The JBS-2 guidelines on prevention of cardiovascular disease in clinical practice: an opportunity missed.
In December 2005, a Working Party for the Joint British Societies (JBS-2) published guidelines on the prevention of cardiovascular disease in clinical practice ‘ to promote a consistent multi-disciplinary approach to the management of people with established atherosclerotic cardiovascular disease and those at high risk of developing symptomatic atherosclerotic disease ’.1 The Working Party has produced a comprehensive document that addresses most aspects of cardiovascular risk prevention. However important issues arise from the JBS-2 guidance in relation to: (i) screening for new diabetes and (ii) the investigation of impaired glucose tolerance.

In the section on risk factor assessment, JBS-2 recommends: ‘ if non-fasting glucose is ⩾6.1 mmol/l then measure fasting glucose for evidence of impaired glucose regulation or new diabetes. If this fasting glucose measurement is normal (⩽6.0 mmol/l) there is no need to repeat it ’. JBS-2 is proposing that a single normal fasting glucose measurement is an adequate screening test for new diabetes. There is however a large body of evidence to refute the wisdom of this pragmatic approach, particularly in the ‘at risk’ population in question.2–8

### Fasting glucose is a poor indicator of impaired glucose regulation

The DECODE study group (Diabetes Epidemiology: Collaborative analysis of Diagnostic criteria in Europe) reported a normal fasting blood glucose (FBG) in 31% of subjects confirmed as diabetic on oral glucose tolerance testing (OGTT).2 Evidence from the Euro Heart Survey emphasizes that without the use of OGTT, almost two-thirds of patients with impaired glucose regulation (new detected diabetes or impaired glucose tolerance, IGT) would remain undiagnosed.3 This holds true for both acute and …