Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands.
BMC Endocr Disord. 2013 Feb 25;13:8. doi: 10.1186/1472-6823-13-8.
The glycated haemoglobin A1c (HbA1c) level may be used for screening for type 2 diabetes and prediabetes instead of a more burdensome oral glucose tolerance test (OGTT). However, among the high-risk South Asian population, little is known about the overlap of the methods or about the metabolic profiles of those disconcordantly diagnosed.
We included 944 South Asians (18-60 years old), whom we screened with the HbA1c level and the OGTT in The Hague, the Netherlands. We calculated the area under the receiver-operator characteristic curve (AUROC) with a 95% confidence interval of HbA1c using the American Diabetes Association classifications, and determined the sensitivity and specificity with 95% confidence intervals at different thresholds. Moreover, we studied differences in metabolic characteristics between those identified by HbA1c and by the OGTT alone.
The overlap between HbA1c and OGTT classifications was partial, both for diabetes and prediabetes. The AUROC of HbA1c for OGTT defined diabetes was 0.86 (0.79-0.93). The sensitivity was 0.46 (0.29-0.63); the specificity 0.98 (0.98-0.99). For prediabetes, the AUROC was 0.73 (0.69-0.77). Each of the 31 individuals with diabetes and 353 with prediabetes identified with the HbA1c level had a high body mass index, large waist circumference, high blood pressure, and low insulin sensitivity, all of which were similar to the values shown by those among the 19 with diabetes or 62 with prediabetes who only met the OGTT criteria, but not the HbA1c criteria.
The HbA1c level identified a partially different group than the OGTT did. However, both those identified with the HbA1c level and those identified with the OGTT alone were at increased metabolic risk.
Dutch Trial Register: NTR1499.
糖化血红蛋白（HbA1c）水平可用于筛查 2 型糖尿病和糖尿病前期，而不是采用更繁琐的口服葡萄糖耐量试验（OGTT）。然而，在南亚高危人群中，对于这些方法的重叠性或诊断不一致人群的代谢特征知之甚少。
我们纳入了 944 名 18-60 岁的南亚人，在荷兰海牙用 HbA1c 水平和 OGTT 对他们进行了筛查。我们用美国糖尿病协会的分类方法计算了 HbA1c 的受试者工作特征曲线下面积（AUROC）及其 95%置信区间，并确定了不同阈值下的敏感性和特异性及其 95%置信区间。此外，我们还研究了仅用 HbA1c 和 OGTT 识别出的人群之间代谢特征的差异。
HbA1c 和 OGTT 分类之间的重叠是部分的，无论是糖尿病还是糖尿病前期。HbA1c 对 OGTT 定义的糖尿病的 AUROC 为 0.86（0.79-0.93）。敏感性为 0.46（0.29-0.63）；特异性为 0.98（0.98-0.99）。对于糖尿病前期，AUROC 为 0.73（0.69-0.77）。用 HbA1c 水平识别出的 31 名糖尿病患者和 353 名糖尿病前期患者的体重指数均较高，腰围较大，血压较高，胰岛素敏感性较低，这些均与 OGTT 标准符合但 HbA1c 标准不符合的 19 名糖尿病患者或 62 名糖尿病前期患者的数值相似。
HbA1c 水平识别出的人群与 OGTT 识别出的人群不完全相同。然而，用 HbA1c 水平识别出的患者和仅用 OGTT 识别出的患者都存在代谢风险增加的情况。
荷兰临床试验注册中心：NTR1499。
