Division of Diabetes, University of Massachusetts Medical School, Worcester, USA.
Am J Med. 2011 May;124(5):395-401. doi: 10.1016/j.amjmed.2010.11.025.
Until 2010, the diagnosis of diabetes mellitus was based solely on glucose concentration, but the American Diabetes Association (ADA) recommendations now include a new criterion: hemoglobin A1C ≥6.5%. Because this change may have significant implications for diabetes diagnosis, we conducted a comprehensive literature review including peer-reviewed articles not referenced in the ADA report. We conclude that A1C and plasma glucose tests are frequently discordant for diagnosing diabetes. A1C ≥6.5% identifies fewer individuals as having diabetes than glucose-based criteria. Convenience of A1C test might increase the number of patients diagnosed, but this is unproven. Diagnostic cut-points for both glucose and A1C are based on consensus judgments regarding optimal sensitivity and specificity for the complications of hyperglycemia. A1C may not accurately reflect levels of glycemia in some situations, but in comparison with glucose measurements, it has greater analytic stability and less temporal variability. When choosing a diagnostic test for diabetes, the limitations of each choice must be understood. Clinical judgment and consideration of patient preference are required to appropriately select among the diagnostic alternatives.
直到 2010 年，糖尿病的诊断仅基于血糖浓度，但美国糖尿病协会（ADA）的建议现在包括一个新的标准：血红蛋白 A1C≥6.5%。由于这一变化可能对糖尿病的诊断产生重大影响，我们进行了一项全面的文献综述，包括 ADA 报告中未引用的同行评议文章。我们的结论是，A1C 和血浆葡萄糖检测在诊断糖尿病方面经常不一致。A1C≥6.5% 识别出的患有糖尿病的个体比基于葡萄糖的标准要少。A1C 检测的便利性可能会增加被诊断出的患者数量，但这尚未得到证实。葡萄糖和 A1C 的诊断切点均基于对高血糖并发症的最佳灵敏度和特异性的共识判断。在某些情况下，A1C 可能无法准确反映血糖水平，但与葡萄糖测量相比，它具有更高的分析稳定性和更少的时间变异性。在选择糖尿病诊断测试时，必须了解每种选择的局限性。需要临床判断和考虑患者的偏好，以便在诊断选择中进行适当的选择。
