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Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2002, Number 4

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Rev Mex Patol Clin Med Lab 2002; 49 (4)

Reliability and applicability of the new criteria on diabetes mellitus diagnosis

Terrés-Speziale AM

Language: Spanish
References: 55
Page: 212-220
PDF size: 66.54 Kb.


ABSTRACT

Until 1997, according to WHO diagnostic criteria for Diabetes Mellitus, including Fasting Glucose (‹ 140 mg/dL) and Post-Prandial Glycemia (‹ 200 mg/dL), it was poorly understood the importance to reduce cut-off values in order to prevent chronic-degenerative diseases, dependent on the premature aging process secondary to hyperlipidemia and protein glycosilation, that generated catastrophic costs on the health care system. With newer criteria, including NOM-015-SSA Para la Prevención, Tratamiento y Control de la Diabetes Mellitus, Glucose Tolerance Tests are now considered obsolete for diagnosis. GTT have been replaced by fasting Glycemia (‹ 126 mg/dL) in combination with post-prandial glycemia (‹ 200 mg/dL). Goal: This paper is a review of available information about the reliability, applicability and impact of the new criteria on Diabetes Mellitus diagnosis, prevention, control and treatment. Outcome: Strong available evidence indicate that with the new criteria, test diagnostic sensitivity will increase and in consequence more individuals will be considered diabetic. It is calculated and predicted that there will also be an increase on false positives proportional to a reduction on specificity. Considering medical, psychological, laboral, economical, and social implications it is obviously necessary to improve diagnostic power. Clinical experience, considering cost/benefit factors, indicates that the best strategy on this purpose is based on Glycohemoglobin HbA1c chromatographic determination with certified methodology establishing a cutoff of › 6.5%. Discussion: Laboratory medicine is a dynamic evolutive specialty that supports scientific and technological development of other medical fields. Recent findings indicate that present international criteria are insufficient and inefficient, pointing to a reasonable need to be modified on a short term, in order to include glycohemoglobin for confirmation purposes as it is already happening in Japan.


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