NYU School of Medicine, Department of Medicine and of Population Health, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, USA.
Research Unit for Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children Hospital, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy.
Diabetes Res Clin Pract. 2018 Dec;146:18-33. doi: 10.1016/j.diabres.2018.09.017. Epub 2018 Sep 28.
Many individuals with prediabetes, as presently defined, will progress to diabetes (T2D) despite the considerable benefit of lifestyle modification. Therefore, it is paramount to screen individuals at increased risk with a more sensitive method capable of identifying prediabetes at an even earlier time point in the lengthy trajectory to T2D. This petition reviews findings demonstrating that the 1-hour (1-h) postload plasma glucose (PG) ≥ 155 mg/dl (8.6 mmol/L) in those with normal glucose tolerance (NGT) during an oral glucose tolerance test (OGTT) is highly predictive for detecting progression to T2D, micro- and macrovascular complications and mortality in individuals at increased risk. Furthermore, the STOP DIABETES Study documented effective interventions that reduce the future risk of T2D in those with NGT and a 1-h PG ≥ 155 mg/dl (8·6 mmol/L). The 1-h OGTT represents a valuable opportunity to extend the proven benefit of diabetes prevention to the sizeable and growing population of individuals at increased risk of progression to T2D. The substantial evidence provided in this petition strongly supports redefining current diagnostic criteria for prediabetes with the elevated 1-h PG level. The authors therefore advocate a 1-h OGTT to detect prediabetes and hence, thwart the global diabetes epidemic.
目前定义的许多糖尿病前期患者尽管生活方式改变有很大益处,但仍会进展为糖尿病(T2D)。因此,至关重要的是,通过更敏感的方法对处于高危状态的个体进行筛查,这种方法能够更早地识别出糖尿病前期,即在进展为 T2D 的漫长轨迹上更早的时间点。本请愿书回顾了一些研究结果,这些结果表明,在口服葡萄糖耐量试验(OGTT)中,那些糖耐量正常(NGT)的个体在 1 小时(1-h)负荷后血浆葡萄糖(PG)≥155mg/dl(8.6mmol/L),具有高度预测价值,可以检测出进展为 T2D、微血管和大血管并发症以及处于高危状态的个体的死亡率。此外,STOP DIABETES 研究记录了有效的干预措施,可降低 NGT 和 1-h PG≥155mg/dl(8·6mmol/L)的个体未来发生 T2D 的风险。1-h OGTT 提供了一个有价值的机会,可以将已证明的糖尿病预防益处扩展到数量庞大且不断增长的处于进展为 T2D 高危状态的个体中。本请愿书中提供的大量证据强烈支持用升高的 1-h PG 水平重新定义当前的糖尿病前期诊断标准。因此,作者提倡使用 1-h OGTT 来检测糖尿病前期,从而遏制全球糖尿病流行。