Type 2 Diabetes Mellitus (NIDDM) is one of the most frequent metabolic diseases. Widely distributed in various populations, the prevalence of type 2 diabetes appears to be increasing rapidly, leading to alarming estimations for the future. According to WHO predictions, the disease could affect more than 250 million people in 2020 instead of the current 100 million people <sup>[1King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections. Diabetes Care, 1998, 21, 1114-1131.

Cliquez ici pour aller à la section Références]</sup>. A similar increase has recently been reported in France: the prevalence in the general population was estimated to be 2.78% in 1999 compared to 2.2% in 1994 <sup>[2Ricordeau P, Weill A, Vallier N, Bourrel R, Fender P, Allemand H. L'épidémiologie du diabète en France Métropolitaine. Diabetes Metab, 2000, 26, 11-24.

Cliquez ici pour aller à la section Références]</sup>. Type 2 diabetes can be overlooked for a long time, allowing development of irreversible vascular complications <sup>[3Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis. Diabetes Care, 1992, 15, 815-819.

Cliquez ici pour aller à la section Références] [4Muggeo M. Accelerated complications in type 2 diabetes mellitus: the need for greater awareness and earlier detection. Diabet Med, 1998, 15, S60-S62.

Cliquez ici pour aller à la section Références]</sup>. Early diagnosis is therefore of major importance, since normalization of glycaemia and treatment of the associated cardiovascular risk factors may reduce the occurrence of the complications of diabetes <sup>[5Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care, 1993, 16, 642-652.

Cliquez ici pour aller à la section Références]</sup>. Unfortunately several studies in different countries have reported that up to 50% of all subjects with diabetes are undiagnosed <sup>[6Harris MI, Eastman RC. Early detection of undiagnosed non-insulin-dependent diabetes mellitus. JAMA, 1996, 276, 1261-1262.

Cliquez ici pour aller à la section Références] [7DECODE Study Group on behalf of the European Diabetes Epidemiology Study Group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. BMJ, 1998, 317, 371-375.

Cliquez ici pour aller à la section Références]</sup>.

Previously based on Fasting Plasma Glucose (FPG) or Oral Glucose Tolerance Test (OGTT), the diagnostic criteria for diabetes mellitus have been modified: a FPG level above 125 mg/dl measured twice is now necessary to diagnose diabetes <sup>[8The Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 1997, 20, 1183-1196.

Cliquez ici pour aller à la section Références]</sup>. This guideline has recently been adopted by the WHO in 1998 <sup>[9Alberti KGMM, Zimmet PZ, for the WHO Consultation. Definition, diagnosis and classification of diabetes melittus and its complications. Part 1: diagnosis and classification of diabetes melittus. Provisional report of a WHO consultation. Diabet Med, 1998, 15, 539-553.

Cliquez ici pour aller à la section Références]</sup>. These new criteria can be applied to epidemiological studies, allowing estimation of the prevalence of the disease in various populations <sup>[8The Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 1997, 20, 1183-1196.

Cliquez ici pour aller à la section Références]</sup>. The three aims in this study were

• to assess the prevalence of diagnosed and undiagnosed diabetes mellitus in a large unselected French population of more than 60,000 male and female subjects;
• to estimate the prevalence of subjects with impaired fasting glycaemia (IFG) and the prevalence of undiagnosed diabetes in this population;
• to define the clinical and biological characteristics and dietary habits of male and female individuals within four subgroups: undiagnosed diabetics with fasting glycaemia >= 140 mg/dl (G4), undiagnosed diabetics with fasting glycaemia in the range [126 to 140 mg/dl[(G3), impaired fasting glycemia in the range [110 to 126 mg/dl[(G2) and controls with fasting glycaemia < 110 mg/dl (G1).

Most people in France (85%) belong to the same social security Medical Insurance system, which covers medical fees and promotes preventive medicine. The IRSA (Institut inter Régional pour la Santé) undertakes preventive health care examinations in volunteers covered by this medical insurance system in several Departments of the western part of France. Therefore 61,724 subjects aged 16 and over living in six Departments of western France (Indre, Indre-et-Loire, Maine-et-Loire, Sarthe, Calvados and Orne in which about 3 millions people are living [INSEE 1999]) applied for a medical check-up from February 1995 to March 1996.

