Harris M I, Eastman R C
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-5460, USA.
Diabetes Metab Res Rev. 2000 Jul-Aug;16(4):230-6. doi: 10.1002/1520-7560(2000)9999:9999<::aid-dmrr122>3.0.co;2-w.
Undiagnosed Type 2 diabetes has become a common condition in the US, comprising one-third of all cases of the disease. We believe that screening for and detection of undiagnosed Type 2 diabetes is an important endeavor. In this review we provide evidence that diabetes is a condition that is appropriate for population screening and detection. This includes evidence that: 1. Type 2 diabetes is a significant health problem. It affects more than 16 million adults in the US and places these individuals at high risk for serious complications of the eyes, nerves, kidneys, and cardiovascular system. 2. There is a latent phase before diagnosis of Type 2 diabetes. During this period of undiagnosed disease, risk factors for diabetic micro- and macrovascular complications are markedly elevated and diabetic complications are developing. 3. Diagnostic criteria for diabetes have been established and are based on plasma glucose values. These criteria define a group of individuals with significant hyperglycemia who also have a high frequency of risk factors for micro- and macrovascular disease. 4. The natural history of Type 2 diabetes is understood. In most patients, diabetes proceeds inexorably from genetic predisposition, through the stage of insulin resistance and hyperinsulinemia, to beta cell failure and overt clinical disease. 5. There are effective and acceptable therapies available for Type 2 diabetes and its complications. Treating hyperglycemia to prevent complications is more effective than treating these complications after they have developed. Furthermore, guidelines for treatment to prevent cardiovascular disease in people known to have diabetes are more stringent than in those individuals who are not known to have diabetes. 6. There is a suitable test for screening for undiagnosed Type 2 diabetes that has high sensitivity and specificity - measurement of fasting plasma glucose. Guidelines for identifying persons at high risk for diabetes have been established.
未诊断出的2型糖尿病在美国已成为一种常见病症，占所有糖尿病病例的三分之一。我们认为，筛查和检测未诊断出的2型糖尿病是一项重要工作。在本综述中，我们提供证据表明糖尿病是适合进行人群筛查和检测的病症。这包括以下证据：1. 2型糖尿病是一个重大的健康问题。它影响着美国超过1600万成年人，并使这些人面临眼睛、神经、肾脏和心血管系统严重并发症的高风险。2. 2型糖尿病在诊断前有一个潜伏期。在这段未被诊断出疾病的时期，糖尿病微血管和大血管并发症的危险因素显著升高，糖尿病并发症正在发展。3. 糖尿病的诊断标准已经确立，且基于血浆葡萄糖值。这些标准定义了一组具有显著高血糖且微血管和大血管疾病危险因素频率也很高的个体。4. 2型糖尿病的自然病程是已知的。在大多数患者中，糖尿病从遗传易感性开始，无情地经过胰岛素抵抗和高胰岛素血症阶段，发展到β细胞功能衰竭和明显的临床疾病。5. 有针对2型糖尿病及其并发症的有效且可接受疗法。治疗高血糖以预防并发症比在并发症发生后进行治疗更有效。此外，已知患有糖尿病的人群预防心血管疾病的治疗指南比未知患有糖尿病的个体更为严格。6. 有一种用于筛查未诊断出的2型糖尿病的合适检测方法，即空腹血浆葡萄糖测量，其具有高灵敏度和特异性。已制定了识别糖尿病高危人群的指南。
