Department of Endocrinology and Metabolism, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan.
Diabetes Res Clin Pract. 2012 Feb;95(2):283-90. doi: 10.1016/j.diabres.2011.10.024. Epub 2011 Nov 21.
To evaluate the impact of HbA1c for diagnosis of diabetes and investigate whether cardiovascular risks profiles differ among individuals with diabetes diagnosed by HbA1c or fasting plasma glucose (FPG).
This cross-sectional study involved 26,884 participants (30.6% women; aged 20-91 years) without known diabetes. Subjects were categorized into 4 groups according to the presence or absence of FPG ≥7.0 mmol/L and/or HbA1c ≥6.5%, which were American Diabetes Association criteria. Oral glucose tolerance test data were not available.
Prevalence of undiagnosed diabetes was 3.6%. Of those individuals, 47.5% fulfilled both two criteria and 26.0% fulfilled only HbA1c criterion. Individuals with diabetes according to FPG ≥7.0 mmol/L alone were characterized as having poorly controlled hypertension while those with HbA1c ≥6.5% alone were characterized as older, female, and having lower blood pressure and γ-glutamyltransferase values. Persons with newly diagnosed diabetes by HbA1c had low HDL cholesterol and high LDL or non-HDL cholesterol levels.
Introducing HbA1c into the diagnosis allowed detection of many previously undiagnosed cases of diabetes in Japanese individuals. Those diagnosed by FPG were characterized by hypertension and those diagnosed by HbA1c had unfavorable lipid profiles, reflecting an atherosclerotic trait.
评估 HbA1c 对糖尿病的诊断价值，并探讨通过 HbA1c 或空腹血糖（FPG）诊断的糖尿病患者心血管风险特征是否存在差异。
本横断面研究纳入了 26884 名（女性占 30.6%；年龄 20-91 岁）无已知糖尿病的参与者。根据是否存在 FPG≥7.0mmol/L 和/或 HbA1c≥6.5%（美国糖尿病协会标准），将受试者分为 4 组。未进行口服葡萄糖耐量试验。
未确诊糖尿病的患病率为 3.6%。在这些患者中，47.5%同时满足两项标准，26.0%仅满足 HbA1c 标准。仅根据 FPG≥7.0mmol/L 诊断的糖尿病患者具有较差的高血压控制情况，而仅根据 HbA1c≥6.5%诊断的糖尿病患者具有年龄较大、女性、血压和γ-谷氨酰转移酶水平较低的特征。新诊断为 HbA1c 阳性的糖尿病患者具有低 HDL 胆固醇和高 LDL 或非 HDL 胆固醇水平。
在诊断中引入 HbA1c 可检测到许多日本人群中以前未确诊的糖尿病病例。根据 FPG 诊断的患者具有高血压特征，而根据 HbA1c 诊断的患者具有不良的血脂谱，反映了动脉粥样硬化的特征。
