Kim Chul-Hee, Kim Hong-Kyu, Kim Eun-Hee, Bae Sung-Jin, Choe Jaewon, Park Joong-Yeol
Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
Health Screening & Promotion Center, Asan Medical Center, Seoul, Republic of Korea.
Diabetes Res Clin Pract. 2016 Aug;118:105-11. doi: 10.1016/j.diabres.2016.06.009. Epub 2016 Jun 18.
To examine the abilities of HbA1c and fasting plasma glucose (FPG) criteria predicting 5-year progression rate to diabetes in Korean adults with prediabetes.
Participants included 17,971 Koreans (aged 20-79years) who underwent routine medical check-ups at a mean interval of 5.2years (3.1-6.7years). Prediabetes was defined as FPG 5.6-6.9mmol/l or HbA1c 5.7-6.4% (39-46mmol/mol). Incident diabetes was defined as FPG⩾7.0mmol/l, HbA1c⩾6.5% (48mmol/mol), or initiation of antidiabetic medications.
At baseline, the prevalence of prediabetes was 30.6% (n=5495) by FPG and 20.4% (n=3664) by HbA1c criteria. The 5-year progression rate to diabetes was significantly higher in prediabetes identified by HbA1c than by FPG tests (14.7% vs. 10.4%, P<0.001). Of individuals diagnosed with prediabetes by only one test, those by HbA1c alone had a higher risk of progression to diabetes than those diagnosed by FPG alone (6.0% vs. 3.9%, P<0.001). Receiver operating characteristic curve analysis showed that area under the curve was greater for HbA1c (0.855, 95% CI 0.840-0.870) than for FPG (0.830, 0.813-0.846) (P=0.016). After adjustment for conventional risk factors, the odds ratio (OR) of developing diabetes was higher in participants with prediabetes identified by HbA1c (OR 9.91, 8.24-11.9) than by FPG (OR 7.29, 5.97-8.89) (P=0.026).
Although fewer individuals with prediabetes were identified by HbA1c than by FPG criteria, the ability to predict progression to diabetes was stronger for HbA1c than for FPG in Koreans.
研究糖化血红蛋白（HbA1c）和空腹血糖（FPG）标准预测韩国糖尿病前期成年人5年糖尿病进展率的能力。
研究对象包括17971名韩国人（年龄20 - 79岁），他们平均每隔5.2年（3.1 - 6.7年）接受一次常规体检。糖尿病前期定义为FPG 5.6 - 6.9mmol/l或HbA1c 5.7 - 6.4%（39 - 46mmol/mol）。新发糖尿病定义为FPG⩾7.0mmol/l、HbA1c⩾6.5%（48mmol/mol）或开始使用抗糖尿病药物。
在基线时，根据FPG标准糖尿病前期患病率为30.6%（n = 5495），根据HbA1c标准为20.4%（n = 3664）。通过HbA1c确定的糖尿病前期患者5年糖尿病进展率显著高于通过FPG检测确定的患者（14.7%对10.4%，P<0.001）。在仅通过一项检测诊断为糖尿病前期的个体中，仅通过HbA1c诊断的个体进展为糖尿病的风险高于仅通过FPG诊断的个体（6.0%对3.9%，P<0.001）。受试者工作特征曲线分析显示，HbA1c的曲线下面积（0.855，95%CI 0.840 - 0.870）大于FPG（0.830，0.813 - 0.846）（P = 0.016）。在调整传统危险因素后，通过HbA1c确定为糖尿病前期的参与者患糖尿病的优势比（OR）高于通过FPG确定的参与者（OR 9.91，8.24 - 11.9）对（OR 7.29，5.97 - 8.89）（P = 0.026）。
尽管通过HbA1c确定的糖尿病前期个体比通过FPG标准确定的少，但在韩国人中，HbA1c预测糖尿病进展的能力比FPG更强。
