Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Clinical Laboratory, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.
Exp Clin Endocrinol Diabetes. 2021 Feb;129(2):86-92. doi: 10.1055/a-0833-8119. Epub 2019 Apr 30.
The HbA1c has been considered as the 'gold standard' in diabetes diagnosis and management, however, age, gender and body mass index (BMI) might have certain effects on HbA1c. We are aiming to further investigate the correlation between age and HbA1c, and whether it was affected by gender and BMI.
A cross-sectional survey including 135,893 nondiabetic individuals who took the physical examination between 2013 and 2017 was conducted. The subjects were grouped by gender, age and BMI, and the interactive and independent effects of the 3 factors on the HbA1c were detected. The median and 95% confidence interval (CI) of HbA1c levels were calculated.
The HbA1c levels gradually increased along with age, both in female and male, and there is a positive association between BMI and the HbA1c. The difference on HbA1c in gender was associated with both age and BMI, the age-related increase in HbAlc was accentuated in the subgroup with higher BMI, and there was a marked accentuation of the positive association between BMI and HbA1c as age increased. In almost all the young and middle-aged (aged 20-59) subgroups, the 97.5 percentiles of HbA1c levels were lower than 6.5%, suggesting that the single HbA1c cutoff value is probably not applicable to the young and middle-aged population.
We recommend that the effects of age, gender and BMI should be taken into consideration when using HbA1c for the diagnosis and management of diabetes, especially in the young and middle-aged population.
糖化血红蛋白（HbA1c）一直被认为是糖尿病诊断和管理的“金标准”，然而，年龄、性别和体重指数（BMI）可能对 HbA1c 有一定影响。我们旨在进一步研究年龄与 HbA1c 之间的相关性，以及其是否受到性别和 BMI 的影响。
本研究采用横断面调查，纳入了 2013 年至 2017 年期间进行体检的 135893 名非糖尿病个体。根据性别、年龄和 BMI 将受试者分组，检测 3 个因素之间的相互作用和独立影响。计算 HbA1c 水平的中位数和 95%置信区间（CI）。
无论在男性还是女性中，HbA1c 水平随年龄逐渐升高，且 BMI 与 HbA1c 呈正相关。性别之间 HbA1c 的差异与年龄和 BMI 有关，HbA1c 的年龄相关性增加在 BMI 较高的亚组中更为明显，且随着年龄的增加，BMI 与 HbA1c 之间的正相关关系更为显著。在几乎所有的年轻和中年（20-59 岁）亚组中，HbA1c 水平的第 97.5 百分位数均低于 6.5%，提示单一的 HbA1c 截断值可能不适用于年轻和中年人群。
我们建议在使用 HbA1c 诊断和管理糖尿病时，应考虑年龄、性别和 BMI 的影响，尤其是在年轻和中年人群中。
