Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo (UiO), Oslo 0318, Norway.
Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará 60020-181, Brazil.
Int J Environ Res Public Health. 2019 Sep 26;16(19):3598. doi: 10.3390/ijerph16193598.
The study evaluated glycated hemoglobin (HbA1c) as a diagnostic tool for diabetes and pre-diabetes in the Brazilian population. Further, the homeostasis model assessment of insulin resistance (HOMA-IR) was also examined against HbA1c values to identify the most suitable cut-off points for HOMA-IR to predict the risk of diabetes. A cross-sectional study was conducted among 714 randomly selected subjects. HbA1c, fasting, and 2 h plasma glucose values were measured. Insulin resistance estimates were calculated with HOMA-IR. The receiver operating characteristic curve assessed HbA1c performance. The adjusted prevalence rate of diabetes mellitus was 14.7%, and pre-diabetes 14.2%. The optimal HbA1c cut-off value was ≥6.8% for the diagnosis of diabetes, and ≥6.0% for pre-diabetes. The area under the curve using HbA1c was 0.85 (95% CI: 0.80-0.90) for detecting diabetes and 0.61 (95% CI: 0.55-0.67) for pre-diabetes. The optimal HOMA-IR cut-off value was 2.06 for HbA1c at 6.8%. The HbA1c cut-off value of ≥6.8% may be suitable for diagnosing diabetes in the Brazilian population. Our results do not support the use of HbA1c to diagnose pre-diabetes. A HOMA-IR cut-off point of 2.06 was a sensitive marker to assess the risk of diabetes.
本研究评估了糖化血红蛋白(HbA1c)在巴西人群中作为糖尿病和糖尿病前期的诊断工具。此外,还针对 HbA1c 值检查了胰岛素抵抗的稳态模型评估(HOMA-IR),以确定最适合的 HOMA-IR 截断值来预测糖尿病风险。这是一项在 714 名随机选择的受试者中进行的横断面研究。测量了 HbA1c、空腹和 2 小时血浆葡萄糖值。使用 HOMA-IR 计算胰岛素抵抗估计值。接受者操作特征曲线评估了 HbA1c 的性能。调整后的糖尿病患病率为 14.7%,糖尿病前期为 14.2%。诊断糖尿病的最佳 HbA1c 截断值为≥6.8%,诊断糖尿病前期的最佳 HbA1c 截断值为≥6.0%。使用 HbA1c 时,曲线下面积(AUC)为 0.85(95%置信区间:0.80-0.90),用于检测糖尿病,AUC 为 0.61(95%置信区间:0.55-0.67),用于检测糖尿病前期。对于 HbA1c 为 6.8%时,最佳 HOMA-IR 截断值为 2.06。HbA1c 截断值≥6.8%可能适合诊断巴西人群中的糖尿病。我们的结果不支持使用 HbA1c 来诊断糖尿病前期。HOMA-IR 截断值 2.06 是评估糖尿病风险的敏感标志物。