Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
Diabetes Res Clin Pract. 2015 Aug;109(2):238-45. doi: 10.1016/j.diabres.2015.05.047. Epub 2015 Jun 1.
The aims were to compare the appropriate cutoffs of glycated hemoglobin (HbA1c) in a population of varying ages and to evaluate the performance of HbA1c for diagnosing diabetes and prediabetes. A total of 1064 participants in the young and middle-aged group and 1671 in the elderly group were included and underwent HbA1c testing and an oral glucose tolerance test (OGTT). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated to evaluate the optimal HbA1c cutoffs. Kappa coefficients were used to test for agreement between HbA1c categorization and OGTT-based diagnoses. The optimal HbA1c cutoffs for diagnosing diabetes were 5.7% (39 mmol/mol) in the young and middle-aged group with a sensitivity of 66.7%, specificity of 86.7%, and AUC of 0.821 (95% CI: 0.686, 0.955) and 5.9% (41 mmol/mol) in the elderly group with a sensitivity of 80.4%, specificity of 73.3%, and AUC of 0.831 (0.801, 0.861). The optimal cutoffs for diagnosing prediabetes were 5.6% (38 mmol/mol) and 5.7% (39 mmol/mol) in the young and middle-aged group and in the elderly group, respectively. Agreement between the OGTT-based diagnosis of diabetes or prediabetes and the optimal HbA1c cutoff was low (all kappa coefficients <0.4). The combination of HbA1c and fasting plasma glucose increased diagnostic sensitivities or specificities. In conclusion, age-specific HbA1c cutoffs for diagnosing diabetes or prediabetes were appropriate. Furthermore, the performance of HbA1c for diagnosing diabetes and prediabetes was poor. HbA1c should be used in combination with traditional glucose criteria when detecting and diagnosing diabetes or prediabetes.
目的是比较不同年龄段人群中糖化血红蛋白（HbA1c）的适当切点，并评估 HbA1c 诊断糖尿病和糖尿病前期的性能。共纳入青年和中年组 1064 例和老年组 1671 例，行 HbA1c 检测和口服葡萄糖耐量试验（OGTT）。计算敏感性、特异性和受试者工作特征曲线（ROC）下面积（AUC），以评估最佳 HbA1c 切点。使用 Kappa 系数检验 HbA1c 分类与 OGTT 诊断的一致性。青年和中年组诊断糖尿病的最佳 HbA1c 切点为 5.7%（39 mmol/mol），敏感性为 66.7%，特异性为 86.7%，AUC 为 0.821（95%CI：0.686，0.955），老年组为 5.9%（41 mmol/mol），敏感性为 80.4%，特异性为 73.3%，AUC 为 0.831（0.801，0.861）。青年和中年组和老年组诊断糖尿病前期的最佳切点分别为 5.6%（38 mmol/mol）和 5.7%（39 mmol/mol）。OGTT 诊断的糖尿病或糖尿病前期与最佳 HbA1c 切点之间的一致性较低（所有 Kappa 系数均<0.4）。HbA1c 与空腹血糖相结合可提高诊断的敏感性或特异性。结论：年龄特异性 HbA1c 切点适用于诊断糖尿病或糖尿病前期。此外，HbA1c 诊断糖尿病和糖尿病前期的性能较差。在检测和诊断糖尿病或糖尿病前期时，HbA1c 应与传统的血糖标准结合使用。
