The limitation of this study is a lack of a baseline
screening for diabetes, i.e.; by fasting plasma glucose or oral
glucose tolerance test. The use of hospital records to adju-
dicate type 2 diabetes might further introduce a bias, as
subjects with well controlled diabetes detected and attended
by their general practitioner only, would be missed. As the
hospital laboratory serves also the general practitioners of
Tromsø, a proportion of those patients would be identified
through HbA1c measurements recorded in the hospital
database, but many general practitioners have their own
HbA1c kit. In the subgroup of 7,160 participantswithHbA1c
and non-fasting glucose measured in a second phase of the
baseline screening, there were 45 subjects with unknown
type 2 diabetes not detected by our validation. This consti-
tutes 33% of all with diabetes at baseline. Including HbA1c
measurements at baseline to define prevalent diabetes,
increased the yield of unknown diabetes substantially from
23%in a previous study in our population using only HbA1c
registered at the hospital [17].Among those 19,495 Tromsø 4
participants who did not take part in the second phase of the
screening in 1994, there were 246 probable cases of pre-
valent type 2 diabetes. Given the same prevalence of
unknown diabetes in this younger population we probably
had 116 undetected cases of diabetes at baseline weakening
our chance of finding associations. As the control group is so
large it is unlikely that these undetected cases have increased
our chance of false positive results.
We used BMI as a proxy of waist circumference as a
modified metabolic syndrome criterion, similar to other
studies [10, 11]. To check the validity of this proxy we
compared the predictive power of BMI and waist circum-
ference in the sub- population with both BMI and waist
The limitation of this study is a lack of a baseline
screening for diabetes, i.e.; by fasting plasma glucose or oral
glucose tolerance test. The use of hospital records to adju-
dicate type 2 diabetes might further introduce a bias, as
subjects with well controlled diabetes detected and attended
by their general practitioner only, would be missed. As the
hospital laboratory serves also the general practitioners of
Tromsø, a proportion of those patients would be identified
through HbA1c measurements recorded in the hospital
database, but many general practitioners have their own
HbA1c kit. In the subgroup of 7,160 participantswithHbA1c
and non-fasting glucose measured in a second phase of the
baseline screening, there were 45 subjects with unknown
type 2 diabetes not detected by our validation. This consti-
tutes 33% of all with diabetes at baseline. Including HbA1c
measurements at baseline to define prevalent diabetes,
increased the yield of unknown diabetes substantially from
23%in a previous study in our population using only HbA1c
registered at the hospital [17].Among those 19,495 Tromsø 4
participants who did not take part in the second phase of the
screening in 1994, there were 246 probable cases of pre-
valent type 2 diabetes. Given the same prevalence of
unknown diabetes in this younger population we probably
had 116 undetected cases of diabetes at baseline weakening
our chance of finding associations. As the control group is so
large it is unlikely that these undetected cases have increased
our chance of false positive results.
We used BMI as a proxy of waist circumference as a
modified metabolic syndrome criterion, similar to other
studies [10, 11]. To check the validity of this proxy we
compared the predictive power of BMI and waist circum-
ference in the sub- population with both BMI and waist
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