Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
Diabetes Care. 2018 Jan;41(1):60-68. doi: 10.2337/dc17-0607. Epub 2017 Oct 26.
Hemoglobin A (HbA) can be used to assess type 2 diabetes (T2D) risk. We asked whether HbA was associated with T2D risk in four scenarios of clinical information availability: ) HbA alone, ) fasting laboratory tests, ) clinic data, and ) fasting laboratory tests and clinic data.
We studied a prospective cohort of white ( = 11,244) and black ( = 2,294) middle-aged participants without diabetes in the Framingham Heart Study and Atherosclerosis Risk in Communities study. Association of HbA with incident T2D (defined by medication use or fasting glucose [FG] ≥126 mg/dL) was evaluated in regression models adjusted for ) age and sex (demographics); ) demographics, FG, HDL, and triglycerides; ) demographics, BMI, blood pressure, and T2D family history; or ) all preceding covariates. We combined results from cohort and race analyses by random-effects meta-analyses. Subsidiary analyses tested the association of HbA with developing T2D within 8 years or only after 8 years.
Over 20 years, 3,315 individuals developed T2D. With adjustment for demographics, the odds of T2D increased fourfold for each percentage-unit increase in HbA. The odds ratio (OR) was 4.00 (95% CI 3.14, 5.10) for blacks and 4.73 (3.10, 7.21) for whites, resulting in a combined OR of 4.50 (3.35, 6.03). After adjustment for fasting laboratory tests and clinic data, the combined OR was 2.68 (2.15, 3.34) over 20 years, 5.79 (2.51, 13.36) within 8 years, and 2.23 (1.94, 2.57) after 8 years.
HbA predicts T2D in different common scenarios and is useful for identifying individuals with elevated T2D risk in both the short- and long-term.
血红蛋白 A（HbA）可用于评估 2 型糖尿病（T2D）风险。我们研究了 HbA 在以下四种临床信息可用情况下与 T2D 风险的相关性：）仅 HbA，）空腹实验室检查，）诊所数据，和）空腹实验室检查和诊所数据。
我们研究了弗雷明汉心脏研究和社区动脉粥样硬化风险研究中无糖尿病的白种人（=11244）和黑人（=2294）中年参与者的前瞻性队列。在调整了年龄和性别（人口统计学）、人口统计学、空腹血糖（FG）、高密度脂蛋白（HDL）和甘油三酯、人口统计学、体重指数、血压和 T2D 家族史或所有前面的协变量后，用回归模型评估了 HbA 与 T2D 事件的相关性（定义为药物使用或 FG≥126mg/dL）。我们通过随机效应荟萃分析结合了队列和种族分析的结果。辅助分析检验了 HbA 与 8 年内或 8 年后发生 T2D 的相关性。
在 20 年的随访中，有 3315 人发生了 T2D。在调整了人口统计学因素后，HbA 每增加一个百分点，T2D 的发生风险增加四倍。黑人的比值比（OR）为 4.00（95%可信区间 3.14，5.10），白人的 OR 为 4.73（3.10，7.21），综合 OR 为 4.50（3.35，6.03）。在调整了空腹实验室检查和诊所数据后，20 年内的综合 OR 为 2.68（2.15，3.34），8 年内为 5.79（2.51，13.36），8 年后为 2.23（1.94，2.57）。
HbA 在不同的常见情况下预测 T2D，对于识别短期和长期内 T2D 风险升高的个体非常有用。
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