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Early diagnosis, early treatment and the new diagnostic criteria of diabetes mellitus

Published online by Cambridge University Press:  09 March 2007

Takeshi Kuzuya
Takeshi Kuzuya*
Affiliation:
JA Shioya General Hospital, Tomita 77, Yaita, Tochigi 329-2145, Japan
*
*Corresponding author: Takeshi Kuzuya, tel 81 287 44 1155, fax 81 287 43 9822.
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Abstract

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The main purpose of treating diabetes is to prevent chronic complications. Strict glycemic control is known to suppress the occurrence and progression of these complications. The test for plasma glucose is essential to identify diabetic patients, as mild hyperglycemia without symptoms can be a risk factor for complications. The new classification and diagnostic criteria for diabetes were proposed by the American Diabetes Association (ADA), WHO and Japan Diabetes Society (JDS) between 1997 and 1999. Diabetes is classified into four etiological categories; type 1, type 2, diabetes due to other specific mechanisms or conditions, and gestational diabetes. Another classification system according to the degree of metabolic abnormality has also been adopted. For diagnosis of diabetes, the JDS Committee classified the glycemic state into three categories based on fasting plasma glucose (FPG) and 2-h plasma glucose in the 75 g oral glucose tolerance test (2hPG); normal type (FPG <110 and 2hPG <140 mg/dl), diabetic type (FPG <126 and/or 2hPG <200 mg/dl), and borderline type (neither normal nor diabetic type). The borderline type corresponds to the sum of impaired fasting glycemia (IFG) and impaired glucose tolerance (IGT) based on ADA and WHO. Using the JDS criteria, diabetes is diagnosed when hyperglycemia of ‘diabetic type’ is confirmed on two or more occasions. ADA recommends the use of FPG alone for the diagnosis of diabetes, but findings from both Japan and Europe indicate that many diabetic subjects would be classified as non-diabetic solely on the FPG test. JDS recommends the use of the glucose tolerance test when the elevation of FPG is mild. Keeping glycemia near-normal by periodic monitoring of glycemic parameters and by appropriate treatment would prevent or reduce the diabetic complications in patients to a minimum.

Keywords

DiabetesClassification of diabetesDiagnostic criteria of diabetes
Type
Research Article
Information
British Journal of Nutrition , Volume 84 , Issue S2 , December 2000 , pp. S177 - S181
Copyright
Copyright © The Nutrition Society 2000

References

Alberti, KGMM & Zimmet PZ for the WHO Consultation (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1. Diabetic Medicine 15, 539–553.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Decode Study Group on behalf of the European Diabetes Epidemiology Group (1998) Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? British Medical Journal 317, 371–375.CrossRefGoogle Scholar
The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes. New England Journal of Medicine 329, 977–986.CrossRefGoogle Scholar
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) Report of the Committee on the Diagnosis and Classification of Diabetes mellitus. Diabetes Care 20, 1183–1197.CrossRefGoogle Scholar
Harris, MIKlein, R, Welborn, TA & Knuiman, MW (1992) Onset of NIDDM occurs at least 4–7 years before clinical diagnosis. Diabetes Care 151, 815–819.CrossRefGoogle Scholar
Igarashi, K, Abe, T, Eguchi, H & Tominaga, M (1998) Chronic diabetic complications in patients with diabetes mellitus and impaired glucose tolerance found in a population-based Funagata Diabetes Study. Journal of Japan Diabetes Society 41, 159–163 (in Japanese).Google Scholar
Ito, C (1998) Correlation between FPG and 2hPG, and criteria for diabetes based on diabetic complications. Journal of Japan Diabetes Society 41 (Suppl. 2), A33–A36 (in Japanese).Google Scholar
Kosaka, K, Akanuma, Y, Goto, Y, Hagura, R, Hirata, Y, Kawate, R, Kuzuya, T, Mimura, G, Nakayama, H, Sakamoto, N & Shigeta, Y (1982) Report of the Committee on the Diagnosis of Diabetes Mellitus. Journal of Japan Diabetes Society 25, 859–866 (in Japanese).Google Scholar
Kuzuya, T, Nakagawa, S, Satoh, J, Kanazawa, Y, Iwamoto, Y, Kobayashi, M, Nanjo, K, Sasaki, A, Ito, C, Shima, K, Nonaka, K & Kadowaki, T (1999) Report of the Committee of Japan Diabetes Society on the Classification and Diagnostic Criteria of Diabetes Mellitus. Journal of Japan Diabetes Society 42 385–404 (in Japanese)Google Scholar
Ohkubo, Y, Kishikawa, H, Araki, E, Miyata, T, Isami, S, Motoyoshi, S, Kojima, Y, Furuyoshi, N & Shichiri, M (1995) Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus. Diabetes Research and Clinical Practice 28, 103–117.CrossRefGoogle ScholarPubMed
Sasaki, A, Shimizu, T & Hasegawa, K (1998) Assessment of new criteria for the diagnosis and classification of diabetes proposed by the American Diabetes Association. Journal of Japan Diabetes Society 41 (Suppl. 2), A37–A39 (in Japanese).Google Scholar
UK Prospective Diabetes Study Group (1998) Effect of intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type2 diabetes. Lancet 352, 837–853.CrossRefGoogle Scholar