Retinopathy, plasma glucose, and the diagnosis of diabetes.

摘要

The current cutoffs for fasting plasma glucose to diagnose diabetes have largely been derived from the prevalence and incidenceof diabetes-specific microvascularcomplications, especially retinopathy, across a range of concentrations. Studies in Pima American Indians and Egyptians, and the third National Health and Nutrition Examination Survey (NHANES III), conveniently suggested that there is an abrupt glycaemic threshold above which the prevalence of retinopathy increases. That finding suggests that most retinopathy in these populations was due to (or associated with) hyperglycaemia. Data from these studies led to the American Diabetes Association (ADA) expert committee3 recommending lowering of the diagnostic cutoff from 7-8 to 7-0 mmol/L in 1997 These studies all had limitations, most notably the poor methodology for detection and grading of retinopathy and the limited numbers of cases of retinopathy (32 in the Pima study, 146 in the Egyptian study, and 111 in NHANES III).