Simmons D, Thompson C F, Engelgau M M
Waikato Clinical School, University of Auckland, Waikato Hospital, Hamilton, New Zealand.
Diabet Med. 2005 Feb;22(2):207-12. doi: 10.1111/j.1464-5491.2004.01378.x.
To compare the detection of undiagnosed diabetes and dysglycaemia (impaired glucose tolerance, impaired fasting glucose, diabetes) using risk factors and laboratory measures of glycaemia.
Casual blood glucose samples were taken from 1899 (69.4% of 2737 invited) European, Maori and Pacific Islands subjects aged 40-79 years from randomly selected households in South Auckland, New Zealand. Of these, 534 attended for a 75-g oral glucose tolerance test (OGTT) if an elevated result was identified [327/478 (68.4%)] or if randomly selected with a 'normal' screening result [207/308 (67.2%)].
Several Europeans with undiagnosed diabetes (25.0%) and dysglycaemia (31.4%) had no diabetes risk factors. Most Maori and Pacific Islanders had at least one risk factor. The area under the receiver operating curve (ROC) for the detection of undiagnosed diabetes was 0.92 (0.89-0.95) using fasting glucose, 0.86 (0.82-0.90) using HbA1c, 0.75 (0.69-0.80) using random glucose, but 0.60 (0.55-0.66) using risk factor screening. The ROC for detecting any dysglycaemia was 0.88 (0.85-0.90), 0.68 (0.64-0.71), 0.72 (0.69-0.75), 0.61 (0.58-0.65), respectively. Screening using fasting glucose (the best test) detected 90.4% of new diabetes and 78.4% of dysglycaemia; risk factor screening followed by fasting glucose detected significantly less cases [88 (82-93)% and 86 (82-89)%, respectively] with 9.2% less OGTTs.
Using risk factors for the identification of who should receive a blood test for dysglycaemia adds little to direct screening with the risk of missing some with significant hyperglycaemia. Screening for dysglycaemia may best be undertaken using blood tests without initial risk factor symptom screening.
比较使用危险因素和血糖实验室检测指标来检测未诊断的糖尿病和血糖异常（糖耐量受损、空腹血糖受损、糖尿病）的情况。
从新西兰南奥克兰随机选取的家庭中，采集了1899名年龄在40 - 79岁的欧洲、毛利和太平洋岛屿受试者（占受邀的2737人的69.4%）的随机血糖样本。其中，如果筛查结果升高[327/478（68.4%）]或随机选取且筛查结果“正常”[207/308（67.2%）]，则534人接受了75克口服葡萄糖耐量试验（OGTT）。
一些未诊断出糖尿病（25.0%）和血糖异常（31.4%）的欧洲人没有糖尿病危险因素。大多数毛利人和太平洋岛屿人至少有一个危险因素。使用空腹血糖检测未诊断糖尿病的受试者工作特征曲线（ROC）下面积为0.92（0.89 - 0.95），使用糖化血红蛋白（HbA1c）为0.86（0.82 - 0.90），使用随机血糖为0.75（0.69 - 0.80），而使用危险因素筛查为0.60（0.55 - 0.66）。检测任何血糖异常的ROC分别为0.88（0.85 - 0.90）、0.68（0.64 - 0.71）、0.72（0.69 - 0.75）、0.61（0.58 - 0.65）。使用空腹血糖筛查（最佳检测方法）可检测出90.4%的新发糖尿病和78.4%的血糖异常；先进行危险因素筛查再进行空腹血糖筛查检测出的病例显著减少[分别为88（82 - 93）%和86（82 - 89）%]，口服葡萄糖耐量试验减少了9.2%。
使用危险因素来确定谁应接受血糖异常的血液检测，相比于直接筛查增加的作用不大，且有遗漏一些严重高血糖患者的风险。血糖异常筛查最好直接进行血液检测，而不进行初始危险因素症状筛查。
