López López Rubén, Fuentes García Ruth, González-Villalpando Maria-Elena, González-Villalpando Clicerio
Diabetes and Cardiovascular Research Unit, National Institute of Public Health, 14080 Mexico City, Mexico.
Center for Studies in Diabetes A.C., 01120 México City, Mexico.
J Endocr Soc. 2017 Aug 31;1(10):1247-1258. doi: 10.1210/js.2017-00266. eCollection 2017 Oct 1.
The agreement between glucose-based and hemoglobin A1c (HbA1c)-based American Diabetes Association criteria in the diagnosis of normal glucose tolerance, prediabetes, or diabetes is under scrutiny. A need to explore the issue among different populations exists.
Examine the results obtained with both methods in the diagnosis of the glycemic status.
The Mexico City Diabetes Study is a population-based, prospective investigation.
Low-income elder urban community.
All 854 participants without known diabetes had both oral glucose tolerance test (OGTT) and HbA1c measurements on the same day of the 2008 phase.
Standardized protocol: questionnaires, anthropometry, and biomarkers.
Diagnostic classification of American Diabetes Association criteria.
We found by OGTT normal glucose tolerance (NGT) in 512 (59.9%) participants, prediabetes [impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT)] in 261 (30.5%), and diabetes in 81 (9.4%). In total, 232 in the NGT group (45.3%) and 158 in the prediabetes group (60.5%) had HbA1c ≥6.5%. Body mass index, waist circumference, and blood pressure were significantly different among OGTT-defined diabetic status groups but not in the HbA1c-diagnosed group. We identified 404 participants in the NGT group with confirmed NGT throughout all phases of the Mexico City Diabetes Study. Of these, 184 (45.5%) had HbA1c ≥6.5%. In a vital/diabetes status follow-up performed subsequently, we found that, of these, 133 remained nondiabetic, 3 had prediabetes, 7 had diabetes, and 13 had died without diabetes; we were unable to ascertain the glycemic status in 5 and vital status in 23.
Normal OGTT coexisting with elevated HbA1c is a common finding in this cohort. It is possible that this finding is not mediated by hyperglycemia. This might occur in similar populations.
基于血糖和基于糖化血红蛋白（HbA1c）的美国糖尿病协会（ADA）标准在正常糖耐量、糖尿病前期或糖尿病诊断中的一致性受到审视。有必要在不同人群中探讨这一问题。
研究两种方法在诊断血糖状态时所获结果。
墨西哥城糖尿病研究是一项基于人群的前瞻性调查。
低收入城市老年社区。
所有854名无糖尿病史的参与者在2008年阶段的同一天均进行了口服葡萄糖耐量试验（OGTT）和HbA1c测量。
标准化方案：问卷调查、人体测量和生物标志物检测。
美国糖尿病协会标准的诊断分类。
通过OGTT，我们发现512名（59.9%）参与者为正常糖耐量（NGT），261名（30.5%）为糖尿病前期[空腹血糖受损（IFG）和/或糖耐量受损（IGT）]，81名（9.4%）为糖尿病。NGT组中共有232名（45.3%）、糖尿病前期组中158名（60.5%）的HbA1c≥6.5%。OGTT定义的糖尿病状态组之间的体重指数、腰围和血压存在显著差异，但HbA1c诊断组中无此差异。我们在墨西哥城糖尿病研究的所有阶段中确定了NGT组的404名参与者确诊为NGT。其中，184名（45.5%）的HbA1c≥6.5%。在随后进行的生命/糖尿病状态随访中，我们发现，其中133名仍无糖尿病，3名有糖尿病前期，7名有糖尿病，13名无糖尿病而死亡；5名的血糖状态和23名的生命状态无法确定。
正常OGTT与升高的HbA1c并存是该队列中的常见发现。这一发现可能并非由高血糖介导。类似人群中可能也会出现这种情况。
