Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non-Communicable Diseases Prevention and Control, and International Diabetes Federation Centre for Education, Chennai, India.
Diabetes Care. 2010 Mar;33(3):515-9. doi: 10.2337/dc09-1694. Epub 2009 Nov 10.
OBJECTIVE To determine A1C cut points for glucose intolerance in Asian Indians. RESEARCH DESIGN AND METHODS A total of 2,188 participants without known diabetes were randomly selected from the Chennai Urban Rural Epidemiology Study. All had fasting plasma glucose (FPG) and 2-h postload plasma glucose measurements after a 75-g load and were classified as having impaired fasting glucose (IFG) (American Diabetes Association [ADA] criteria, FPG > or =5.5 and <7 mmol/l, and World Health Organization [WHO] criteria, FPG > or =6.1 and <7 mmol/l), impaired glucose tolerance (IGT) (2-h postload plasma glucose > or =7.8 and <11.1 mmol/l), or diabetes (FPG > or =7 mmol/l and/or 2-h postload plasma glucose > or =11.1 mmol/l). A1C was measured using the Bio-Rad Variant machine. Based on receiver operating characteristic curves, optimum sensitivity and specificity were derived for defining A1C cut points for diabetes, IGT, and IFG. RESULTS Mean +/- SD values of A1C among subjects with normal glucose tolerance, IGT, and diabetes were 5.5 +/- 0.4, 5.9 +/- 0.6, and 8.3 +/- 2.0%, respectively (P(trend) < 0.001) with considerable overlap. To identify diabetes based on 2-h postload plasma glucose, the A1C cut point of 6.1% had an area under the curve (AUC) of 0.941 with 88.0% sensitivity and 87.9% specificity. When diabetes was defined as FPG > or =7.0 mmol/l, the A1C cut point was 6.4% (AUC = 0.966, sensitivity 93.3%, and specificity 92.3%). For IGT, AUC = 0.708; for IFG, AUC = 0.632 (WHO criteria) and 0.708 (ADA criteria), and the A1C cut point was 5.6%. CONCLUSIONS In Asian Indians, A1C cut points of 6.1 and 6.4% defined diabetes by 2-h postload plasma glucose or FPG criteria, respectively. A value of 5.6% optimally identified IGT or IFG but was <70% accurate.
确定亚洲印第安人葡萄糖耐量受损的 A1C 切点。
本研究共纳入 2188 名无已知糖尿病的参与者，他们均来自 Chennai Urban Rural Epidemiology Study，所有参与者均进行了空腹血糖（FPG）和 75g 负荷后 2 小时血糖检测，并根据美国糖尿病协会（ADA）标准（FPG > 5.5 且 < 7mmol/L）和世界卫生组织（WHO）标准（FPG > 6.1 且 < 7mmol/L）分为空腹血糖受损（IFG）组，根据 2 小时血糖检测结果分为糖耐量受损（IGT）组（2 小时血糖 > 7.8 且 < 11.1mmol/L）或糖尿病（FPG > 7mmol/L 和/或 2 小时血糖 > 11.1mmol/L）组。采用 Bio-Rad Variant 仪器检测 A1C。根据受试者工作特征曲线，得出诊断糖尿病、IGT 和 IFG 的 A1C 切点的最佳灵敏度和特异性。
糖耐量正常、IGT 和糖尿病患者的 A1C 平均值分别为 5.5% ± 0.4%、5.9% ± 0.6%和 8.3% ± 2.0%（P < 0.001），且差异有统计学意义。以 2 小时血糖为依据诊断糖尿病时，A1C 切点为 6.1%，曲线下面积（AUC）为 0.941，灵敏度为 88.0%，特异性为 87.9%。当以 FPG > 7.0mmol/L 定义糖尿病时，A1C 切点为 6.4%（AUC = 0.966，灵敏度为 93.3%，特异性为 92.3%）。IGT 的 AUC 为 0.708，IFG（WHO 标准）的 AUC 为 0.632，IFG（ADA 标准）的 AUC 为 0.708，A1C 切点均为 5.6%。
在亚洲印第安人中，以 2 小时血糖或 FPG 为依据，A1C 切点分别为 6.1%和 6.4%可诊断为糖尿病。A1C 切点为 5.6%时可较好地识别 IGT 或 IFG，但准确率 < 70%。
