Department of Endocrinology-Diabetology-Nutrition, Jean-Verdier Hospital, AP-HP, avenue-du-14-juillet, 93143 Bondy cedex, France.
Diabetes Metab. 2012 Jun;38(3):217-24. doi: 10.1016/j.diabet.2011.11.007. Epub 2012 Feb 1.
To test if the use of either HbA(1c) level or calculated clinical scores including two published scores and a new score (the Bondy score) could help in selecting overweight or obese women who should benefit from oral glucose tolerance test (OGTT) to detect dysglycaemia.
The French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) score and the Finnish Diabetes risk score (Findrisk) were calculated, whereas the Bondy score was built in a development sample of 698 women, BMI 37±7 kg/m(2), without known diabetes. External validation was performed in a validation sample of 212 women.
A dysglycaemia (according to OGTT results, WHO criteria) was diagnosed in 161 (23.1%) patients. Sensitivity of fasting plasma glucose (FPG)≥6.1 mmol/l and HbA(1c)≥6% to identify dysglycaemia were respectively 27 and 41%. Areas under Receiver Operator Curve (AROC) of HbA(1c), DESIR score and Findrisk to detect dysglycaemia were 0.630 [95% confidence interval 0.580-0.680], 0.606 [0.561-0.652] and 0.635 [0.588-0.683], respectively. The Bondy score, based on age and waist circumference, had a better AROC (0.674 [0.626-0.721]) than the DESIR score (P<0.05). These performances were confirmed in the validation sample. Performing OGTT only in subjects with a Bondy score≥4 (41% of the sample) had a sensitivity of 61% and a better net benefit (0.128) than measuring FPG in all subjects (0.069).
Performing OGTT in obese women selected on a simple clinical score is more sensitive to identify dysglycaemia than measuring FPG in all of them and may be cost-effective.
检验糖化血红蛋白（HbA1c）水平或包含两项已发表评分和一项新评分（邦迪评分）的临床计算评分是否有助于选择超重或肥胖的女性，使她们受益于口服葡萄糖耐量试验（OGTT）以检测糖代谢异常。
计算了法国流行病学研究中关于胰岛素抵抗综合征（DESIR）评分和芬兰糖尿病风险评分（Findrisk），同时在 698 名 BMI 为 37±7kg/m2、无已知糖尿病的女性的发展样本中构建了邦迪评分。在 212 名女性的验证样本中进行了外部验证。
根据 OGTT 结果（WHO 标准），161 例（23.1%）患者被诊断为糖代谢异常。空腹血糖（FPG）≥6.1mmol/L 和 HbA1c≥6%的敏感性分别为 27%和 41%。HbA1c、DESIR 评分和 Findrisk 检测糖代谢异常的受试者工作特征曲线下面积（AROC）分别为 0.630[95%置信区间 0.580-0.680]、0.606[0.561-0.652]和 0.635[0.588-0.683]。基于年龄和腰围的邦迪评分具有更好的 AROC（0.674[0.626-0.721]），优于 DESIR 评分（P<0.05）。这些结果在验证样本中得到了验证。仅对邦迪评分≥4 的患者（占样本的 41%）进行 OGTT，其敏感性为 61%，净获益（0.128）优于对所有患者进行 FPG 测量（0.069）。
对简单的临床评分选择的肥胖女性进行 OGTT 检测糖代谢异常的敏感性高于对所有女性进行 FPG 测量，并且可能具有成本效益。
