Harris M I
National Diabetes Data Group, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
Prim Care. 1988 Jun;15(2):205-25.
Diabetes mellitus is composed of a heterogeneous group of disorders characterized by high blood glucose levels. Four major types of diabetes have been defined by the National Diabetes Data Group. Insulin-dependent diabetes (IDDM), also called type I diabetes, is characterized by abrupt clinical onset, insulinopenia, proneness to ketosis even in the basal state, and dependence on exogenous insulin to sustain life. Non-insulin-dependent diabetes (NIDDM), also called type II diabetes, may remain relatively asymptomatic for years. Insulin levels may be normal, lower than normal, or elevated as a consequence of insulin resistance. Ketosis is not part of the general clinical picture except in times of metabolic stress, although the classic complications of diabetes can be expected to develop in long-duration diabetics. Gestational diabetes (GDM) refers to the recognition of abnormal glucose intolerance in pregnancy, although unrecognized abnormal tolerance may indeed have predated the pregnancy. Rates of macrosomia are higher than in non-GDM pregnancies, but fetal mortality and congenital anomalies appear to be no greater than in the general population. Other types of diabetes include a number of diverse conditions in which glucose intolerance is a feature and in which it may be etiologically related. Impaired glucose tolerance (IGT) is a class that encompasses persons whose glucose tolerance is intermediate between normal and diabetic. These individuals do not manifest the microvascular complications of diabetes, but they appear to have higher rates of macrovascular disease associated with the known cardiovascular risk factors. Two statistical risk categories have also been defined that replace the older terms prediabetes, potential diabetes, and latent diabetes. Diabetes can be diagnosed by the presence of classical signs and symptoms of diabetes and unequivocally elevated blood glucose levels; by a fasting plasma glucose greater than or equal to 140 mg/dl; or by an abnormal oral glucose tolerance test, with a venous plasma glucose value greater than or equal to 200 mg/dl at 2 hours after 75 grams oral glucose, being a hallmark criterion for diabetes. For the latter two criteria, the abnormality should be reconfirmed at a later occasion before a definitive diagnosis of diabetes is made. The oral glucose tolerance test has been standardized at a 75-gram glucose (or carbohydrate equivalent) load, given in the morning after an overnight fast. Glucose should be determined for two hours after administration of the challenge.
糖尿病是一组异质性疾病，其特征为血糖水平升高。美国国家糖尿病数据组定义了四种主要类型的糖尿病。胰岛素依赖型糖尿病（IDDM），也称为I型糖尿病，其临床发病突然，胰岛素分泌不足，即使在基础状态下也易发生酮症，且依赖外源性胰岛素维持生命。非胰岛素依赖型糖尿病（NIDDM），也称为II型糖尿病，可能多年相对无症状。由于胰岛素抵抗，胰岛素水平可能正常、低于正常或升高。除了在代谢应激时，酮症并非一般临床表现的一部分，不过长期糖尿病患者可能会出现糖尿病的典型并发症。妊娠期糖尿病（GDM）是指在孕期发现的异常糖耐量，尽管未被识别的异常糖耐量可能在妊娠前就已存在。巨大儿发生率高于非GDM妊娠，但胎儿死亡率和先天性畸形似乎并不高于一般人群。其他类型的糖尿病包括多种不同情况，其中糖耐量异常是一个特征，且可能与病因相关。糖耐量受损（IGT）是一类涵盖糖耐量介于正常和糖尿病之间的人群。这些个体不表现出糖尿病的微血管并发症，但他们似乎有更高的与已知心血管危险因素相关的大血管疾病发生率。还定义了两个统计风险类别，取代了旧术语糖尿病前期、潜在糖尿病和潜伏性糖尿病。糖尿病可通过糖尿病的典型体征和症状以及明确升高的血糖水平来诊断；空腹血糖大于或等于140mg/dl；或口服葡萄糖耐量试验异常，口服75克葡萄糖后2小时静脉血浆葡萄糖值大于或等于200mg/dl，这是糖尿病的标志性标准。对于后两个标准，在做出糖尿病的明确诊断之前，应在以后的时间再次确认异常情况。口服葡萄糖耐量试验已标准化为在隔夜禁食后的早晨给予75克葡萄糖（或碳水化合物当量）负荷。在给予挑战后两小时应测定血糖。
