Department of Laboratory Medicine and Pathology, Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.
Department of Medicine, Haukeland University Hospital, Bergen, Norway.
J Diabetes. 2019 Jun;11(6):466-476. doi: 10.1111/1753-0407.12873. Epub 2018 Nov 26.
Peripheral arterial disease (PAD) and diabetes mellitus (DM) represent major public health challenges and are tightly associated. To facilitate early diagnosis, HbA1c has been implemented as the preferred diagnostic tool for the diagnosis of type 2 DM. In this study, we compared and evaluated HbA1c, fasting plasma glucose (FPG), and 2-hour post-load glucose values to determine which test best predicted mortality in patients with PAD.
In all, 273 PAD patients with unknown glycemic status admitted to Haukeland University Hospital for elective surgery between October 2006 and September 2007 were included in the study. All 273 patients underwent a standard oral glucose tolerance test (OGTT) in addition to determination of HbA1c; patients were then grouped into those with DM, intermediate hyperglycemia, and normoglycemia according to World Health Organization and International Expert Committee criteria.
All-cause mortality was 40% over a 9-year follow-up period. After adjusting for age, sex, and relevant medication, HbA1c was a predictor for mortality (hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.03-2.32]; P = 0.04). The association did not achieve statistical significance in a fully adjusted Cox regression model, although the effect estimation of HbA1c on all-cause mortality remained largely unchanged (HR 1.39; 95% CI 0.92-2.09; P = 0.13). The OGTT was not a predictor of long-term mortality.
The results indicate that HbA1c is a useful marker in the preoperative screening of patients of unknown glycemic status at the time of admission for vascular surgery, and may identify people at high risk of long-term mortality following surgical treatment for PAD.
外周动脉疾病（PAD）和糖尿病（DM）是主要的公共卫生挑战，二者紧密相关。为了促进早期诊断，HbA1c 已被用作诊断 2 型 DM 的首选诊断工具。在这项研究中，我们比较和评估了 HbA1c、空腹血浆葡萄糖（FPG）和 2 小时负荷后血糖值，以确定哪种测试最能预测 PAD 患者的死亡率。
共纳入 273 例因择期手术于 2006 年 10 月至 2007 年 9 月入住豪克兰大学医院且血糖状态未知的 PAD 患者。所有 273 例患者均接受了标准口服葡萄糖耐量试验（OGTT），并测定了 HbA1c；然后根据世界卫生组织和国际专家委员会标准，将患者分为 DM 组、中间高血糖组和正常血糖组。
在 9 年的随访期间，全因死亡率为 40%。在校正年龄、性别和相关药物后，HbA1c 是死亡率的预测因子（危险比 [HR] 1.54；95%置信区间 [CI] 1.03-2.32；P = 0.04）。在完全调整的 Cox 回归模型中，这种关联未达到统计学意义，但 HbA1c 对全因死亡率的影响估计基本保持不变（HR 1.39；95% CI 0.92-2.09；P = 0.13）。OGTT 不是长期死亡率的预测因子。
结果表明，HbA1c 是血管外科手术时未知血糖状态患者术前筛查的有用标志物，可识别接受 PAD 手术治疗后长期死亡率高的人群。
