Información del artículo
Actualmente existen numerosas pruebas de laboratorio para el diagnóstico y el seguimiento de los pacientes con diabetes mellitus:determinación de glucemia en ayunas y posprandial, autoanálisis de glucemia capilar, presencia de cuerpos cetónicos, hemoglobina glucosilada y fructosamina, microalbuminuria y determinación de marcadores genéticos y de autoinmunidad. La evidencia científica que respalda cada una de ellas varía sustancialmente y las guías de práctica clínica proporcionan las recomendaciones con mayor soporte científico junto con otras basadas tan sólo en consensos de expertos. En este trabajo se revisan las determinaciones de laboratorio más importantes en diabetes mellitus y se evalúa su grado de evidencia científica.
Palabras clave:
Diabetes mellitus
Análisis de laboratorio
Glucemia
Hemoglobina glucosilada
Numerous laboratory tests for the diagnosis and follow-up of patients with diabetes mellitus are currently available: fasting and postprandial glycemia, self monitoring blood glucose, ketone bodies, glycosylated hemoglobin, fructosamine, microalbuminuria and genetic and autoimmune markers. The scientific evidence supporting these tests varies substantially and the recommendations with the greatest scientific support are provided by clinical practice guidelines together with others based only on expert consensus. In this article, the most important laboratory analyses in diabetes are reviewed and their degree of scientific evidence is evaluated.
Key words:
Diabetes mellitus
Laboratory analyses
Glucemia
Glycosylated hemoglobin
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Bibliografía
[1.]
American Diabetes Association. Report of the Expert Commitee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-97.
[2.]
Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis of Diagnostic criteria in Europe. Lancet. 1999;354:617-21.
[3.]
American Diabetes Association. Screening for type 2 diabetes.Diabetes Care. 2004;27 Suppl 1:S11-4.
[4.]
A.Y.W. Chan, R. Swaminathan, C.S. Cockram.
Effectiveness of sodium fluoride as a preservative of glucose in blood.
Clin Chem, 35 (1989), pp. 315-317
[5.]
C. Ricos, V. Alvarez, F. Cava, J.V. Garcia-Lario, A. Hernandez, C.V. Jimenez, et al.
Current databases on biological variation: pros, cons and progress.
Scand J Clin Lab Invest, 59 (1999), pp. 491-500
[6.]
American Diabetes Association. Selfmonitoring of blood glucose.Diabetes Care. 1987;10:95-9.
[7.]
DCCT Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86.
[8.]
UK Prospective Diabetes Study (UKPDS) Group.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet, 352 (1998), pp. 837-853
[9.]
American Diabetes Association. Self-monitoring of blood glucose Diabetes Care. 1996;19 Suppl 1:S62-6.
[10.]
U.M. Kabadi, K.M. O’Connell, J. Johnson, M. Kabadi.
The effect of recurrent practice at home on the acceptability of capillary blood glucose readings. Accuracy of self blood glucose testing.
Diabetes Care, 10 (1994), pp. 1110-1123
[11.]
J.H. Fuller, M.J. Shipley, G. Rose, R.J. Jarrett, H. Keen.
Coronaryheart disease risk and impaired glucose tolerance: the Whitehall Study.
Lancet, 1 (1980), pp. 1373-1376
[12.]
P. McCartney, H. Keen, R.J. Jarrett.
The Bedford Survey: observations on retina and lens of subjects with impaired glucose tolerance and in controls with normal glucose tolerance.
Diab Metab, 9 (1983), pp. 303-305
[13.]
G.M. Reaven.
Role of insulin resistance in human disease.
Diabetes, 37 (1988), pp. 1595-1607
[14.]
T.P. Monsod, D.E. Flanagan, F. Rife, R. Saenz, S. Caprio, R.S. Sherwin.
Do sensor glucose levels accurately predict plasma glucose concentrations during hypoglycemia and hyperinsulinemia?.
Diabetes Care, 25 (2002), pp. 889-893
[15.]
American Diabetes Association. Urine glucose and ketone determinations (Position Statement). Diabetes Care. 1992;15 Suppl 2:S38.
[16.]
American Diabetes Association.
Standards of medical care for patients with diabetes mellitus.
Diabetes Care, 23 (2000), pp. S32-42
[17.]
D.B. Sacks.
Carbohydrates.
Tietz textbook of clinical chemistry, pp. 750-808
[18.]
American Diabetes Association.
Tests of glycemia (Position Statement), 23 (2000), pp. S80-S82
[19.]
American Diabetes Association.
Implications of the Diabetes Control and Complications Trial (Position Statement), 23 (2000), pp. S24-S26
[20.]
R.J. Benjamin, D.B. Sacks.
Glycated protein update: implications of recent studies including the Diabetes Control and Complications Trial.
Clin Chem, 40 (1994), pp. 683-687
[21.]
D.E. Goldstein, R.R. Little.
Bringing order to chaos: the National Glycohemoglobin Standardization Program.
Contemp Int Med, 9 (1997), pp. 27-32
[22.]
NGSP Steering Committee. Implementation of the national glycohemoglobin standardization program (NGSP). Diabetes.1997;46:151A.
[23.]
