Dankner Rachel, Abdul-Ghani Muhammad A, Gerber Yariv, Chetrit Angela, Wainstein Julio, Raz Itamar
Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Israel.
Diabetes Metab Res Rev. 2007 Oct;23(7):551-8. doi: 10.1002/dmrr.728.
The long-range prediction from clinical variables of the onset of diabetes is important to patients and clinicians. Our objective was to evaluate the efficacy of various glucose-related clinical measurements in predicting the 20-year risk of developing type 2 diabetes (T2DM) in an elderly population.
In a prospective study, 672 men and women aged 59-92 years, who were not diabetic in 1980 and were part of a nationwide longitudinal randomized study, were followed-up in 2000-2003. Fasting glucose, 1- and 2-h post-oral glucose tolerance and insulin were measured in 1980 and 2000-2003.
A group of 174 (25.9%) survivors had progressed to diabetes during the 20-year follow-up. Fasting glucose values were a good predictor for diabetes. With the 100 mg/dL cut-off of impaired fasting glucose (IFG), a 2-4-times higher predictive sensitivity followed the dramatic increase in IFG prevalence compared to the 110 mg/dL cut-off, but at a cost of reduced specificity and positive predictive value (PPV). By receiver operating curve (ROC) analysis, a 1-h post-load glucose was similar to 2 h and fasting glucose in prediction of the 20-year incidence of diabetes, and classifying correctly the 77, 74 and 73% of the group, respectively. In adjusted logistic regressions, 2.28, 1.78 and 1.69-folds increased the 20-year risk, and were associated with each SD increment of the respective glucose values (p < 0.001).
Although the best population-based strategy for the diagnosis of T2DM would be the combination of fasting glucose followed by post-load glucose, for the purposes of long-term prediction of T2DM risk, fasting glucose is sufficient.
从临床变量对糖尿病发病进行长期预测对患者和临床医生都很重要。我们的目标是评估各种与血糖相关的临床测量指标在预测老年人群2型糖尿病（T2DM）20年发病风险方面的效果。
在一项前瞻性研究中，对672名年龄在59 - 92岁、1980年时非糖尿病患者且参与全国纵向随机研究的男性和女性，于2000 - 2003年进行随访。在1980年以及2000 - 2003年测量空腹血糖、口服葡萄糖耐量试验后1小时和2小时血糖以及胰岛素水平。
在20年随访期间，174名（25.9%）幸存者进展为糖尿病。空腹血糖值是糖尿病的良好预测指标。以空腹血糖受损（IFG）的100mg/dL切点值为例，与110mg/dL切点值相比，IFG患病率显著增加后，预测敏感性提高了2 - 4倍，但特异性和阳性预测值（PPV）有所降低。通过受试者工作特征曲线（ROC）分析，负荷后1小时血糖在预测20年糖尿病发病率方面与2小时血糖和空腹血糖相似，分别正确分类了该组的77%、74%和73%。在调整后的逻辑回归分析中，各自血糖值每增加1个标准差，20年风险分别增加2.28倍、1.78倍和1.69倍（p < 0.001）。
虽然基于人群诊断T2DM的最佳策略是空腹血糖联合负荷后血糖，但就长期预测T2DM风险而言，空腹血糖就足够了。
