糖化血红蛋白和口服葡萄糖耐量试验用于诊断糖尿病高危儿童 2 型糖尿病的比较。

Comparison of HbA1c and OGTT for the diagnosis of type 2 diabetes in children at risk of diabetes.

机构信息

Department of Pediatrics, Chonbuk National University Medical School, South Korea; Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, South Korea.

出版信息

Pediatr Neonatol. 2019 Aug;60(4):428-434. doi: 10.1016/j.pedneo.2018.11.002. Epub 2018 Nov 9.

DOI:10.1016/j.pedneo.2018.11.002

PMID:30497969

Abstract

BACKGROUND

The aim of this study was to evaluate the correlation between plasma glucose and HbA1c and the diagnostic accuracy of HbA1c as a screening tool to identify asymptomatic diabetes mellitus in children and adolescents with obesity or asymptomatic glucosuria.

METHODS

A total of 190 subjects who underwent an oral glucose tolerance test (OGTT) to confirm diabetes were categorized into normal glucose tolerance (NGT; n = 117), impaired glucose tolerance (IGT; n = 33), and diabetes (DM; n = 40) according to the OGTT. Forty-seven patients with DM were diagnosed by either OGTT or HbA1c levels. The diagnostic accuracy for the detection of diabetes is based on 47 patients. Laboratory tests were performed after 12 h of fasting.

RESULTS

According to the HbA1c criterion, 107 (55.3%) subjects were in the NGT group, 41 (21.6%) were in the IGT group, and 42 (22.1%) were in the DM group. Diagnostic sensitivities of HbA1c and 2-hour plasma glucose level following OGTT (2-h OGTT) for DM were significantly higher than that of fasting plasma glucose, FPG (89.4, 85.1 vs. 63.8%). In addition, the area under the curves of diagnostic criteria was 0.970 for HbA1c, 0.939 for FPG and 0.977 for 2-h OGTT. Mean FPG and 2-h OGTT for HbA1c level >6.5% were 115.2 mg/dL and 181.8 mg/dL, respectively. The optimal HbA1c level cut-off point for predicting DM is 6.15%, with a sensitivity of 95.7% in Korean children and adolescents.

CONCLUSION

The HbA1c criterion ≥6.5% was adequate to detect DM among Korean children and adolescents with obesity or asymptomatic glucosuria. We also recommend HbA1c level of 6.15% as the optimal cut-off point for detecting DM in Korean children and adolescents.

摘要

背景

本研究旨在评估血浆葡萄糖与 HbA1c 的相关性，以及 HbA1c 作为筛查工具识别肥胖或无症状糖尿病人群中糖尿病的准确性。

方法

共纳入 190 例行口服葡萄糖耐量试验（OGTT）以明确糖尿病的患者，根据 OGTT 结果分为正常糖耐量（NGT；n=117）、糖耐量受损（IGT；n=33）和糖尿病（DM；n=40）。47 例 DM 患者根据 OGTT 或 HbA1c 确诊。基于 47 例 DM 患者评估检测糖尿病的诊断准确性。所有患者均于禁食 12 h 后进行实验室检查。

结果

根据 HbA1c 标准，107 例（55.3%）患者为 NGT 组，41 例（21.6%）为 IGT 组，42 例（22.1%）为 DM 组。HbA1c 和 OGTT 后 2 小时血糖（2-h OGTT）对 DM 的诊断敏感度显著高于空腹血糖（FPG），分别为 89.4%、85.1%和 63.8%。此外，诊断标准的曲线下面积（AUC）为 HbA1c 0.970、FPG 0.939 和 2-h OGTT 0.977。HbA1c 水平>6.5%时的平均 FPG 和 2-h OGTT 分别为 115.2 mg/dL 和 181.8 mg/dL。预测 DM 的最佳 HbA1c 水平截断值为 6.15%，在韩国儿童和青少年中具有 95.7%的敏感度。