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To examine whether the current adult guidelines for diagnosis of diabetes are applicable to youth (age <20 years).We analyzed fasting plasma glucose (FPG) and 2-h plasma glucose (PG) in two groups of Pima Indians, youths aged 5-19 years and adults aged 20-34 years, in relation to the incidence of microvascular disease when subjects were reexamined at ages 25-39 (youths) and 40-54 (adults). Microvascular disease was defined as retinopathy or a urine protein-to-creatinine ratio ≥0.5 g.An increase in the incidence of microvascular disease occurred at nearly the same level of glycemia in both groups. For youths, this increase occurred at FPG ∼7.3 mmol/l and 2-h PG ∼10.0 mmol/l; for adults, this increase occurred at FPG ∼7.5 mmol/l and 2-h PG ∼10.3 mmol/l. Sensitivity of the adult diagnostic guidelines of FPG ≥7.0 mmol/l and 2-h PG ≥11.1 mmol/l for the detection of microvascular disease was much lower (with higher specificity) in youths than in adults. Receiver operating characteristics (ROC) curve areas were lower for FPG and 2-h PG for youths, suggesting that microvascular disease was less strongly predicted by baseline glucose.The current adult guidelines for diagnosis of diabetes are applicable to youth, as they identify a population at high risk of microvascular complications.