Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
Department of Endocrinology and Metabolism, People's Hospital of Tibet Autonomous Region, Tibet, China.
J Clin Endocrinol Metab. 2020 Apr 1;105(4). doi: 10.1210/clinem/dgaa001.
CONTEXT: The hemoglobin A1c (HbA1c) test is a standard test for diabetes screening and diagnosis. OBJECTIVE: To evaluate A1c performance for diabetes screening in high-altitude polycythemia compared to a population with a high proportion of people living in an oxygen-deficient environment. DESIGN: A population-based epidemiological survey was conducted. SETTING: The cities Lhasa and Shigatse were selected. Volunteers were recruited through educational advertisements about diabetes. PARTICIPANTS: A total of 1401 Tibetan adults without known diabetes. INTERVENTIONS: Oral glucose tolerance test (OGTT), HbA1c, and complete blood cell count were performed. Hemoglobin A1c was evaluated using high-performance liquid chromatography, and serum glucose level, using the hexokinase method. MAIN OUTCOME MEASURES: World Health Organization criteria were used to define diabetes and prediabetes. Hemoglobin A1c test performance was evaluated using receiver operating characteristic analysis. RESULTS: The participants' mean age was 44.3 ± 15.0 years; 33.3% of the participants were men and 38.6% lived in urban areas. The prediabetes and diabetes prevalence rates were 7.5% and 3.6%, respectively. The optimal HbA1c cutoff for detecting diabetes was 46 mmol/mol (6.4%), with a sensitivity and specificity of 60.8% and 93.6%, respectively. The cutoff for detecting diabetes was 6.7% (50 mmol/mol) in subjects with high-altitude polycythemia (HAPC). The relationship between red blood cell (RBC) counts and HbA1c was significant (P < 0.001), while there was no correlation between hemoglobin (Hb) and HbA1c (P = 0.085). Multiple linear regression analysis showed that after adjusting for age and fasting serum glucose or 2-hour OGTT (OGTT2h) serum glucose, RBC count and not Hb level was an independent risk factor for HbA1c (β = 0.140, P < 0.001). CONCLUSIONS: The optimal HbA1c cutoff for detecting diabetes was 46 mmol/mol (6.4%) in Tibet. Red blood cell count was an independent risk factor for elevated HbA1c, and HAPC may affect the predictive ability of HbA1c.
背景：血红蛋白 A1c（HbA1c）检测是糖尿病筛查和诊断的标准检测方法。
目的：评估在高原红细胞增多症人群中，HbA1c 检测用于糖尿病筛查的性能，与生活在缺氧环境人群的检测性能进行比较。
设计：一项基于人群的流行病学调查。
地点：选择拉萨和日喀则市。通过关于糖尿病的教育广告招募志愿者。
参与者：共纳入 1401 名无已知糖尿病的藏族成年人。
干预措施：进行口服葡萄糖耐量试验（OGTT）、HbA1c 和全血细胞计数。使用高效液相色谱法评估血红蛋白 A1c，使用己糖激酶法评估血清葡萄糖水平。
主要观察指标：采用世界卫生组织标准定义糖尿病和糖尿病前期。使用受试者工作特征分析评估 HbA1c 检测性能。
结果：参与者的平均年龄为 44.3±15.0 岁；33.3%为男性，38.6%居住在城市。糖尿病前期和糖尿病的患病率分别为 7.5%和 3.6%。检测糖尿病的最佳 HbA1c 切点为 46mmol/mol（6.4%），其灵敏度和特异度分别为 60.8%和 93.6%。高原红细胞增多症（HAPC）患者的 HbA1c 检测切点为 6.7%（50mmol/mol）。红细胞（RBC）计数与 HbA1c 之间存在显著相关性（P＜0.001），而血红蛋白（Hb）与 HbA1c 之间无相关性（P=0.085）。多元线性回归分析显示，在校正年龄和空腹血糖或 2 小时 OGTT（OGTT2h）血清葡萄糖后，RBC 计数而非 Hb 水平是 HbA1c 的独立危险因素（β=0.140，P＜0.001）。
结论：在西藏，检测糖尿病的最佳 HbA1c 切点为 46mmol/mol（6.4%）。红细胞计数是 HbA1c 升高的独立危险因素，HAPC 可能影响 HbA1c 的预测能力。
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