Colagiuri Stephen, Cull Carole A, Holman Rury R
Diabetes Center, Prince of Wales Hospital, Randwick, Australia. Diabetes Trials Unit, Oxford Center for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
Diabetes Care. 2002 Aug;25(8):1410-7. doi: 10.2337/diacare.25.8.1410.
Type 2 diabetes may be present for several years before diagnosis, by which time many patients have already developed diabetic complications. Earlier detection and treatment may reduce this burden, but evidence to support this approach is lacking.
Glycemic control and clinical and surrogate outcomes were compared for 5,088 of 5,102 U.K. Diabetes Prospective Study participants according to whether they had low (<140 mg/dl [<7.8 mmol/l]), intermediate (140 to <180 mg/dl [7.8 to <10.0 mmol/l]), or high (> or =180 mg/dl [> or =10 mmol/l]) fasting plasma glucose (FPG) levels at diagnosis. Individuals who presented with and without diabetic symptoms were also compared.
Fewer people with FPG in the lowest category had retinopathy, abnormal biothesiometer measurements, or reported erectile dysfunction. The rate of increase in FPG and HbA(1c) during the study was identical in all three groups, although absolute differences persisted. Individuals in the low FPG group had a significantly reduced risk for each predefined clinical outcome except stroke, whereas those in the intermediate group had significantly reduced risk for each outcome except stroke and myocardial infarction. The low and intermediate FPG groups had a significantly reduced risk for progression of retinopathy, reduction in vibration sensory threshold, or development of microalbuminuria.
People presenting with type 2 diabetes with lower initial glycemia who may be earlier in the course of their disease had fewer adverse clinical outcomes despite similar glycemic progression. Since most such people are asymptomatic at diagnosis, active case detection programs would be required to identify them.
2型糖尿病在诊断前可能已存在数年，此时许多患者已出现糖尿病并发症。早期检测和治疗可能会减轻这种负担，但缺乏支持这种方法的证据。
根据英国糖尿病前瞻性研究的5102名参与者中5088人的空腹血糖（FPG）水平在诊断时是低（<140mg/dl [<7.8mmol/l]）、中（140至<180mg/dl [7.8至<10.0mmol/l]）还是高（≥180mg/dl [≥10mmol/l]），比较了血糖控制情况以及临床和替代结局。还比较了有和无糖尿病症状的个体。
FPG处于最低类别的人群中，患视网膜病变、生物感觉测量异常或报告有勃起功能障碍的人数较少。尽管绝对差异仍然存在，但在研究期间，三组中FPG和糖化血红蛋白（HbA1c）的升高率相同。FPG低的组除中风外，每种预定义临床结局的风险均显著降低，而中等FPG组除中风和心肌梗死外，每种结局的风险均显著降低。FPG低和中等的组视网膜病变进展、振动感觉阈值降低或微量白蛋白尿发生的风险显著降低。
2型糖尿病患者初始血糖较低，可能处于疾病进程早期，尽管血糖进展相似，但不良临床结局较少。由于大多数此类患者在诊断时无症状，因此需要开展主动病例检测计划来识别他们。
