Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance
Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance
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由美国国立卫生研究院国家糖尿病数据组赞助的一个国际工作组，根据对这种异质性综合征的当代知识，对糖尿病和其他类型的葡萄糖耐受不良进行了分类。美国糖尿病协会的专业成员对这一分类和修订后的糖尿病诊断标准进行了审查，英国糖尿病协会、澳大利亚糖尿病协会和欧洲糖尿病研究协会也发布了类似的版本。《美国糖尿病法》核准了国际工作组的建议，世界卫生组织糖尿病问题专家委员会也接受了其实质性建议。建议将这一分类作为开展临床和流行病学研究的统一框架，以便在各种形式的糖尿病和其他类型的葡萄糖不耐受的范围和影响方面获得更有意义和比较的数据。本文不考虑糖尿病的医学治疗，分类也不是试图为患者的治疗定义指南。在分类中提出的显著变化是：1。胰岛素依赖型、酮症倾向型糖尿病，与6号染色体上某些组织相容性抗原（HLA）和胰岛细胞抗体的频率增加或减少有关，被认为是糖尿病的一个独特亚类[胰岛素依赖型糖尿病（IDDM）]。这种类型的糖尿病被不恰当地称为青少年糖尿病。由于它可以发生在任何年龄，因此建议取消基于发病年龄的诊断。2. 非胰岛素依赖型、非酮症易感性的糖尿病，不继发于其他疾病或病症，被认为是糖尿病的第二个不同亚类[非胰岛素依赖型糖尿病（NIDDM）]。该亚类根据是否存在肥胖（分别为肥胖型NIDDM和非肥胖型NIDDM）进行了划分，该亚类患者可以根据他们接受的治疗类型（胰岛素、口服降糖药、饮食）或研究人员感兴趣的其他特征进一步表征。我们相信，这一亚类以及IDDM的异质性将通过进一步的研究得到证实。3. 由其他疾病引起的糖尿病类型或发现与其他疾病的频率增加（暗示病因关系）被认为是糖尿病的第三个亚类-与某些疾病和综合征相关的糖尿病。这一亚类已根据已知或可疑的病因关系进行划分。4. 妊娠期糖尿病仅限于妊娠期出现或发现葡萄糖耐受不良的妇女。5. 血浆葡萄糖（PG）水平介于正常和糖尿病之间的个体被称为糖耐量受损。我们建议放弃用于这一类人的术语化学性、潜伏性、边缘性、亚临床和无症状糖尿病，因为使用术语糖尿病会引起社会、心理和经济制裁，鉴于他们的葡萄糖耐受性不严重，这些制裁是不合理的。
A classification of diabetes and other categories of glucose intolerance, based on contemporary knowledge of this heterogeneous syndrome, was developed by an international workgroup sponsored by the National Diabetes Data Group of the NIH. This classification, and revised criteria for the diagnosis of diabetes, were reviewed by the professional members of the American Diabetes Association, and similar versions were circulated by the British Diabetic Association, the Australian Diabetes Society, and the European Association for the Study of Diabetes. The ADA has endorsed the proposals of the international workgroup, and the Expert Committee on Diabetes of the World Health Organization has accepted its substantive recommendations. It is proposed that this classification be used as a uniform framework in which to conduct clinical and epidemiologie research so that more meaningful and comparative data will be obtained on the scope and impact of the various forms of diabetes and other classes of glucose intolerance. Medical treatment of diabetes is not considered in this paper, and the classification is not an attempt to define guidelines for therapy of patients. The salient changes proposed in the classification are that 1. The insulin-dependent, ketosis-prone type of diabetes, which is associated with increased or decreased frequency of certain histocompatibility antigens (HLA) on chromosome 6 and with islet cell antibodies, be considered a distinct subclass of diabetes [insulin-dependent diabetes mellitus (IDDM)]. This type of diabetes has been inappropriately termed juvenile diabetes. Since it can occur at any age, it is recommended that diagnosis based on age of onset be eliminated. 2. The noninsulin-dependent, nonketosis-prone types of diabetes, which are not secondary to other diseases or conditions, be considered a second distinct subclass of diabetes [noninsulin-dependent diabetes mellitus (NIDDM)]. This subclass has been divided-according to whether or not obesity is present (obese NIDDM and nonobese NIDDM, respectively), and patients in this subclass can be further characterized by the type of treatment they receive (insulin, oral hypoglycemie agents, diet) or by other characteristics of interest to the researcher. It is believed that heterogeneity within this subclass, and also within IDDM, will be demonstrated by further research. 3. The types of diabetes caused by other conditions or found in increased frequency with other conditions (implying an etiologie relationship) be considered a third subclass of diabetes mellitus—diabetes associated with certain conditions and syndromes. This subclass has been divided according to the known or suspected etiologie relationships. 4. The class gestational diabetes be restricted to women in whom glucose intolerance develops or is discovered during pregnancy. 5. Individuals with plasma glucose (PG) levels intermediate between those considered normal and those considered diabetic [see (8)] be termed to have impaired glucose tolerance. It is proposed that the terms chemical, latent, borderline, subclinical, and asymptomatic diabetes, which have been applied to persons in this class, be abandoned, since use of the term diabetes invokes social, psychologic, and economic sanctions that are unjustified in light of the lack of severity of their glucose intolerance.