糖尿病の診断における断食中のグルコースと網膜病変の関係:人口ベースの3つの横断的な研究
Tien Y Wong1, Gerald Liew, Robyn J Tapp
1Centre for Eye Research Australia, University of Melbourne, VIC, Australia. twong@unimelb.edu.au
Lancet (London, England)
|March 4, 2008
まとめ
現在の糖尿病診断基準は,断食プラズマグルコース (FPG) に基づいており,糖尿病性網膜症を効果的に特定できない可能性があります. これらの値の再評価は,より良い患者ケアと糖尿病合併症の診断のために提案されています.
科学分野:
- オフタルモロジック (眼科)
- エンドクリノロジー エンドクリノロジー
- 公衆衛生は公衆衛生である.
背景:
- 糖尿病の現在の診断基準は,網膜病変を検出するための血糖値の値に依存しています.
- これらの値を支持する以前の研究では,網膜病変の検出に制限がありました.
- 断食プラズマグルコース (FPG) と網膜病変の関係を評価するために,更新されたデータが必要です.
研究 の 目的:
- FPGと網膜病変の関係に関する最新データを提供するために.
- 流行性および発生性網膜病変の特定のための現在のFPGの値の診断精度を評価する.
主な方法:
- 青い山脈の眼の研究 (BMES),オーストラリアの糖尿病,肥満およびライフスタイルの研究 (AusDiab),および動脈硬化症の多民族研究 (MESA) の3つの大きな多民族の成人の集団の分析.
- 網膜写真から診断され,修正されたエアリーハウス分類を用いて分類される網膜症.
- 断食の静脈血血糖濃度が測定されました.
主要な成果:
- 網膜病変の罹患率は11.5% (BMES),9.6% (AusDiab),15.8% (MESA) でした.
- 均一な血糖値の値に関する不一致な証拠;継続的な関係が観察された.
- 7.0mmol/LのFPGのカットオフ値は,網膜病変の検出に対する感度が低い (<40%) で,特異性が高い (80.8-95.8%) でした.
- FPGと網膜病変のROC曲線の下の面積は低い (0.56-0.61) でした.
結論:
- 人口全体で網膜病変の存在または発生に関する明確で一貫した血糖値の値は見つかりませんでした.
- FPGの現在の糖尿病の診断基準は,網膜病変の有無を正確に特定できない.
- 糖尿病の診断基準の再評価は,これらの発見に基づいて正当化されています.
関連する概念動画
Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
Type 2 diabetes mellitus develops gradually and is often asymptomatic in early stages.Clinical ManifestationsWhen symptoms appear, they include fatigue, blurred vision, pruritus, delayed wound healing, and recurrent infections, particularly candidal infections. Peripheral neuropathy may present as numbness or tingling in the extremities. Classic hyperglycemia symptoms—polyuria, polydipsia, and polyphagia—are less common. Most patients are overweight and frequently have associated hypertension...
Diabetic Retinopathy
DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...
Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
Diabetes: Symptoms, Diagnosis, and Complications
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is based on...
Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
Type I Diabetes III: Clinical Manifestations
Type 1 diabetes mellitus typically presents with rapid-onset symptoms due to the body’s inability to utilize glucose in the absence of insulin. Since insulin is required for glucose uptake into cells, its deficiency leads to hyperglycemia and cellular energy deprivation, resulting in characteristic clinical features.Polyuria and PolydipsiaOne of the earliest, most prominent symptoms is polyuria (excessive urination). When blood glucose concentrations rise above the renal threshold, the kidneys...

