AP-HP, Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, CRNH-IdF, Bondy, France.
Diabet Med. 2011 May;28(5):567-74. doi: 10.1111/j.1464-5491.2010.03215.x.
In 2010, the American Diabetes Association has published recommendations on the population to be screened for dysglycaemia; the diagnostic criteria for intermediate hyperglycaemia and diabetes using oral glucose tolerance testing and HbA(1c); and the patients eligible for treatment with metformin. We aimed to evaluate the consequences of screening with oral glucose tolerance test or HbA(1c) in an at-risk population.
Among 1177 overweight or obese consecutive adults without known diabetes who were referred to our department for weight management, we selected 1157 individuals (83% female; 80% European) fulfilling the American Diabetes Association 2010 criteria for dysglycaemia screening.
Mean age was 41.2 ± 13 years, BMI 37.0 ± 7.2 kg/m(2), fasting plasma glucose 4.9 ± 0.8 mmol/l and HbA(1c) (turbidimetric immunoassay) 5.7 ± 0.7% (39 mmol/mol). Based on oral glucose tolerance test and HbA(1c), respectively, 76 (6.6%) and 113 (9.8%) patients had diabetes, including 34 sharing both criteria; 307 (26.5%) and 478 (41.3%) had intermediate hyperglycaemia; and 130 (11.2%) and 255 (22.0%) would be treated with metformin. The sensitivity/specificity of HbA(1c) ≥ 6.5% (48 mmol/mol) for the diagnosis of diabetes according to the oral glucose tolerance test were 44.7/92.7%. Diabetes risk scores and UK Prospective Diabetes Study cardiovascular risk score were the highest in the 130 patients having both an abnormal oral glucose tolerance test and HbA(1c) ≥ 5.7%.
In a population at risk for diabetes, the HbA(1c) strategy could lead to diagnosing more cases of dysglycaemia and to treating more patients with metformin than the oral glucose tolerance test strategy. The consistency of either diagnostic criteria was low. The patients with the highest a priori risk of diabetes and cardiovascular disease were those fulfilling both oral glucose tolerance test and HbA(1c) criteria.
2010 年，美国糖尿病协会发布了关于对糖基化紊乱人群进行筛查的建议；使用口服葡萄糖耐量试验和糖化血红蛋白（HbA(1c)）对中间高血糖和糖尿病的诊断标准；以及二甲双胍治疗的适用患者。我们旨在评估在高危人群中进行口服葡萄糖耐量试验或 HbA(1c)筛查的后果。
在我们部门因体重管理而就诊的 1177 名超重或肥胖的连续成年人中，我们选择了 1157 名符合美国糖尿病协会 2010 年糖基化紊乱筛查标准的个体（83%为女性；80%为欧洲人）。
平均年龄为 41.2 ± 13 岁，BMI 为 37.0 ± 7.2kg/m(2)，空腹血浆葡萄糖为 4.9 ± 0.8mmol/l，HbA(1c)（比浊免疫测定）为 5.7 ± 0.7%（39mmol/mol）。分别根据口服葡萄糖耐量试验和 HbA(1c)，76（6.6%）和 113（9.8%）名患者患有糖尿病，其中 34 名患者同时符合这两个标准；307（26.5%）和 478（41.3%）名患者患有中间高血糖症；130（11.2%）和 255（22.0%）名患者将接受二甲双胍治疗。HbA(1c)≥6.5%（48mmol/mol）对根据口服葡萄糖耐量试验诊断糖尿病的敏感性/特异性分别为 44.7/92.7%。在同时存在异常口服葡萄糖耐量试验和 HbA(1c)≥5.7%的 130 名患者中，糖尿病风险评分和英国前瞻性糖尿病研究心血管风险评分最高。
在糖尿病高危人群中，与口服葡萄糖耐量试验策略相比，HbA(1c)策略可能会导致更多的糖基化紊乱病例被诊断出来，并使更多的患者接受二甲双胍治疗。两种诊断标准的一致性较低。那些同时符合口服葡萄糖耐量试验和 HbA(1c)标准的患者具有最高的糖尿病和心血管疾病的先验风险。
