El-Kebbi Imad M, Ziemer David C, Cook Curtiss B, Gallina Daniel L, Barnes Catherine S, Phillips Lawrence S
Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Diabetes Care. 2004 Feb;27(2):335-9. doi: 10.2337/diacare.27.2.335.
Because readily available glycemic indicators are needed to guide clinical decision-making for intensification of diabetes therapy, our goals were to define the relationship between casual postprandial plasma glucose (cPPG) levels and HbA(1c) in patients with type 2 diabetes and to determine the predictive characteristics of a convenient glucose cutoff.
We examined the relationship between cPPG levels (1-4 h post meal) and HbA(1c) levels in 1,827 unique patients who had both determinations during a single office visit.
The population studied was predominantly African American and middle-aged, with average cPPG of 201 mg/dl and HbA(1c) of 8.4%. The prevalence of HbA(1c) > or = 7.0% was 67% and HbA(1c) >6.5% was 77%. Overall, cPPG and HbA(1c) were linearly correlated (r = 0.63, P < 0.001). The correlation between cPPG and HbA(1c) was strongest in patients treated with diet alone (n = 348, r = 0.75, P < 0.001) and weaker but still highly significant for patients treated with oral agents (n = 610, r = 0.64, P < 0.001) or insulin (n = 869, r = 0.56, P < 0.001). A cutoff cPPG >150 mg/dl predicted an HbA(1c) level > or = 7.0% in the whole group, with a sensitivity of 78%, a specificity of 62%, and an 80% positive predictive value. The same cPPG cutoff of 150 mg/dl predicted an HbA(1c) level >6.5%, with a sensitivity of 74%, a specificity of 66%, and an 88% positive predictive value.
When rapid-turnaround HbA(1c) determinations are not available, a single cPPG level >150 mg/dl may be used during a clinic visit to identify most inadequately controlled patients and allow timely intensification of therapy.
由于需要易于获得的血糖指标来指导糖尿病强化治疗的临床决策，我们的目标是确定2型糖尿病患者餐后随机血糖（cPPG）水平与糖化血红蛋白（HbA1c）之间的关系，并确定一个便捷的血糖临界值的预测特征。
我们在1827例在单次门诊就诊时同时测定了cPPG水平（餐后1 - 4小时）和HbA1c水平的患者中，研究了二者之间的关系。
所研究人群主要为非裔美国中年患者，平均cPPG为201mg/dl，HbA1c为8.4%。HbA1c≥7.0%的患病率为67%，HbA1c>6.5%的患病率为77%。总体而言，cPPG与HbA1c呈线性相关（r = 0.63，P < 0.001）。cPPG与HbA1c之间的相关性在仅接受饮食治疗的患者中最强（n = 348，r = 0.75，P < 0.001），而在接受口服降糖药治疗的患者中（n = 610，r = 0.64，P < 0.001）或胰岛素治疗的患者中（n = 869，r = 0.56，P < 0.001）较弱但仍高度显著。cPPG>150mg/dl这一临界值在整个研究组中预测HbA1c水平≥7.0%，敏感性为78%，特异性为62%，阳性预测值为80%。相同的150mg/dl的cPPG临界值预测HbA1c水平>6.5%，敏感性为74%，特异性为66%，阳性预测值为88%。
当无法快速获得HbA1c测定结果时，在门诊就诊时单次cPPG水平>l50mg/dl可用于识别大多数血糖控制不佳的患者，并及时强化治疗。
