Diabezes Research and Clinical Practice, 18 (1992) 13 l- 136 0
1992 Elsevier Science Publishers
131
B.V. All rights reserved 0168-8227/92/$05.00
DIABET 00687
Brief Report Is A. Akinmokun,
diabetes always diabetes? P. Harris, P.D. Home and K.G.M.M.
Alberti
Department of Medicine, Univer.sitv of Newcastle upon Tyne, The Medical School, Frandington Place, Newcastle upon Qne. NE2 4HH,
UK
(Received 3 March 1992) (Accepted 2 July 1992)
Summary Diabetes is always taken to be a life-long diagnosis. In order to re-examine this question, 75 g glucose tolerance tests (OGTT) were performed twice on 37 previously confirmed diabetic patients (mean duration of diabetes of 4.6 years; range 1-15 years) with normal glycosylated haemoglobin levels on regular review. Weight loss since institution of a healthy diet was 7.6 f 4.8 kg ( f SE). Normal glucose tolerance was found in 27 y0 of patients and impaired glucose tolerance in 2 1 y0 with no significant change on rechallenge. HbA, was 6.3 + 1.5% (k SD) (normal ~7.5%) in patients with normal glucose tolerance compared to 7.0 k 0.9% (& SD) in those with impaired glucose tolerance, P-cO.05. The response of the OGTT in these patients varied with dietary intake and weight. Such individuals could be regarded as having perfectly controlled diabetes or alternatively to have been cured. The definition of diabetes should be reviewed to allow people to escape the diagnosis where permanent change in dietary habits is established. Key words: Non-insulin-dependent criteria
diabetes
mellitus;
Introduction The diagnosis of diabetes is assumed to long in the absence of any precipitating such as stress or drug therapy [l-3], as sized in the 1985 WHO technical report The oral glucose tolerance test (OGTT)
be lifecause empha[4]. is rec-
Correspondence to: K.G.M.M. Alberti, Department of Medicine, University of Newcastle upon Tyne. The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
Glucose
tolerance;
Obesity;
Diet; Diagnostic
ommended for the diagnosis of diabetes where random blood glucose concentration with or without symptoms is not thought to be diagnostic [5,6]. Clinically the basis of management is that blood glucose levels can be controlled in many patients by restriction of rapidly absorbed carbohydrate [ 71. Current criteria for diabetes allow individuals to be diagnosed according to the level of blood glucose at the time of diagnosis without cognizance of the dietary background and the degree of adiposity of the individual con-
132 cerned [ 891. Patients with blood glucose levels in the diagnostic range are thus labelled diabetic, a label which often affects the individual’s employment [lo], insurance status and/or their social standing in society as well as the psychological state of the patient. With increasing awareness of the condition and more widespread screening, people with lesser degrees of metabolic disturbance are being diagnosed. The hypothesis underlying this study is that there is now a cohort of people who fit the WHO criteria at diagnosis, but no longer do so when following a diet no different from that recommended for the general population. If this is so, it has important consequences not only for the individual, but also for clinical management and resource allocation. Indeed, do they still have diabetes mellitus?
Materials and Methods Subjects Thirty-seven diet-controlled patients previously diagnosed as having diabetes mellitus were studied. All patients were being followed on a regular basis in the outpatient clinic of the Freeman Hospital, Newcastle upon Tyne, UK. The following information was obtained: age, sex, weight at diagnosis, weight at time of test, duration of diabetes, and family history of diabetes. Patients were included in the study if they had documentary evidence of diabetes (WHO criteria: whole blood venous glucose fasting > 6.7 mmol/l, random or 2 h post prandial > 10.0 mmol/l on more than one occasion) in the absence of acute illness, with at least two consecutive estimations of HbA, level >7.5% (reference range 5.0-7.5?/,). Patients were excluded from the study if they had received insulin or oral hypoglycaemic agents at any time since diagnosis. Clinical characteristics of subjects are shown in Table 1. Methods Standard oral glucose tolerance tests were performed on two consecutive days in each patient
1
TABLE Clinical
characteristics
of subjects Mean
Range
(+_ SEM) 62 + 2
Age (years)
sex Duration
of diabetes
BMI at diagnosis BMI
(years)
(kg/m’)
at diagnosis
Weight
(kg)
at test (kg)
HbA,
at diagnosis
HbA,
at test (“,)
Fasting
4&3 30 + 5
at test (kg/m’)
Weight
40-79
27M/ IOF
28+4*
23-41
83.5 + 2.5
60-123
17.6 + 1.5*** 9.2 + 0.5
(“,)
blood
glucose
(mmol/l)
serum
insulin
(mu/l)
1-5 24-45
56-99 7.5-16.0
6.5+0.1**
5.4-7.5
6.1 +0.9
4.0-7.6
10.3 & 1.3
2.0-33.6
at test Fasting
* P
1992 Elsevier Science Publishers
131
B.V. All rights reserved 0168-8227/92/$05.00
DIABET 00687
Brief Report Is A. Akinmokun,
diabetes always diabetes? P. Harris, P.D. Home and K.G.M.M.
