Aydan Aksöyek, Emre Bozkırlı, Okan Sefa Bakiner, Akatlı Kürşad Özşahin

Prediyabet: Tanısal Karmaşayı Engellemek İçin bir Güncelleme

Bu derlemenin amacı hekimlerin prediyabet farkındalığını artırmak ve en az sayıda test ile en fazla sayıda prediyabetik hastanın teşhis edilmesine yardımcı olmaktır. Prediyabet mikrovasküler ve makrovasküler komplikasyonlar oluşturması, metabolik sendroma eşlik etmesi ve diyabet gelişimini öngürdürmesi açısından önemli bir sağlık sorunudur. Dünyada oldukça yaygın olup tek bir testle tanısal değeri düşük olduğu için hastaların çoğu teşhis alamamaktadır. Ek olarak değişik çalışma gruplarının ortaya koyduğu değişik yaklaşımlar klinisyenlerin konsept karmaşasını artırmaktadır. Sonuç olarak erken dönemde teşhis edilememiş hastalarda gelişen komplikasyonlar daha fazla çaba ve maliyete sebep olur. Bu yüzden prediyabetin erken ve doğru teşhisi gereklidir. Maliyetler gözönüne alındığında prediyabet teşhisine yönelik her hasta için çok sayıda test istenmesi de akla yakın gözükmemektedir. Buna göre; tanı için gerekli testlerin belirlenmesinde vakaların sahip olduları risk durumuna göre sınıflandırılması doğru olacaktır. Risk belirlenmesi konu içinde tartışılmıştır. Birinci basamak hekimlerinin prediyabete yönelik yeterliliklerinin sağlanması koruyucu hekimlik hizmeti sunmalarının da önünü açacaktır.

Prediabetes: An Update and a Rational for Diagnostic Confusion

The aim of this review is to increase awareness for prediabetes and help diagnose maximum number of prediabetic patientswith minimum number of tests for physicians and health care workers. Prediabetes is a significant health problem because itcan cause microvascular and macrovascular complications, accompany metabolic syndrome and predict the development ofdiabetes. It is common worldwide; however, most patients cannot be diagnosed because single tests used for scanning it havelow diagnostic value alone. In addition; different definitions released by different organizations increase the clinicians’ conceptof confusion. As a result; developing complications in initially undiagnosed patients call for greater efforts and costs. Therefore:an early and correct diagnosis of prediabetes is important. It is not rational to increase the number of tests for every caseconsidering increased costs. According to this; classification of cases depending on risk status would be correct to assess thetests for scanning. The risk stratification is also discussed. Primary care physicians need to have a good understanding ofscreening for prediabetes as a core competency and to serve proactively.