Each patient was asked to give general information such as age, socio-economic category, educational level and history of previous disease including cardiovascular risk factors, familial medical history, and current medical treatment. Food intake was evaluated by a short previously validated self-administered questionnaire (NAQA) <sup>[10Lasfargues G, Vol S, Le Clésiau H, Bedouet M, Hagel L, Constans T, Tichet J. Validité d'un auto-questionnaire alimentaire court par comparaison avec un entretien diététique. Presse Med, 1990, 19, 953-957.

Cliquez ici pour aller à la section Références]</sup>. Alcohol, sucrose, lipid, cholesterol and protein consumption and overall energy intake were determined. A clinical examination was performed by a physician recording heart rate and blood pressure after 5 minutes' rest, weight, height, and waist/hip circumference measurements. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. Hypertension was defined as systolic blood pressure >= 140 mm Hg and/or diastolic blood pressure >= 90 mm Hg. Central obesity was considered as WHR >= 1.0 in men and >= 0.8 in women and overweight as BMI >= 27 kg/m ² .

Biological analyses were performed on blood samples collected after 12 hour overnight fasting. Fasting plasma glucose (FPG) was obtained by the glucose-oxydase-peroxidase method (RA1000, Bayer diagnostics F92807 Puteaux). Total plasma cholesterol, triglycerides, gamma-glutamyl transferase (GGT), blood creatinine were measured in both genders by appropriate methods (DAX24, Bayer Diagnostics, F 92807) and uric acid levels were determined for all men and postmenopausal women only. Creatinine clearance (ml/mn) was calculated using the Cockroft formula: [(140-age) X weight (kg)]/[y X blood creatinine (µmol/l)] with y = 1.0 for males and 0.85 for females.

Five groups were defined within the population according to their fasting plasma glucose levels, prior personal history of diabetes mellitus and current glucose lowering treatment

• G1: FPG < 110 mg/dl and no personal history of diabetes mellitus and no glucose lowering treatment (controls);
• G2: FPG from 110 to 125 mg/dl, impaired fasting glycaemia (IFG);
• G3: FPG from 126 to 139 mg/dl with no personal history of diabetes mellitus or glucose lowering medication (new diabetics with ADA criteria recently adopted by WHO);
• G4: FPG >= 140 mg/dl with no personal history of diabetes mellitus or glucose lowering treatment (1985 WHO criteria for diabetes); G3 and G4 represented undiagnosed diabetics (people with abnormal fasting plasma glucose without an established diagnosis of diabetes melittus);
• G5: Known cases of diabetes mellitus with or without medical treatment (not reported here). The prevalence of undiagnosed diabetes was calculated for each sex according to three age classes: < 50 (mean age 35), 50-64 (mean age 56), > 64 years (mean age 69).

All the statistics were performed with the NCSS 2000 program (Number Cruncher Statistical Systems, Dr Hintze, Kaysville, Utah, USA). Variables were expressed as percentages or means (± standard deviation). As age was significantly different between the groups in both genders and as variable levels strongly differed according to gender, analyses were performed separately for males and females and after adjustment for age. Due to the skewed distribution of triglyceride and gamma glutamyl transferase levels, these variables were log- transformed. Analysis of covariance was used to compare biometric, biological and nutritional variables, with age adjustment. A logistic regression model was used with age adjustment for the comparison of discrete variables. Comparisons were performed between consecutive groups (G2/G1, G3/G2, G4/G3). A p value < 0.05 was considered to be significant.

Of 61,724 subjects, 58,981 had complete clinical and biological data. The number of known diabetics was 993 (G5), 263 subjects were undiagnosed diabetics with the criteria FPG >= 140 mg/dl (G4) and 419 with the criteria FPG 126-139 (G3). The number of subjects with impaired fasting glycaemia (IFG: 110-125 mg/dl) (G2) was 3698. The control group comprised 53,608 subjects (G1) (Table I). The prevalence of diabetes in this study using the new criteria was 3.6% and 2.1% for men and women, respectively and prevalence increased with age from 2.3% to 9.2% in males and from 1.5 to 5.9% in females.

