M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu, India.
Diabetes Res Clin Pract. 2013 Oct;102(1):60-4. doi: 10.1016/j.diabres.2013.08.007. Epub 2013 Aug 31.
The methods used for diagnosis of diabetes have limitations particularly in situations associated with stress hyperglycemia. Aim of this study was to evaluate the performance of A1c and fasting plasma glucose (FPG) tests for screening newly diagnosed diabetes (NDD) defined by OGTT among tuberculosis (TB) cases in India.
A total of 983 subjects aged ≥18 years with TB were selected from 7 TB units - 4 urban, 2 rural and 1 semi-urban areas of Tamil Nadu, India, during August 2010-March 2011. Screening for diabetes was carried out by 2-h 75g OGTT. Classification of glucose intolerance status was based on WHO criteria. HbA1c was measured by high performance liquid chromatography using Bio-Rad turbo machine. HbA1c≥47.5mmol/mol was used for diagnosis of diabetes. FPG was estimated by glucose-oxidase method. Known cases of subjects with diabetes were excluded and final analysis was done using data of 779 individuals. The performance of A1c and FPG tests was evaluated against the results of OGTT using receiver operating characteristic curve analysis.
Prevalence of NDD was 10.8%. The areas under the curve (AUC) were 0.754 [95% confidence interval (CI) 0.68-0.83] (p<0.001) for A1c and 0.662 (95% CI 0.58-0.74) for FPG (p<0.001) in NDD subjects. The HbA1c cut-off point of ≥47.5mmol/mol gave a sensitivity of 59.1% and specificity of 91.7%, and the respective values were 34.8% and 97.5% for FPG in subjects with NDD.
HbA1c performed better than FPG as a screening tool for newly diagnosed diabetes among subjects with TB.
糖尿病的诊断方法存在局限性，特别是在应激性高血糖相关情况下。本研究旨在评估 A1c 和空腹血浆葡萄糖（FPG）检测在印度结核病（TB）患者中筛查新诊断糖尿病（NDD）的表现，该诊断方法采用口服葡萄糖耐量试验（OGTT）定义。
2010 年 8 月至 2011 年 3 月，从印度泰米尔纳德邦的 7 个结核病单位（4 个城市、2 个农村和 1 个半城市地区）中选择了 983 名年龄≥18 岁的结核病患者。通过 2 小时 75g OGTT 进行糖尿病筛查。根据世界卫生组织（WHO）标准对葡萄糖耐量状态进行分类。采用 Bio-Rad turbo 机器的高效液相色谱法测量 HbA1c。HbA1c≥47.5mmol/mol 用于诊断糖尿病。采用葡萄糖氧化酶法测量 FPG。排除有糖尿病病史的患者，对 779 名个体的最终分析结果进行分析。使用受试者工作特征曲线分析评估 A1c 和 FPG 检测对 OGTT 结果的性能。
NDD 的患病率为 10.8%。NDD 患者的曲线下面积（AUC）分别为 0.754[95%置信区间（CI）0.68-0.83]（p<0.001）（AUC）为 0.662（95%CI 0.58-0.74）（p<0.001）。HbA1c 切点≥47.5mmol/mol 时，NDD 患者的灵敏度为 59.1%，特异性为 91.7%，FPG 的灵敏度和特异性分别为 34.8%和 97.5%。
HbA1c 作为结核病患者新诊断糖尿病的筛查工具，其性能优于 FPG。
