AACE/ACE Statement on Criteria for the Diagnosis of Impaired Fasting Glucose

AACE Committee on Impaired Fasting Glucose
Richard Hellman, MD, FACE
Paul S. Jellinger, MD, FACE
Philip Levy, MD, FACE

A report of the American Diabetes Association's Expert Committee on the Diagnosis and Classification of Diabetes Mellitus¹, published in the November 2003 issue of Diabetes Care, contained recommendations for two important changes. In response to this report, the following statement had been developed by the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) to outline their position.

The committee recommended that there be a reduction of the cut-off value for the diagnosis of impaired fasting glucose (IFG) from 110mg% to 100 mg%. This change was made after the realization that in many populations, the predictive value of the fasting plasma glucose (FPG) to predict diabetes, as measured by the receiver-operator characteristic curve (ROC) closest to the ideal of 100% sensitivity and 100% specificity, was often at or below 100 mg%, ranging from a value of 103 mg/dl (5.7 mmol/liter) in a Dutch population, and 94 mg/dl (5.2 mmol/liter) in a San Antonio population. This evidence indicates that the previous value for the lower limit for IFG of 110 mg% was inappropriately high. As a result, the committee recommended that the IFG cut-point be reduced to 100mg% (5.6 mmol/liter).

Also in the committee report was an acknowledgement that, if the goal was to predict the development of diabetes or cardiovascular disease, they no longer could recommend IFG over impaired glucose tolerance testing (IGT), since each test had its merits.

The ACE, in January 2002, published guidelines and a consensus statement related to targets for glucose management, and established targets for pre and postprandial glucose control^2,3. The ACE consensus conference agreed on the high importance of postprandial targets because of the robust epidemiologic evidence linking cardiovascular risk associated with postprandial hyperglycemia. The committee felt that in order to deal with the worldwide epidemic of diabetes, there was a great need to improve the proportion of those being identified as being at risk for either the development of diabetes or cardiovascular disease.

Both the AACE and ACE are pleased by the expert committee's recommendation of a change in the lower cut-point for the diagnosis of IFG. While it is true, particularly in ethnic populations, that a level of 95 mg% may be even more useful as a predictor of the development of diabetes and cardiovascular disease, the lowering of the cut-point for IFG to 100 mg% is an improvement, and is to be applauded. AACE believes strongly that the public will be better served by using both IFG levels and post-challenge glucose testing as tools to identify the populations that are at risk. In the future, when insulin assays become better standardized and more widely available, we may be able to identify the at-risk populations even earlier. But for the present, the reduction in the cut-point for the diagnosis of impaired fasting glucose is a good start.

¹The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160-3167, 2003.

²American College of Endocrinology Consensus Statement on Guidelines for Glycemic Control. Endocrine Practice Supplement January/February 2002:5-11.

³American College of Endocrinology Diabetes Consensus Conference Presentations. Endocrine Practice, Supplement January/February 2002:12-48.

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