Is There a Clear Threshold for Fasting Plasma Glucose That Differentiates Between Those With and Without Neuropathy and Chronic Kidney Disease?
Is There a Clear Threshold for Fasting Plasma Glucose That Differentiates Between Those With and Without Neuropathy and Chronic Kidney Disease?
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DOI：
10.1093/aje/kwp076
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发表时间：
2009-06-15
影响因子：
5
通讯作者：
Lee, Jeannette
中科院分区：
文献类型：
--
作者：
Nang, Ei Ei Khaing;Khoo, Chin Meng;Lee, Jeannette
最近的研究表明，没有明显的血糖阈值一贯区分个体有或没有视网膜病变。作者试图确定其他微血管并发症是否也是如此。他们研究了新加坡（1982-1998年）进行的4次横断面调查中的5,094名空腹血糖值和并发微血管并发症的参与者，他们在2004-2007年参加了随访检查。根据对10 g单丝或神经感觉计测试的异常反应诊断周围神经病变。慢性肾脏疾病以各种方式定义，通过使用白蛋白尿（尿白蛋白：肌酐比值> 30 μ g/mg）和估计的肾小球滤过率，单独或联合使用。周围神经病变的患病率为7.5%。对于慢性肾脏疾病，蛋白尿的患病率仅为10.5%，估计肾小球滤过率< 60 mL/min/1.73 m2仅为4.1%，两者均为2.1%。周围神经病变和慢性肾脏疾病的患病率与空腹血糖相关，从低于现有糖尿病诊断阈值7.0 mmol/L（126 mg/dL）的水平开始逐渐增加。对于慢性肾脏疾病，在调整年龄、性别、种族和高血压后，这些相关性仍然存在。目前糖尿病的诊断阈值对于识别具有这些微血管并发症的个体具有有限的灵敏度。确定这些个体可能需要开发和应用新的筛选策略。
Recent studies suggest that no distinct glycemic threshold consistently differentiates individuals with or without retinopathy. The authors sought to determine whether the same was true for other microvascular complications. They studied 5,094 participants with fasting plasma glucose values and concurrent microvascular complications from 4 previous cross-sectional surveys carried out in Singapore (1982-1998) who attended a follow-up examination in 2004-2007. Peripheral neuropathy was diagnosed based on abnormal responses to a 10-g monofilament or neurothesiometer test. Chronic kidney disease was defined in various ways by using albuminuria (urine albumin:creatinine ratio > 30 mu g/mg) and estimated glomerular filtration rate, alone and in combination. Prevalence of peripheral neuropathy was 7.5%. For chronic kidney disease, prevalence of albuminuria only was 10.5%, estimated glomerular filtration rate of < 60 mL/minute per 1.73 m(2) only was 4.1%, and both was 2.1%. Prevalence of peripheral neuropathy and chronic kidney disease gradually increased in relation to fasting plasma glucose, beginning at levels below the existing diagnostic threshold for diabetes mellitus of 7.0 mmol/L (126 mg/dL). For chronic kidney disease, these associations persisted after adjustment for age, gender, ethnic group, and hypertension. Current diagnostic thresholds for diabetes mellitus have limited sensitivity for identifying individuals with these microvascular complications. Ascertaining these individuals may require development and application of novel screening strategies.