Diyabetin Tanı Kriterleri ve Etiyolojik Sınıflandırılması
Özet
Diyabet; insülin eksikliği veya yetersizliği sonucu oluşan, organ hasarlarına ve ölümcül komplikasyonlara yol açabilen kronik bir metabolizma hastalığıdır. Tanısı; HbA1c'nin %6.5 ve üzeri, açlık plazma glikozunun 126 mg/dl ve üzeri, OGTT 2. saat değerinin veya rastgele plazma glikozunun 200 mg/dl ve üzerinde bulunması kriterlerinden en az birinin varlığıyla konur. Asemptomatik bireylerde tanı, testlerin tekrarıyla doğrulanmalıdır. Açlık glikozunun 100-125 mg/dl veya OGTT 2. saat değerinin 140-200 mg/dl olması durumu prediyabet (gizli şeker) olarak adlandırılır. Diyabet; beta hücrelerinin otoimmün tahribatıyla gelişen Tip 1 diyabet, insülin direnci ve yetersizliğiyle ortaya çıkan ve en sık görülen Tip 2 diyabet, monojenik defektleri içeren MODY gibi diğer spesifik tipler ve hamilelikte gelişen gestasyonel diyabet olmak üzere dört temel etiyolojik sınıfa ayrılır. Hastalığın yönetiminde erken tanı, C-peptid ve otoantikor testleri gibi ileri tetkikler, yaşam tarzı değişiklikleri ve etiyolojiye uygun tedavi yöntemleri morbidite ve mortaliteyi azaltmada kritik öneme sahiptir.
Diabetes is a chronic metabolic disease characterized by high blood sugar resulting from the body's inability to produce or effectively use insulin, potentially leading to permanent organ damage and severe complications. Diagnosis is established by meeting at least one of the following criteria: an HbA1c level of 6.5% or higher, a fasting plasma glucose level of 126 mg/dl or higher, or a 2-hour OGTT or random plasma glucose level of 200 mg/dl or higher, with asymptomatic cases requiring confirmation through repeated testing. Prediabetes is defined by a fasting glucose level of 100-125 mg/dl or a 2-hour OGTT value of 140-200 mg/dl, signifying a high risk for developing type 2 diabetes. Etiologically, diabetes is categorized into four main types: Type 1 diabetes, driven by autoimmune destruction of beta cells; Type 2 diabetes, the most prevalent form associated with insulin resistance and obesity; other specific types encompassing monogenic defects like MODY; and gestational diabetes that onset during pregnancy. Early diagnosis, advanced laboratory assessments including C-peptide and autoantibodies, and etiology-specific interventions are vital to mitigating complications and mortality.
Referanslar
International Diabetes Federation (IDF). Diabetes Atlas 10th Edition 2021. (20.08.2022 tarihinde https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf adresinden ulaşılmıştır).
World Health Organization (WHO). (20.08.2022 tarihinde https://www.who.int/health-topics/diabetes#tab=tab_1 adresinden ulaşılmıştır).
World Health Organization (WHO). Global report on diabetes 2016. (20/08/2022 tarihinde https://www.who.int/publications/i/item/9789241565257 adresinden ulaşılmıştır).
Satman İ, TURDEP-II Çalışma Grubu. Türkiye diyabet, hipertansiyon, obezite ve endokrinolojik hastalıklar prevalans çalışması (TURDEP-II) sonuçları. 2011.
American Diabetes Association: Screening for diabetes. Diabetes Care. 2002;25(Suppl. 1): S21-S24.
Akalın NS, Diyabet Sınıflaması ve Tanı. In: İmamoğlu Ş, Satman İ, Akalın NS, Salman S, Yılmaz C. Geçmişten Geleceğe Diabetes Mellitus. Ankara: BAYT Bilimsel Araştırmalar Basın Yayın ve Tanıtım Ltd. Şti. 2015, p. 17-22.
TÜRKDİAB Diyabet tanı ve tedavi rehberi, 10. Baskı, İstanbul, Armoni Nüans Baskı Sanatları A.Ş., Türkiye Diyabet Vakfı, 2021, ss.14-25.
American Diabetes Association. 2. Classification and Diagnosis of Diabetes. Diabetes Care. 2017;40: S11.
Selvin E, Crainiceanu CM, Brancati FL, et al. Short-term variability in measures of glycemia and implications for the classification of diabetes. Archives of Internal Medicine. 2007;167(14): 1545-1551.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1: S62.
