Diabetes mellitusun tanı ve izlem kriterleri

Abstract

Diabetes mellitus (DM); Tip 1 DM, Tip 2 DM, başka nedenlere bağlı özel diyabet tipleri ve gestasyonel DM olarak 4 gruba ayrılır. Açlık plazma glukozu (APG) ≥126 mg/dL, 75 g oral glukoz tolerans testinin (OGTT) 2. saatinde bakılan plazma glukozu ≥200 mg/ dL veya HbA1C ≥%6,5 ise sonuçların bir kez daha doğrulanması koşuluyla DM tanısı konabilir. Hiperglisemi semptomlarının varlığında rastgele bakılan plazma glukozunun ≥200 mg/dL olması da tanı koydurucudur. Bu durumda testin konfirme edilmesine gerek yoktur. Gestasyonel DM için 24-28. haftalarda yapılan 75 g OGTT’de APG ≥92 mg/dL veya 1.saat plazma glukozu ≥180 mg/dL veya 2. saat plazma glukozu ≥153 mg/dL olması tanı koydurucudur. DM tanısı alan gebe olmayan hastalarda glisemik kontrol hedefleri HbA1C için <%7, APG için 70-130 mg/dL ve tokluk plazma glukozu için <180 mg/ dL’dir. Ancak bu hedefler DM süresi, hipoglisemi sıklığı, kardiyovasküler hastalık varlığı ve yaşam beklentisi gibi faktörlere göre kişiselleştirilebilir. Gestasyonel DM’de glisemik kontrol hedefleri ise; preprandiyal plazma glukozunun ≤95 mg/dL ve 1.saat postprandiyal plazma glukozunun ≤140 mg/dL veya 2. saat postprandiyal plazma glukozunun ≤120 mg/ dL olmasıdır. Criteria for diagnosis and follow-up diabetes mellitus Diabetes mellitus (DM) is classified into 4 groups as Type 1 DM, Type 2 DM, other specific types of diabetes and gestational DM. Fasting plasma glucose (FPG) ≥126 mg/dL, 2–hour plasma glucose during a 75 g oral glucose tolerance test (OGTT) ≥200 mg/dL and HbA1C ≥6.5% establishes the diagnosis of DM, provided that the results are confirmed at another time. In a patient with classical symptoms of hyperglycemia, a random plasma glucose ≥200 mg/dL also establishes the diagnosis. In such a case, there is no need to confirm the diagnosis at another time. The diagnosis of gestational DM is made when any of the following criteria are met during a 75 g OGTT at 24-28 weeks of gestation: FPG ≥92 mg/dL or 1-hour plasma glucose ≥180 mg/dL or 2-hour plasma glucose ≥153 mg/dL. HbA1C <7%, FPG 70-130 mg/dL and postprandial plasma glucose <180 mg/dL are glycemic goals for nonpregnant adults. However, these goals may be individualized based on the duration of DM, occurence of hypoglycemia, presence of cardiovascular disease and life expectancy. Preprandial plasma glucose ≤95 mg/dL and 1-hour postprandial plasma glucose ≤140 mg/dL or 2-hour postprandial plasma glucose ≤120 mg/dL are glycemic goals for gestational DM. J. Exp. Clin. Med., 2012; 29:S2-S6

Keywords

• Diabetes mellitus; Glisemik kontrol; Sınıflandırma; İzlem kriterleri ( Diabetes mellitus; Glycemic control; Classification; Follow-up criteria)

