Objetivo: evaluar el impacto de la disminución del valor de normalidad de la glucemia en ayuno propuesta por la Asociación Americana de Diabetes en 2003 (ADA-2003) sobre la prevalencia de glucosa en ayuno alterada (GAA), y la concordancia entre GAA según el criterio ADA-2003 e intolerancia a la glucosa, en una población con sospecha diagnóstica de diabetes.
Métodos: análisis retrospectivo de los resultados de glucosa en ayuno y dos horas poscarga de 75 g de glucosa en 2062 pacientes con riesgo para diabetes. Comparación de la prevalencia de GAA con base en los criterios ADA-1997 y ADA-2003.
Resultados: la disminución del punto de corte incrementa la prevalencia de GAA de 17.7 a 41.3 %. Con ADA-2003 se identificó a 55 % de todos los sujetos con intolerancia a la glucosa; con ADA1997, a 22.6 %. Kappa pesada mostró concordancia diagonal entre GAA (ADA-2003) y la prueba de intolerancia a la glucosa (criterios actuales de la Organización Mundial de la Salud).
Conclusiones: la utilización del criterio ADA-2003 para la glucosa en ayuno alterada permite identificar mayor proporción de pacientes con intolerancia a la glucosa o diabetes tipo 2.
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20(7):1183-1197.
National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes Care 1979;28(12):1039-1057.
World Health Organization. Diabetes mellitus: report of a WHO Study Group. World Health Org Tech Rep Ser 1985;727:1-113.
DECODE Study Group on Behalf of the European Diabetes Epidemiology Study Group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. BMJ 1998;317(7155):371-375.
Gómez-Pérez FJ, Aguilar-Salinas CA, LópezAlvarenga JC, Pérez-Jáuregui J, Guillén-Pineda LE, Rull JA. Lack of agreement between the World Health Organization category of impaired glucose tolerance and the American Diabetes Association category of impaired fasting glucose. Diabetes Care 1998;21(11):1886-1888.
Larsson H, Berglund G, Lindgarde F, Ahren B. Comparison of ADA and WHO criteria for diagnosis and glucose intolerance (Letter). Diabetologia 1998;41(9):1124-1125.
The Expert Committee in the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003;26(11):3160-3167.
Davidson MB, Landsman PB, Alexander CM. Lowering the criterion for impaired fasting glucose will not provide clinical benefits. Diabetes Care 2003;26(123):3329-3330.
Schriger DL, Lorber B. Lowering the cut point for impaired fasting glucose: where is the evidence? Where is the logic? Diabetes Care 2004;27(2);592-601.
Vaccaro O, Riccardi G. Changing the definition of impaired fasting glucose. Impact on the classification of individuals and risk definition. Diabetes Care 2005;28(7):1786-1788.
Borch-Johnsen K, Colagiuri S, Balkau B, Glümer C, Carstensen B, Ramachandran A, et al. Creating a pandemic of prediabetes: the proposed new diagnostic criteria for impaired fasting glycaemia. Diabetologia 2004;47(8):1396-1402.
Landis JR, Koch GC. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1):159-174.
Guerrero-Romero F, Rodríguez-Morán M. Lowered criterion for normal fasting plasma glucose: impact on the detection of impaired glucose tolerance and metabolic syndrome. Arch Med Res 2006;37(1):140-144.
Gómez-Díaz R, Aguilar-Salinas CA, Morán-Villota S, Barradas-González R, Herrera-Márquez R, CruzLópez M, et al. Lack of agreement between the revised criteria of impaired fasting glucose and impaired glucose tolerance in children with excess body weight. Diabetes Care 2004;27(9):2229-2233.
Weyer C, Bogardus C, Pratley RE. Metabolic characteristics of individuals with impaired fasting glucose and/or impaired glucose tolerance. Diabetes 1999;48(11):2197-2203.
Davies MJ, Raymond NT, Day JL, Hales CN, Burden AC. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics. Diabet Med 2000;17(6):433-440.
Carnevale-Schianca GP, Rossi A, Sainaghi PP, Maduli E, Barttoli E. The significance of impaired fasting glucose versus impaired glucose tolerance. Diabetes Care 2003;26(5):1333-1337.
Alberti GA. A desktop guide to type 2 diabetes mellitus: European Diabetes Policy Group 1998-1999 International Diabetes Federation European Region. Exp Clin Endocrinol Diabetes 1999;1078(7):390-420
Robles-Osorio L, Aguilar-Salinas CA, Mehta R, Gómez-Pérez FJ, Rull JA. Analysis of fasting plasma glucose values for optimal detection of abnormal responses on the oral glucose tolerance test in at-risk study subjects. Endocr Pract 2007;13(6):583-589.
Secretaría de Salud. Modificación a la Norma Oficial Mexicana NOM-015-SSA2-1994, para la prevención, tratamiento y control de la diabetes mellitus en la atención primaria. México: Secretaria de Salud; 2000.