The prevalence of undiagnosed diabetes was 1.2% (1.7% and 0.6% for males and females respectively) when the new ADA/WHO criteria for diabetes were applied, accounting for 41% of the overall prevalence of the disease (682/1,675). The prevalence increased with age from 1.2% to 3.3% (males) and from 0.3% to 2.5% (females) (Table I). Similarly, the prevalence of IFG increased with age from 7.9% to 14.1% (two-fold increase) in males and from 2.3% to 7.1% (three-fold increase) in females. The proportion of unknown diabetics decreased with age in males (50% to 36%). Conversely, it increased in females from 25% to 42%.

The characteristics of subjects were compared between groups, from controls (G1) to undiagnosed diabetics using the former WHO criteria (G4) (Table IIafor males and IIbfor females). Every parameter was significantly higher in G2 (IFG) compared to G1 (controls) for both genders, i.e. personal history of hypertension or familial history of diabetes, heart rate and blood pressure, BMI and WHR, cholesterol, triglyceride, uric acid, gamma glutamyl transferase levels and creatinine clearance. Similarly, many parameters were significantly higher in G3 versus G2, i.e. personal history of hypertension or familial history of diabetes, heart rate and blood pressure, BMI and WHR, triglycerides, uric acid and gamma glutamyl transferase levels in males and familial history of diabetes, diastolic blood pressure, BMI and WHR, triglyceride, uric acid, gamma glutamyl transferase levels and creatinine clearance in females. Comparison of G4 and G3 was only significant in the increase in BMI and WHR, triglyceride and gamma glutamyl transferase levels in males, BMI, triglyceride levels and creatinine clearance in females. Overall each parameter increased consistently from G1 to G4 in men and women, with the exception of creatinine clearance in men.

Dietary and smoking habits are shown in Table IIIafor males and IIIbfor females. Current smoking was more frequently observed in controls and this tendency was even more evident in females. Several significant unbalanced nutritional habits were noted in G2 compared to G1 in both genders: missing breakfast, skipped lunches, overconsumption of eggs, alcohol and cholesterol and lack of dairy products. Missing breakfast, lack of dairy products and excess alcohol intake were still significant in males in G3 compared to G2 and consumption of sucrose, lipids, cholesterol and energy intake were increased in females. In G4, no further differences were noted in nutritional habits compared to G3.

Reassessment of the epidemiology of diabetes is required since diagnostic criteria have recently been revised. The participants were volunteers for a health examination provided by the French Social Security System; at least 85% of the French population is included in this insurance system. Our population presents many similarities concerning nutritional habits and biological characteristics with the French population aged 20-74 but cannot be considered as strictly representative. More people in our study had a higher level of education than the general population (IRSA: 19% versus INSEE: 14% had university degrees) and it is well known that this characteristic might decrease the prevalence of diabetes <sup>[11Vol S, Doctoriarena A, Le Clesiau H, Tichet J. Food habits of adults in France. Epidemiological data. Presse Med, 1992, 21, 1105-1109.

Cliquez ici pour aller à la section Références]</sup>. They were also volunteers and this could have generated a bias. A limitation in our findings is linked to diagnosis based on a single FPG evaluation instead of two FPG above 126 mg/dl <sup>[8The Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 1997, 20, 1183-1196.

Cliquez ici pour aller à la section Références]</sup>. A single FPG has been recognised to be sufficient for epidemiological studies <sup>[9Alberti KGMM, Zimmet PZ, for the WHO Consultation. Definition, diagnosis and classification of diabetes melittus and its complications. Part 1: diagnosis and classification of diabetes melittus. Provisional report of a WHO consultation. Diabet Med, 1998, 15, 539-553.

Cliquez ici pour aller à la section Références]</sup>but it leads to an overestimation of the prevalence of diabetes <sup>[12Charles MA, Simon D, Balkau B, Eschwege E. Révision des critères diagnostiques du diabète: les raisons et les conséquences. Diabetes Metab, 1998, 24, 75-79.

Cliquez ici pour aller à la section Références]</sup>.

This study revealed a significant contribution of undiagnosed diabetes (1.2%) to the overall prevalence of the disease (2.8%). This contribution was increased (0.5% to 1.2%) when using the diagnostic criteria of the ADA <sup>[8The Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 1997, 20, 1183-1196.