Alberti
Department of Medicine, Univer.sitv of Newcastle upon Tyne, The Medical School, Frandington Place, Newcastle upon Qne. NE2 4HH,
UK
(Received 3 March 1992) (Accepted 2 July 1992)
Summary Diabetes is always taken to be a life-long diagnosis. In order to re-examine this question, 75 g glucose tolerance tests (OGTT) were performed twice on 37 previously confirmed diabetic patients (mean duration of diabetes of 4.6 years; range 1-15 years) with normal glycosylated haemoglobin levels on regular review. Weight loss since institution of a healthy diet was 7.6 f 4.8 kg ( f SE). Normal glucose tolerance was found in 27 y0 of patients and impaired glucose tolerance in 2 1 y0 with no significant change on rechallenge. HbA, was 6.3 + 1.5% (k SD) (normal ~7.5%) in patients with normal glucose tolerance compared to 7.0 k 0.9% (& SD) in those with impaired glucose tolerance, P-cO.05. The response of the OGTT in these patients varied with dietary intake and weight. Such individuals could be regarded as having perfectly controlled diabetes or alternatively to have been cured. The definition of diabetes should be reviewed to allow people to escape the diagnosis where permanent change in dietary habits is established. Key words: Non-insulin-dependent criteria
diabetes
mellitus;
Introduction The diagnosis of diabetes is assumed to long in the absence of any precipitating such as stress or drug therapy [l-3], as sized in the 1985 WHO technical report The oral glucose tolerance test (OGTT)
be lifecause empha[4]. is rec-
Correspondence to: K.G.M.M. Alberti, Department of Medicine, University of Newcastle upon Tyne. The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
Glucose
tolerance;
Obesity;
Diet; Diagnostic
ommended for the diagnosis of diabetes where random blood glucose concentration with or without symptoms is not thought to be diagnostic [5,6]. Clinically the basis of management is that blood glucose levels can be controlled in many patients by restriction of rapidly absorbed carbohydrate [ 71. Current criteria for diabetes allow individuals to be diagnosed according to the level of blood glucose at the time of diagnosis without cognizance of the dietary background and the degree of adiposity of the individual con-
132 cerned [ 891. Patients with blood glucose levels in the diagnostic range are thus labelled diabetic, a label which often affects the individual’s employment [lo], insurance status and/or their social standing in society as well as the psychological state of the patient. With increasing awareness of the condition and more widespread screening, people with lesser degrees of metabolic disturbance are being diagnosed. The hypothesis underlying this study is that there is now a cohort of people who fit the WHO criteria at diagnosis, but no longer do so when following a diet no different from that recommended for the general population. If this is so, it has important consequences not only for the individual, but also for clinical management and resource allocation. Indeed, do they still have diabetes mellitus?
Materials and Methods Subjects Thirty-seven diet-controlled patients previously diagnosed as having diabetes mellitus were studied. All patients were being followed on a regular basis in the outpatient clinic of the Freeman Hospital, Newcastle upon Tyne, UK. The following information was obtained: age, sex, weight at diagnosis, weight at time of test, duration of diabetes, and family history of diabetes. Patients were included in the study if they had documentary evidence of diabetes (WHO criteria: whole blood venous glucose fasting > 6.7 mmol/l, random or 2 h post prandial > 10.0 mmol/l on more than one occasion) in the absence of acute illness, with at least two consecutive estimations of HbA, level >7.5% (reference range 5.0-7.5?/,). Patients were excluded from the study if they had received insulin or oral hypoglycaemic agents at any time since diagnosis. Clinical characteristics of subjects are shown in Table 1. Methods Standard oral glucose tolerance tests were performed on two consecutive days in each patient
1
TABLE Clinical
characteristics
of subjects Mean
Range
(+_ SEM) 62 + 2
Age (years)
sex Duration
of diabetes
BMI at diagnosis BMI
(years)
(kg/m’)
at diagnosis
Weight
(kg)
at test (kg)
HbA,
at diagnosis
HbA,
at test (“,)
Fasting
4&3 30 + 5
at test (kg/m’)
Weight
40-79
27M/ IOF
28+4*
23-41
83.5 + 2.5
60-123
17.6 + 1.5*** 9.2 + 0.5
(“,)
blood
glucose
(mmol/l)
serum
insulin
(mu/l)
1-5 24-45
56-99 7.5-16.0
6.5+0.1**
5.4-7.5
6.1 +0.9
4.0-7.6
10.3 & 1.3
2.0-33.6
at test Fasting
* P
