Qiao Q, Tuomilehto J
Diabetes and Genetic Epidemiology Unit, National Public Health Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
Minerva Med. 2001 Apr;92(2):113-9.
In 1997 American Diabetes Association (ADA) Expert Committee approved changing the diagnostic criteria for diabetes. The major change is to lower fasting plasma glucose from 7.8 mmol/l to 7.0 mmol/l for diabetes and did not recommend the use of 2-hour 75 g oral glucose tolerance test (OGTT). The decision by the ADA not to recommend the OGTT has been criticised based on the findings of several recent studies, in particularly those from the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) and in Asia (DECODA) Studies. These studies have reported that only 29% of all newly screened diabetic subjects qualified for diabetes on both the fasting and the 2-hour glucose criteria in European and 37% in Asian populations. It has now been clearly shown that elderly and less obese patients are more likely to have diagnostic 2-hour values, whereas fasting hyperglycaemia is more common among obese subjects. Analysis of the prospective DECODE data showed that elevated 2-hour glucose was a better predictor of mortality from all-cause and from cardiovascular and non-cardiovascular diseases than elevated fasting glucose alone. The largest absolute number of excess deaths was observed in subjects with impaired glucose tolerance (IGT), especially in those whose fasting glucose was normal.
1997年，美国糖尿病协会（ADA）专家委员会批准了糖尿病诊断标准的变更。主要变化是将糖尿病的空腹血糖从7.8 mmol/l降至7.0 mmol/l，并且不建议使用2小时75克口服葡萄糖耐量试验（OGTT）。ADA不建议使用OGTT的决定受到了批评，这是基于最近几项研究的结果，特别是来自欧洲糖尿病流行病学：诊断标准协作分析（DECODE）和亚洲（DECODA）研究的结果。这些研究报告称，在欧洲，所有新筛查出的糖尿病患者中，只有29%的患者空腹和2小时血糖标准均符合糖尿病诊断标准，在亚洲人群中这一比例为37%。现已清楚表明，老年和肥胖程度较低的患者更有可能出现诊断性2小时血糖值，而空腹血糖过高在肥胖受试者中更为常见。对DECODE前瞻性数据的分析表明，与单纯空腹血糖升高相比，2小时血糖升高是全因死亡率以及心血管疾病和非心血管疾病死亡率的更好预测指标。在糖耐量受损（IGT）患者中观察到的额外死亡绝对数最多，尤其是那些空腹血糖正常的患者。
