Kwon Soon Sung, Kwon Ja-Young, Park Yong-Won, Kim Young-Han, Lim Jong-Baeck
Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Medicine, The graduate school, Yonsei University, Seoul, Republic of Korea.
Department of Obstetrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
Diabetes Res Clin Pract. 2015 Oct;110(1):38-43. doi: 10.1016/j.diabres.2015.07.014. Epub 2015 Aug 13.
HbA1c is a widely used marker in diagnosing type 2 diabetes mellitus (DM), but its clinical utility in diagnosing gestational diabetes mellitus (GDM) is not established. Here, we evaluated the clinical usefulness of HbA1c in diagnosing GDM and predicting the risk of future type 2 DM development among GDM patients.
This retrospective, cross-sectional study included 321 subjects who underwent 100-g oral glucose tolerance tests (OGTT) during pregnancy. HbA1c and other variables were analyzed to evaluate their diagnostic performance for GDM. To evaluate the clinical usefulness of HbA1c in predicting future type 2 DM development, we classified GDM subjects who had more than 3 months of follow-up data into two subgroups: those who developed postpartum type 2 DM (PDM) and those who did not.
HbA1c was significantly higher in the GDM group than in the normal control group. With the 100-g OGTT as reference, HbA1c showed 91.3% sensitivity and 62% specificity at a cut-off value of 5.05% (32 mmol/mol) for GDM diagnosis. At a cut-off value of 5.25% (34 mmol/mol), sensitivity was 73.6% and specificity was 77.2%. HbA1c levels during pregnancy were higher in those with PDM than in those without PDM (5.91 [41 mmol/mol] vs. 5.44% [36 mmol/mol], p<0.001). The prognostic value of HbA1c for PDM was evaluated by ROC curve analysis, with sensitivity of 78.6% and specificity of 72.5% at a cut-off value of 5.55% (37 mmol/mol).
HbA1c showed high sensitivity with relatively low specificity for diagnosis of GDM in pregnant women and was a potential predictor of PDM. HbA1c may be able to be used as a simple and less invasive alternative screening test for OGTT in GDM patients.
糖化血红蛋白（HbA1c）是诊断2型糖尿病（DM）时广泛使用的指标，但其在诊断妊娠期糖尿病（GDM）中的临床应用价值尚未确立。在此，我们评估了HbA1c在诊断GDM以及预测GDM患者未来发生2型糖尿病风险方面的临床实用性。
这项回顾性横断面研究纳入了321名在孕期接受100克口服葡萄糖耐量试验（OGTT）的受试者。分析HbA1c及其他变量，以评估它们对GDM的诊断性能。为评估HbA1c在预测未来发生2型糖尿病方面的临床实用性，我们将有超过3个月随访数据的GDM受试者分为两个亚组：产后发生2型糖尿病（PDM）的受试者和未发生的受试者。
GDM组的HbA1c显著高于正常对照组。以100克OGTT为参照，对于GDM诊断，HbA1c在截断值为5.05%（32 mmol/mol）时显示出91.3%的敏感性和62%的特异性。在截断值为5.25%（34 mmol/mol）时，敏感性为73.6%，特异性为77.2%。发生PDM者孕期的HbA1c水平高于未发生PDM者（5.91 [41 mmol/mol] 对5.44% [36 mmol/mol]，p<0.001）。通过ROC曲线分析评估HbA1c对PDM的预后价值，在截断值为5.55%（37 mmol/mol）时，敏感性为78.6%，特异性为72.5%。
HbA1c在诊断孕妇GDM时显示出高敏感性和相对较低的特异性，并且是PDM的潜在预测指标。HbA1c或许能够作为GDM患者OGTT的一种简单且侵入性较小的替代筛查试验。