Cliquez ici pour aller à la section Références]</sup>recently adopted by WHO <sup>[9Alberti KGMM, Zimmet PZ, for the WHO Consultation. Definition, diagnosis and classification of diabetes melittus and its complications. Part 1: diagnosis and classification of diabetes melittus. Provisional report of a WHO consultation. Diabet Med, 1998, 15, 539-553.

Cliquez ici pour aller à la section Références]</sup>. We also found a great number of subjects with impaired fasting glycaemia, (9.5% in males and 3.3% in females, (Table I).

Ricordeau et al. <sup>[2Ricordeau P, Weill A, Vallier N, Bourrel R, Fender P, Allemand H. L'épidémiologie du diabète en France Métropolitaine. Diabetes Metab, 2000, 26, 11-24.

Cliquez ici pour aller à la section Références]</sup>published new figures in 1999 when the number of diabetics in the population covered by the French Social Security system was 2.78%, thus demonstrating increased prevalence in France. The percentage of 2.8% in our study is concordant with the previous estimation although methods of evaluation were different: fasting plasma glucose levels with medical validation of the diagnosis of diabetes instead of cost of drugs in Ricordeau's estimation. However, compared to the DECODE study <sup>[8The Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 1997, 20, 1183-1196.

Cliquez ici pour aller à la section Références]</sup>, our findings may have underestimated the prevalence of unknown diabetics assessed by the former WHO criteria since oral glucose tolerance tests (OGTT) were not performed. We observed a striking age effect: the prevalence of unknown diabetics was 3 times higher in older males and 8 times higher in older females. Similarly, the prevalence of IFG was two-fold greater in older males and three-fold greater in older females. This emphasises the need for early awareness of glucose abnormalities if we want to counteract efficiently the increase in the prevalence of the disease in the near future.

Undiagnosed diabetes (1.2%, in our study) accounted for 41% of the overall prevalence of the disease. The prevalence in the DECODE study <sup>[8The Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 1997, 20, 1183-1196.

Cliquez ici pour aller à la section Références]</sup>was 5.8%, accounting for 61% of diabetics overall. However the populations for calculations in the DECODE study were much older than those in this study and, as already mentioned, included OGTT. The increasing rate of unknown female diabetics according to age might be explained by more frequent biological check up performed in young women (oral contraception, HRT).

The characteristics of our undiagnosed diabetic population and subjects with impaired fasting glycaemia showed a regular progression from controls (G1) to undiagnosed diabetics with the highest fasting glycaemia (G4) and there was a progressive increase in BMI, WHR and triglyceride levels in males and females. Central obesity is known to be associated with a higher degree of insulin resistance and triglyceride levels are a hallmark of the metabolic syndrome. The role played by hypertriglyceridaemia in the occurrence of coronary heart disease in type 2 diabetes is still a matter of debate <sup>[13Schlechte JA, Kreisberg R. Update in endocrinology. Ann Intern Med, 1998, 129, 719-724.

Cliquez ici pour aller à la section Références]</sup>. Increased levels of triglycerides and hypertension were independent cardiovascular risk factors in the male diabetic population in the Paris Prospective study <sup>[14Fontbonne A, Eschwege E. Insulin-resistance, hypertriglyceridemia and cardiovascular risk: the Paris prospective study. Diabetes Metab, 1991, 17, 93-95.

Cliquez ici pour aller à la section Références]</sup>. A significant increase in lipid parameters was observed as soon as PFG exceeded 110 mg/dl in the DESIR study <sup>[15Balkau B, Eschwege E, Tichet J, Marre M et D.E.S.I.R. Study group. Proposed criteria for the diagnosis of diabetes: evidence from a French epidemiological study (DESIR ). Diabetes Metab, 1997, 23, 428-434.

Cliquez ici pour aller à la section Références]</sup>, and we found similar results for triglyceride levels.

Blood pressure was significantly higher in both genders in G2 compared to G1 and in males in G3 compared to G2. More than 50% females and 65% males with undiagnosed diabetes (G3 and G4) had elevated blood pressure. However, blood pressure was measured only once in our study. According to the ADA guidelines, blood pressure should be measured three times to be sure that levels are abnormal <sup>[16ADA Consensus: treatment of hypertension in diabetes mellitus. Diabetes Care, 1993, 16, 1394-1410.

