Endocrinology Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian, China.
Endocrinology Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian, China.
Diabetes Res Clin Pract. 2013 Jul;101(1):28-34. doi: 10.1016/j.diabres.2013.04.008. Epub 2013 May 15.
To assess the suitability of HbA1c as a criterion for the diagnosis of diabetes in patients with Graves' disease.
This study enrolled 310 patients with untreated newly diagnosed Graves' disease, 208 patients with euthyroid goiter and 329 age-matched (control) subjects without thyroid disease from Fuzhou, China. The performance of HbA1c against the OGTT for diagnosing diabetes was determined. The Framingham risk score was used to assess general cardiovascular disease (CVD) risk.
The percentage of patients with abnormal glucose metabolism as classified by HbA1c levels was lower than by OGTT criteria in patients with Graves' disease-33.2% vs. 41.3% for pre-diabetes and 4.5% vs. 11.3% for diabetes, respectively. The sensitivity of HbA1c for diagnosing diabetes in patients with Graves' disease was lower than in patients with euthyroid goiter and subjects without thyroid disease (34.9%, 63.2% and 60.6% respectively), while the specificity was similar (99.3%, 98.6%, 97.4%). Approximately 7.4% of patients with Graves' disease diagnosed with diabetes according to OGTT criteria were misdiagnosed as not having the disease by HbA1c, much higher than that for the other two groups. Patients with Graves' disease with diabetes not diagnosed with the disease by HbA1c showed a high risk for CVD.
The low sensitivity of the HbA1c criterion underestimated the percentage of diabetes in patients with Graves' disease. Patients with diabetes who were misdiagnosed as not having the disease by HbA1c were at high risk for CVD.
评估糖化血红蛋白（HbA1c）作为诊断格雷夫斯病（Graves’ disease）患者糖尿病的标准的适用性。
本研究纳入了 310 例未经治疗的新诊断的格雷夫斯病患者、208 例甲状腺功能正常的甲状腺肿患者和 329 例年龄匹配（对照组）的无甲状腺疾病患者，这些患者均来自中国福州。确定 HbA1c 对诊断糖尿病的 OGTT 的性能。使用 Framingham 风险评分评估一般心血管疾病（CVD）风险。
根据 HbA1c 水平分类的葡萄糖代谢异常患者百分比低于 OGTT 标准，格雷夫斯病患者中分别为 33.2%（糖尿病前期）和 4.5%（糖尿病），而甲状腺功能正常的甲状腺肿患者和无甲状腺疾病患者中分别为 41.3%和 11.3%。HbA1c 诊断格雷夫斯病患者糖尿病的敏感性低于甲状腺功能正常的甲状腺肿患者和无甲状腺疾病患者（分别为 34.9%、63.2%和 60.6%），而特异性相似（99.3%、98.6%和 97.4%）。根据 OGTT 标准诊断为糖尿病的格雷夫斯病患者中，约有 7.4%被 HbA1c 误诊为未患该病，远高于其他两组。HbA1c 未诊断为糖尿病的格雷夫斯病患者 CVD 风险较高。
HbA1c 标准的低敏感性低估了格雷夫斯病患者中糖尿病的百分比。被 HbA1c 误诊为未患该病的糖尿病患者 CVD 风险较高。
