| Titre : | Classifying diabetes according to the new WHO clinical stages. (2001) |
| Auteurs : | E. LINDHOLM ; C.D. AGARDH ; AGARDH (E.) : SWE. Department of Ophthalmology. University Hospital Mas. Malm". ; L. GROOP ; T. TUOMI ; Department of Endocrinology. University Hospital Mas. Malm". SWE |
| Type de document : | Article |
| Dans : | European journal of epidemiology (vol. 17, n° 11, 2001) |
| Pagination : | 983-989 |
| Langues: | Anglais |
| Mots-clés : | Diabète ; Classification ; OMS ; Complication ; Epidémiologie ; Diagnostic ; Homme ; Suède ; Europe ; Glande endocrine [pathologie] |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 5CSR0xlv. Diffusion soumise ... autorisation]. Aims/Hypothesis : To test the usefulness of the new WHO criteria for clinical staging of diabetes in the characterization of 1977 diabetic patients. Methods : The following clinical stages were used : patients on diet and/or oral antidiabetic agents 2 years after diagnosis were considered as non-insulin requiring (NIR ; n=711) and patients who required insulin therapy after 1 year as insulin requiring for control (IRC ; n=543). Patients who because of deteriorating hyperglycemia within 1 year required insulin therapy were considered as insulin requiring for survival (IRS ; n=743). Results : The NIR patients had the highest age at onset (52 ñ 12 years ; mean ñ SD), BMI (29.3 ñ 5.2 kg/m2) and C-peptide concentrations (median 0.98 nmol/l ; interquartile range 0.72-1.31 nmol/l) but the lowest frequency of GAD antibodies (5.50%) compared to the IRC and IRS groups. The IRC group had a high age at onset (49 ñ 13 years), BMI (28.0 ñ 4.8 kg/m2), frequency of GAD antibodies (16.8%), intermediate C-peptide concentrations (0.56 nmol/l, interquartile range 0.28-0.94), and the highest prevalence of nephropathy (31.5%) and neuropathy (68.1%). The IRS group had the lowest age at onset (23 ñ 15 years), BMI (24.2 ñ 3.4 kg/m2), C-peptide concentrations (0.05 nmol/l, interquartile range below detection limit 0.01) and highest frequency of GAD antibodies (44.5%). Retinopathy was more common in IRS than in IRC patients (62.1 vs. 43.9% ; p<0.001). Conclusions : The new WHO criteria seem to discriminate three distinct subgroups and thus provide a useful tool for clinical staging. The IRC patients seem to have a more severe disease than the IRS patients, which has not been clearly acknowledged in the etiological classification. However, because of the cross-sectional nature of these data, they need to be confirmed in a prospective study with defined cut-off limits for when insulin should be initiated. |
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