Institute of Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
Diabetes Care. 2010 Sep;33(9):2077-83. doi: 10.2337/dc10-0262. Epub 2010 Jun 23.
A1C has been proposed as a new indicator for high risk of type 2 diabetes. The long-term predictive power and comparability of elevated A1C with the currently used high-risk indicators remain unclear. We assessed A1C, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) as predictors of type 2 diabetes and cardiovascular disease (CVD) at 10 years.
This prospective population-based study of 593 inhabitants from northern Finland, born in 1935, was conducted between 1996 and 2008. An oral glucose tolerance test (OGTT) was conducted at baseline and follow-up, and A1C was determined at baseline. Those with a history of diabetes were excluded from the study. Elevated A1C was defined as 5.7-6.4%. Incident type 2 diabetes was confirmed by two OGTTs. Cardiovascular outcome was measured as incident CVD or CVD mortality. Multivariate log-binomial regression models were used to predict diabetes, CVD, and CVD mortality at 10 years. Receiver operating characteristic curves compared predictive values of A1C, IGT, and IFG.
Incidence of diabetes during the follow-up was 17.1%. Two of three of the cases of newly diagnosed diabetes were predicted by a raise in >or=1 of the markers. Elevated A1C, IGT, or IFG preceded diabetes in 32.8, 40.6, and 21.9%, respectively. CVD was predicted by an intermediate and diabetic range of 2-h glucose but only by diabetic A1C levels in women.
A1C predicted 10-year risk of type 2 diabetes at a range of A1C 5.7-6.4% but CVD only in women at A1C >or=6.5%.
A1C 已被提议作为 2 型糖尿病高危的新指标。目前，升高的 A1C 与目前使用的高危指标相比，其长期预测能力和可比性尚不清楚。我们评估了 A1C、葡萄糖耐量受损（IGT）和空腹血糖受损（IFG）作为 10 年内 2 型糖尿病和心血管疾病（CVD）的预测指标。
这是一项前瞻性的基于人群的研究，对象为 1935 年出生于芬兰北部的 593 名居民，研究于 1996 年至 2008 年进行。在基线和随访时进行口服葡萄糖耐量试验（OGTT），并在基线时测定 A1C。患有糖尿病的患者被排除在研究之外。升高的 A1C 定义为 5.7-6.4%。通过两次 OGTT 确诊新发 2 型糖尿病。心血管结局的测量指标为新发 CVD 或 CVD 死亡率。使用多变量对数二项式回归模型预测 10 年内的糖尿病、CVD 和 CVD 死亡率。受试者工作特征曲线比较了 A1C、IGT 和 IFG 的预测值。
随访期间糖尿病的发生率为 17.1%。三种标志物升高≥1 种可预测 2/3 的新发糖尿病病例。升高的 A1C、IGT 或 IFG 分别在 32.8%、40.6%和 21.9%的病例中先于糖尿病发生。中等和糖尿病范围内的 2 小时血糖可预测 CVD，但仅在女性中 A1C >or=6.5%时可预测 CVD。
A1C 在 5.7-6.4%A1C 范围内可预测 10 年内 2 型糖尿病的风险，但仅在女性 A1C >or=6.5%时可预测 CVD。
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