Zhang Yun-liang, Guo Shu-qin, Ma Wen-bin, Wang Jun, Bai Guang-qin, Yang Qian, Ti Su-fang, Ma Rui, Wei Rui-pu, Liu Wen-xuan, Li Zhe, Yang Lei, Liu Dian-wu, Li Zhi-hong
Department of Endocrinology, No. 1 Central Hospital in Baoding City of Hebei Province, Baoding 071000, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2010 Oct;31(10):1174-8.
To determine the efficient cut-off points of fasting fingertip blood glucose test for undiagnosed diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in community-based residents aged above 45 years old.
A cluster-randomized study was conducted from May 2008 to January 2009. A total of 3250 subjects aged above 45 years in two communities of Baoding city received questionnaire investigation and tested for fingertip blood glucose. Those subjects whose capillary blood glucose level ≥ 5.1 mmol/L were subjected to 75 g oral glucose tolerance test. Undiagnosed diabetes mellitus and pre-diabetes were identified by fasting plasma glucose and OGTT. In this study, the cut-off points of fasting capillary blood glucose for detecting undiagnosed diabetes and pre-diabetes were evaluated, using receiver operator characteristic curve (ROC).
Of 1351 subjects that having had oral glucose tolerance test, 230 cases were diagnosed as diabetes mellitus (7.3%), 166 cases (5.2%) as IFG, and 204 (6.7%) as IGT under fasting capillary blood glucose as test variable and state variables according to the following criteria. (1) FPG≥7.0 mmol/L or/and 2hPG≥11.1 mmol/L (2) FPG<5.6 mmol/L (3) FPG<7.0 mmol/L and 7.8 mmol/L≤2hPG≤11.1 mmol/L, areas under three ROC curves were 0.905, 0.633 and 0.719, respectively. The cut-off values of screening for undiagnosed DM, IGT and IFG were 6.0 mmol/L, 5.7 mmol/L, and 5.7 mmol/L, respectively. When cut-off value of screening for undiagnosed DM was 6.0 mmol/L, the maximal sensitivity was 78.0% and specificity was 89.3%. But there were both lower sensitivity and specificity in screening for IFG and IGT according to the best predicting value (5.7 mmol/L) from the ROC curves (50.3% and 28.0% vs. 60.8% and 28.0%).
Fasting capillary blood glucose with the lower cut-point of 6.0 mmol/L in screening for undiagnosed diabetes mellitus alone, was relatively reliable, whereas for both IFG and IGT the fasting fingertip blood glucose tests were fallible. It was convenient and could be used in screening the DM at the community level.
确定45岁以上社区居民空腹指尖血糖检测未诊断糖尿病（DM）、糖耐量受损（IGT）和空腹血糖受损（IFG）的有效切点。
2008年5月至2009年1月进行一项整群随机研究。保定市两个社区共3250名45岁以上的受试者接受问卷调查并检测指尖血糖。毛细血管血糖水平≥5.1 mmol/L的受试者接受75 g口服葡萄糖耐量试验。通过空腹血糖和口服葡萄糖耐量试验确定未诊断的糖尿病和糖尿病前期。在本研究中，采用受试者工作特征曲线（ROC）评估空腹毛细血管血糖检测未诊断糖尿病和糖尿病前期的切点。
在1351名进行口服葡萄糖耐量试验的受试者中，以空腹毛细血管血糖为检测变量，根据以下标准将状态变量中的230例诊断为糖尿病（7.3%），166例（5.2%）诊断为IFG，204例（6.7%）诊断为IGT。（1）空腹血糖≥7.0 mmol/L或/和餐后2小时血糖≥11.1 mmol/L；（2）空腹血糖<5.6 mmol/L；（3）空腹血糖<7.0 mmol/L且7.8 mmol/L≤餐后2小时血糖≤11.1 mmol/L，三条ROC曲线下面积分别为0.905、0.633和0.719。筛查未诊断DM、IGT和IFG的切点值分别为6.0 mmol/L、5.7 mmol/L和5.7 mmol/L。当筛查未诊断DM的切点值为6.0 mmol/L时，最大灵敏度为78.0%，特异性为89.3%。但根据ROC曲线的最佳预测值（5.7 mmol/L）筛查IFG和IGT时，灵敏度和特异性均较低（分别为50.3%和28.0%，而60.8%和28.0%）。
仅筛查未诊断糖尿病时，空腹毛细血管血糖切点为6.0 mmol/L相对可靠，而对于IFG和IGT，空腹指尖血糖检测均不可靠。它方便易行，可用于社区层面的糖尿病筛查。
