Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China.
J Investig Med. 2012 Aug;60(6):888-94. doi: 10.2310/JIM.0b013e31825a47fe.
To examine the performance of hemoglobin A1c (HbA1c) in diagnosing prediabetes and whether it was associated with cardiometabolic risk factors in Chinese adolescents without known diabetes.
This was a cross-sectional study including 933 adolescents (aged 11-16 years; 46.5% girls) with HbA1c of 6.4% or less and fasting plasma glucose (FPG) of 6.9 mmol/L or less. All participants underwent anthropometric and biochemical examinations. The individuals with an increased HbA1c (5.7%-6.4%) were given a 75-g oral glucose tolerance test (OGTT).
Of 213 subjects with an increased HbA1c or increased FPG (5.6-6.9 mmol/L), only 4.7% (n = 10) met both criteria. Among the 68 students with increased HbA1c who agreed to undergo the OGTT, only 18 subjects (26.5%) were confirmed to be prediabetic, and the receiver operating characteristic curve for HbA1c to identify prediabetes diagnosed by OGTT had an AUC of 0.53, which was not statistically significant (P = 0.69). The waist circumference, FPG, uric acid, and homeostasis assessment model of insulin resistance were correlated with HbA1c (all P < 0.05). Hemoglobin A1c showed significant association with abdominal obesity and dyslipidemia and the clustering of cardiometabolic risk factors (odds ratios, 1.58-1.90; all P < 0.05). The cutoff point of HbA1c was 5.6% with a maximum accuracy in determining multiple cardiometabolic risk factors (sensitivity, 35.1%; specificity, 72.2%).
There is poor agreement between HbA1c and FPG or OGTT in diagnosing prediabetes, but the former was associated with the presence of multiple cardiometabolic risk factors in Chinese adolescents.
研究血红蛋白 A1c（HbA1c）在诊断中国青少年糖尿病前期中的表现及其与心血管代谢危险因素的关系。
这是一项横断面研究，纳入了 933 名 HbA1c ＜6.4%且空腹血糖（FPG）＜6.9mmol/L 的青少年（年龄 11-16 岁，46.5%为女性）。所有参与者均接受了人体测量学和生化检查。HbA1c 升高（5.7%-6.4%）的个体进行了 75g 口服葡萄糖耐量试验（OGTT）。
在 213 名 HbA1c 或 FPG 升高（5.6-6.9mmol/L）的受试者中，仅 4.7%（n=10）同时符合两项标准。在同意行 OGTT 的 68 名 HbA1c 升高的学生中，仅有 18 名（26.5%）被确诊为糖尿病前期，HbA1c 诊断 OGTT 确诊的糖尿病前期的受试者工作特征曲线的 AUC 为 0.53，无统计学意义（P=0.69）。腰围、FPG、尿酸和胰岛素抵抗的稳态模型评估与 HbA1c 相关（均 P＜0.05）。HbA1c 与腹型肥胖和血脂异常及心血管代谢危险因素聚集显著相关（比值比，1.58-1.90；均 P＜0.05）。HbA1c 的最佳截断值为 5.6%，对确定多种心血管代谢危险因素具有最高的准确性（灵敏度 35.1%，特异性 72.2%）。
HbA1c 与 FPG 或 OGTT 诊断糖尿病前期的一致性较差，但前者与中国青少年中存在多种心血管代谢危险因素相关。