World Health Organization (WHO). (20.08.2022 tarihinde http://www.who.int/diabetes/publications/report-hba1c_2011.pdf adresinden ulaşılmıştır).
Genuth S, Alberti KG, Bennett P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26: 3160.
International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32: 1327.
Berlianti AAIAA, Surudarma IW, Wiryanthini IAD, et.al., tRNAleu A3243G gene mutation of mitochondrial DNA as a risk factor for diabetic retinopathy in type 2 diabetes mellitus in Bali. International Journal of Research and Review. 2022;9(1): 182-188. https://doi.org/10.52403/ijrr.20220124
Gokcel A, Baltali M, Tarim E, et al. Detection of Insulin Resistance in Turkish Adults: A Hospital-Based Study. Diabetes Obesity & Metabolism. 2003;5(2): 126-130.
Erem C, Yıldız R, Kavgacı H, et al. Prevalence of diabetes, obesity and hypertension in a Turkish population (Trabzon city). Diabetes Research and Clinical Practice. 2001;54(3): 203-208.
Balasubramanyam A, Nalini R, Hampe CS, et al. Syndromes of ketosis-prone diabetes mellitus. Endocrine Reviews. 2008;29(3): 292-302. https://doi.org/10.1210/er.2007-0026
Colclough K, Patel K. How do I diagnose Maturity Onset Diabetes of the Young in my patients?. Clinical Endocrinology. 2022; 10.1111/cen.14744. Advance online publication. https://doi.org/10.1111/cen.14744
Carlsson A, Shepherd M, Ellard S, et al. Absence of islet autoantibodies and modestly raised glucose values at diabetes diagnosis should lead to testing for MODY: lessons from a 5‐year pediatric Swedish National Cohort Study. Diabetes Care. 2020;43(1): 82‐89.
Owen KR. Treating young adults with type 2 diabetes or monogenic diabetes. Best Practice & Research. Clinical Endocrinology & Metabolism. 2016;30(3): 455‐467. https://doi.org/10.1016/j.beem.2016.05.002
Zhang H, Colclough K, Gloyn AL, et al. Monogenic diabetes: a gateway to precision medicine in diabetes. The Journal of Clinical Investigation. 2021;131(3): 266‐268. e142244. https://doi.org/10.1172/JCI142244
Palmieri VO, De Rasmo D, Signorile A, et al. T16189C mitochondrial DNA variant is associated with metabolic syndrome in Caucasian subjects Nutrition. 2011;27(7- 8): 773-777.
Saldana-Rivera, E, Careaga-Castilla MJ, Olvera-Cardenas GD, et al. Mitochondrial T16189C polymorphism Is associated with metabolic syndrome in the Mexican population. Disease Markers. 2018;(25): 2018:3981315.
Alberti KGMM. The classification and diagnosis of diabetes mellitus. Textbook of Diabetes. 4th edition. Eds: Holt RIG, Cockram C, Flyvbjerg A, Goldstein BJ. Singapore, WileyBlackwell, 2010, p. 24-30.
Maassen JA, T Hart LM, Van Essen E, et al. Mitochondrial diabetes: molecular mechanisms and clinical presentation. Diabetes. 2004;53(Suppl 1): S103-S109.
Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus: New diagnostic criteria of fulminant type 1 diabetes mellitus (2012). Journal of Diabetes Investigation. 2012;3(6): 536-539. https://doi.org/10.1111/jdi.12024J
Atlı H, Önalan E. Diabetes Mellitusun ve Diyabetle İlişkili Genetik Sendromların Sınıflandırılması. Özyiğit F, (ed) Güncel Yaklaşımlarla Diyabet. 2022;205-224. Publisher: Akademisyen Kitabevi DOI:10.37609/akya.1707
Maassen JA, Jahangir Tafrechi RS, Janssen GM, et al. New insights in the molecular pathogenesis of the maternally inherited diabetes and deafness syndrome. Endocrinology and Metabolism Clinics of North America. 2006;35(2): 385-396. https://doi.org/10.1016/j.ecl.2006.02.014
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36(Suppl 1): S67-S74.
Altuntaş Y. Diabetes mellitusun tanımı, tanısı ve sınıflaması, Her yönüyle Diabetes Mellitus kitabı. Nobel Tıp Kitabevleri; İstanbul, 2001. p. 85-128.
