Færch Kristine, Johansen Nanna B, Witte Daniel R, Lauritzen Torsten, Jørgensen Marit E, Vistisen Dorte
Steno Diabetes Center (K.F., N.B.J., M.E.J., D.V.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J.), 5000 Odense, Denmark; Centre de Recherche Public de la Santé (D.R.W.), 1445 Strassen, Luxembourg; and Institute of Public Health (T.L.), Section of General Practice, University of Aarhus, 8000 Aarhus, Denmark.
J Clin Endocrinol Metab. 2015 Feb;100(2):707-16. doi: 10.1210/jc.2014-2853. Epub 2014 Nov 11.
There is little overlap between diabetes diagnosed by glycated hemoglobin (HbA1c) and blood glucose, and it is unclear which pathophysiological defects are captured when using HbA1c for diagnosis.
We examined and compared the relationship between insulin sensitivity and β-cell function in different subphenotypes of prediabetes and type 2 diabetes (T2D).
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of the Danish ADDITION-PRO study was performed (n = 1713). Participants without known diabetes were classified into subgroups of prediabetes and T2D based on fasting or 2-hour glucose criteria or HbA1c. Insulin sensitivity and insulin release were determined from glucose and insulin concentrations during the oral glucose tolerance test, and disposition indices were calculated.
Individuals with prediabetes or T2D diagnosed by fasting glucose had lower absolute insulin release (P ≤ .01) and higher insulin sensitivity in response to glucose intake (P ≤ .01) but a similar disposition index (P ≥ .36), compared with individuals with elevated 2-hour glucose concentrations. Individuals with HbA1c-defined T2D or prediabetes had a mixture of the pathophysiological defects observed in the glucose-defined subgroups, and individuals with normoglycemia by HbA1c had worse pathophysiological abnormalities than individuals with normoglycemia by the glucose criteria.
On average, the diagnostic HbA1c criteria for diabetes and prediabetes identified individuals with a mixture of the pathophysiological characteristics found when using the glucose criteria, but the diversity and pathophysiology captured by the oral glucose tolerance test cannot be captured when applying the more simple HbA1c criteria. Whether the disease progression and prognosis will differ in individuals diagnosed by fasting glucose, 2-hour glucose, or HbA1c should be examined in longitudinal studies.
糖化血红蛋白（HbA1c）诊断的糖尿病与血糖诊断的糖尿病之间几乎没有重叠，并且尚不清楚使用HbA1c进行诊断时捕捉到了哪些病理生理缺陷。
我们研究并比较了糖尿病前期和2型糖尿病（T2D）不同亚表型中胰岛素敏感性与β细胞功能之间的关系。
设计、地点和参与者：对丹麦ADDITION-PRO研究进行了横断面分析（n = 1713）。根据空腹或2小时血糖标准或HbA1c，将无糖尿病史的参与者分为糖尿病前期和T2D亚组。通过口服葡萄糖耐量试验期间的葡萄糖和胰岛素浓度测定胰岛素敏感性和胰岛素释放，并计算处置指数。
与2小时血糖浓度升高的个体相比，空腹血糖诊断为糖尿病前期或T2D的个体绝对胰岛素释放较低（P≤0.01），对葡萄糖摄入的胰岛素敏感性较高（P≤0.01），但处置指数相似（P≥0.36）。HbA1c定义的T2D或糖尿病前期个体具有在葡萄糖定义的亚组中观察到的病理生理缺陷的混合情况，并且HbA1c血糖正常的个体比葡萄糖标准血糖正常的个体具有更差的病理生理异常。
平均而言，糖尿病和糖尿病前期的诊断性HbA1c标准识别出的个体具有使用葡萄糖标准时发现的病理生理特征的混合情况，但应用更简单的HbA1c标准时无法捕捉口服葡萄糖耐量试验所捕捉到的多样性和病理生理学。空腹血糖、2小时血糖或HbA1c诊断的个体疾病进展和预后是否会有所不同，应在纵向研究中进行检查。
