Huang Jean, Ou Horng-Yih, Karnchanasorn Rudruidee, Samoa Raynald, Chuang Lee-Ming, Chiu Ken C, Feng Wei
Department of Clinical Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA.
Endocrine. 2015 Mar;48(2):511-8. doi: 10.1007/s12020-014-0301-3. Epub 2014 Jun 4.
Fasting plasma glucose (FPG) is the preferred test in diagnosis of diabetes mellitus (DM) to 2-h post-challenged plasma glucose (2hPG). There is little information available on the comparison between FPG and 2hPG diagnostic criteria. This study included adult participants (≥18 years old) of the NHANES 2005-2010 with FPG, 2hPG, and BMI measured. Subjects with established DM were excluded. The sensitivity of FPG and 2hPG diagnostic criteria was compared as the main outcome measure. Among 5,782 subjects, 476 subjects (8.23 %) were diagnosed with DM by either FPG, 2hPG, or both criteria. Among the subjects meeting the criterion of FPG, those with 2hPG <200 mg/dL were younger (57 ± 16 vs. 61 ± 15 years old, P < 0.05, mean ± STD) and less obese (30.81 ± 7.89 vs. 32.71 ± 6.68 kg/m(2), P < 0.05) as compared to those with 2hPG ≥200 mg/dL. Among the subjects meeting the criterion of 2hPG, those with FPG <126 mg/dL were more female (55.41 vs. 39.88 %, P < 0.0002), less obese (29.24 ± 5.83 vs. 32.71 ± 6.68 kg/m(2), P < 0.000001), lower diastolic blood pressure (67 ± 12 vs. 71 ± 14 mmHg, P < 0.02), and less family history of DM (36.35 vs. 48.47 %, P < 0.02) as compared to those with FPG ≥126 mg/dL. The sensitivity of diagnosis of DM was only 41.37 % for FPG criterion, while it was 66.53 % for 2hPG criterion. Thus, compared to 2hPG criterion, FPG criterion had a lower sensitivity detecting new cases of DM. The use of FPG criterion would more likely result in underdiagnosing DM, especially in female and less obese subjects, as compared to the use of 2hPG criterion.
在糖尿病（DM）诊断中，空腹血糖（FPG）比口服葡萄糖耐量试验2小时血糖（2hPG）更受青睐。关于FPG和2hPG诊断标准之间的比较，现有信息较少。本研究纳入了2005 - 2010年美国国家健康与营养检查调查（NHANES）中测量了FPG、2hPG和体重指数（BMI）的成年参与者（≥18岁）。已确诊DM的受试者被排除。以比较FPG和2hPG诊断标准的敏感性作为主要结局指标。在5782名受试者中，476名受试者（8.23%）通过FPG、2hPG或两者标准被诊断为DM。在符合FPG标准的受试者中，2hPG<200mg/dL的受试者比2hPG≥200mg/dL的受试者更年轻（57±16岁对61±15岁，P<0.05，均值±标准差）且肥胖程度更低（30.81±7.89对32.71±6.68kg/m²，P<0.05）。在符合2hPG标准的受试者中，FPG<126mg/dL的受试者比FPG≥126mg/dL的受试者女性比例更高（55.41%对39.88%，P<0.0002）、肥胖程度更低（29.24±5.83对32.71±6.68kg/m²，P<0.000001）、舒张压更低（67±12对71±14mmHg，P<0.02）且DM家族史更少（36.35%对48.47%，P<0.02）。FPG标准诊断DM的敏感性仅为41.37%，而2hPG标准为66.53%。因此，与2hPG标准相比，FPG标准检测DM新病例的敏感性较低。与使用2hPG标准相比，使用FPG标准更有可能导致DM诊断不足，尤其是在女性和肥胖程度较低的受试者中。
