Brauchen wir den Oralen Glukose-Toleranz-Test?

Zusammenfassung

Hintergrund: Viele nationale und internationale Leitlinien empfehlen die regelmäßige Durchführung des oralen Glukose-Toleranz-Testes (OGT) bei allen Personen mit einem Risiko für Diabetes mellitus. Methoden: Der vorliegende Artikel untersucht die Brauchbarkeit des OGT für die hausärztliche Praxis auf Grundlage der vorhandenen Literatur. Ergebnis: Der OGT ist sensitiver als die Bestimmung der Nüchtern-Glukose bezüglich des kadiovaskulären Risikos. Der Test ist aber zu aufwändig für die hausärztliche Routine, nur mäßig reliabel, und es fehlen spezifische therapeutische Konsequenzen im Fall eines positiven Testergebnisses. Schlussfolgerung: Der OGT ist für den regelmäßigen Einsatz nicht geeignet. Im Rahmen der Beratung zum kardiovaskulären Risiko (ARRIBA-Konzept) kann er im Einzelfall bei unklaren Situationen zur Entscheidungsfindung mit herangezogen werden.

Abstract

Background: Many German and international guidelines recommend to carry out the oral glucose tolerance test (OGT) in all patients at risk for diabetes mellitus. Methods: The present article examines the practicability of the OGT for daily general practice using the existing literature. Result: The sensitivity of OGT is higher than fasting blood glucose regarding the cardiovascular risk. But the test is too largescale for general practitioners daily routine. It owns only poor reliability, and there are no specific therapeutic consequences in case of positive testing. Conclusion: The OGT is not suitable for regular practice. In isolated cases realizing an evidence based consultation with principles of shared decision making (ARRIBA) it may be used to give more clarity about the patients risk.

Schlüsselwörter

oraler Glukosetoleranztest - Prädiabetes - kardiovaskuläres Risiko - Praktikabilität - geteilte Entscheidungsfindung

Key words

oral glucose tolerance test - prediabetes - cardiovascular risk - practicability - shared decision making

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1 Reliabilität: die Untersuchung kommt auch wiederholt angewendet zum selben Ergebnis.

2 Als Hazard Ratio (HR) bezeichnet man in Interventionsstudien den Quotienten aus der Ereignisrate in einer Interventionsgruppe geteilt durch die einer Kontrollgruppe. In epidemiologischen Zusammenhängen dividiert man die Ereignisrate in einer beobachteten definierten Gruppe durch die der anderen - hier jeweils bezogen auf die Normal-Wert-Gruppe der mit Nüchtern-BZ und OGT Diagnostizierten.