Kumar Ritesh, Nandhini Lakshmana Perumal, Kamalanathan Sadishkumar, Sahoo Jayaprakash, Vivekanadan Muthupillai
Ritesh Kumar, Lakshmana Perumal Nandhini, Sadishkumar Kamalanathan, Jayaprakash Sahoo, Muthupillai Vivekanadan, Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.
World J Diabetes. 2016 Sep 15;7(17):396-405. doi: 10.4239/wjd.v7.i17.396.
Diabetes mellitus is a non-communicable metabolic derangement afflicting several millions of individuals globally. It is associated with several micro and macrovascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Association (ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of evidence.This review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose (FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications.
糖尿病是一种非传染性代谢紊乱疾病，全球有数百万患者受其困扰。它与多种微血管和大血管并发症相关，也是导致死亡的主要原因。尚未解决的问题是糖尿病诊断阈值的定义。世界卫生组织和美国糖尿病协会（ADA）基于不断积累的证据，制定了多种糖尿病和糖尿病前期的诊断标准。本综述试图分析支持这些不同标准合理性的科学证据。诊断糖尿病的证据确凿，两个专业机构的观点一致。然而，在描述空腹血糖（FPG）正常下限方面存在争议，几乎没有证据支持ADA降低FPG下限的做法。多项研究还表明，按照现行标准定义的糖尿病前期患者会出现糖尿病特有的并发症，尽管血糖正常个体中此类患病率也有显著重叠。理想情况下，涉及基线时无糖尿病和视网膜病变受试者的大型跨国纵向前瞻性研究，将有助于确定未来发生糖尿病及其并发症的血糖测量阈值。
