Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Out-Patient Department of Lanzhou Military Region, Lanzhou, China.
J Diabetes. 2018 Mar;10(3):232-239. doi: 10.1111/1753-0407.12578. Epub 2017 Aug 18.
Diagnostic criteria for metabolic syndrome (MS) proposed by the Chinese Diabetes Society (CDS) may have limitations because an additional 2-h postprandial plasma glucose (2-h PPG) test is required to diagnose hyperglycemia. The aim of this study was to revise the CDS-MS criteria by removing the 2-h PPG test and determining the optimal fasting plasma glucose (FPG) cut-off for a diagnosis of hyperglycemia in the Chinese population.
The study population was from the 2007-08 China Diabetes and Metabolic Disorders Study. The optimal FPG diagnostic cut-off value was determined using receiver operating characteristic curves. Hyperglycemia defined using CDS-MS criteria was the end-point. Agreement between different diagnostic methods was assessed using κ values.
The study enrolled 46 239 participants (mean age 44.95 years). The optimal diagnostic cut-off for FPG was found to be 5.62 mmol/L, which showed a sensitivity of 66.92%, a specificity of 89.09%, and an area under the curve of 0.848. Using this diagnostic criterion, the standardized prevalence of MS was similar to that using the CDS-MS criteria (18.26% vs 17.89%, respectively), with both values being lower than those obtained using conventional international criteria (20.64-26.67%). Compared with the CDS-MS criteria, the recommended FPG cut-off showed better agreement (κ) with international criteria: 0.695, 0.774, and 0.730 with the International Diabetes Federation (IDF), revised Adult Treatment Panel III, and Joint Interim Statement of the IDF criteria, respectively.
We recommend eliminating the 2-h PPG blood test and lowering the FPG diagnostic cut-off value to 5.6 mmol/L in the CDS-MS diagnostic criteria.
中国糖尿病学会（CDS）提出的代谢综合征（MS）诊断标准可能存在局限性，因为需要进行额外的餐后 2 小时血糖（2-h PPG）检测来诊断高血糖。本研究旨在通过去除 2-h PPG 检测并确定中国人群中诊断高血糖的最佳空腹血糖（FPG）截断值来修订 CDS-MS 标准。
研究人群来自 2007-08 年中国糖尿病和代谢紊乱研究。使用受试者工作特征曲线确定最佳 FPG 诊断截断值。使用 CDS-MS 标准定义的高血糖是终点。使用κ 值评估不同诊断方法之间的一致性。
本研究共纳入 46239 名参与者（平均年龄 44.95 岁）。发现 FPG 的最佳诊断截断值为 5.62mmol/L，其灵敏度为 66.92%，特异性为 89.09%，曲线下面积为 0.848。使用该诊断标准，MS 的标准化患病率与 CDS-MS 标准相似（分别为 18.26%和 17.89%），均低于使用传统国际标准（20.64-26.67%）获得的值。与 CDS-MS 标准相比，推荐的 FPG 截断值与国际标准具有更好的一致性（κ）：与国际糖尿病联合会（IDF）、修订的成人治疗小组 III 和 IDF 标准的联合临时声明的一致性分别为 0.695、0.774 和 0.730。
我们建议在 CDS-MS 诊断标准中消除 2-h PPG 血液检测，并将 FPG 诊断截断值降低至 5.6mmol/L。
