Ziemer David C, Kolm Paul, Foster Jovonne K, Weintraub William S, Vaccarino Viola, Rhee Mary K, Varughese Rincy M, Tsui Circe W, Koch David D, Twombly Jennifer G, Narayan K M Venkat, Phillips Lawrence S
Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, GA, USA.
J Gen Intern Med. 2008 May;23(5):528-35. doi: 10.1007/s11606-008-0524-1. Epub 2008 Mar 12.
With positive results from diabetes prevention studies, there is interest in convenient ways to incorporate screening for glucose intolerance into routine care and to limit the need for fasting diagnostic tests.
The aim of this study is to determine whether random plasma glucose (RPG) could be used to screen for glucose intolerance.
This is a cross-sectional study.
The participants of this study include a voluntary sample of 990 adults not known to have diabetes.
RPG was measured, and each subject had a 75-g oral glucose tolerance test several weeks later. Glucose intolerance targets included diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose(110) (IFG(110); fasting glucose, 110-125 mg/dl, and 2 h glucose < 140 mg/dl). Screening performance was measured by area under receiver operating characteristic curves (AROC).
Mean age was 48 years, and body mass index (BMI) was 30.4 kg/m(2); 66% were women, and 52% were black; 5.1% had previously unrecognized diabetes, and 24.0% had any "high-risk" glucose intolerance (diabetes or IGT or IFG(110)). The AROC was 0.80 (95% CI 0.74-0.86) for RPG to identify diabetes and 0.72 (0.68-0.75) to identify any glucose intolerance, both highly significant (p < 0.001). Screening performance was generally consistent at different times of the day, regardless of meal status, and across a range of risk factors such as age, BMI, high density lipoprotein cholesterol, triglycerides, and blood pressure.
RPG values should be considered by health care providers to be an opportunistic initial screening test and used to prompt further evaluation of patients at risk of glucose intolerance. Such "serendipitous screening" could help to identify unrecognized diabetes and prediabetes.
鉴于糖尿病预防研究取得了积极成果，人们希望找到便捷的方法，将葡萄糖耐量筛查纳入常规医疗，并减少空腹诊断测试的需求。
本研究旨在确定随机血浆葡萄糖（RPG）是否可用于筛查葡萄糖耐量异常。
这是一项横断面研究。
本研究的参与者包括990名未知患有糖尿病的成年人的自愿样本。
测量RPG，并在数周后让每位受试者进行75克口服葡萄糖耐量试验。葡萄糖耐量异常的指标包括糖尿病、糖耐量受损（IGT）和空腹血糖受损（IFG(110)；空腹血糖为110 - 125毫克/分升，2小时血糖<140毫克/分升）。通过受试者操作特征曲线下面积（AROC）来衡量筛查性能。
平均年龄为48岁，体重指数（BMI）为30.4千克/平方米；66%为女性，52%为黑人；5.1%曾患有未被识别的糖尿病，24.0%患有任何“高危”葡萄糖耐量异常（糖尿病或IGT或IFG(110)）。RPG用于识别糖尿病的AROC为0.80（95%可信区间0.74 - 0.86），用于识别任何葡萄糖耐量异常的AROC为0.72（0.68 - 0.75），两者均具有高度显著性（p < 0.001）。无论用餐状态如何，在一天中的不同时间以及一系列风险因素（如年龄、BMI、高密度脂蛋白胆固醇、甘油三酯和血压）范围内，筛查性能总体上是一致的。
医疗保健提供者应将RPG值视为一种机会性的初始筛查测试，并用于促使对有葡萄糖耐量异常风险的患者进行进一步评估。这种“偶然筛查”有助于识别未被发现的糖尿病和糖尿病前期。
