Published online Sep 15, 2016. doi: 10.4239/wjd.v7.i17.396
Peer-review started: March 30, 2016
First decision: May 17, 2016
Revised: June 29, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: September 15, 2016
Processing time: 165 Days and 22.6 Hours
Diabetes mellitus is a non-communicable metabolic derangement afflicting several millions of individuals globally. It is associated with several micro and macrovascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Association (ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of evidence.This review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose (FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications.
Core tip: The diagnostic criteria for diabetes and prediabetes have evolved along the timeline taking into account new evidences which had developed. The major professional bodies have converged on to a consensus in developing the different thresholds for diagnosis of diabetes and associated states. Nevertheless,controversy remains on certain issues. There is need to review the evolution of these criteria, the logistics behind their adoption and their association with different complications.