It has been known that the diagnosis of diabetes should be made early to prevent cardiovascular and other metabolic complications (such as malignancy, etc). So far, determination of blood glucose levels has been used to diagnose diabetes. As a matter of fact, some diabetic patients had already had chronic complication at the first time of diagnosis. It shows why the glucose-centric definition for diagnosing diabetes that has been used so far could not be applied to the sole diagnosis criteria for a group of patients with such “syndrome”. Blood glucose examination and the cut-off point for diagnosing diabetes have become controversial debates for a long time. In 1979, the National Diabetes Data Group (NDDG) made diagnostic criteria for diabetes, which subsequently have been used for over 2 decades. At that time, the Committee used the cut-off point of blood glucose level based on distribution and it was not associated with the correlation between blood glucose level and chronic complication. Diagnosis of diabetes was established when fasting plasma glucose level (FPG) >140 mg/dL; 2-hour post-prandial blood glucose or 2-hours PPG >200 mg/dL.1-5 In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus reviewed the principles of diagnosis for diabetes. The Committee used the new approach for diagnosing diabetes by correlating the blood glucose level with the distribution of long-term complications. The Committee considered three epidemiological studies, i.e. the population study in Egypt (n=1018)6, US National Health and Nutrition Examination Survey (NHANES) survey (n=2821), PIMA Indians study with Hb A1c as diagnostic criteria (n=960).7 Those three studies used retinopathy complication as the dependent variable for determining the cut-off point of blood glucose level. By applying such approach, the criteria of diabetes has been changed, particularly from FPG >140 mg/dL into >126 mg/dL. The cut-off point may reveal more linearity association between FPG and PPG. In addition to establishing diagnosis criteria for diabetes, the Committee also introduced the terms “impaired fasting glucose” (IFG) and “impaired glucose tolerance” (IGT) to differentiate metabolic conditions between the normal groups and diabetics; with the criteria of 110-125 mg/dL and 140-199 mg/dL, respectively. Consequently, WHO adapted such approach and suggested individual with IFG should have oral glucose tolerance test (OGTT) to avoid the false-negative result and recommended OGTT as the gold standard for diagnosing diabetes. In 2003, the Committee revised the criteria from IFG >110 mg/dL into >100 mg/dL. However, WHO still used the criteria of 110 mg/dL for IFG. Since a long time ago, the experts have realized that determination of cut-off point for diagnosing diabetes will be revised over time with the lower blood glucose level as the more sensitive diagnosis for detecting the occurring complication.

Dante Saksono Harbuwono

Acta medica Indonesiana

Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine is an open accessed online journal and comprehensive peer-reviewed medical journal published by the Indonesian Society of Internal Medicine since 1968. Our main mission is to encourage the novel and important science in the clinical area in internal medicine.    We welcome authors for original articles (research), review articles, interesting case reports, special articles, clinical practices, and medical illustrations that focus on the clinical area of internal medicine.    Subjects suitable for publication include, but are not limited to the following fields of:    -Allergy and immunology  -Emergency medicine  -Cancer and stem cells  -Cardiovascular  -Endocrinology and Metabolism  -Gastroenterology  -Gerontology  -Hematology  -Hepatology  -Tropical and Infectious Disease  -Virology  -Internal medicine  -Psychosomatic  -Pulmonology  -Rheumatology  -Renal and Hypertension  -Thyroid

Acta Medica Indonesiana is an open-access online journal and a comprehensive peer-reviewed medical journal published by the Indonesian Society of Internal Medicine since 1968. Our main mission is to promote novel and significant scientific research in the clinical field of internal medicine. We welcome authors to submit original research articles, review articles, interesting case reports, special articles, clinical practices, and medical illustrations that focus on the clinical aspects of internal medicine. Suitable subjects for publication include, but are not limited to, the following fields: Allergy and Immunology, Emergency Medicine, Cancer and Stem Cells, Cardiovascular, Endocrinology and Metabolism, Gastroenterology, Gerontology, Hematology, Hepatology, Tropical and Infectious Diseases, Virology, Internal Medicine, Psychosomatic Medicine, Pulmonology, Rheumatology, Renal and Hypertension, and Thyroid.

《Acta Medica Indonesiana》是由印度尼西亚内科学会自1968年起出版的开放获取在线期刊，致力于全面的同行评审医学研究。我们的主要使命是促进内科学领域的新颖和重要科学研究。我们欢迎作者提交原创研究文章、综述文章、有趣的病例报告、特别文章、临床实践和医学插图，重点关注内科学的临床领域。适合发表的主题包括但不限于以下领域：过敏与免疫学、急救医学、癌症与干细胞、心血管、内分泌与代谢、胃肠病学、老年医学、血液学、肝病学、热带与传染病、病毒学、内科学、心理生理学、肺病学、风湿病学、肾脏与高血压、甲状腺。

Redefining diabetes: is it really necessary?

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Category	Quartile
MEDICINE, GENERAL & INTERNAL	3