References

1. ADVANCE Colloborative Group, Patel, A., MacMahon, S., Chalmers, J., Neal, B., Billot, L., Oodward, M., Marre, M., Cooper, M., Glasziou, P., Grobbee, D., Hamet, P., Harrap, S., Heller, S., Liu, L., Mancia, G., Mogensen, C.E., Pan, C., Poulter, N., Rodgers, A., Williams, B., Bom- point, S., De Galan, B.E., Joshi, R., Travert, F., 2008. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N. Engl. J. Med. 358, 2560-2572.
2. American Diabetes Association, 2010. Diagnosis and classification of diabetes mellitus. Diabetes Care 33 Suppl. 1, S62-S69.
3. American Diabetes Association, 2011. Standards of medical care in diabetes-2011. Diabetes Care 34 Suppl. 1, S11-S61.
4. DCCT, 1993. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group, N. Engl. J. Med. 329, 977-986.
5. DCCT-EDIC, 2000. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. The Diabetes Con- trol and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. N. Engl. J. Med. 342, 381-389.
6. Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P.D., Zieve, F.J., Marks, J., Davis, S.N., Hayward, R., Warren, S.R., Goldman, S., McCarren, M., Vitek, M.E., Henderson, W.G., Huang, G.D., VADT Investigators, 2009. Glucose control and vascular compli- cations in veterans with type 2 diabetes. N. Engl. J. Med. 360, 129-139.
7. Gerstein, H.C., Miller, M.E., Byington, R.P., Goff, D.J. Jr, Bigger, J.T., Buse, J.B., Cushman, W.C., Genuth, S., Ismail-Beigi, F., Grimm, R.H. Jr, Probstfield, J.L., Simons-Morton, D.G., Friedewald, W.T., 2008. Action to control cardiovascular risk in diabetes. Effects of intensive glucose lowering in type 2 diabetes. N. Engl. J. Med. 358, 2545-2559.
8. HAPO Study Cooperative Research Group, Metzger, B.E., Lowe, L.P., Dyer, A.R., Trimble, E.R., Chaovarindr, U., Coustan, D.R., Hadden, D.R., McCance, D.R., Hod, M., McIntyre, H.D., Oats, J.J., Persson, B., Rogers, M.S., Sacks, D.A., 2008. Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med. 358, 1991-2002.

9. Holman, R.R., Paul S.K., Bethel, M.A., Matthews, D.R., Neil, H.A., 2008. 10-year follow-up of intensive glucose control in type 2 diabetes. N. Engl. J. Med. 359, 1577-1589.
10. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger, B.E., Gabbe, S.G., Persson, B., Buchanan, T.A., Catalano, P.A., Damm, P., Dyer, A.R., Leiva, A., Hod, M., Kitzmiler, J.L., Lowe, L.P., McIntyre, H.D., Oats, J.J., Omori, Y., Schmidt, M.I., 2010. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglyce- mia in pregnancy. Diabetes Care 33, 676-682.
11. International Expert Committee, 2009. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 32, 1327-1334.
12. Kitzmiller, J.L., Block, J.M., Brown, F.M., Catalano, P.M., Conway, D.L., Coustan, D.R., Gunderson, E.P., Herman, W.H., Hoffman, L.D., Inturrisi, M., Jovanovic, L.B., Kjos, S.I., Knopp, R.H., Montoro, M.N., Ogata, E.S., Paramsothy, P., Reader, D.M., Rosenn, B.M., Thomas, A.M., Kirkman, M.S., 2008. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 31, 1060-1079.
13. Martin, C.L., Albers, J., Herman, W.H., Cleary, P., Waberski, B., Greene, D.A., Stevens, M.J., Feldman, E.L., DCCT/EDIC Research Group, 2006. Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion. Diabetes Care 29, 340-344.
14. Metzger, B.E., Buchanan, T.A., Coustan, D.R., De Leiva, A., Dunger, D.B., Hadden, D.R., Hod, M., Kitzmiller, J.L., Kjos, S.L., Oats, J.N., Pettitt, D.J., Sacks, D.A., Zoupas, C., 2007. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 30 Suppl.2, S251-S260.
15. Nathan, D.M., Cleary, P.A., Backlund, J.Y., Genuth, S.M., Lachin, J.M., Orchard, T.J., Raskin, P., Zinman, B., Diabetes Control and Complica- tions Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group, 2005. Intensive diabetes treat- ment and cardiovascular disease in patients with type 1 diabetes. N. Engl. J. Med. 353, 2643-2653.
16. Sacks, D.B., Bruns, D.E., Goldstein, D.E., Maclaren, N.K., McDonald, J.M., Parrott, M., 2002. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin. Chem. 48, 436-472.
17. Selvin , E., Steffes, M.W., Zhu, H,. Matsushita, K., Wagenknecht, L., Pankow, J., Coresh, J., Brancati, F.L., 2010. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N. Engl. J. Med. 362, 800-811.
18. UKPDS,1998. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352, 837-853.
19. Zhang, X., Gregg, E.W., Williamson, D.F., Barker, L.E., Thomas, W., Bullard, K.M., Imperatore, G., Williams, D.E., Albright, A.L., 2010. A1C level and future risk of diabetes: A systematic review. Diabetes Care 33, 1665-1673.