Cefalu William T
Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
Diabetes Care. 2016 Aug;39(8):1472-7. doi: 10.2337/dc16-1143.
The category of "prediabetes" defined by the American Diabetes Association comprises a range of intermediate hyperglycemia based on fasting or 2-h postload glucose or on HbA1c Over the recent past, the "cut points" identifying this stage have changed, i.e., a lower fasting glucose level is used. On one hand, it can be argued that the change to a lower cut point identifies a group of individuals still at higher risk and provides heightened awareness for a condition associated with higher risk for cardiovascular disease. In addition, identification of individuals at this stage may represent a chance of earlier intervention in the disease. However, the argument against this definition of prediabetes is that it disguises the differences in the three subcategories and creates problems in interpreting observations on interventions and outcomes. In addition, it can be argued that the enormous numbers of people identified with the criteria far exceeds the capacity of health care systems to respond through individual care, particularly without evidence that interventions benefit any category other than impaired glucose tolerance. Thus, there does not appear to be consensus on the definition using the cut points identified. Controversy also remains as to whether there are glycemic metrics beyond HbA1c that can be used in addition to HbA1c to help assess risk of an individual developing diabetes complications. Given the current controversy, a Point-Counterpoint debate on this issue is provided herein. In the preceding point narrative, Dr. Yudkin provides his argument that there are significant problems with this label. In the counterpoint narrative below, Dr. Cefalu argues that the cut points are appropriate and do provide useful and important information in trying to reduce the future burden of diabetes.-William T. CefaluEditor in Chief, Diabetes Care.
美国糖尿病协会定义的“糖尿病前期”类别包括一系列基于空腹血糖、餐后2小时血糖或糖化血红蛋白（HbA1c）的中间高血糖状态。在最近，用于识别这一阶段的“切点”发生了变化，即采用了更低的空腹血糖水平。一方面，可以认为将切点降低能识别出仍处于较高风险的一群人，并提高对与心血管疾病高风险相关病症的认识。此外，识别处于这一阶段的个体可能意味着有机会对该疾病进行更早的干预。然而，反对糖尿病前期这一定义的观点认为，它掩盖了三个亚类之间的差异，并在解释干预措施和结果的观察结果时产生问题。此外，可以认为，按照这些标准识别出的大量人群远远超出了医疗保健系统通过个体化护理做出反应的能力，尤其是在没有证据表明干预措施能使除糖耐量受损之外的任何类别受益的情况下。因此，对于使用所确定的切点进行定义似乎没有达成共识。对于除HbA1c之外是否还有其他血糖指标可用于辅助评估个体发生糖尿病并发症的风险，也仍然存在争议。鉴于当前的争议，本文提供了关于这个问题的正反观点辩论。在前一篇正方叙述中，尤德金博士提出了他的观点，即这个标签存在重大问题。在下面的反方叙述中，塞法卢博士认为这些切点是合适的，并且在试图减轻未来糖尿病负担方面确实提供了有用且重要的信息。——威廉·T·塞法卢《糖尿病护理》主编
