评估ADA糖化血红蛋白（HbA1c）标准在诊断中国糖尿病高危青少年及青年人群的糖尿病前期和糖尿病中的应用：一项横断面研究。
Evaluation of ADA HbA1c criteria in the diagnosis of pre-diabetes and diabetes in a population of Chinese adolescents and young adults at high risk for diabetes: a cross-sectional study.
作者信息
Li Ge, Han Lanwen, Wang Yonghui, Zhao Yanglu, Li Yu, Fu Junling, Li Ming, Gao Shan, Willi Steven M
机构信息
Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, People's Republic of China.
Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
出版信息
BMJ Open. 2018 Aug 8;8(8):e020665. doi: 10.1136/bmjopen-2017-020665.
OBJECTIVE
We aimed to assess haemoglobin A1c (HbA1c) for the diagnosis of pre-diabetes and diabetes in a population of Chinese youths at risk of metabolic syndrome.
SETTING
Beijing, China.
PARTICIPANTS
A total of 581 subjects aged 14-28 years underwent evaluation including an oral glucose tolerance test (OGTT). Insulin sensitivity, β-cell function and a number of cardiovascular disease risk factors were evaluated. Receiver operating characteristic (ROC) curves were used to assess the screening efficacy of HbA1c.
RESULTS
Using OGTT data as a standard, the majority (70.0%, 7/10) of subjects with diabetes would have been diagnosed with HbA1c ≥6.5%. In contrast, only 28.1% (16/57) of subjects with pre-diabetes possessed elevated HbA1cs, while the majority (68.4%) had normal HbA1cs. On the contrary, a total of 8.1% (39/479) of youths in the normal HbA1c category (<5.7%) and 21.3% in the pre-diabetes category had pre-diabetes. In the ROC analysis, the area under the curve (AUC) for HbA1c identifying pre-diabetes was 0.680(95% CI 0.640 to 0.719); the optimal threshold was 5.5%, with a sensitivity of 61.4% and specificity of 68.5%. For type 2 diabetes mellitus, the AUC for HbA1c was 0.970 (0.952 to 0.982), and the optimal threshold was 6.1%, with a sensitivity of 90.0% and a specificity of 98.7%. Applying these new cut-offs, pre-diabetic participants (HbA1c 5.5%-6.1%) had lower disposition index and higher risk of dyslipidaemia (OR=1.61,95% CI 1.10 to 2.37) and metabolic syndrome (OR=2.09, 1.27 to 3.45) than those with normal HbA1c (<5.5%).
CONCLUSION
The American Diabetes Association's established HbA1c criteria for pre-diabetes and diabetes (5.7% and 6.5%) may not be appropriately applied to adolescents and young adults in China. Our findings suggest that those with HbA1c of 5.5%-6.1% already exhibit impaired β-cell function and increased cardiometabolic risk factors which may warrant intervention.
TRIAL REGISTRATION NUMBER
NCT03421444.
目的
我们旨在评估糖化血红蛋白（HbA1c）用于诊断有代谢综合征风险的中国青年人群中的糖尿病前期和糖尿病。
地点
中国北京。
参与者
共有581名年龄在14 - 28岁的受试者接受了包括口服葡萄糖耐量试验（OGTT）在内的评估。评估了胰岛素敏感性、β细胞功能以及一些心血管疾病风险因素。采用受试者工作特征（ROC）曲线评估HbA1c的筛查效能。
结果
以OGTT数据为标准，大多数（70.0%，7/10）糖尿病患者若采用HbA1c≥6.5%的标准可被诊断出来。相比之下，糖尿病前期患者中只有28.1%（16/57）的HbA1c升高，而大多数（68.4%）的HbA1c正常。相反，HbA1c正常类别（<5.7%）的青年中有8.1%（39/479）以及糖尿病前期类别中有21.3%的人患有糖尿病前期。在ROC分析中，HbA1c识别糖尿病前期的曲线下面积（AUC）为0.680（95%CI 0.640至0.719）；最佳阈值为5.5%，敏感性为61.4%，特异性为68.5%。对于2型糖尿病，HbA1c的AUC为0.970（0.952至0.982），最佳阈值为6.1%，敏感性为90.0%，特异性为98.7%。应用这些新的临界值，糖尿病前期参与者（HbA1c 5.5% - 6.1%）与HbA1c正常（<5.5%）的参与者相比，其处置指数较低，血脂异常风险（OR = 1.61，95%CI 1.10至2.37）和代谢综合征风险（OR = 2.09，1.27至3.45）较高。
结论
美国糖尿病协会制定的糖尿病前期和糖尿病的HbA1c标准（5.7%和6.5%）可能不适用于中国的青少年和青年成年人。我们的研究结果表明，HbA1c为5.5% - 6.1%的人群已经表现出β细胞功能受损和心血管代谢风险因素增加，可能需要进行干预。
试验注册号
NCT03421444。
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