Re: what is the real range of numbers for the FBG?



Susan wrote:


If you do a Medline search on Impaired Glucose Tolerance, which is
alleged by the NIH and ADA to be non-diabetic, and peripheral
neuropathy, for example, you find many reports of diabetic complications
in those with FBG below yours.

Would you be willing to post some links to specific abstracts?
That is generally the way it's done.



Your body, your science experiment. I'd recommend you do your own
research in the peer reviewed medical literature instead of reading
predigested pap fed to you by those with financial stakes in something
other than your health.

Sure, here's what I found out:
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http://tinyurl.com/rk9e3

Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes
associated with improved outcomes?: U.K. prospective diabetes study 61.

quote:
"Individuals in the low FPG group had a significantly reduced risk for
each predefined clinical outcome except stroke,"
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It does not recommend any lower level for establishing diabetes as
opposed to "pre-diabetes," to prevent any possibility of complications.

I don't know how they could, actually. They can't take people in the
normal range and call them "pre-diabetic." I think that even though
complications may happen in pre-diabetics, that may not mean the
category should be done away with, if there's a chance at reversal.
It kind of makes sense that complications could start at the
pre-diabetic
stage. How else can one notice symptoms and go do something
about it?

This was also interesting, but not necessarily related:
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http://tinyurl.com/gqa6f

Comparison of fasting and 2-hour glucose and HbA1c levels for
diagnosing diabetes. Diagnostic criteria and performance revisited.

CONCLUSIONS: Optimal cutpoints for defining diabetes differ according
to how diabetes itself is defined. When diabetes is defined as the
upper component of the bimodal population distribution, a fasting
glucose level somewhat lower than the current WHO cutpoint and a 2-h
glucose level somewhat higher than the current WHO cutpoint minimized
misclassification. When diabetic retinopathy defines diabetes, we found
that the current fasting diagnostic criterion favors specificity and
the current 2-h criterion favors sensitivity. These results should
prove valuable for defining the optimal tests and cutpoint values for
diagnosing diabetes.
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here's another interesting one:
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http://tinyurl.com/zrvgd

Revisiting the oral glucose tolerance test criterion for the diagnosis
of diabetes.

CONCLUSION: Since Hb A1C levels are the best measures presently
available that reflect long-term glycemia, we conclude that the 2-hour
glucose concentration criterion on an oral glucose tolerance test for
the diagnosis of diabetes should be raised from >/= 11.1 mmol/L (200
mg/dL) to >/= 13.3 mmol/L (240 mg/dL) to remain faithful to the concept
that diagnostic concentrations of glucose should predict the subsequent
development of specific diabetic complications (e.g., retinopathy).
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These guys actually want to raise the mg/DL for
the 2-hour glucose concentration criterion.

OK, I was wrong about the A1C not being used
for diagnosis. I'll have to go
tell that guy.

This next is more related to what you brought up:
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http://tinyurl.com/kub84

Tests of glycemia for the diagnosis of type 2 diabetes mellitus.

This paper discusses tests of glycemia for the diagnosis of type 2
diabetes mellitus, with particular reference to the 1997 diagnostic
criteria of the American Diabetes Association. The potential benefits
of the lower diagnostic threshold for fasting plasma glucose are not
well defined. However, the change in the diagnostic cut-off for
diabetes mellitus affects as many as 1.9 million persons in the United
States; therefore, the medical and social costs of the lower threshold
may be considerable. Type 2 diabetes mellitus is defined by a threshold
imposed on the continuous distribution of glycemic levels, typically
with respect to risk for microvascular complications. However, the
burden of type 2 diabetes relates more to macrovascular than
microvascular complications. Because no clear threshold exists for
macrovascular complications, a formal balancing of direct and indirect
costs with both microvascular and macrovascular complications may be
appropriate to establish glycemic thresholds. Because fasting plasma
glucose, hemoglobin A1c, and the oral glucose tolerance test all
predict diabetic complications yet test reliability is better for
fasting plasma glucose and hemoglobin A1c than for the oral glucose
tolerance test, we suggest an alternative diagnostic approach: If
random plasma glucose is elevated (> or =11.1 mmol/L [200 mg/dL]) and
the hemoglobin A1c level is more than 2 SDs above the laboratory mean,
then diabetes mellitus should be diagnosed, and management should be
based on the hemoglobin A1c level. If the result of only one of these
tests is positive, then fasting plasma glucose should be tested to
evaluate the patient for impaired fasting glucose and diabetes
mellitus. The glycemic threshold for type 2 diabetes should be
established by cost-effectiveness analysis. The clinical diagnosis of
diabetes mellitus could be streamlined by incorporation of hemoglobin
A1c into established criteria.
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This is where I learned about the Random Plasma glucose Test.

.



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