Fallstricke bei der Diabetesdiagnostik: Wird zu lax mit Laborwerten umgegangen?

Zusammenfassung

Die Diabetesdiagnose zeigt viele präanalytische und analytische Probleme. Nüchtern-Glukose (NG), orale Glukosetoleranztest (oGTT) und HbA1c haben Vor- und Nachteile und sind nicht gleichwertig in ihrer diagnostischen Aussagekraft. Der oGTT ist der empfindlichste Test, die Reproduzierbarkeit ist relativ niedrig (VK ± 15 %). Die NG entdeckt maximal 70 – 80 % der Patienten mit einem manifesten Diabetes. Die Glukose-Messung wird durch unsachgemäße Blutabnahme, intraindividuelle Glukose-Schwankungen, Fastendauer und Fehler beim oGTT verfälscht. HbA1c ist trotz IFCC-Standardisierung bei erlaubter Abweichung von ± 18 % in Ringversuchen und dem Einsatz von nicht kommutablem Ringversuchsmaterial schlecht überprüfbar. HbA1c-Analyse zeigt viele Interferenzen und ist nur begrenzt zur Diabetesdiagnose geeignet. Der Schwellenwert von HbA1c von ≥ 6,5 % (≥ 48 mmol/mol Hb) beruht nicht auf harter Evidenz. Der Aufwand bei der Diagnose (NG und/oder oGTT+HbA1c) ist bei den sich daraus ergebenden klinischen Konsequenzen minimal invasiv, zumutbar, preiswert und verhindert eine Über- und Unterdiagnostik.

Abstract

The diagnosis of diabetes is associated with pre-analytical and analytical problems. Fasting glucose (FG), oral glucose tolerance test (oGTT) and HbA1c have advantages and shortcomings and have no equal diagnostic validity. oGTT is the most sensitive test, but its reproducibility is rather poor (CV± 15 %). FG detects only 70 – 80 % of overt diabetes. FG is falsified by inappropriate blood sampling, intra-individual fluctuations and mistakes with the oGTT. HbA1c despite IFC- standardization, but with a tolerable coefficient of variation of ± 18 % in round robin tests and use of not commutable control material is not easy to interpret. HbA1c analysis shows also interferences and is therefore of limited diagnostic value. Its threshold value of ≥ 6.5 % (≥ 48 mmol/mol Hb) is based on consensus and not on evidence. The diagnostic effort (FG and/or oGTT+HbA1c) with serious consequences is minimal invasive, reasonable and cheap. It prevents over- and underdiagnosis.

Schlüsselwörter

Diabetesdiagnose - (prä)-analytische Probleme - Plasmaglukose - HbA1c - oGTT

Key words

diabetes diagnosis - (pre)-analytic problems - plasma glucose - HbA1c - oGTT

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