Fasting and 2-Hour Postchallenge Serum Glucose Measures and Risk of Incident Cardiovascular Events in the Elderly

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Abstract
IN 1997, THE American Diabetes Association (ADA) revised diabetes diagnostic criteria by lowering the fasting plasma glucose threshold and by recommending against the routine use of glucose challenge testing, especially as it concerns epidemiologic studies.1 The change was justified primarily by epidemiologic data indicating that the new criteria would identify roughly the same number of people with microvascular complications as the previous criteria, without the burden of glucose challenge testing. These revised criteria have prompted the research community to examine the effects of the diagnostic change on the identification of persons at risk for cardiovascular disease (CVD), the primary complication of glucose disorders in old age, and all-cause mortality.2,3 Findings indicate that the current ADA criteria do not maximize the identification of persons at risk for these major health outcomes. Nonetheless, the individual and joint associations of fasting and 2-hour glucose measures with cardiovascular morbidity and mortality remain ill-defined, especially for those who do not meet 1997 ADA diabetes criteria.