Shaw J E, Zimmet P Z, McCarty D, de Courten M
International Diabetes Institute, Melbourne, Victoria, Australia.
Diabetes Care. 2000 Apr;23 Suppl 2:B5-10.
Two major reports have recently revised the classification of and diagnostic criteria for diabetes. Classification was previously based on the need for insulin (insulin-dependent or non-insulin-dependent), but this has become increasingly confusing. Now, the type of diabetes is determined by the etiological process rather than the treatment modality. Type 1 diabetes is thus characterized by islet cell destruction and type 2 diabetes by a combination of defects in insulin secretion and action. An individual with either type of diabetes may be on any treatment modality. This classification should prove to be more logical and, for example, allow latent autoimmune diabetes in adults, which typically does not require insulin at presentation, to be classified as type 1 diabetes. The fasting plasma glucose diagnostic threshold for diabetes has been lowered to 7.0 mmol/l (126 mg/dl), and impaired fasting glucose (fasting plasma glucose 6.1-6.9 mmol/l [110-125 mg/dl]) has been introduced as a new category of intermediate glucose metabolism. These changes recognize that the old fasting threshold did not match the 2-h (postload) threshold well and that both micro- and macrovascular disease develop at lower fasting glucose levels than previously recognized. Although the prevalences of diabetes according to the new fasting and 2-h criteria are now similar in most populations, the actual individuals identified as having diabetes are often different. Over 30% of all those with diabetes have a nondiabetic fasting glucose but still have increased cardiovascular mortality. Thus, it is important to retain the oral glucose tolerance test for the diagnosis of diabetes.
最近有两份主要报告修订了糖尿病的分类和诊断标准。以前的分类是基于对胰岛素的需求（胰岛素依赖型或非胰岛素依赖型），但这已变得越来越混乱。现在，糖尿病的类型是由病因过程而非治疗方式决定的。因此，1型糖尿病的特征是胰岛细胞破坏，2型糖尿病的特征是胰岛素分泌和作用缺陷的组合。患有任何一种糖尿病的个体都可能采用任何治疗方式。这种分类应该会被证明更具逻辑性，例如，它能将成人隐匿性自身免疫性糖尿病（通常在发病时不需要胰岛素治疗）归类为1型糖尿病。糖尿病的空腹血糖诊断阈值已降至7.0 mmol/l（126 mg/dl），空腹血糖受损（空腹血糖6.1 - 6.9 mmol/l [110 - 125 mg/dl]）已被引入作为一种新的中间糖代谢类别。这些变化认识到旧的空腹阈值与2小时（负荷后）阈值不太匹配，而且微血管和大血管疾病在比以前认识到的更低的空腹血糖水平时就会发生。虽然根据新的空腹和2小时标准，大多数人群中糖尿病的患病率现在相似，但实际被确定为患有糖尿病的个体往往不同。所有糖尿病患者中超过30%的人空腹血糖正常，但心血管死亡率仍然增加。因此，保留口服葡萄糖耐量试验用于糖尿病诊断很重要。
