NEW CLASSIFICATION AND DIAGNOSTIC-CRITERIA FOR DIABETES-MELLITUS

The new Classification and Diagnostic Criteria for Diabetes Mellitus ( DM), prepared by a group of experts from the American Diabetes Associa tion is presented and analyzed. On an etiopathogenic basis, it designa tes Insulin Dependent and Non Insulin Dependent as Type 1 and Type 2 r espectively. It specifies DM having specific known causes. It maintain s Gestational Diabetes and Glucose Intolerance and adds the Impaired F asting Glucose Condition. It recommends fasting plasma glucose for sea rch and diagnosis, and lowers the level to greater than or equal to 12 6 mg/dl instead of greater than or equal to 140 mg/dl, due to its asso ciation with chronical complications of DM. If mantains the diagnostic criteria of random and post charge glycemia greater than or equal to 200 mg/dl. It does not alter the glucose intolerance figure (140-200 m g/dl in OGTT) and introduces fasting abnormality greater than or equal to 110 and <126 mg/dl. It encourages the search with fasting glucose every 3 years in individuals aged over 45, and at more frequent interv als in younger individuals with high risk factors. Analysis of the rep ort allows to conclude that, although the classification does not intr oduce any significant change in daily clinical use, its pathogenic ori entation makes future innovations possible. The preferential use of fa sting glucose greater than or equal to 126 mg/dl for diagnosis of DM h as theoretical basis and practical advantages. Identification of indiv iduals with impaired fasting glucose allows to detect, in a simple man ner, a high risk group in which to start preventive measures. However there is a percentage of cases cases which are not diagnosed by fastin g glycemia, but are diagnosed by OGTT; therefore the latter should not be discarded.