Karnchanasorn Rudruidee, Huang Jean, Ou Horng-Yih, Feng Wei, Chuang Lee-Ming, Chiu Ken C, Samoa Raynald
Division of Endocrinology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Department of Clinical Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, CA 91010, USA; Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
J Diabetes Res. 2016;2016:6195494. doi: 10.1155/2016/6195494. Epub 2016 Aug 11.
To determine the effectiveness of hemoglobin A1c (HbA1c) ≥ 6.5% in diagnosing diabetes compared to fasting plasma glucose (FPG) ≥ 126 mg/dL and 2-hour plasma glucose (2hPG) ≥ 200 mg/dL in a previously undiagnosed diabetic cohort, we included 5,764 adult subjects without established diabetes for whom HbA1c, FPG, 2hPG, and BMI measurements were collected. Compared to the FPG criterion, the sensitivity of HbA1c ≥ 6.5% was only 43.3% (106 subjects). Compared to the 2hPG criterion, the sensitivity of HbA1c ≥ 6.5% was only 28.1% (110 subjects). Patients who were diabetic using 2hPG criterion but had HbA1c < 6.5% were more likely to be older (64 ± 15 versus 60 ± 15 years old, P = 0.01, mean ± STD), female (53.2% versus 38.2%, P = 0.008), leaner (29.7 ± 6.1 versus 33.0 ± 6.6 kg/m(2), P = 0.000005), and less likely to be current smokers (18.1% versus 29.1%, P = 0.02) as compared to those with HbA1c ≥ 6.5%. The diagnostic agreement in the clinical setting revealed the current HbA1c ≥ 6.5% is less likely to detect diabetes than those defined by FPG and 2hPG. HbA1c ≥ 6.5% detects less than 50% of diabetic patients defined by FPG and less than 30% of diabetic patients defined by 2hPG. When the diagnosis of diabetes is in doubt by HbA1c, FPG and/or 2hPG should be obtained.
为了确定在一个既往未诊断的糖尿病队列中，与空腹血糖（FPG）≥126mg/dL和餐后2小时血糖（2hPG）≥200mg/dL相比，糖化血红蛋白（HbA1c）≥6.5%用于诊断糖尿病的有效性，我们纳入了5764名无糖尿病确诊史的成年受试者，并收集了他们的HbA1c、FPG、2hPG和BMI测量值。与FPG标准相比，HbA1c≥6.5%的敏感性仅为43.3%（106名受试者）。与2hPG标准相比，HbA1c≥6.5%的敏感性仅为28.1%（110名受试者）。使用2hPG标准诊断为糖尿病但HbA1c<6.5%的患者比HbA1c≥6.5%的患者更可能年龄较大（64±15岁对60±15岁，P = 0.01，均值±标准差）、为女性（53.2%对38.2%，P = 0.008）、体型较瘦（29.7±6.1对33.0±6.6kg/m²，P = 0.000005），且当前吸烟者的可能性较小（18.1%对29.1%，P = 0.02）。临床环境中的诊断一致性表明，与FPG和2hPG定义的糖尿病相比，目前HbA1c≥6.5%检测出糖尿病的可能性较小。HbA1c≥6.5%检测出的FPG定义的糖尿病患者不到50%，2hPG定义的糖尿病患者不到30%。当HbA1c对糖尿病诊断存疑时，应检测FPG和/或2hPG。
