From policemen to policies:: What is the future for 2-h glucose?: The Kelly West Lecture 2000

OBJECTIVE - To describe the characteristics and Vital prognosis of men vith diabetes diagnosed by one fasting plasma glucose (FPG) concentration greater than or equal to7.0 mmol/l, with diabetes diagnosed by one isolated postchallenge hyperglycemia (IPH) (FPG <7.0 mmol/l and a 2-h plasma glucose concentration greater than or equal to 11.1 mmol/l), or with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS - This study involved a cohort of 6,881 Caucasian nondiabetic men from the Paris Prospective Study, aged 44-55 years, who were followed for cause of death for 20 years. RESULTS - Diabetes was diagnosed in 4.3% of the men (1.0% diabetes diagnosed by IPH), and IGT was diagnosed in 9% of the men. At baseline, the men with diabetes diagnosed by IPH had a lower cardiovascular risk profile than those with diabetes diagnosed by FPG, as did the men with IGT and a normal fasting glucose level (<0.1 mmol/l, IGT and normal fasting glucose), compared with men with Impaired fasting glucose (6.1-6.9 mmol/l, IGT and impaired fasting glucose [IFG]). At 20 years of follow-up, all-cause and cancer death rates were higher in men with diabetes diagnosed by IPH than in men with diabetes diagnosed by FPG (55 Vs. 44%, P < 0.1 and 31 Vs. 17%, P < 0.01, respectively) but ere not significantly different for coronary causes (6 Vs. 11%). Men with IGT and normal fasting glucose also had significantly higher cancer death rates than men with IGT and IFG. CONCLUSIONS - The most likely explanation for the high cancer and tow coronary death rates is that men with diabetes diagnosed by IPH consumed alcohol the men in this stud), drank 49g of pure alcohol on average per day, equivalent to 0.61 of wine. if these results are confirmed by other prospective studies, screening subjects for isolated postchallenge hyperglycemia may not be worthwhile.