Liu Yongquan, Tian Hui, Fang Fusheng, Xiao Haiying, Lu Yanhui, Shao Yinghong, Li Chunlin
Department of Geriatric Endocrinology, General Hospital of PLA, Beijing 100853, China.
Department of Geriatric Endocrinology, General Hospital of PLA, Beijing 100853, China. Email:
Zhonghua Yi Xue Za Zhi. 2014 May 13;94(18):1388-92.
To explore the significance of 2-hour blood glucose after standardized steamed bread meal (SB-2 hBG) in diabetic screening.
A retrospective study was conducted for diabetic screening data of annual check-up at PLA General Hospital from May 1996 to June 2002. And 100 g standardized steamed bread meal test was performed for non-diabetic subjects. Those subjects with SB-2 h BG ≥ 7.2 mmol/L underwent a 75 g oral glucose tolerance test (OGTT) within 2 weeks to determine whether the diagnosis of diabetes mellitus (DM) could be established (WHO, 1985, 1999, Diagnostic Criteria for Diabetes). By extracting the data for 7 consecutive years, we analyzed the significance and the cut-off point of SB-2 hBG in the diagnosis of DM and investigated the changes of blood glucose curves in different glucose tolerance status after different glucose loading tests.
A total of 3 343 subjects with complete information were recruited. There were 3 101 males and 242 females with an age range of 40-94 years. According to the results of OGTT, 429 (12.8%) subjects were diagnosed as DM, 1 405 (42.1%) were diagnosed as impaired glucose regulation (IGR) and 1 509(45.1%) had normal glucose tolerance (NGT).With a deterioration of glucose tolerance status, the difference between SB-2 hBG and OGTT-2 hBG increased gradually in 3 group (P < 0.01), namely the NGT group 1.7 (0.8-2.8) mmol/L, IGR group -0.4 (-1.2-0.6) mmol/L, DM group -2.7(-3.8-1.1) mmol/L. The cut-off points of FBG for the diagnosis of IGR and DM were 5.3 (sensitivity of 46.2%, specificity of 68.5%) and 5.6 (sensitivity of 57.4%, specificity of 76.4%) mmol/L respectively. The cut-off points of SB-2 h BG were 8.2 mmol/L for the diagnosis of IGR (sensitivity of 63.8%, specificity of 59.9%) and 9.2 mmol/L for the diagnosis of DM (sensitivity of 66.4%, specificity of 76.4%).If the cut-off point of SB-2 h BG was set at 7.2 mmol/L, the diagnostic specificity became quite low.However, at 11.1 mmol/L, the sensitivity was 31.5% and the specificity 95.7% for the diagnosis of DM. The coincidences of cut-off points of FBG and SB-2 hBG for the diagnosis of IGR and DM were equal (P > 0.05).When the cut-off point of SB-2 h BG was set at 7.8 mmol/L, the sensitivity was 77.4% and the specificity 41.8% for the diagnosis of IGR. And it was much better than FBG at 5.6 mmol/L (P < 0.01).
With a deterioration of glucose tolerance, the difference between SB-2 hBG and OGTT-2 hBG increases gradually. Compared to the diagnostic criteria of OGTT, the optimal cut-off points for the diagnosis of IGR and DM were 5.3 vs 5.6 mmol/L for FBG and 8.2 vs 9.2 mmol/L for SB-2 hBG respectively.For diabetic screening in middle-aged and elders, the cut-off points of FBG at 5.3 mmol/L and SB-2 hBG at 7.8 mmol/L are indicators for further OGTT.
探讨标准化馒头餐2小时血糖（SB-2 hBG）在糖尿病筛查中的意义。
对1996年5月至2002年6月解放军总医院年度体检的糖尿病筛查数据进行回顾性研究。对非糖尿病受试者进行100 g标准化馒头餐试验。SB-2 h BG≥7.2 mmol/L的受试者在2周内进行75 g口服葡萄糖耐量试验（OGTT），以确定是否可确诊糖尿病（DM）（WHO，1985年、1999年，糖尿病诊断标准）。通过提取连续7年的数据，分析SB-2 hBG在DM诊断中的意义及切点，并研究不同糖耐量状态下不同葡萄糖负荷试验后血糖曲线的变化。
共纳入3343例信息完整的受试者。其中男性3101例，女性242例，年龄范围为40 - 94岁。根据OGTT结果，429例（12.8%）受试者被诊断为DM，1405例（42.1%）被诊断为糖调节受损（IGR），1509例（45.1%）糖耐量正常（NGT）。随着糖耐量状态变差，3组中SB-2 hBG与OGTT-2 hBG的差值逐渐增大（P < 0.01），即NGT组为1.7（0.8 - 2.8）mmol/L，IGR组为 - 0.4（ - 1.2 - 0.6）mmol/L，DM组为 - 2.7（ - 3.8 - 1.1）mmol/L。诊断IGR和DM的空腹血糖（FBG）切点分别为5.3 mmol/L（敏感度46.2%，特异度68.5%）和5.6 mmol/L（敏感度57.4%，特异度76.4%）。诊断IGR的SB-2 h BG切点为8.2 mmol/L（敏感度63.8%，特异度59.9%），诊断DM的切点为9.2 mmol/L（敏感度66.4%，特异度76.4%）。若将SB-2 h BG切点设定为7.2 mmol/L，诊断特异度会变得很低。然而，设定为11.1 mmol/L时，诊断DM的敏感度为31.5%，特异度为95.7%。诊断IGR和DM时FBG与SB-2 hBG切点的符合率相同（P > 0.05）。当SB-2 h BG切点设定为7.8 mmol/L时，诊断IGR的敏感度为77.4%，特异度为41.8%，优于FBG为5.6 mmol/L时（P < 0.01）。
随着糖耐量变差，SB-2 hBG与OGTT-2 hBG的差值逐渐增大。与OGTT诊断标准相比，诊断IGR和DM的最佳切点分别为FBG的5.3和5.6 mmol/L，SB-2 hBG的8.2和9.2 mmol/L。对于中老年糖尿病筛查，FBG切点5.3 mmol/L和SB-2 hBG切点7.8 mmol/L是进一步进行OGTT的指标。
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