Hosseinpanah Farhad, Rambod Mehdi, Azizi Fereidoun
Obesity Research Center, Research Institute for Endocrine Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Diabetes Res Clin Pract. 2008 Mar;79(3):490-6. doi: 10.1016/j.diabres.2007.10.010. Epub 2007 Nov 19.
To identify subjects who would most likely benefit from oral glucose tolerance test (OGTT) for diagnosis of diabetes mellitus (DM), namely isolated postchallenge hyperglycemia (IPH) (i.e. FPG<126mg/dl and 2h-PG>or=200mg/dl), we evaluated data and results of OGTT of 9745 participants of Tehran Lipid and Glucose Study (TLGS), aged >20 years and without previously diagnosed DM. The overall prevalence of IPH was 3.1% (95% CI: 2.8-3.4%, n=302). In the multivariate logistic regression analysis, the odds ratios (OR) for IPH were statistically significant for FPG>or=100mg/dl (OR 9.5; 95% CI: 7.1-12.5), age >or=40 years (OR 2.6; 95% CI: 1.8-3.7), triglycerides >or=200mg/dl (OR 2.1; 95% CI: 1.6-2.7), hypertension (OR 2.0; 95% CI: 1.5-2.6) and abnormal waist circumference (OR 1.9; 95% CI: 1.3-2.8). In subjects with FPG<126mg/dl, findings that best distinguished between IPH and non-diabetic subjects were FPG>or=100mg/dl [positive likelihood ratio (LR(+))=5.2], FPG>or=100mg/dl together with triglycerides >or=200mg/dl [LR(+)=9.7] and a combination of all the five factors [LR(+)=12.9]. This analysis showed that in Iranian urban subjects with FPG<126mg/dl, factors such as FPG>or=100mg/dl, older age, hypertriglyceridemia, hypertension and abnormal waist circumference were the best predictors of presence of IPH; OGTT would hence be recommended for opportunistic screening of IPH in subjects with above mentioned characteristics.
为了确定哪些受试者最有可能从口服葡萄糖耐量试验(OGTT)中受益以诊断糖尿病(DM),即孤立性餐后高血糖(IPH)(即空腹血糖(FPG)<126mg/dl且餐后2小时血糖(2h-PG)≥200mg/dl),我们评估了德黑兰血脂与血糖研究(TLGS)中9745名年龄>20岁且既往未诊断为DM的参与者的OGTT数据和结果。IPH的总体患病率为3.1%(95%置信区间:2.8-3.4%,n=302)。在多因素逻辑回归分析中,FPG≥100mg/dl(比值比(OR)9.5;95%置信区间:7.1-12.5)、年龄≥40岁(OR 2.6;95%置信区间:1.8-3.7)、甘油三酯≥200mg/dl(OR 2.1;95%置信区间:1.6-2.7)、高血压(OR 2.0;95%置信区间:1.5-2.6)和腰围异常(OR 1.9;95%置信区间:1.3-2.8)对IPH的OR值具有统计学意义。在FPG<126mg/dl的受试者中,最能区分IPH与非糖尿病受试者的发现是FPG≥100mg/dl[阳性似然比(LR(+))=5.2]、FPG≥100mg/dl且甘油三酯≥200mg/dl[LR(+)=9.7]以及所有五个因素的组合[LR(+)=12.9]。该分析表明,在FPG<126mg/dl的伊朗城市受试者中,FPG≥100mg/dl、年龄较大、高甘油三酯血症、高血压和腰围异常等因素是IPH存在的最佳预测因素;因此,建议对具有上述特征的受试者进行OGTT以进行IPH的机会性筛查。