Živković Mila, Tönjes Anke, Baber Ronny, Wirkner Kerstin, Loeffler Markus, Engel Christoph
LIFE - Leipzig Research Centre for Civilization Diseases University of Leipzig Leipzig Germany.
Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig Leipzig Germany.
Endocrinol Diabetes Metab. 2018 Jul 11;1(4):e00030. doi: 10.1002/edm2.30. eCollection 2018 Oct.
Diabetes screening strategies using glycated haemoglobin (HbA1c) as first-instance diagnostic parameter may cause failure to detect individuals with abnormal glucose regulation and possible signs of microvascular complications despite "rule-out" HbA1c levels. This cross-sectional study examined the diagnostic performance of HbA1c in relation to fasting and two-hour postload plasma glucose (FPG/2 h-PG), and investigated whether individuals with normal HbA1c but abnormal FPG/2 h-PG have a higher prevalence of moderately increased albuminuria as possible sign of early stage kidney damage.
A total of 2695 individuals (age 40-79 years, 48% men) without prior diagnosis of diabetes and complete measurement of HbA1c, FPG, 2 h-PG and urine albumin-creatinine ratio (UACR) were taken from a large population-based epidemiological study in the City of Leipzig, Germany.
A total of 2439 individuals (90.5%, 95% CI: 89.4-91.6) had normal HbA1c levels, <39 mmol/mol (<5.7%), while 234 (8.7%, 95% CI: 7.7-9.8) had prediabetes, HbA1c ≥39 and <48 mmol/mol (≥5.7 and <6.5%), and 22 (0.8%, 95% CI: 0.5-1.2) had diabetes, HbA1c ≥48 mmol/mol (≥6.5%), according to HbA1c. Among individuals with normal HbA1c, 35.6% (95% CI: 33.7-37.5) had impaired fasting glucose or impaired glucose tolerance and 1.8% (95% CI: 1.4-2.4) had diabetes according to FPG/2 h-PG. Individuals with normal HbA1c but prediabetic or diabetic FPG/2 h-PG had a significantly higher prevalence of moderately increased albuminuria (9.4%, 95% CI: 7.6-11.5 and 13.3%, 95% CI: 5.8-25.4, respectively) than individuals with normal HbA1c and normal FPG/2 h-PG (3.9%, 95% CI: 3.0-5.0).
The prevalence of prediabetes according to FPG/2 h-PG among individuals with normal HbA1c is considerably high, and the prevalence of moderately increased albuminuria in this group is significantly elevated. Risk factors for diabetes such as age, gender and BMI may help to better identify this at-risk group.
使用糖化血红蛋白（HbA1c）作为首要诊断参数的糖尿病筛查策略可能会导致无法检测出葡萄糖调节异常以及存在微血管并发症潜在迹象的个体，尽管其HbA1c水平处于“排除”范围。这项横断面研究检验了HbA1c相对于空腹及餐后两小时血浆葡萄糖（FPG/2h-PG）的诊断性能，并调查了HbA1c正常但FPG/2h-PG异常的个体中，中度蛋白尿增加（作为早期肾脏损害的潜在迹象）的患病率是否更高。
从德国莱比锡市一项基于人群的大型流行病学研究中选取了2695名个体（年龄40 - 79岁，48%为男性），这些个体之前未被诊断出患有糖尿病，且HbA1c、FPG、2h-PG及尿白蛋白肌酐比值（UACR）测量完整。
根据HbA1c，共有2439名个体（90.5%，95%CI：89.4 - 91.6）的HbA1c水平正常，<39 mmol/mol（<5.7%），234名个体（8.7%，95%CI：7.7 - 9.8）患有糖尿病前期，HbA1c≥39且<48 mmol/mol（≥5.7且<6.5%），22名个体（0.8%，95%CI：0.5 - 1.2）患有糖尿病，HbA1c≥48 mmol/mol（≥6.5%）。在HbA1c正常的个体中，根据FPG/2h-PG，35.6%（95%CI：33.7 - 37.5）存在空腹血糖受损或糖耐量受损，1.8%（95%CI：1.4 - 2.4）患有糖尿病。HbA1c正常但FPG/2h-PG处于糖尿病前期或糖尿病范围的个体中，中度蛋白尿增加的患病率（分别为9.4%，95%CI：7.6 - 11.5和13.3%，95%CI：5.8 - 25.4）显著高于HbA1c正常且FPG/2h-PG正常的个体（3.9%，95%CI：3.0 - 5.0）。
HbA1c正常的个体中，根据FPG/2h-PG诊断的糖尿病前期患病率相当高，且该组中中度蛋白尿增加的患病率显著升高。年龄、性别和BMI等糖尿病风险因素可能有助于更好地识别这一高危人群。
