Romain A J, Letendre E, Akrass Z, Avignon A, Karelis A D, Sultan A, Abdel-Baki A
University of Montreal Hospital Research Centre (CRCHUM), Montréal, Qc, Canada.
Department of Metabolic Medicine, University Hospital of Montreal, Montreal, Qc, Canada.
Exp Clin Endocrinol Diabetes. 2017 Apr;125(4):251-255. doi: 10.1055/s-0042-116313. Epub 2017 Jan 12.
Prediabetes and type 2 diabetes are highly prevalent among individuals with serious mental illness and increased by antipsychotic medication. Although widely recommended, many obstacles prevent these patients from obtaining a proper screening for dysglycemia. Currently, glycated hemoglobin (HbA1c), fasting glucose, and 2-hour glucose levels from the oral glucose tolerance test are used for screening prediabetes and type 2 diabetes. The objective of this study was to investigate if HbA1c could be used as the only screening test among individuals with serious mental illness. Cross sectional study comparing the sensitivity of HbA1c, fasting glucose, and 2-h oral glucose tolerance test to detect dysglycemias in serious mental illness participants referred for metabolic complications. A total of 84 participants (43 female; aged: 38.5±12.8 years; BMI: 35.0±6.8 kg/m²) was included. Regarding prediabetes, 44, 44 and 76% were identified by HbA1c, fasting glucose, and 2 h- oral glucose tolerance test respectively and for type 2 diabetes, 60, 53 and 66% were identified by HbA1c, fasting glucose and 2 h-oral glucose tolerance test. The overlap between the 3 markers was low (8% of participants for prediabetes and 26% for Type 2 diabetes). Sensitivity of HbA1c were moderate (range 40-62.5%), while its specificity was excellent (92-93%). The present study indicates a low agreement between HbA1c, fasting glucose and 2-h oral glucose tolerance test. It appears that these markers do not identify the same participants. Thus, HbA1c may not be used alone to detect all glucose abnormalities among individuals with serious mental illness.
糖尿病前期和2型糖尿病在患有严重精神疾病的个体中高度流行，且会因抗精神病药物治疗而增加。尽管有广泛的推荐，但许多障碍使这些患者无法获得适当的血糖异常筛查。目前，糖化血红蛋白（HbA1c）、空腹血糖以及口服葡萄糖耐量试验中的2小时血糖水平被用于筛查糖尿病前期和2型糖尿病。本研究的目的是调查HbA1c是否可作为患有严重精神疾病个体的唯一筛查测试。横断面研究比较了HbA1c、空腹血糖和2小时口服葡萄糖耐量试验在因代谢并发症转诊的严重精神疾病参与者中检测血糖异常的敏感性。共纳入84名参与者（43名女性；年龄：38.5±12.8岁；体重指数：35.0±6.8kg/m²）。对于糖尿病前期，分别通过HbA1c、空腹血糖和2小时口服葡萄糖耐量试验识别出44%、44%和76%的患者；对于2型糖尿病，分别通过HbA1c、空腹血糖和2小时口服葡萄糖耐量试验识别出60%、53%和66%的患者。这三种标志物之间的重叠率较低（糖尿病前期参与者为8%，2型糖尿病患者为26%）。HbA1c的敏感性中等（范围为40 - 62.5%），而其特异性极佳（92 - 93%）。本研究表明HbA1c、空腹血糖和2小时口服葡萄糖耐量试验之间的一致性较低。似乎这些标志物识别的不是同一批参与者。因此，HbA1c可能不能单独用于检测患有严重精神疾病个体中的所有血糖异常情况。
