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Screening op type 2-diabetes mellitus: de heilige graal?

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Tijdschrift voor Kindergeneeskunde

Samenvatting

Obesitas is een groeiend probleem in de westerse wereld. Ook bij kinderen wordt een sterke toename van het percentage overgewicht en obesitas gezien. Hiermee neemt het risico toe op comorbiditeit en complicaties, zoals type 2-diabetes mellitus en het metabool syndroom, met als gevolg micro- en macrovasculaire afwijkingen. Met de stijging van de incidentie en prevalentie van type 2-diabetes mellitus is de vraag ontstaan naar betrouwbare screening op de ziekte en haar voorlopers. Tot op heden wordt, op advies van de American Diabetes Association, gescreend door bepaling van nuchtere plasmaglucose. De vraag is echter of deze screeningsmethode afdoende is om alle patiënten met een verstoord glucosemetabolisme op te sporen.

In dit artikel hebben we verschillende onderzoeken vergeleken om de waarde van screening door bepaling van nuchtere plasmaglucose vast te stellen.We kunnen op basis van de literatuur concluderen dat deze screeningsmethode niet afdoende is, de maximale sensitiviteit die bereikt wordt is slechts 50%.We evalueerden daarom ook andere screeningsmarkers, waaronder HbA1c, nuchtere triglyceriden en het Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), een surrogaatmarker voor insulinegevoeligheid. Van deze markers is HOMA-IR de meest veelbelovende, aangezien hiermee een sensitiviteit van 72,2% gehaald wordt. Daarnaast identificeer je door middel van HOMA-IR ook patiënten met verminderde insulinegevoeligheid, een onderdeel van het metabool syndroom en een voorstadium van type 2-diabetes mellitus, dat vroegtijdige interventie rechtvaardigt.

Hoewel het toevoegen van HOMA-IR aan de screening naar type 2 diabetes mellitus en zijn voorlopers een grote verbetering van de screeningsresultaten geeft, is de heilige graal nog niet gevonden. Toekomstig onderzoek zal moeten uitwijzen wat de ideale screeningsmethode is voor het identificeren van risicopatiënten.

Summary

Obesity poses a major health problem in the western world. The alarming increase in obesity is not only seen in adults, but also in children and adolescents. Paralleled with this increasing incidence, the risk of obesity related complications and comorbidities increases, such as type 2 diabetes mellitus (T2DM) and the metabolic syndrome and, consequently, micro- and macrovascular disease. With the rise in incidence and prevalence of type 2 diabetes mellitus a need has emerged for adequate screening for the disease and its precursors. Up till now screening is performed by measurement of fasting plasma glucose, according to the guidelines of the American Diabetes Association. It is however questionable whether this screening is sufficient to detect all patients with altered glucose metabolism.

In this article we have compared several studies to establish the value of screening with fasting plasma glucose.We can conclude, based on the literature, that this screening is not sufficient as the maximal sensitivity acquired is only 50%. Therefore, we evaluated other possible markers for screening, namely HbA1c, fasting triglycerides and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), a surrogate marker for insulin sensitivity. Of these markers, HOMA-IR is the most promising one, as a sensitivity of 72.2% is achieved with this method. Furthermore, screening with HOMA-IR identifies patients with lowered insulin sensitivity, which is a part of the metabolic syndrome and a precursor of T2DM that justifies early intervention.

Although adding HOMA-IR to the screening for T2DM and its precursors greatly improves screening results, the holy grail has yet to be found. Future research is needed to find the ideal screening method to identify patients at risk.

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Authors and Affiliations

  1. afdeling Kindergeneeskunde, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands

    M.A.J. Elst,  M.P. van der Aa &  M.M.J. van der Vorst

  2. afdeling Kindergeneeskunde, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch, The Netherlands

    E.G.A.H. van Mil

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  1. M.A.J. Elst
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  2. M.P. van der Aa
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  3. E.G.A.H. van Mil
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  4. M.M.J. van der Vorst
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Correspondence to M.A.J. Elst.

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Auteurs

Mw. M.A.J. Elst MD, mw. M.P. van der Aa MD en mw. dr. M.M.J. van der Vorst, afdeling Kindergeneeskunde, St. Antonius Ziekenhuis, Nieuwegein. Dhr. dr. E.G.A.H. van Mil, afdeling Kindergeneeskunde, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch. Correspondentieadres: Dr. M.M.J. van der Vorst, afdeling Kindergeneeskunde, St. Antonius Ziekenhuis, Koekoekslaan 1, 3435 CM Nieuwegein, m.van.der.vorst@antoniusziekenhuis.nl.

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Elst, M., van der Aa, M., van Mil, E. et al. Screening op type 2-diabetes mellitus: de heilige graal?. Tijdschr Kindergeneeskd 83, 27–35 (2015). https://doi.org/10.1007/s12456-015-0006-4

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