Advanced

Classifying diabetes according to the new WHO clinical stages.

Lindholm, Eero LU ; Agardh, Elisabet LU ; Tuomi, Tiinamaija LU and Agardh, Carl-David LU (2001) In European Journal of Epidemiology 17(11). p.983-989
Abstract
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 ± 12 years; mean ± SD), BMI (29.3 ± 5.2 kg/m2) and C-peptide concentrations (median 0.98 nmol/l;... (More)
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 ± 12 years; mean ± SD), BMI (29.3 ± 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 (5.5%) compared to the IRC and IRS groups. The IRC group had a high age at onset (49 ± 13 years), BMI (28.0 ± 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 ± 15 years), BMI (24.2 ± 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. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clinical stages, C-peptide concentrations, Diabetic complications, Diabetes criteria, Etiological classification, GAD antibodies, HbA1c, Insulin treatment
in
European Journal of Epidemiology
volume
17
issue
11
pages
983 - 989
publisher
Springer
external identifiers
  • scopus:0035758580
ISSN
1573-7284
DOI
10.1023/A:1020036805655
language
English
LU publication?
yes
id
14e440ba-32f8-48e7-aa0c-b5fe528f0405 (old id 632892)
date added to LUP
2008-07-03 13:20:50
date last changed
2018-08-19 03:23:56
@article{14e440ba-32f8-48e7-aa0c-b5fe528f0405,
  abstract     = {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 ± 12 years; mean ± SD), BMI (29.3 ± 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 (5.5%) compared to the IRC and IRS groups. The IRC group had a high age at onset (49 ± 13 years), BMI (28.0 ± 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 ± 15 years), BMI (24.2 ± 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 &lt; 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.},
  author       = {Lindholm, Eero and Agardh, Elisabet and Tuomi, Tiinamaija and Agardh, Carl-David},
  issn         = {1573-7284},
  keyword      = {Clinical stages,C-peptide concentrations,Diabetic complications,Diabetes criteria,Etiological classification,GAD antibodies,HbA1c,Insulin treatment},
  language     = {eng},
  number       = {11},
  pages        = {983--989},
  publisher    = {Springer},
  series       = {European Journal of Epidemiology},
  title        = {Classifying diabetes according to the new WHO clinical stages.},
  url          = {http://dx.doi.org/10.1023/A:1020036805655},
  volume       = {17},
  year         = {2001},
}