Bowen Michael E, Xuan Lei, Lingvay Ildiko, Halm Ethan A
Division of General Internal Medicine, Department of Medicine (M.E.B., E.A.H.), Division of Outcomes and Health Services Research, Department of Clinical Sciences (M.E.B., L.X., E.A.H.), Division of Endocrinology, Department of Medicine (I.L.), and Department of Clinical Sciences (I.L.), University of Texas Southwestern Medical Center, Dallas, Texas 75390.
J Clin Endocrinol Metab. 2015 Apr;100(4):1503-10. doi: 10.1210/jc.2014-4116. Epub 2015 Feb 4.
Although random blood glucose (RBG) values are common in clinical practice, the role of elevated RBG values as a risk factor for type 2 diabetes is not well described.
This study aimed to examine nondiagnostic, RBG values as a risk factor for type 2 diabetes
This was a cross-sectional study of National Health and Nutrition Examination Surveys (NHANES) participants (2005-2010).
Nonfasting NHANES participants (n = 13 792) without diagnosed diabetes were included.
The primary outcome was glycemic status (normal glycemia, undiagnosed prediabetes, or undiagnosed diabetes) using hemoglobin HbA1C as the criterion standard.
Multinomial logistic regression examined associations between diabetes risk factors and RBG values according to glycemic status. Associations between current U.S. screening strategies and a hypothetical RBG screening strategy with undiagnosed diabetes were examined.
In unadjusted analyses, a single RBG ≥ 100 mg/dL (5.6 mmol/L) was more strongly associated with undiagnosed diabetes than any single risk factor (odds ratio [OR], 31.2; 95% confidence interval [CI], 21.3-45.5) and remained strongly associated with undiagnosed diabetes (OR, 20.4; 95% CI, 14.0-29.6) after adjustment for traditional diabetes risk factors. Using RBG < 100 mg/dL as a reference, the adjusted odds of undiagnosed diabetes increased significantly as RBG increased. RBG 100-119 mg/dL (OR 7.1; 95% CI 4.4-11.4); RBG 120-139 mg/dL (OR 30.3; 95% CI 20.0-46.0); RBG ≥ 140 mg/dL (OR 256; 95% CI 150.0-436.9). As a hypothetical screening strategy, an elevated RBG was more strongly associated with undiagnosed diabetes than current United States Preventative Services Task Force guidelines (hypertension alone; P < .0001) and similar to American Diabetes Association guidelines (P = .12).
A single RBG ≥ 100 mg/dL is more strongly associated with undiagnosed diabetes than traditional risk factors. Abnormal RBG values are a risk factor for diabetes and should be considered in screening guidelines.
尽管随机血糖（RBG）值在临床实践中很常见，但RBG值升高作为2型糖尿病风险因素的作用尚未得到充分描述。
本研究旨在检验非诊断性RBG值作为2型糖尿病的风险因素。
这是一项对国家健康和营养检查调查（NHANES，2005 - 2010年）参与者的横断面研究。
纳入未诊断出糖尿病的非空腹NHANES参与者（n = 13792）。
以糖化血红蛋白HbA1C作为标准，主要结局是血糖状态（正常血糖、未诊断的糖尿病前期或未诊断的糖尿病）。
多项逻辑回归根据血糖状态检验糖尿病风险因素与RBG值之间的关联。检验了当前美国筛查策略与假设的RBG筛查策略对未诊断糖尿病的关联。
在未调整分析中，单次RBG≥100mg/dL（5.6mmol/L）与未诊断糖尿病的关联比任何单一风险因素都更强（优势比[OR]，31.2；95%置信区间[CI]，21.3 - 45.5），在调整传统糖尿病风险因素后，仍与未诊断糖尿病密切相关（OR，20.4；95%CI，14.0 - 29.6）。以RBG<100mg/dL作为参照，随着RBG升高，未诊断糖尿病的调整后优势显著增加。RBG 100 - 119mg/dL（OR 7.1；95%CI 4.4 - 11.4）；RBG 120 - 139mg/dL（OR 30.3；95%CI 20.0 - 46.0）；RBG≥140mg/dL（OR 256；95%CI 150.0 - 436.9）。作为一种假设的筛查策略，RBG升高与未诊断糖尿病的关联比当前美国预防服务工作组指南（仅高血压；P<.0001）更强，与美国糖尿病协会指南相似（P = 0.12）。
单次RBG≥100mg/dL与未诊断糖尿病的关联比传统风险因素更强。异常RBG值是糖尿病的一个风险因素，应在筛查指南中予以考虑。
