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Gepubliceerd in: Tijdschrift voor Kindergeneeskunde 1/2015

01-03-2015

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

Auteurs: Mw. M.A.J. Elst, mw. M.P. van der Aa, E.G.A.H. van Mil, dr. M.M.J. van der Vorst

Gepubliceerd in: Tijdschrift voor Kindergeneeskunde | Uitgave 1/2015

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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.
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Metagegevens
Titel
Screening op type 2-diabetes mellitus: de heilige graal?
Auteurs
Mw. M.A.J. Elst
mw. M.P. van der Aa
E.G.A.H. van Mil
dr. M.M.J. van der Vorst
Publicatiedatum
01-03-2015
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Tijdschrift voor Kindergeneeskunde / Uitgave 1/2015
Print ISSN: 0376-7442
Elektronisch ISSN: 1875-6840
DOI
https://doi.org/10.1007/s12456-015-0006-4

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