Li Qing, Pan Jie-min, Ma Xiao-jing, Bao Yu-qian, Tang Jun-ling, Yuan Qiao-ying, Lu Hui-juan, Jia Wei-ping
Department of Endocrinology & Metabolism, Shanghai Jiaotong University, Shanghai 200233, China.
Zhonghua Yi Xue Za Zhi. 2011 Jul 12;91(26):1813-6.
To assess the validity of combined detection of hemoglobin A1c (HbA1c) and glycated albumin (GA) in diabetic screening.
A total of 1480 subjects at our out-patient department from March 2007 to December 2009. Those suspected of diabetes or at a high risk of diabetes were enrolled. The study population included 677 males and 803 females with a mean age of 52.7 years. All subjects received an oral glucose tolerance test (OGTT) after a 10-hour fasting. Glycated albumin (GA) and hemoglobin A1c (HbA1c) were measured with liquid enzyme method and high pressure liquid chromatography respectively.
(1) According to World Health Organization diabetes diagnosis criteria, there were 562 subjects with normal glucose tolerance (NGT), 411 subjects with impaired glucose regulation (IGR) and 507 subjects with newly diagnosed diabetes mellitus (DM). The level of HbA1c and GA had a rising tendency among NGT, IGR and DM groups (P < 0.01). (2) Pearson correlation analysis demonstrated that HbA1c had a positive association with GA (r = 0.75, P < 0.01). (3) Using OGTT as golden standard of diabetic diagnosis, receiver operator characteristic (ROC) curve indicated that HbA1c and GA were strong predictors of diabetes. The area under curve (AUC) was 0.882 and 0.881 respectively with no significant difference (P > 0.05). (4) The sensitivity of combined use of HbA1c and GA at optimal cut-off points of 6.1% and 17.1% was significantly higher than that of single use of HbA1c or GA in diabetic screening (94.7% vs 81.1%, 88.4%, P < 0.01).
A combined detection of HbA1c and GA may improve the efficacy of diabetic screening. The subject with HbA1c ≥ 6.1% or GA ≥ 17.1% is recommended to undergo OGTT for confirming a diagnosis of diabetes.
评估糖化血红蛋白（HbA1c）与糖化白蛋白（GA）联合检测在糖尿病筛查中的有效性。
选取2007年3月至2009年12月在我院门诊就诊的1480名受试者。纳入疑似糖尿病或糖尿病高危人群。研究人群包括677名男性和803名女性，平均年龄52.7岁。所有受试者在禁食10小时后接受口服葡萄糖耐量试验（OGTT）。分别采用液体酶法和高压液相色谱法测定糖化白蛋白（GA）和糖化血红蛋白（HbA1c）。
（1）根据世界卫生组织糖尿病诊断标准，有562名葡萄糖耐量正常（NGT）受试者，411名糖调节受损（IGR）受试者和507名新诊断糖尿病（DM）受试者。HbA1c和GA水平在NGT、IGR和DM组中呈上升趋势（P<0.01）。（2）Pearson相关性分析表明，HbA1c与GA呈正相关（r = 0.75，P<0.01）。（3）以OGTT作为糖尿病诊断的金标准，受试者工作特征（ROC）曲线表明，HbA1c和GA是糖尿病的强预测指标。曲线下面积（AUC）分别为0.882和0.881，无显著差异（P>0.05）。（4）在糖尿病筛查中，HbA1c和GA联合使用的最佳切点分别为6.1%和17.1%时，其灵敏度显著高于单独使用HbA1c或GA（94.7%对81.1%，88.4%，P<0.01）。
HbA1c和GA联合检测可能提高糖尿病筛查的效果。建议HbA1c≥6.1%或GA≥17.1%的受试者进行OGTT以确诊糖尿病。
