application of the new ADA criteria for the diagnosis of diabetes to population studies in sub-Saharan Africa. British Diabetic Association.
Levitt NS, Unwin NC, Bradshaw D, Kitange HM, Mbanya JC, Mollentze WF,Omar MA, Motala AA, Joubert G, Masuki G, Machibya H.
Diabet Med 2000;17(5):381-385.
Summary

Objectives
To examine the implications of the American Diabetes Association recommendation that the fasting blood glucose at a lowered level becomes the main diagnostic test for diabetes on cross-sectional-based data from sub-Saharan Africa.

Research design and methods
Data from 11 of a possible 13 surveys conducted in rural, peri-urban and urban Cameroon (n = 1804), South Africa (n = 3799) and Tanzania (n = 10013) which measured fasting (ADA criteria) and 2-hour blood glucose concentrations during a standard 75g OGTT (WHO criteria) were analysed.

Results
The prevalence of diabetes was higher in 8 of the 11 surveys when applying the ADA compared to the WHO criteria. With the exception of one population (Mara, Tanzania) the absolute difference in prevalence between the two classifications tended to be small (<2%). There was considerable variation in individuals' categorisation using the ADA and WHO criteria. The level of agreement between the two ranged from fair to good (Kappa statistic 0.17 – 0.86). The prevalence of impaired fasting glycaemia was lower than that of impaired glucose tolerance in 10 of the surveys and the agreement between the two was fair, £0.26 in all the surveys.

Conclusions
Although the use of the new ADA fasting criteria for prevalence surveys is an attractive and practical option, particularly in Africa, further information is required on the characteristics and prognosis of individuals classified by the fasting criteria, prior to wide adoption of the ADA criteria.

KEY WORDS: Diagnostic Criteria, World Health Organisation, American Diabetes Association, Fasting Glucose, Glucose tolerance test.