THE RECENT LOWERING of the fasting glucose level for the diagnosis of diabetes from 7.8 mmol/L (140 mg/dL) to 7.0 mmol/L (126 mg/dL) by the American Diabetes Association (ADA), as well as the definition of a new category—impaired fasting glucose (IFG)—defined as a fasting glucose level between 6.1 and 6.9 mmol/L (110 and 125 mg/dL) (mainly to circumvent the need to perform an oral glucose tolerance test to identify the state of impaired glucose tolerance [IGT]), draws attention to the consequences of mild elevations of the fasting plasma glucose level.1 It is estimated that about 5.3 million previously undiagnosed individuals with diabetes as well as a large proportion of the estimated 11.6 million people with IGT in the United States may now be identifiable through the application of these new criteria using the fasting plasma glucose test. Identifying diabetes at an earlier point in its course may have significant benefit, since earlier diagnosis and treatment of hyperglycemia will reduce the extent of microvascular complications, and hygienic measures applied to individuals with IGT may retard its progression to diabetes.
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