The category of “prediabetes” defined by the American Diabetes Association comprises a range of intermediate hyperglycemia based on fasting or 2-h postload glucose or on HbA1c. Over the recent past, the “cut points” identifying this stage have changed, i.e., a lower fasting glucose level is used. On one hand, it can be argued that the change to a lower cut point identifies a group of individuals still at higher risk and provides heightened awareness for a condition associated with higher risk for cardiovascular disease. In addition, identification of individuals at this stage may represent a chance of earlier intervention in the disease. However, the argument against this definition of prediabetes is that it disguises the differences in the three subcategories and creates problems in interpreting observations on interventions and outcomes. In addition, it can be argued that the enormous numbers of people identified with the criteria far exceeds the capacity of health care systems to respond through individual care, particularly without evidence that interventions benefit any category other than impaired glucose tolerance. Thus, there does not appear to be consensus on the definition using the cut points identified. Controversy also remains as to whether there are glycemic metrics beyond HbA1c that can be used in addition to HbA1c to help assess risk of an individual developing diabetes complications. Given the current controversy, a Point-Counterpoint debate on this issue is provided herein. In the preceding point narrative, Dr. Yudkin provides his argument that there are significant problems with this label. In the counterpoint narrative below, Dr. Cefalu argues that the cut points are appropriate and do provide useful and important information in trying to reduce the future burden of diabetes.—William T. CefaluEditor in Chief, Diabetes Care
展开▼
机译:美国糖尿病协会定义的“糖尿病前期”类别包括一系列基于空腹或2小时后负荷葡萄糖或HbA1c的中等高血糖。在最近的过去,识别该阶段的“切点”已经改变,即,使用了较低的空腹血糖水平。一方面,可以争辩说,降低到较低的切入点可以识别出一组仍然处于较高风险中的个体,并且可以提高人们对与心血管疾病高风险相关的疾病的认识。另外,在此阶段识别个体可能代表对该疾病进行早期干预的机会。但是,反对糖尿病前期定义的论点是,它掩盖了这三个子类别的差异,并在解释有关干预措施和结果的意见时产生了问题。此外,可以说,根据标准确定的人数众多,远远超出了卫生保健系统通过个人护理做出反应的能力,特别是没有证据表明干预措施除了对糖耐量下降外,对任何其他类别都有益。因此,对于使用确定的切点的定义似乎没有达成共识。关于HbA1c以外是否还有其他可用于HbA1c的血糖指标,以帮助评估个体发生糖尿病并发症的风险,也存在争议。鉴于当前的争议,本文提供了有关此问题的“点对点”辩论。在前面的叙述中,Yudkin博士提出了他的论点,认为该标签存在重大问题。在下面的对立叙述中,Cefalu博士认为切点是适当的,并且确实在试图减轻糖尿病的未来负担方面提供了有用和重要的信息。—William T. Cefalu糖尿病护理总编辑
展开▼