Zhang Ruyi, Wang Jiao, Luo Jinhua, Yang Xiaoyan, Yang Rui, Cai Dehong, Zhang Hua
Department of Endocrinology, Guangzhou Red Cross Hospital, Medical College of Jinan University, Guangzhou, Guangdong, China.
Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Asia Pac J Clin Nutr. 2015;24(3):360-6. doi: 10.6133/apjcn.2015.24.3.14.
To evaluate the cutoff value of HbA1c for predicting diabetes and prediabetes in a Chinese high risk population aged over 45.
A total of 619 people aged over 45 without diabetes were randomly recruited to complete Finnish Diabetes Risk Score (FINDRISC) questionnaire. 208 high-risk individuals (defined by Diabetes Risk Score >=9) had OGTT and HbA1c determined at the same time.
In a Chinese population aged over 45, the best cutoff value of HbA1c for detecting diabetes and prediabetes was 5.8% and 5.4% respectively. The area under the receiver operating characteristic (AUROC) curve of HbA1c for detecting diabetes was 0.85 (95% CI: 0.80-0.90) and prediabetes was 0.62 (95% CI: 0.54-0.70). The combined use of HbA1c and fasting blood glucose (FPG) had larger AUROC than HbA1c alone (0.88, 95%CI: 0.83-0.92 in detecting diabetes vs 0.75, 95% CI: 0.67-0.82 in prediabetes), and had a higher sensitivity in predicting diabetes and higher specificity and positive predictive value (PPV) in predicting prediabetes. However, the AUROC between HbA1c alone and combined use in predicting diabetes was not significantly different (p=0.173).
FINDRISC is feasible tool to screen people who are at high risk of diabetes. The cutoff values of HbA1c to diagnose diabetes and prediabetes in a Chinese high risk population aged over 45 were 5.8% and 5.4%, respectively. The sensitivity and specificity of HbA1c for detecting diabetes and prediabetes was relatively low, so that the combined use of HbA1c and FPG may be more effective in prediction.
评估糖化血红蛋白（HbA1c）在预测45岁以上中国高危人群患糖尿病及糖尿病前期的临界值。
随机招募619名45岁以上无糖尿病的人群，完成芬兰糖尿病风险评分（FINDRISC）问卷。208名高危个体（糖尿病风险评分≥9定义）同时进行口服葡萄糖耐量试验（OGTT）及HbA1c检测。
在45岁以上中国人群中，HbA1c检测糖尿病及糖尿病前期的最佳临界值分别为5.8%和5.4%。HbA1c检测糖尿病的受试者工作特征曲线下面积（AUROC）为0.85（95%可信区间：0.80 - 0.90），检测糖尿病前期为0.62（95%可信区间：0.54 - 0.70）。HbA1c与空腹血糖（FPG）联合使用的AUROC大于单独使用HbA1c（检测糖尿病时分别为0.88，95%可信区间：0.83 - 0.92；检测糖尿病前期时分别为0.75，95%可信区间：0.67 - 0.82），且在预测糖尿病时敏感性更高，预测糖尿病前期时特异性及阳性预测值（PPV）更高。然而，单独使用HbA1c与联合使用在预测糖尿病时的AUROC无显著差异（p = 0.173）。
FINDRISC是筛查糖尿病高危人群的可行工具。45岁以上中国高危人群中诊断糖尿病及糖尿病前期的HbA1c临界值分别为5.8%和5.4%。HbA1c检测糖尿病及糖尿病前期的敏感性和特异性相对较低，因此HbA1c与FPG联合使用在预测中可能更有效。
