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News & InformationCDC Statements on Diabetes IssuesDiagnosis and Classification of Diabetes Mellitus
1. Who developed the new guidelines for the diagnosis and classification of diabetes, and what was CDC's role?* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link. An international Expert Committee on the Diagnosis and Classification of Diabetes Mellitus working under the sponsorship of the American Diabetes Association (ADA) developed the new guidelines. The committee published its report in Diabetes Care 1997; 20(7):1183-97, which was updated in Diabetes Care 2004;27:S5-S10.* The committee had 17 members including clinicians and researchers from academia, the private sector, the National Institutes of Health (NIH), and the ADA. Open collaboration in the World Health Organization (WHO) occurred. No Centers for Disease Control and Prevention (CDC) experts were on the committee, but they were consulted during the process. They reviewed and commented on preliminary drafts of the report, and provided some epidemiologic data to the committee. Among other sources of information, CDC's data were used to study the diagnostic criteria. 2. What are the major recommendations in the report for the diagnosis and classification of diabetes?The major recommendations in the report include the following: For classification
For diagnosis
For testing
3. What is CDC's opinion on the recommendations made by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus?CDC strongly recommends that the new diagnostic and classification criteria be adopted, promulgated, and implemented by all individuals and organizations that identify and care for people with diabetes. The new diagnostic criteria are based on sound scientific evidence. On balance, patients should benefit by having a greater opportunity to be diagnosed and to receive treatment before complications develop. Simultaneously, more data are necessary to validate and support the committee's recommendation to test all people 45 years and older every 3 years. The entire issue of GDM needs further investigation and discussion. 4. What scientific research supports these recommendations?For classification
For diagnosis
For testing
5. What is the rationale for screening people aged 45 years and over every 3 years?The committee cited the following reasons:
At present, CDC does not recommend broad-based, population screening programs. 6. What are the public health implications and challenges?Data from the NHANES III survey (a U.S. population-based survey) were used to develop the new diagnostic criteria (that is, using the new fasting measurement alone with no OGTT). These criteria lower the estimated total (diagnosed and undiagnosed) diabetes prevalence in people 40 to 74 years of age to 12.3%, compared with 14.3% found by applying the WHO's current diagnostic criteria, which uses both a fasting value of 140 mg/dl and the OGGT measurement. The impact of the new FPG criteria on total prevalence will vary by clinic and state. However, the new fasting diagnostic criteria will help find asymptomatic people with undiagnosed diabetes because of the utility and ease of obtaining fasting measurements compared with the difficulty of using OGTTs. The number of people who shift from undiagnosed to diagnosed diabetes may potentially increase the total by 2 million; that is, from 8 million to 10 million people diagnosed with diabetes. Thus, the new criteria should begin to address the "missing 8 million." Public health challenges include addressing issues for newly diagnosed people, and issues for the health care system. Patient anxiety, personal economic impact, insurability, and employability will need attention. However, these concerns possibly will be overshadowed by the benefit to the individual in terms of the potential of a healthier life and of living fewer years with disabling diabetic complications. Issues for the health care system include the following concerns:
Ensuring that evidence-based, cost-effective interventions are used to maximize the nation's investment value is critical. 7. What are the economic implications?The use of the new fasting criteria will identify a higher proportion of those with diabetes who are currently undiagnosed. As noted, about 2 million people with diabetes may be diagnosed. This may initially result in an increase in diabetes expenditures. However, over a lifetime, the cost may decrease to care for people with diabetes diagnosed using the new criteria, because disease will be diagnosed at an earlier stage and complications may be easier to prevent. No scientific study, to date, has been carried out to support or refute these conjectures. However, CDC is presently engaged in a cost-effectiveness analysis of more active screening programs. 8. What impact will these recommendations have on CDC's state diabetes control programs?The new recommendations will probably result in people with early, undiagnosed diabetes being found more frequently. Most of these new cases will have few diabetic complications, if any. Identifying cases earlier provides an opportunity and greater "potential" to prevent microvascular and macrovascular complications. State diabetes control programs will need to emphasize using the fasting criteria to diagnose cases to aggressively prevent complications in newly diagnosed people, along with those with diabetes of longer duration. 9. What impact will these recommendations have on the National Diabetes Education Program?These issues may require that National Diabetes Education Program representatives develop initiatives that focus on adopting, communicating, and implementing the new recommendations, which include the classification system, the diagnostic criteria, and the testing algorithm. Emphasizing quality care of patients with newly diagnosed diabetes and considering the role of diet and physical activity as an aggressive initial treatment option will also be important. 10. What CDC activities will further understanding of the committee's recommendations?Currently, most of CDC's focus is on important public health research issues. Activities include the following:
The findings of this research agenda should enhance CDC's ability to support an effective, efficient, and appropriate public health response to the impact of diabetes in the United States. Return to CDC Statements on Diabetes Issues
Page last reviewed: August 31, 2007
Page last modified: December 20, 2005 Content Source: National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation |