Abstract
Objetivos
Estimar cómo se modifica el número de diabéticos conocidos tipo 2 aplicando los nuevos criterios de la Asociación Americana de Diabetes (ADA). Calcular la sensibilidad, especificidad y valores predictivos de los criterios diagnósticos ADA.
Diseño
Estudio descriptivo, transversal.
Ámbito de estudio
Un total de 15.451 personas pertenecientes a 2 centros de salud urbanos. Se estudiaron 1.292 individuos mediante muestreo aleatorio sistemático.
Sujetos de estudio
Población general de 40-75 años.
Intervenciones
Revisión de historias clínicas, seleccionando las glucemias basales realizadas en los últimos 3 años, considerando la última en caso de existir varias y realizando analítica en caso de no haber datos. En el rango ≥ 110-139 se realizó una nueva glucemia y sobrecarga oral de glucosa (SOG). Se registró también edad, sexo y diagnóstico previo de diabetes.
Mediciones y resultados
La edad media fue 56 años, con un 56,1% de mujeres. Glucemias normales (< 110), 830 individuos (86,2%). La prevalencia de diabetes fue del 10,5% aplicando criterios OMS y del 8,7% utilizando los de ADA. La sensibilidad fue del 39,29%, la especificidad del 100%, el valor predictivo positivo del 100% y el negativo de un 98,5%. Presentaban glucemia basal alterada 49 individuos (5,5%), de los cuales 17 (34,7%) fueron diabéticos según criterios OMS.
Conclusiones
La prevalencia de diabetes aplicando criterios OMS es significativamente superior que si se aplican criterios ADA (p = 0,000). La glucemia basal ≥ 126 es menos sensible que la SOG. Ningún paciente normoglucémico por criterios ADA sería diabético por criterios OMS; sin embargo, ADA y OMS clasifican a los no normoglucémicos en grupos diferentes. En principio los criterios OMS (rigurosamente empleados) suponen el mejor método diagnóstico de diabetes y la SOG es una prueba de la que no deberíamos prescindir.
Palabras clave: Diabetes mellitus, Diagnóstico, ADA
Abstract
Objectives
To estimate how the number of diabetics known as type 2 is modified by applying the American Diabetes Association (ADA) new diagnostic criteria. To calculate the sensitivity, specificity and predictive values of the ADA diagnostic criteria.
Design
Transversal descriptive study.
Scope of the study
15451 people belonging to two urban health care centers. 1292 individuals were studied by routine random sampling.
Subjects of the study
General population between 40 and 75 years of age. Method. Review of clinical histories, selecting the basal glycemias performed over the last three years, considering the last one in the event that more than one existed, and performing the necessary analysis if no data existed. A new glycemia measurement was carried out as well as a glucose tolerance test for those values ≥ 110-139. Age, sex, and prior diagnosis of diabetes were also recorded.
Measurements and results
The mean age was 56 years, 56.1% were females. Normal glycemias (< 110) – 830 individuals (86.2%). The prevalence of diabetes was 10.5% when the WHO criteria were applied and 8.7% when ADA criteria were applied. Sensitivity was 39.29%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 98.5%. 49 individuals presented an altered basal glycemia (5.5%), 17 of whom (34.7%) were diabetic according to the WHO.
Conclusions
The prevalence of diabetes when the WHO criteria are applied is significantly higher than when ADA criteria are applied (p = 0.000). The basal glycemia value of ≥ 126 is less sensitive than the glucose tolerance test. No normoglycemic patient according to the ADA would be diabetic according to the WHO; however the ADA and the WHO classify the non-normoglycemics in different groups. The WHO criteria (scrupulously applied) are the better diagnostic method for diabetes in principle and the glucose tolerance test is a test not to be done away with.
Key words: Diabetes mellitus, Diagnosis, ADA
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