International Medical Journal, Vol. 22., Iss. 1, 2016, P. 17−20.
DIAGNOSTIC APPROACHES TO GLUСOMETABOLIC CATEGORIES VERIFICATION: VIEWS EVOLUTION
Kharkiv National Medical University, Ukraine
According to the International Diabetes Federation, in 2011 about 52 million of Europeans aged 20−79 had diabetes, and by 2030 it forecasts the growth to 64 million. In addition to these statistical data of diabetes prevalence, in 2011 the experts found impaired glucose tolerance (IGT) in 63 million Europeans. Given the almost comparable epidemiological data on the prevalence of both diabetes and IGT, the subject of intense scientific discussion is diagnostic and prognostic approach to identifying violations of carbohydrate metabolism prior to the development and clinical manifestation of type 2 diabetes. Based on clinical studies, fasting hyperglycemia > 7.0 mmol/l and plasma glucose level after 2 hrs. of glucose tolerance test (OGTT) > 11.1 mmol/l are considered pre−clinical manifestations of diabetes. These disorders can be termed «prediabetes» to focus on the clinical sense of the state, and emphasize the high risk of developing diabetes in the future. The importance of prediabetes is defined by the fact that it is not only a predictor of diabetes, but also a predictor of cardiovascular and cerebrovascular disease. This group of patients with prediabetes should be a major contingent for preventing both type 2 diabetes and the risk of cardiovascular and cerebrovascular diseases. Classically diagnosis of diabetes is based on determining plasma fasting glucose or 2 hrs. after OGTT. It should be noted that a significant disadvantage of determining glucose to diagnose diabetes is the high variability of this parameter depending on the diet, particularly relevant for determining the level of glucose. In 2009 the International Expert Committee, comprising representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF) and the European Association for the Study of Diabetes (EASD), recommended the use of the most objective test for type 2 diabetes mellitus diagnosis to determine the level of glycosylated hemoglobin (HbA1c) with its growth ? 6.5 %. Epidemiological data indicate relationship between elevated HbA1c, fasting and post OGTT hyperglycemia and development of diabetic retinopathy. However, determining HbA1c has several advantages, namely, it is independent of the power supply and does not require fasting; it is a reflection of carbohydrate homeostasis in the recent 6−8 weeks. HbA1c is most objective parameter, since it does not affect the level of short−term limitations and errors in diet. At the same time normal level HbA1c not exclude the diagnosis of diabetes and impaired carbohydrate tolerance.
Key words: prediabetes, diabetes, diagnostic criteria, plasma glucose, glucose tolerance disorders, glyco−sylated hemoglobin.