血红蛋白 A1c 在急性护理环境中用于筛查先前未诊断的糖尿病前期和糖尿病。
Hemoglobin A1c as a screen for previously undiagnosed prediabetes and diabetes in an acute-care setting.
机构信息
Department of Emergency Medicine, Long Island Jewish Medical Center, Long Island, NY, USA.
出版信息
Diabetes Care. 2011 Sep;34(9):1908-12. doi: 10.2337/dc10-0996. Epub 2011 Jul 20.
OBJECTIVE
Hemoglobin A(1c) (HbA(1c)) is recommended for identifying diabetes and prediabetes. Because HbA(1c) does not fluctuate with recent eating or acute illness, it can be measured in a variety of clinical settings. Although outpatient studies identified HbA(1c)-screening cutoff values for diabetes and prediabetes, HbA(1c)-screening thresholds have not been determined for acute-care settings. Using follow-up fasting blood glucose (FBG) and the 2-h oral glucose tolerance test (OGTT) as the criterion gold standard, we determined optimal HbA(1c)-screening cutoffs for undiagnosed dysglycemia in the emergency department setting.
RESEARCH DESIGN AND METHODS
This was a prospective observational study of adults aged ≥18 years with no known history of hyperglycemia presenting to an emergency department with acute illness. Outpatient FBS and 2-h OGTT were performed after recovery from the acute illness, resulting in diagnostic categorizations of prediabetes, diabetes, and dysglycemia (prediabetes or diabetes). Optimal cutoffs were determined and performance data identified for cut points.
RESULTS
A total of 618 patients were included, with a mean age of 49.7 (±14.9) years and mean HbA(1c) of 5.68% (±0.86). On the basis of an OGTT, the prevalence of previously undiagnosed prediabetes and diabetes was 31.9 and 10.5%, respectively. The optimal HbA(1c)-screening cutoff for prediabetes was 5.7% (area under the curve [AUC] = 0.659, sensitivity = 55%, and specificity = 71%), for dysglycemia 5.8% (AUC = 0.717, sensitivity = 57%, and specificity = 79%), and for diabetes 6.0% (AUC = 0.868, sensitivity = 77%, and specificity = 87%).
CONCLUSIONS
We identified HbA(1c) cut points to screen for prediabetes and diabetes in an emergency department adult population. The values coincide with published outpatient study findings and suggest that an emergency department visit provides an opportunity for HbA(1c)-based dysglycemia screening.
目的
血红蛋白 A1c（HbA1c）被推荐用于识别糖尿病和糖尿病前期。由于 HbA1c 不受近期饮食或急性疾病的影响，因此可以在各种临床环境中进行测量。尽管门诊研究确定了糖尿病和糖尿病前期的 HbA1c 筛查切点，但尚未确定急性护理环境的 HbA1c 筛查阈值。本研究使用随访空腹血糖（FBG）和 2 小时口服葡萄糖耐量试验（OGTT）作为标准金标准，确定了急诊科未确诊的糖调节受损的最佳 HbA1c 筛查切点。
研究设计和方法
这是一项前瞻性观察性研究，纳入了年龄≥18 岁、无高血糖既往史的成年人，他们因急性疾病到急诊科就诊。在急性疾病恢复后进行门诊 FBG 和 2 小时 OGTT，根据诊断将患者分为糖尿病前期、糖尿病和糖调节受损（糖尿病前期或糖尿病）。确定最佳切点，并确定切点的性能数据。
结果
共纳入 618 例患者，平均年龄为 49.7（±14.9）岁，平均 HbA1c 为 5.68%（±0.86）。根据 OGTT，先前未确诊的糖尿病前期和糖尿病的患病率分别为 31.9%和 10.5%。用于筛查糖尿病前期的最佳 HbA1c 切点为 5.7%（曲线下面积[AUC] = 0.659，灵敏度 = 55%，特异性 = 71%），用于筛查糖调节受损的最佳切点为 5.8%（AUC = 0.717，灵敏度 = 57%，特异性 = 79%），用于筛查糖尿病的最佳切点为 6.0%（AUC = 0.868，灵敏度 = 77%，特异性 = 87%）。
结论
我们确定了用于筛查急诊科成年人群糖尿病前期和糖尿病的 HbA1c 切点。这些值与已发表的门诊研究结果一致，表明急诊科就诊提供了基于 HbA1c 的糖调节受损筛查机会。
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