Zhou Xianfeng, Ruan Xiaonan, Hao Lipeng, Zhou Yi, Gu Jianjun, Qiu Hua, Wu Kang, Yu Siyu, Rui Xinyi, Wang Xiaonan, Liu Xiaolin, Ke Juzhong, Zhao Genming, Sun Qiao
School of Public Health, Fudan University, No. 130, Dongan Road, Shanghai 200032, China; Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China.
Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China.
Prim Care Diabetes. 2018 Jun;12(3):238-244. doi: 10.1016/j.pcd.2017.12.006. Epub 2018 Jan 20.
Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia.
We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycemia.
The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC=0.798, 95%CI: 0.779-0.818) and 5.6% (AUC=0.655, 95%CI: 0.638-0.671). When compared with elderly age group (≥70 years), HbA1c for detecting NDD performed better in youth (15-39 years: P=0.003, 40-49 years: P<0.001). There were 13.81% and 13.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis.
The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard.
由于中国人群的多样性，评估糖化血红蛋白（HbA1c）诊断高血糖的阈值需要大量研究。
我们纳入了2013年浦东新区社区队列基线中7909名年龄≥15岁且无已知糖尿病的受试者。参与者进行了口服葡萄糖耐量试验（OGTT）和HbA1c检测。通过受试者工作特征曲线确定HbA1c在诊断高血糖中的阈值。
该人群中诊断新诊断糖尿病（NDD）和糖尿病前期的最佳HbA1c阈值分别为6.0%（AUC=0.798，95%CI：0.779-0.818）和5.6%（AUC=0.655，95%CI：0.638-0.671）。与老年年龄组（≥70岁）相比，HbA1c检测NDD在年轻人中表现更好（15-39岁：P=0.003，40-49岁：P<0.001）。通过HbA1c标准将分别有13.81%和13.34%的参与者被新检测为NDD和糖尿病前期；同时，通过OGTT标准诊断为NDD和糖尿病前期的参与者中分别有3.20%和15.52%会被漏诊。
NDD和糖尿病前期的最佳HbA1c阈值低于美国糖尿病协会（ADA）标准。对于是否选择HbA1c作为诊断标准或结合两种诊断标准，有必要仔细考虑。当推荐HbA1c作为诊断标准时，应考虑特定年龄的诊断阈值。
