Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
Diabet Med. 2013 Mar;30(3):318-25. doi: 10.1111/dme.12008.
To evaluate whether homeostasis model assessment and high-sensitivity C-reactive protein improve the prediction of isolated post-load hyperglycaemia.
The subjects were 1458 adults without self-reported diabetes recruited between 2006 and 2010. Isolated post-load hyperglycaemia was defined as fasting plasma glucose < 7 mmol/l and 2-h post-load plasma glucose ≥ 11.1 mmol/l. Risk scores of isolated post-load hyperglycaemia were constructed by multivariate logistic regression. An independent group (n = 154) was enrolled from 2010 to 2011 to validate the models' performance.
One hundred and twenty-three subjects (8.28%) were newly diagnosed as having diabetes mellitus. Among those with undiagnosed diabetes, 64 subjects (52%) had isolated post-load hyperglycaemia. Subjects with isolated post-load hyperglycaemia were older, more centrally obese and had higher blood pressure, HbA(1c), fasting plasma glucose, triglycerides, LDL cholesterol, high-sensitivity C-reactive protein and homeostasis model assessment of insulin resistance and lower homeostasis model assessment of β-cell function than those without diabetes. The risk scores included age, gender, BMI, homeostasis model assessment, high-sensitivity C-reactive protein and HbA(1c). The full model had high sensitivity (84%) and specificity (87%) and area under the receiver operating characteristic curve (0.91), with a cut-off point of 23.81; validation in an independent data set showed 88% sensitivity, 77% specificity and an area under curve of 0.89.
Over half of those with undiagnosed diabetes had isolated post-load hyperglycaemia. Homeostasis model assessment and high-sensitivity C-reactive protein are useful to identify subjects with isolated post-load hyperglycaemia, with improved performance over fasting plasma glucose or HbA(1c) alone.
评估稳态模型评估和高敏 C 反应蛋白是否能提高对孤立性负荷后高血糖的预测能力。
该研究纳入了 1458 名无糖尿病自述的成年人，他们于 2006 年至 2010 年间被招募。孤立性负荷后高血糖定义为空腹血糖<7mmol/L 且 2 小时负荷后血糖≥11.1mmol/L。采用多变量逻辑回归构建孤立性负荷后高血糖的风险评分。2010 年至 2011 年，一个独立的小组(n=154)被纳入以验证模型的性能。
有 123 名受试者(8.28%)被新诊断为糖尿病。在未诊断出糖尿病的人群中，有 64 名受试者(52%)患有孤立性负荷后高血糖。与无糖尿病者相比，孤立性负荷后高血糖者年龄较大、中心性肥胖、血压较高、糖化血红蛋白(HbA1c)、空腹血糖、甘油三酯、低密度脂蛋白胆固醇、高敏 C 反应蛋白和胰岛素抵抗稳态模型评估值较高，而胰岛β细胞功能稳态模型评估值较低。风险评分包括年龄、性别、体重指数、稳态模型评估、高敏 C 反应蛋白和 HbA1c。全模型具有较高的敏感性(84%)和特异性(87%)，受试者工作特征曲线下面积为 0.91，截断值为 23.81；在独立数据集的验证中，敏感性为 88%，特异性为 77%，曲线下面积为 0.89。
超过一半的未诊断出糖尿病者患有孤立性负荷后高血糖。稳态模型评估和高敏 C 反应蛋白有助于识别孤立性负荷后高血糖者，其性能优于单独的空腹血糖或 HbA1c。
