Alberti K G, Zimmet P Z
Department of Medicine, University of Newcastle upon Tyne, UK.
Diabet Med. 1998 Jul;15(7):539-53. doi: 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S.
The classification of diabetes mellitus and the tests used for its diagnosis were brought into order by the National Diabetes Data Group of the USA and the second World Health Organization Expert Committee on Diabetes Mellitus in 1979 and 1980. Apart from minor modifications by WHO in 1985, little has been changed since that time. There is however considerable new knowledge regarding the aetiology of different forms of diabetes as well as more information on the predictive value of different blood glucose values for the complications of diabetes. A WHO Consultation has therefore taken place in parallel with a report by an American Diabetes Association Expert Committee to re-examine diagnostic criteria and classification. The present document includes the conclusions of the former and is intended for wide distribution and discussion before final proposals are submitted to WHO for approval. The main changes proposed are as follows. The diagnostic fasting plasma (blood) glucose value has been lowered to > or =7.0 mmol l(-1) (6.1 mmol l(-1)). Impaired Glucose Tolerance (IGT) is changed to allow for the new fasting level. A new category of Impaired Fasting Glycaemia (IFG) is proposed to encompass values which are above normal but below the diagnostic cut-off for diabetes (plasma > or =6.1 to <7.0 mmol l(-1); whole blood > or =5.6 to <6.1 mmol l(-1)). Gestational Diabetes Mellitus (GDM) now includes gestational impaired glucose tolerance as well as the previous GDM. The classification defines both process and stage of the disease. The processes include Type 1, autoimmune and non-autoimmune, with beta-cell destruction; Type 2 with varying degrees of insulin resistance and insulin hyposecretion; Gestational Diabetes Mellitus; and Other Types where the cause is known (e.g. MODY, endocrinopathies). It is anticipated that this group will expand as causes of Type 2 become known. Stages range from normoglycaemia to insulin required for survival. It is hoped that the new classification will allow better classification of individuals and lead to fewer therapeutic misjudgements.
1979年和1980年，美国国家糖尿病数据组以及世界卫生组织糖尿病专家委员会第二次会议对糖尿病的分类及其诊断所用检测方法进行了规范。自那时起，除了1985年世界卫生组织做的一些小修改外，几乎没有什么变化。然而，目前关于不同类型糖尿病病因的新知识大量涌现，同时关于不同血糖值对糖尿病并发症预测价值的信息也更多了。因此，世界卫生组织进行了一次磋商，并与美国糖尿病协会专家委员会的一份报告同步，重新审视诊断标准和分类。本文件包含了前者的结论，旨在广泛分发和讨论，然后再将最终提案提交世界卫生组织批准。提议的主要变化如下。诊断性空腹血浆（血液）葡萄糖值已降至≥7.0 mmol/L（6.1 mmol/L）。糖耐量受损（IGT）的标准做了调整，以适应新的空腹血糖水平。提议设立一个新的空腹血糖受损（IFG）类别，涵盖高于正常水平但低于糖尿病诊断临界值的值（血浆≥6.1至<7.0 mmol/L；全血≥5.6至<6.1 mmol/L）。妊娠期糖尿病（GDM）现在包括妊娠糖耐量受损以及之前的妊娠期糖尿病。该分类定义了疾病的进程和阶段。进程包括1型，自身免疫性和非自身免疫性，伴有β细胞破坏；2型，伴有不同程度的胰岛素抵抗和胰岛素分泌不足；妊娠期糖尿病；以及病因已知的其他类型（如青年发病的成年型糖尿病、内分泌病）。预计随着2型糖尿病病因的明确，这一类别将会扩大。阶段范围从血糖正常到生存所需胰岛素治疗。希望新的分类能够对个体进行更好的分类，并减少治疗判断失误。
