Stolk R P, de Vegt F, Heine R J
Julius Centrum voor Patiëntgebonden Onderzoek, Universiteit Utrecht.
Ned Tijdschr Geneeskd. 1998 Jan 31;142(5):222-5.
The American Diabetes Association (ADA) recently issued new guidelines for classification and diagnosis of diabetes mellitus. The main change is the decrease of the liminal value of the fasting plasma glucose level from 7.8 to 7.0 mmol/l. A fasting level of 6.1-6.9 mmol/l indicates impaired glucose tolerance (which eliminates the category 'impaired glucose tolerance', which was established on the basis of a slightly increased 2-hour glucose level after ingestion of 75 g glucose). Consequently, the ADA criteria render the oral glucose tolerance test (GTT) redundant for clinical practice. Given these criteria, the prevalence of diabetes mellitus among the general Dutch population will change only slightly, but the number of persons to be classified in a different category after their introduction is considerable: 39.2% of the ADA diabetics are not diabetics according to the current WHO classification, while 38.1% of the WHO diabetics are not diabetics according to the ADA criteria. The criteria established by the ADA accommodate clinical practice, in which the GTT is hardly used anymore. The WHO still has to decide about whether or not accepting the ADA guidelines.
美国糖尿病协会（ADA）最近发布了糖尿病分类和诊断的新指南。主要变化是将空腹血糖水平的临界值从7.8 mmol/l降至7.0 mmol/l。空腹血糖水平为6.1 - 6.9 mmol/l表明糖耐量受损（这取消了“糖耐量受损”类别，该类别是基于摄入75克葡萄糖后2小时血糖水平略有升高而设立的）。因此，ADA标准使口服葡萄糖耐量试验（GTT）在临床实践中变得多余。基于这些标准，荷兰普通人群中糖尿病的患病率只会略有变化，但引入这些标准后被归类到不同类别的人数相当可观：根据ADA标准，39.2%的ADA糖尿病患者按照目前的WHO分类并非糖尿病患者，而按照WHO标准，38.1%的WHO糖尿病患者按照ADA标准并非糖尿病患者。ADA制定的标准符合临床实践情况，在临床实践中GTT已很少使用。WHO仍需决定是否接受ADA指南。
