Ziemer David C, Kolm Paul, Weintraub William S, Vaccarino Viola, Rhee Mary K, Caudle Jane M, Irving Jade M, Koch David D, Narayan K M Venkat, Phillips Lawrence S
Division of Endocrinology and Metabolism, Emory University, Atlanta, Georgia 30322, USA.
Diabetes Care. 2008 May;31(5):884-6. doi: 10.2337/dc07-2282. Epub 2008 Feb 29.
Age, BMI, and race/ethnicity are used in National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and American Diabetes Association (ADA) guidelines to prompt screening for pre-diabetes and diabetes, but cutoffs have not been evaluated rigorously.
Random plasma glucose (RPG) was measured and 75-g oral glucose tolerance tests were performed in 1,139 individuals without known diabetes. Screening performance was assessed by logistic regression and area under the receiver operating characteristic curve (AROC).
NIDDK/ADA indicators age >45 years and BMI >25 kg/m(2) provided significant detection of both diabetes and dysglycemia (both AROCs 0.63), but screening was better with continuous-variable models of age, BMI, and race and better still with models of age, BMI, race, sex, and family history (AROC 0.78 and 0.72). However, screening was even better with RPG alone (AROCs 0.81 and 0.72). RPG >125 mg/dl could be used to prompt further evaluation with an OGTT.
Use of age, BMI, and race/ethnicity in guidelines for screening to detect diabetes and pre-diabetes may be less important than evaluation of RPG. RPG should be investigated further as a convenient, inexpensive screen with good predictive utility.
美国国立糖尿病、消化和肾脏疾病研究所（NIDDK）及美国糖尿病协会（ADA）的指南中使用年龄、体重指数（BMI）和种族/族裔来促使对糖尿病前期和糖尿病进行筛查，但相关临界值尚未得到严格评估。
对1139名无糖尿病史的个体测量随机血糖（RPG）并进行75克口服葡萄糖耐量试验。通过逻辑回归和受试者操作特征曲线下面积（AROC）评估筛查性能。
NIDDK/ADA指标年龄>45岁和BMI>25kg/m²对糖尿病和血糖异常均有显著检出率（AROC均为0.63），但年龄、BMI和种族的连续变量模型筛查效果更好，年龄、BMI、种族、性别和家族史模型的筛查效果更佳（AROC分别为0.78和0.72）。然而，单独使用RPG筛查效果更好（AROC分别为0.81和0.72）。RPG>125mg/dl可用于促使进行口服葡萄糖耐量试验（OGTT）进一步评估。
在筛查糖尿病和糖尿病前期的指南中使用年龄、BMI和种族/族裔可能不如评估RPG重要。RPG作为一种方便、廉价且具有良好预测效用的筛查方法应进一步研究。