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1. Seshasai SR, Kaptoge S, Thompson A, et al, for the Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specifi c death. N Engl J Med 2011;364(9), 829-841
2. Balkau B. The DECODE study. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe. Diabetes Metab. 2000 Sep;26(4):282-6.
3. American Diabetes Association Screening for type 2 diabetes. Diabetes Care 2004;27 Suppl 1: 11–14.
4. CDC national diabetes statistics report 2014 available in http//www.cdc.gov/diabetes/pubs/statsreport14 /national-diabetes-report-web.pdf –accessed september 4 2017
5. Karve A, Hayvard RA. Prevalence, diagnosis, and treatment of impaired fasting glucose and impaired glucose tolerance in nondiabetic U.S. adultsDiabetes Care 2010:33; p:2355-2359
6. www.idf.org/idf-diabetes-atlas-seventhedition-2015 - accessed september 4 2017
7. Satman I, Yilmaz T, Sengül A et al..Populationbased study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP)Diabetes Care2002;25:1551-6
8. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, Karsidag K, Genc S, Telci A, Canbaz B, Turker F, Yilmaz T, Cakir B, Tuomilehto J; TURDEP-II Study Group.Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013 Feb;28(2):169-80.
9. Lam DW, LeRoith D. The worldwide diabetes epidemic. Curr Opin Endocrinol Diabetes Obes 2012;19:93–6.
10. American Diabetes Association. Standards of medical care in diabetes.Diabetes Care 2005 Jan; 28(suppl 1): s4-s36
11. World Health Organization, International DF. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. Geneva: World Health Organization; 2006. P: 127-128
12. International Expert Committee.International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009; 32:1327–34
13. Faerch K, Borch-Johnsen K, Holst JJ, Vaag A. Pathophysiology and aetiology of impaired fasting glycaemia and impaired glucose tolerance: does it matter for prevention and treatment of type 2 diabetes?Diabetologia. 2009 Sep;52(9):1714-23
14. Abdul-Ghani M, DeFronzo RA, Jayyousi A.Prediabetes and risk of diabetes and associated complications: impaired fasting glucose versus impaired glucose tolerance: does it matter? Curr Opin Clin Nutr Metab Care 2016, 19:394–399.
15. Buysschaert M, Medina JL, Bergman M, Shah A, Lonier J.Prediabetes and associated disorders. Endocrine (2015) 48:371–393
16. Gerstein HC, Santaguida P, Raina Pet al.Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and meta-analysis of prospective studies. Diabetes Res Clin Pract 2007;78(3):305–12.
17. Zhang X. Gregg EW, Williamson DFet al. A1C level and future risk of diabetes: a systematic review.Diabetes Care2010;33:1665–73.
18. Tabak AG. Jokela M, Akbaraly TN et al.Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study.Lancet. 2009; 373:2215–21.
19. Grundy SM. Pre-diabetes, metabolic syndrome, and cardiovascular risk.J Am Coll Cardiol. 2012;59(7):635-643
20. Tong PC, Kong AP, So WY et al.The usefulness of the International Diabetes Federation and the National Cholesterol Education Program's Adult Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in subjects with type 2 diabetes.Diabetes Care 2007 May; 30(5): 1206- 1211
21. Lorenzo C, Williams K, Hunt KJ, Haffner SM.The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes.Diabetes Care 2007 Jan; 30(1): 8-13
22. Goldberg RD, Mather K.Targeting the consequences of the metabolic syndrome in the Diabetes Prevention Program.Arterioscler Thromb Vasc Biol. 2012 September ; 32(9): 2077–2090
23. Grundy SM.Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds.J Am Coll Cardiol. 2006;47(6):1093- 1100
24. Anselmino M,Mellbin L, Wallander M, Rydén L.Early detection and integrated management of dysglycemia in cardiovascular disease: a key factor for decreasing the likelihood of future events.Rev Cardiovasc Med.2008;9:29-38
25. Kristensen SL, Preiss D, Jhund PS, Squire Iet al. Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial.Circ Heart Fail. 2016;Jan;9(1). pii: e002560 p: 87-93
26. Bianchi C, Miccoli R, Bonadonna RC, et al. Metabolic syndrome in subjects at high risk for type 2 diabetes: the genetic, physiopathology and evolution of type 2 diabetes (GENFIEV) study. Nutr Metab Cardiovasc Dis 2011;21:699–705.
27. Platinga LC, Crews DC, Coresh J, et al.Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clin J Am Soc Nephrol.2010;5:673-682
28. DPP Res Group. The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the Diabetes Prevention Program.Diabet Med.24;2:137-144
29. Wong TY,Liew G, Tapp RJ et al. Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies.Lancet 2008;371:736- 743
30. Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A; KORA Study Group.Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3.Pain Med. 2009 Mar;10(2):393-400.
31. Weili Xu, Caracciolo B, Wang HX et al.Accelerated progression from mild cognitive impairment to dementia in people with diabetes. Diabetes 2010;59:2928-2935
32. Nichols G, Hillier TA, Brown JB. Normal fasting plasma glucose and risk of type 2 diabetes diagnosis. The American Journal of Medicine. 2008;121:519-524
33. The Emerging Risk Factors Collaboration. Sarwar N, Gao P, Seshasai SR et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.Lancet 2010; 375:2215-2222
34. Fisman EZ, Motro M, Tenenbaum A, et al.Impaired fasting glucose concentrations in nondiabetic patients with ischemic heart disease: a marker for a worse prognosis. Am Heart J 2001;141:485-490
35. Kersten S, Desvergne B, Wahli W. Roles of PPARs in health and disease.Nature 2000; 405:421-424
36. Faerch K, Witte DR, Tabák AGet al. Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of type 2 diabetes: a post-hoc analysis of the longitudinal Whitehall II cohort study.Lancet Diabetes Endocrinol 2013; 1: 43-51
37. Saudek CD, Herman WH, Sacks DB.et al. A new look at screening and diagnosing diabetes mellitus.J Clin Endocrinol Metab. 2008;93:2447-2453
38. Cowe CC, Rust KF, Byrd-Holt DD et al.Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006. Diabetes Care 2010;33:562-568
39. Van 't Riet E, Alssema M, Rijkelijkhuizen JM et al.Relationship between A1C and glucose levels in the general Dutch population: the new Hoorn study.Diabetes Care 2010-33:61–66,
40. De Vegt F, Dekker JM, Ruhé HG et al.Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study Diabetologia. 1999;42:926-931
41. M Tominaga, Eguchi H, Manaka H et al.Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care 1999 Jun; 22(6): 920-924
42. Gokcel A, Ozsahin AK, Sezgin N et al. High prevalence of diabetes in Adana, a southern province of Turkey.Diabetes Care. 2003 Nov;26(11):3031-4
43. Abdul-Ghani MA,Lyssenko V, Tuomi T, DeFronzo RA, Groop L.Fasting versus postload plasma glucose concentration and the risk for future type 2 diabetes: results from the Botnia Study. Diabetes Care 2009; 32:281-286
44. Catherine M,Kenneth C. Prediabetes : A Worldwide Epidemic. Endocrinol Metab Clin N Am 2016;Volume 45, Issue 4,751–764
45. Balion CM, Raina PS, Gerstein HC et al.Reproducibility of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) classification: a systematic review.Clin Chem Lab Med 2007;45:1180–5
46. Okosun IS, Seale JP, Lyn R, Davis-Smith YM. Improving Detection of Prediabetes in Children and Adults: Using Combinations of Blood Glucose Tests.Front. Public Health, 2015;Nov 20;3:260
47. Handelsman Y,loomgarden ZT, Grunberger Get al. American association of clinical endocrinologists and american college of endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015.Endocr Pract. 2015 April ; 21(Suppl 1): 1–87