Assessing the preprandial glucose target: 100 mg/dL versus 110 mg/dL

To assess the potential value of lowering the impaired fasting glucose (IFG) cut point from 110 mg/dL to 100 mg/dL.

Data from pertinent published studies are analyzed in an effort to identify the risk of diabetes, cardiovascular disease, and mortality under various glycemic conditions.

The risk of developing diabetes increases with advancing age. The relationship is strongest when the 2-hour plasma glucose level is analyzed, whereas the fasting plasma glucose level is generally stable and changes little with aging. The 2-hour plasma glucose level has a linear relationship with cardiovascular disease and mortality. Most patients with acute myocardial infarction have high 2-hour plasma glucose levels but normal fasting plasma glucose values. Increased mortality risk based on the fasting plasma glucose level does not appear until values of approximately 7 mmol/L (126 mg/dL) and remains relatively flat at lower levels.

Lowering the cut point for IFG from 6.1 mmol/L to 5.6 mmol/L (110 mg/dL to 100 mg/dL) increases the prevalence of IFG but does not predict mortality below 7 mmol/L (126 mg/dL).