D.E. Goldstein, R.R. Little, J.D. England, H.M. Wiedemeyer, E. Mc-Kenzie.
Methods of glycosylated hemoglobins: high performance liquid chromatography and thiobarbituric acid colorimetric methods.
Methods in diabetes research, pp. 475-504
[24.]
DCCT Research Group.
Feasibility of centralized measurements of glycated hemoglobin in the diabetes control and complications trial: a multicenter study, 33 (1987), pp. 2267-2271
[25.]
W.J. Schnedl, R. Krause, G. Halwachs-Baumann, M. Trinker, R.W. Lipp, G.J. Krejs.
Evaluation of HbA1c determination methods in patients with hemoglobinopathies.
Diabetes Care, 23 (2000), pp. 339-344
[26.]
L. Bry, P.C. Chen, D.B. Sacks.
Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin.
Clin Chem, 47 (2001), pp. 153-163
[27.]
American Diabetes Association.
Tests of glycemia in diabetes.
Diabetes Care, 24 (2001), pp. S80-S82
[28.]
American Diabetes Association.
Type 2 diabetes in children and adolescents.
Diabetes Care, 23 (2000), pp. 381-389
[29.]
DCCT Research Group.
The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial.
Diabetes, 44 (1995), pp. 968-983
[30.]
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.
Report of the Expert Committee on the diagnosis and classification of diabetes mellitus.
Diabetes Care, 23 (2000), pp. S4-18
[31.]
J.R. Baker, P.A. Metcalf, I.M. Holdaway, R.N. Johnson.
Serum fructosamine concentration as a measure of blood glucose control in type 1 (insulin dependent) diabetes mellitus.
Br Med J, 290 (1985), pp. 352-355
[32.]
R.N. Johnson, P.A. Metcalf, J.R. Baker.
Fructosamine: a new approach to the estimation of serum glycosylprotein. An index of diabetic control.
Clin Chim Acta, 127 (1983), pp. 87-95
[33.]
W.T. Celalu, T.B. Parker, C.R. Johnson.
Validity of serum fructosamine as index of short-term glycemic control in diabetic outpatients.
Diabetes Care, 11 (1988), pp. 662-664
[34.]
L. Castano, G.S. Eisenberth.
Type I diabetes: a chronic autoimmune disease of human, mose and rat.
Annu Rev Immunol, 8 (1990), pp. 647-680
[35.]
American Diabetes Association.
Diabetes nephropathy.
Diabetes Care, 22 (1999), pp. S66-S69
[36.]
R.W. Holl, M. Grabert, A. Thon, E. Heinze.
Urinary excretion of albumin in adolescents with type 1 diabetes: persistent versus intermittent microalbuminuria and relationship to duration of diabetes, sex, and metabolic control.
Diabetes Care, 22 (1999), pp. 1555-1560
[37.]
M. Christie, U. Roll, M.A. Payton, E.CI. Hatfield, A.G. Ziegler.
Validity of screening for individuals at risk for type I diabetes by combined analysis of antibodies to recombinant proteins.
Diabetes Care, 20 (1997), pp. 965-970
[38.]
W.J. Riley, N.K. Maclaren, J. Krischer, R.P. Spillar, J.H. Silverstein, D.A. Schatz, et al.
A prospective study of the development of diabetes in relatives of patients with insulin-dependent diabetes.
New Engl J Med, 323 (1990), pp. 1167-1172
[39.]
F.J. Bruining, J.L. Molenaar, D.E. Grobbee, A. Hofman, G.J. Scheffer, H.A. Bruining, et al.
Ten-year follow-up study of islet cell antibodies and childhood diabetes mellitus.
Lancet, 1 (1989), pp. 1100-1103
[40.]
F.K. Gorus, P. Goubert, C. Semakula, C.L. Vandewalle, J. De Schepper, A. Scheen, et al.
IA-2-autoantibodies complement GAD65-autoantibodies in new-onset IDDM patientes and help predict impending diabetes in their siblings. The Belgian Diabetes Registry.
Diabetologia, 40 (1997), pp. 95-99
[41.]
C.F. Verge, R. Gianani, E. Kawasaki, L. Yu, M. Pietropaolo, R.A. Jackson, et al.
Prediction of type I diabetes in first-degree relatives using a combination of insulin, GAD and ICA 512bdc/IA-2 autoantibodies.
Diabetes, 45 (1996), pp. 926-933
[42.]
P.J. Bingley, E. Bonifacio, A.J.K. Williams, S. Genovese, G.F. Bottazzo, E.A.M. Gale.
Prediction of IDDM in the general population.Strategies based on combinations of autoantibody markers.
Diabetes, 46 (1997), pp. 1701-1710
[43.]
D.B. Sacks, D.E. Bruns, D.E. Goldstein, N.K. Maclaren, J.M. McDonald, M. Parrott.
Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus.Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus.
Clin Chem, 48 (2002), pp. 436-472
Este trabajo ha sido posible gracias a las ayudas del FIS (Instituto Carlos III, Ministerio de Sanidad) a través de la Red de Grupo de Diabetes (GO3/212) y al Plan Andaluz de Investigación (PAI-368).
Copyright © 2006. Sociedad Española de Endocrinología y Nutrición