Recently, the International diabetes Federation (IDF) released the IDF's Position Statement on Hyperglycemia and Type 2 diabetes in the Diagnosis of Blood Glucose One Hour after Load in Diabetes Research and Clinical Practice.
The Position Statement proposed that the 1-hour blood glucose of the oral glucose tolerance test (OGTT) should be used as the criteria for the diagnosis of intermediate hyperglycemia and type 2 diabetes: if the 1-hour blood glucose of OGTT is ≥ 8.6mmol/L, it can be diagnosed as intermediate diabetes, and if the 1-hour blood glucose of OGTT is ≥ 11.6mmol/L, it can be diagnosed as type 2 diabetes.
After the release of this data, it immediately sparked widespread discussion and attention. Some people can't help asking: if we follow this new standard, won't China's diabetes patients increase by millions overnight?
In the current WHO and domestic clinical guidelines, OGTT 2-hour blood glucose has always been used as the diagnostic criterion. The Chinese Guidelines for the Prevention and Treatment of Type 2 diabetes (2020 Edition) also mentioned that "blood glucose at other time points of OGTT is not a diagnostic standard".
What does the latest IDF Position Statement mean; What changes will occur in clinical practice; Will people who have not been diagnosed before become diabetes overnight?
First of all, as an important indicator of diabetes diagnosis, glycosylated hemoglobin has an unshakable position. However, compared with OGTT, the sensitivity of glycosylated hemoglobin is still low - about 40% of diabetes patients can be diagnosed as diabetes according to OGTT standards, but the glycosylated hemoglobin value does not reach 6.5%.
Secondly, according to the current follow-up data, if the old standard OGTT 2 hours is used as the cutoff value, a large sample of 10 years of follow-up found that in fact 50-60% of pre diabetes (IDF called intermediate hyperglycemia, IH) does not necessarily progress to diabetes. At the same time, 1/3 of the people diagnosed with diabetes 10 years later had normal glucose tolerance at baseline.
Based on this, there is also a lot of evidence from OGTT's 1-hour research in recent years, and the IDF's "Position Statement" further summarizes and improves on the basis of previous research. The main idea is still to focus on pancreatic islets β Cell protection, currently found that OGTT 1-hour blood glucose is a simple and practical indicator, but it can detect pancreatic islets relatively early β Indicators of cellular abnormalities. If early detection can lead to early intervention, it will have the opportunity to prevent the occurrence of diabetes, which is conducive to the prevention of diabetes, and also conforms to the disease key is prevention, rather than intervention after diagnosis of diabetes.
IDF also analyzed the correlation between 1-hour blood glucose as a diagnostic criterion for UACR, cardiovascular disease, sleep apnea syndrome, metabolic dysfunction related fatty liver, etc., and found that its value is not lower than the classic 2-hour blood glucose. In addition, the repeatability is also good.
Changing OGTT from 2 hours to 1 hour has some advantages in addition to the previous medical evidence. Firstly, from protecting the pancreatic islets β From the perspective of cell and prevention of diabetes, it is a better indicator, which is beneficial to patients' health; Secondly, from the perspective of health economics, IDF has also conducted a detailed analysis, and the evidence for reducing expenditures is also very sufficient. Thirdly, in clinical practice, which one has higher satisfaction when we ask patients undergoing OGTT to wait for 1 hour or 2 hours? It is also evident.
In addition, previous studies have confirmed that the sensitive indicator for diagnosing Asian hyperglycemia and diabetes is postprandial blood glucose, not fasting blood glucose or glycosylated hemoglobin. Therefore, if we assume that the time point of 1 hour of OGTT will be used as the standard for pre diabetes and diabetes in the future, the Asian population may benefit more.
