Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain.
Diabetes Metab. 2011 Feb;37(1):27-32. doi: 10.1016/j.diabet.2010.07.002. Epub 2010 Oct 8.
Fasting plasma glucose (FPG) and the 2-h post-challenge plasma glucose (2hPG) are commonly used to identify those at risk of type 2 diabetes. However, the role of HbA(1c) in this prediction has still not been ascertained.
The Asturias study is a prospective population-based survey of diabetes and cardiovascular risk factors. Baseline examination, carried out during 1998-1999, involved 1034 individuals, aged 30-75 years, randomly selected to determine the prevalence of type 2 diabetes and prediabetes in the principality of Asturias (northern Spain). In 2004-2005, these same subjects were invited to a follow-up examination, and 700 participated. The present study includes only those who did not have diabetes at baseline. All participants with no known diabetes underwent an OGTT. Baseline HbA(1c) levels were measured by HPLC.
Diabetes had developed in 44 participants at the time of follow-up. Quartiles of baseline HbA(1c) values were 3.4-4.8 (Q1), 4.9-5.1 (Q2), 5.2-5.4 (Q3) and 5.5-6.9 (Q4), and the incidence rates of diabetes by quartiles were 1.0 (0.1-7.1), 4.0 (1.5-10.7), 7.9 (4.0-15.9) and 32.6 (22.9-46.4) cases/1000 person-years, respectively. ROC curve analysis comparing HbA(1c), FPG and 2hPG in the prediction of diabetes showed areas under the curve (ROC-AUC) of 0.80 (0.74-0.86), 0.83 (0.77-0.90) and 0.79 (0.72-0.87), respectively. The combination of FPG and HbA(1c) had the best predictive performance with an ROC-AUC of 0.88 (0.82-0.93).
Our study indicates that HbA(1c) is strongly predictive of new-onset diabetes in this northern Spanish population, and was similar to FPG and 2hPG in predictive capability. Also, the combined measurement of FPG and HbA(1c) improved their individual predictive performance.
空腹血糖（FPG）和餐后 2 小时血糖（2hPG）常用于识别 2 型糖尿病风险人群。然而，HbA(1c) 在这一预测中的作用仍未确定。
阿斯图里亚斯研究是一项针对糖尿病和心血管危险因素的前瞻性基于人群的调查。基线检查于 1998-1999 年进行，涉及 1034 名年龄在 30-75 岁之间的随机选择的个体，以确定阿斯图里亚斯公国（西班牙北部）的 2 型糖尿病和糖尿病前期的患病率。2004-2005 年，这些相同的受试者被邀请参加随访检查，其中 700 人参加了检查。本研究仅包括基线时无糖尿病的受试者。所有无已知糖尿病的受试者均接受 OGTT 检查。基线时 HbA(1c) 水平通过 HPLC 进行测量。
在随访时，44 名参与者发生了糖尿病。HbA(1c) 值基线四分位区间为 3.4-4.8（Q1）、4.9-5.1（Q2）、5.2-5.4（Q3）和 5.5-6.9（Q4），四分位区间的糖尿病发病率分别为 1.0（0.1-7.1）、4.0（1.5-10.7）、7.9（4.0-15.9）和 32.6（22.9-46.4）例/1000 人年。比较 HbA(1c)、FPG 和 2hPG 在预测糖尿病中的 ROC 曲线分析显示，曲线下面积（ROC-AUC）分别为 0.80（0.74-0.86）、0.83（0.77-0.90）和 0.79（0.72-0.87）。FPG 和 HbA(1c) 的联合检测具有最佳的预测性能，ROC-AUC 为 0.88（0.82-0.93）。
本研究表明，HbA(1c) 可强烈预测该西班牙北部人群的新发糖尿病，其预测能力与 FPG 和 2hPG 相似。此外，FPG 和 HbA(1c) 的联合测量提高了它们各自的预测性能。
