Borch-Johnsen K
Steno Diabetes Centre, Niels Steensens Vej 2, DK 2820 Gentofte, Denmark.
Exp Clin Endocrinol Diabetes. 2001;109 Suppl 2:S86-93. doi: 10.1055/s-2001-18572.
In 1999 WHO published the new recommendations for diagnostic criteria for diabetes. The same publication introduced several new categories including the first proposal for diagnostic criteria for the metabolic syndrome. Also, WHO established a new category labelled "impaired fasting glycaemia", and thereafter this new group and the already established impaired glucose tolerance was combined as a common entity labelled "impaired glucose regulation".--These recommendations from WHO followed a decision in the American Diabetes Association to lower the diagnostic plasma glucose threshold for diabetes in the fasting state from 7.8 to 7.0 mmol/l and to use fasting values as the diagnostic test for diabetes. The suggested changes in the diagnostic criteria will include a new group of individuals as having diabetes, while others may be left undiagnosed if fasting glucose values are used as the only diagnostic criteria. The consequence of this has been analysed by several groups including the collaborative European activity (the DECODE-study).--This review summarises the findings. One major problem is that if fasting glucose values are used as the only diagnostic criteria in screening for diabetes, approximately one third of the diabetic individuals will be left undiagnosed. Furthermore, this group is the group of diabetic patients that have the highest mortality from cardiovascular disease and stroke, and the group with the worst cardiovascular risk profile compared to individuals with elevated fasting glucose values alone. This observation raises the need for a continued use of the oral glucose tolerance test in selected groups.
1999年，世界卫生组织（WHO）发布了糖尿病诊断标准的新建议。同一出版物引入了几个新类别，包括首次提出的代谢综合征诊断标准。此外，WHO设立了一个名为“空腹血糖受损”的新类别，此后，这个新类别与已有的糖耐量受损合并为一个共同的实体，称为“糖调节受损”。——WHO的这些建议是在美国糖尿病协会决定将空腹状态下糖尿病的诊断血浆葡萄糖阈值从7.8 mmol/l降至7.0 mmol/l，并将空腹血糖值用作糖尿病诊断测试之后提出的。诊断标准的建议变化将使一群新的个体被诊断为患有糖尿病，而如果仅将空腹血糖值用作唯一的诊断标准，其他一些人可能会漏诊。包括欧洲协作项目（DECODE研究）在内的几个研究小组已经分析了这种情况的后果。——这篇综述总结了研究结果。一个主要问题是，如果在糖尿病筛查中仅将空腹血糖值用作唯一的诊断标准，大约三分之一的糖尿病患者将漏诊。此外，与仅空腹血糖值升高的个体相比，这群糖尿病患者是心血管疾病和中风死亡率最高的群体，也是心血管风险状况最差的群体。这一观察结果表明，在特定人群中仍有必要继续使用口服葡萄糖耐量试验。
