Comparison of ADA and WHO Criteria in Detecting Pattern of Glucose Disorders in a Population-Based Study: Tehran Lipid and Glucose Study

Many studies have been performed to compare WHO and ADA criteria fordetection of diabetic patients. Thisstudy aims to compare these two criteriain a community-based epidemiological surveyin an urban population of Tehran, Iran.Materials and Methods: Subjects were chosenfrom among 15005 urban individuals, 3 years oldand over, selected by cluster random sampling inthe cross-sectional phase of a longitudinal studyconducted in the east of Tehran; there were 3870men and 5359 women aged 20 years and over.Those with known diabetes were excluded.Blood samples were taken after 12-14 hoursovernight fast and 2 hours post 75gr glucosetaken orally. Prevalence of glucose tolerancecategories and the level of agreement (Kstatistic)were obtained using WHO and ADA criteria.Results: Based on WHO criteria 6.0% (0.95 CI,5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7)had IGT (Impaired glucose tolerance). UsingADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8%(4.4-5.2) had IFG (Impaired fasting glucose);p 0.05 and 0.001 for diabetes and IGT, respectivelyand 7355 (84%) had concordance with bothcriteria. Among 7105 normal subjects classifiedaccording to WHO criteria, 153 (2.2%) had IFG or diabetes by ADA, whereas from 8068 normalsubjects according to ADA criteria, 1116 (13.8%)had IGT or diabetes based on WHO criteria. Thelevel of agreement (K statistic) between the twocriteria was 35% (p O.OOl). Sensitivity and specificityof ADA criteria were 45.5 and 100%, respectively,considering WHO as the gold standard.Conclusion: Our data shows a low level of agreementbetween WHO and ADA diagnostic criteriafor detection of diabetes. Patients with unknowndiabetes, glucose disorders are detected more frequentlyusingWHO criteria.