Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Can J Diabetes. 2018 Dec;42(6):582-587. doi: 10.1016/j.jcjd.2018.03.005. Epub 2018 Mar 12.
The aim of this study was to evaluate the capability of glycated hemoglobin (A1C) levels to be a tool for identifying Iranian adults with diabetes and prediabetes.
In a cross-sectional population-based study, 1,813 adults, men and women 35 to 75 years of age and without a history of diabetes and hemoglobinopathies, were included. Fasting blood glucose and A1C levels were obtained. According to the criteria of the American Diabetes Association, participants were categorized into 3 groups: newly diagnosed diabetes, prediabetes and healthy subjects. The optimal cutoff point for A1C in diabetes and prediabetes diagnosis was determined by studying the sensitivity and specificity of different cutoff points for A1C, while using different levels of fasting blood glucose as the gold standard.
Participants with newly diagnosed diabetes were significantly older than subjects with prediabetes and healthy subjects (mean [± SD] 47.3±12.9, 44.6±13.0 and 39.2±14.1 years, respectively) and also had higher body mass indexes. As expected, the levels of fasting blood glucose (8.79±2.24, 6.01±0.38 and 4.97±0.4 mmol/L) and A1C (6.55±1.4%, 5.61±0.61% and 5.28±0.59%) were significantly different in the groups (p<0.001). The optimal cutoff point for A1C to predict prediabetes was 5.5% (sensitivity of 60.5% and specificity of 63.1%) and for diabetes was 5.9% (sensitivity of 66.7% and specificity of 81.2%). ADA cutoff points for prediabetes and diabetes detection yielded a sensitivity of 45.2% and 39.8%, respectively.
The findings suggest the necessity of determining the A1C cutoffs for detecting diabetes or prediabetes in each region's population. They also suggest that the combination of these A1C cutoffs with fasting blood glucose levels are required to determine diabetes and prediabetes more accurately.
本研究旨在评估糖化血红蛋白（HbA1c）水平作为识别伊朗成年人糖尿病和糖尿病前期的工具的能力。
在一项横断面基于人群的研究中，纳入了 1813 名年龄在 35 至 75 岁之间、无糖尿病和血红蛋白病病史的男性和女性。检测空腹血糖和 HbA1c 水平。根据美国糖尿病协会的标准，参与者分为 3 组：新诊断的糖尿病、糖尿病前期和健康人群。通过研究不同 HbA1c 切点的灵敏度和特异性，同时使用不同水平的空腹血糖作为金标准，确定诊断糖尿病和糖尿病前期的 HbA1c 最佳切点。
新诊断的糖尿病患者明显比糖尿病前期和健康人群年龄大（分别为 47.3±12.9、44.6±13.0 和 39.2±14.1 岁），体重指数也更高。正如预期的那样，空腹血糖（8.79±2.24、6.01±0.38 和 4.97±0.4mmol/L）和 HbA1c（6.55±1.4%、5.61±0.61%和 5.28±0.59%）水平在各组之间差异显著（p<0.001）。预测糖尿病前期的 HbA1c 最佳切点为 5.5%（灵敏度为 60.5%，特异性为 63.1%），预测糖尿病的最佳切点为 5.9%（灵敏度为 66.7%，特异性为 81.2%）。ADA 用于检测糖尿病前期和糖尿病的切点灵敏度分别为 45.2%和 39.8%。
研究结果表明，有必要在每个地区的人群中确定 HbA1c 切点以检测糖尿病或糖尿病前期。研究结果还表明，需要结合这些 HbA1c 切点和空腹血糖水平，以更准确地确定糖尿病和糖尿病前期。
