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To the Editor: Dr Lang and colleagues¹ reported that higher levels of urinary bisphenol A (BPA) were associated with type 2 diabetes and cardiovascular diseases in a cross-sectional analysis of US National Health and Nutrition Examination Survey (NHANES) data. While these findings have public health importance, I am concerned about the classification of diabetes in this study, in which the authors combined self-reported diagnosed diabetes and borderline diabetes as a single group of diabetes.

To my knowledge, a majority of patients who were classified as borderline diabetes by interviewers in NHANES data did not have evidence of taking diabetes medications or meeting plasma glucose criteria for diabetes by the American Diabetes Association. Selective recall of diabetes due to increased exposure to suspected diabetic agents such as fat and some chemicals is possible in participants with borderline diabetes. For this reason, it would be better to eliminate those participants with borderline . . . [Full Text of this Article]

Ming Wei, MD
weinedss@yahoo.com
Holy Hospital
Mechanicsburg, Pennsylvania

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