Cliquez ici pour aller à la section Références]</sup>. Hypertension is a well known abnormality in diabetes, with elevated blood pressure levels observed 1.5 to 2 times more frequently than in non-diabetics <sup>[17Arauz-Pacheco C, Raskin P. Hypertension in diabetes mellitus. Endocrinol Metab Clin North Am, 1996, 25, 401-423.

Cliquez ici pour aller à la section Références]</sup>. It is a major factor of risk for cardiovascular disease and kidney disease. A high percentage of hypertension was observed in the families of our undiagnosed diabetic males, and to a lesser degree of females, suggesting a genetic determinant <sup>[18Jeunemaitre X. Aspects génétiques de l'hypertension artérielle: du polygénique au monogénique. Diabétologie et facteurs de risque, 1996, 2, 197-202.

Cliquez ici pour aller à la section Références]</sup>. According to the results of the UKPDS study, normal blood pressure has a major impact upon the reduction of microvascular and macrovascular complications and overall causes of mortality <sup>[19UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. BMJ, 1998, 317, 703-710.

Cliquez ici pour aller à la section Références]</sup>. It is necessary to normalise already increased blood pressure <sup>[20Cooper ME. Pathogenesis, prevention, and treatment of diabetic nephropathy. Lancet, 1998, 352, 213-219.

Cliquez ici pour aller à la section Références]</sup>in subjects with IFG as quickly as possible. Uric acid significantly increased in males and females with IFG and in unknown diabetics with FPG above 126 mg/dl. This finding is emphasised since it has recently been shown that it is a useful predictor of strokes in type 2 diabetes <sup>[21Lehto S, Niskanen L, Rönnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke, 1998, 29, 635-639.

Cliquez ici pour aller à la section Références]</sup>.

Environmental factors also play an important role in type 2 diabetes, as demonstrated in Pima Indians where the prevalence of diabetes has increased considerably since they modified their way of living <sup>[22Bennett PH. Type 2 diabetes among the Pima Indians of Arizona: an epidemic attributable to environmental change? Nutr Rev, 1999, 57, S 51-54.

Cliquez ici pour aller à la section Références]</sup>and in Japanese consuming higher rates of fat and protein when they live in the USA <sup>[23Tsunehara CH, Leonetti DL, Fujimoto WY. Diet of second-generation Japanese-American men with and without non-insulin-dependent diabetes. Am J Clin Nutr, 1990, 52, 731-738.

Cliquez ici pour aller à la section Références]</sup>. Unfortunately, the changes in dietary habits are combined with increasingly sedentary lifestyle and stress, obesity and prevalence of urban living, thus adding difficulties for the interpretation of these findings <sup>[24Karamanos B. Diabète et régime alimentaire. In Le diabète en Europe. INSERM Ed , 1994, 117-142.

Cliquez ici pour aller à la section Références]</sup>. Current smoking was less frequently observed in groups of subjects with IFG or undiagnosed diabetes. Active smoking is a well-known risk factor of cardiovascular disease, especially in diabetic patients <sup>[25Yudkin JS. How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects. B M J, 1993, 306, 1313-1318.

Cliquez ici pour aller à la section Références]</sup>. Similarly, increased tobacco consumption was not demonstrated by Harris in an American population of undiagnosed diabetics <sup>[5Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care, 1993, 16, 642-652.

Cliquez ici pour aller à la section Références]</sup>. Cardiovascular risk seems to decrease rapidly when men and women who smoke quit and then to return to the same level as non-smokers within 3 years <sup>[26Dobson AJ, Alexander HM, Heller RF, Lloyd DM. How soon after quitting smoking does risk of heart attack decline? J Clin Epidemiol, 1991, 44, 1247-1253.

Cliquez ici pour aller à la section Références]</sup>or within 10 years in a more recent evaluation in a female cohort <sup>[27Al-Delaimy WK, Willett WC, Manson JE, Speizer FE, Hu FB. Smoking and mortality among women with type 2 diabetes: the nurses'health study cohort Diabetes care, 2001, 24, 2043-2048.

Cliquez ici pour aller à la section Références]</sup>.

