Diabetes mellitus: diagnostika a screening

Souhrn

Podle etiologie rozlišujeme následující typy diabetes mellitus: 1. a 2. typu, latentní autoimunitní diabetes, diabetes dospělého typu objevující se u mladých lidí (maturity-onset diabetes of youth - MODY) a diabetes vzniklý z různých příčin. Diagnostika se opírá o stanovení koncentrace HbA1c, glykémie hodnocené na lačno nebo v náhodném okamžiku, případně o orální glukózový toleranční test.

Jednotlivé směrnice se sice neshodují, nicméně podle většiny z nich by screening na diabetes měl být prováděn u pacientů trpících hypertenzí a hyper lipidémií. Kalkulátory rizika diabetu mají vysokou negativní prediktivní hodnotu a usnadňují rozpoznání nemocných, u nichž je přítomnost diabetu nepravděpodobná.

Mezi vyšetření, která mohou přispět k rozpoznání typu diabetu nebo setrvalé potřeby inzulinu, patří testy odrážející funkci ß-buněk, jako jsou stanovení koncentrací C-peptidu a markerů imunologicky zprostředkované destrukce ß-buněk (např. autoprotilátek proti buňkám Langerhansových ostrůvků, proti inzulinu, dekarboxyláze kyseliny glutamové a tyrosinfosfatáze [IA-2? a IA-2ß]). Vyšetřování autoprotilátek je omezeno dostupností příslušných testů, náklady na jejich provádění a jejich prediktivní hodnotou.

Summary

Based on etiology, diabetes is classified as type 1 diabetes mellitus, type 2 diabetes mellitus, latent autoimmune diabetes, maturity-onset diabetes of youth, and miscellaneous causes. The diagnosis is based on measurement of A1C level, fasting or random blood glucose level, or oral glucose tolerance testing. Although there are confl icting guidelines, most agree that patients with hypertension or hyperlipidemia should be screened for diabetes. Diabetes risk calculators have a high negative predictive value and help defi ne patients who are unlikely to have diabetes. Tests that may help establish the type of diabetes or the continued need for insulin include those refl ective of beta cell function, such as C peptide levels, and markers of immune-mediated beta cell destruction (e.g., autoantibodies to islet cells, insulin, glutamic acid decarboxylase, tyrosine phosphatase [IA-2? and IA-2ß]). Antibody testing is limited by availability, cost, and predictive value.

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 Plnou verzi článku najdete v časopisu Medicína po promoci číslo 4/2010

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