A new concept of impaired glucose tolerance. Relation to cardiovascular risk.
A new concept of impaired glucose tolerance. Relation to cardiovascular risk.
复制标题
糖耐量受损的新概念。
DOI：
10.1161/01.atv.5.4.311
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Haffner,SM
中科院分区：
文献类型：
--
作者：
Stern,MP;Rosenthal,M;Haffner,SM
Both the National Diabetes Data Group (NDDG) and the World Health Organiza-tion (WHO) have included in their classification schemes for diabetes an entity labeled" impaired glucose tolerance"(IGT). 12 The presumed significance of this entity is twofold: first, it is commonly believed that IGT represents a transitional state between normality and diabetes; and second, IGT is also believed to be a risk factor for cardiovascular disease, either in its own right, or as a consequence of its presumed precursor relationship to diabetes. These relationships will be critically examined in this editorial. Our thesis is that IGT is not a homogeneous category, but consists of at least three entities which, although conceptually distinct, cannot be distinguished by glucose tolerance testing alone. The arguments in defense of this viewpoint rest heavily on the concept that plasma glucose concentrations are biomodally distributed in populations. Therefore, the evidence for bimodality will be briefly reviewed.Bimodality of plasma glucose distributions has now been reported in several populations, most of which are of New World or Pacific Island origin. 3" 6 In addition to having a high prevalence of diabetes, these populations are relatively isolated genetically. While the high prevalence of diabetes facilitates detection of the second (hyperglycemic) mode, the highly selected nature of these populations raises the possibility that bimodality is somehow unique to them. We have recently reported bimodality in San Antonio Mexican Americans, 7 a population which, although it contains substantial New World genetic admixture, is nevertheless more than 50% Caucasian. 8'9 Moreover, Mexican Americans are a much larger and genetically less isolated population than those in which bimodality has previously been reported, since they live side-by-side with other ethnic groups and thereby have greater opportunities for intermarriage. It could still be argued that bimodality in Mexican Americans is somehow a consequence of their New World genes. We feel, however, that our findings do tend to move the bimodality argument in the direction of greater generalizability to include populations such as Caucasians and blacks. Bimodality in these populations would, if present, be difficult to detect because of the much lower prevalence of diabetes and the second mode. Apart from the data, which are admittedly still incomplete, bimodality is theoretically appealing, since it fits with the clinicians' view that diabetes is a discrete clinical entity and not merely the right-hand tail of a continuous distribution of glucose values. Assuming the reader is willing to accept the concept of bimodality as a general phenomenon, we will now explore the implications of this phenomenon as they relate to IGT. From Figure 1 it is clear that the IGT category contains many individ-
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DOI：
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