The absence of daily breakfast or low consumption of dairy products was significantly more frequent in IFG in both genders, compared to controls and in men with undiagnosed diabetes compared to IFG. It has been suggested that a protective role in the risk of the metabolic syndrome could be linked to increased consumption of dairy products or bread <sup>[28Mennen LI, Lefay L, Feskens EJM, Novak M, Lépinay P, Balkau B. Possible protective effect of bread and dairy products on the risk of the metabolic syndrome. Nutr Res, 2000, 20, 335-347.

Cliquez ici pour aller à la section Références]</sup>. Other variations in diet were small. The frequency of missed breakfast in males in G4 was the same as in controls; this could be explained by patients' misunderstanding of restrictive regimen advice already given to these groups with worse BMI and higher central adiposity. This has already been shown in other studies <sup>[29Mayer-Davis EJ, Levin S, Marshall JA. Heterogeneity in associations between macronutrient intake and lipoprotein profile in individuals with type 2 diabetes. DiabetesCare, 1999, 22, 1632-1639.

Cliquez ici pour aller à la section Références]</sup>. Alcohol consumption was significantly higher in IFG and undiagnosed diabetic males and in IFG females. The possible role of alcohol intake as a risk factor for type 2 diabetes is still controversial, possibly because of differences in the populations studied and in the definitions used for diabetes <sup>[30Hodge AM, Dowse GK, Collins VR, Zimmet PZ. Abnormal glucose tolerance and alcohol consumption in three populations at high risk of non-insulin-dependent diabetes mellitus. Am J Epidemiol, 1993, 137, 178-189.

Cliquez ici pour aller à la section Références] [31Holbrook TL, Barrett-Connor E, Wingard DL. A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus. Am J Epidemiol, 1990, 132, 902-909.

Cliquez ici pour aller à la section Références]</sup>. In a recent study of 4,367 men and women aged 40-64 years who were not known to have diabetes, alcohol intake was positively associated with fasting glucose in men and women <sup>[31Holbrook TL, Barrett-Connor E, Wingard DL. A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus. Am J Epidemiol, 1990, 132, 902-909.

Cliquez ici pour aller à la section Références]</sup>. The higher levels of GGT found in our study in men and in women were usually highly correlated with increased alcohol consumption.

All these cardiovascular and metabolic risk factors were greater in group G2 and even more so in G3, in parallel with the increased fasting blood glucose levels. These results support the choice of FPG at 126 mg/dl and suggest that it would be necessary to investigate cardiovascular risk factors as soon as fasting glycaemia is found to be over 110 mg/dl. This cluster of risk factors has already been observed in a population with type 2 diabetes and found to be linked to coronary heart disease <sup>[32Pomerleau J, McKeigue PM, Chaturvedi N. Relationships of fasting and postload glucose levels to sex and alcohol consumption. Are American Diabetes Association criteria biased against detection of diabetes in women? Diabetes Care, 1999, 22, 430-433.

Cliquez ici pour aller à la section Références]</sup>and similar findings were reported in a non-diabetic population of the Framingham Offspring Study <sup>[33Lehto S, Rönnemaa T, Haffner SM, Pyörälä K, Kallio V, Laakso M. Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with NIDDM. Diabetes, 1997, 46, 1354-1359.

Cliquez ici pour aller à la section Références]</sup>. There was only a small number of subjects in group G4 of both genders (189 and 74 respectively), possibly explaining some non-significant results. Nevertheless, a tendency for parameters to increase was frequently observed in this group.

In conclusion, the prevalence of diabetes in this study using the new criteria was 3.6% and 2.1% for males and females respectively. Undiagnosed diabetes accounted for 41% of all diabetics and impaired fasting glycaemia occurred in 9.5% and 3.3% for males and females. We showed greater levels of clinical and biological abnormalities in subjects with impaired fasting glycaemia and undiagnosed diabetes identified with the new criteria and the old criteria than in controls. In subjects with impaired fasting glycaemia particularly, cardiovascular risk factors were greater: increased weight and central adiposity, hypertension, high plasma lipid levels and poor dietary habits associated with a genetic background (high prevalence of familial history of diabetes). These new diagnostic criteria should make it possible to discover abnormal glycaemia levels sooner. This should in turn make it possible to promote better ways of living, including better dietary habits, stopping smoking and reducing lipid levels, high blood pressure excess and obesity. This should lead to a reduction in multiple cardiovascular risk factors and thus to a decrease in morbidity and mortality linked to diabetes mellitus.