolerance Test?” It is in the 16 April 2002 issue of Annals of Internal Medicine (volume 136, pages 575-581). The authors are MP Stern, K Williams, and SM Haffner.

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