Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan.
Diabet Med. 2012 Jul;29(7):e75-81. doi: 10.1111/j.1464-5491.2011.03536.x.
We investigated the value of persistent fasting hyperglycaemia as assessed by repeated elevated fasting plasma glucose in predicting the progression to diabetes.
A retrospective cohort study was conducted from 1998 to 2006 inclusive among 7929 persons (37,742 person-years), with a mean age of 53.0 years at baseline. The cumulative incidence of diabetes was measured. A baseline and follow-up fasting plasma glucose were categorized as normal fasting glucose (< 5.56 mmol/l), or impaired fasting glucose (5.56-6.94 mmol/l).
The cumulative incidence and incidence density of diabetes were 3.5% (275 cases) and 7.3 per 1000 person-years over a mean follow-up period of 4.8 years. The cumulative incidence of diabetes among subjects with impaired fasting glucose at both previous examinations (persistent impaired fasting glucose) was 30.4% (222/1518) compared with 0.6% (15/5063) of those with normal fasting glucose at both baseline and initial follow-up. The hazard ratios to develop diabetes, adjusted for possible confounders, was 37.10 (95% CI, 21.6-63.7) for persistent impaired fasting glucose versus persistent normal fasting glucose. Persistent impaired fasting glucose predicted diabetes at 80.7% (222/275) sensitivity and 83.1% (6358/7654) specificity, whereas first baseline impaired fasting glucose only predicted diabetes at 86.9% (239/275) sensitivity and 74.9% (5730/7654) specificity. The model using both previous fasting plasma glucose levels had a greater AUROC (area under receiver operating characteristic) than that using first baseline fasting plasma glucose only (0.92 vs. 0.88; P < 0.001).
Repeated measurements of fasting plasma glucose better predicts incidence of diabetes than a single test. In particular, persistent fasting hyperglycaemia adds more substantial precision to the prediction of future diabetes than transient impaired fasting glucose. This combination is cost efficient and may be practical for early detection of high-risk individuals.
我们通过重复检测空腹高血糖来评估持续性空腹高血糖的价值，以预测其向糖尿病的进展。
本研究是一项回顾性队列研究，纳入了 1998 年至 2006 年期间的 7929 名参与者（37742 人年），其基线时的平均年龄为 53.0 岁。测量了糖尿病的累积发病率。基线和随访时的空腹血糖被分为正常空腹血糖（<5.56mmol/L）或受损空腹血糖（5.56-6.94mmol/L）。
在平均 4.8 年的随访期间，糖尿病的累积发病率和发病率密度分别为 3.5%（275 例）和 7.3/1000 人年。在之前两次检查中均存在受损空腹血糖（持续性受损空腹血糖）的参与者中，糖尿病的累积发病率为 30.4%（222/1518），而在基线和初始随访时均存在正常空腹血糖的参与者中，糖尿病的发病率为 0.6%（15/5063）。调整可能的混杂因素后，与持续性正常空腹血糖相比，持续性受损空腹血糖发生糖尿病的风险比为 37.10（95%CI，21.6-63.7）。持续性受损空腹血糖对糖尿病的敏感性为 80.7%（222/275），特异性为 83.1%（6358/7654），而首次基线受损空腹血糖对糖尿病的敏感性为 86.9%（239/275），特异性为 74.9%（5730/7654）。与仅使用首次基线空腹血糖相比，使用之前两次空腹血糖水平的模型具有更大的 AUROC（接受者操作特征曲线下面积）（0.92 比 0.88；P<0.001）。
空腹血糖的重复测量比单次检测更能预测糖尿病的发生。特别是，持续性空腹高血糖比一过性受损空腹血糖更能准确预测未来的糖尿病。这种组合具有成本效益，可能适用于高危人群的早期检测。
