Smulders Yvo, Serné Erik
Amsterdam UMC, afd. Interne Geneeskunde, Amsterdam.
Contact: Y. Smulders (
Ned Tijdschr Geneeskd. 2019 Sep 9;163:D4225.
The disease 'diabetes' is based on an agreement and we have nothing to lose by changing that agreement in one based on HbA1c instead of an isolated glucose measurement. We discuss the advantages and disadvantages of this proposal and conclude that the advantages have the upper hand. Clinical chemists are pleading for a combination of HbA1c and glucose measurements. However, this would add little value in practice. In another comment, Rutten opposes the proposal. His argument is based, among other things, on the concepts of sensitivity and specificity, from which can be concluded that the 'agreement aspect' of the diabetes mellitus diagnosis does not seem to be easily accepted by everyone. We ourselves believe that, despite the disadvantages and the doubts, our patients will be better off with the HbA1c-based classification system. We understand the hesitation and are inviting discussion, which will hopefully lead to a unanimous position.
“糖尿病”这一疾病是基于一种共识，而通过将基于糖化血红蛋白（HbA1c）而非单纯血糖测量的共识取而代之，我们不会有任何损失。我们讨论了这一提议的优缺点，并得出优点更为突出的结论。临床化学家们主张同时进行糖化血红蛋白和血糖测量。然而，在实际中这增加的价值不大。在另一篇评论中，鲁滕反对该提议。他的论点尤其基于敏感性和特异性的概念，由此可以得出，糖尿病诊断的“共识方面”似乎并非能轻易被所有人接受。我们自己认为，尽管存在缺点和疑虑，但基于糖化血红蛋白的分类系统会让我们的患者受益更多。我们理解这种犹豫，并邀请大家展开讨论，希望能达成一致立场。
