在撒哈拉以南非洲地区贫血比例较高的人群中，通过糖化血红蛋白评估糖尿病和糖尿病前期的患病率及预测因素：一项前瞻性横断面研究。
Assessment of diabetes and prediabetes prevalence and predictors by HbA1c in a population from sub-Saharan Africa with a high proportion of anemia: a prospective cross-sectional study.
作者信息
Hodel Nikolai Carl, Hamad Ali, Reither Klaus, Mwangoka Grace, Kasella Irene, Praehauser Claudia, Abdulla Salim, Hatz Christoph F R, Mayr Michael
机构信息
Medical Outpatient Department, Universitätsspital Basel, Basel, Switzerland.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
出版信息
BMJ Open Diabetes Res Care. 2020 May;8(1). doi: 10.1136/bmjdrc-2019-000939.
INTRODUCTION
Epidemiological data about diabetes mellitus (DM) for sub-Saharan Africa (SSA) are scarce and the utility of glycated hemoglobin (HbA1c) to diagnose DM is uncertain in African populations with a high proportion of anemia.
RESEARCH DESIGN AND METHODS
In a cross-sectional study, age-adjusted prevalence rates and predictors for DM and pre-DM were prospectively assessed by HbA1c in a semirural walk-in population of Tanzania (n=992). Predictors for DM were calculated by logistic regression. Correlations between HbA1c, hemoglobin, and blood glucose levels were done by Pearson's correlation.
RESULTS
Overall, DM and pre-DM prevalence rates were 6.8% (95% CI 5.3 to 8.5) and 25% (95% CI 22.8 to 28.3), respectively. There was an increase in DM prevalence in patients 50-59 (14.9%; 95% CI 9.1 to 22.5), ≥60 years old (18.5%; 95% CI 12.2 to 26.2) and in patients with overweight (9.3%; 95% CI 5.9 to 13.7), obesity (10.9%; 95% CI 6.9 to 16) compared with patients 18-29 years old (2.2%; 95% CI 0.9 to 4.4) (p<0.001) and to normal-weight patients (3.6%; 95% CI 2.1 to 5.6) (p<0.01), respectively. Age (OR 1.08, 95% CI 1.05 to 1.12; p<0.001), body mass index (BMI) (OR 1.10, 95% CI 1.04 to 1.16; p<0.001), and acute infection (OR 3.46, 95% CI 1.02 to 10.8; p=0.038) were predictors for DM. Comparing patients with a BMI of 20 kg/m and a BMI of 35 kg/m, the relative risk for DM increases in average by 2.12-fold (range 1.91-2.24) across the age groups. Comparing patients 20 years old with patients 70 years old, the relative risk for DM increases in average 9.7-fold (range 8.9-10.4) across the BMI groups. Overall, 333 patients (36%) suffered from anemia. Pearson's correlation coefficients (r) between HbA1c and hemoglobin was -0.009 (p=0.779), and between HbA1c and fasting blood glucose and random blood glucose, it was 0.775 and 0.622, respectively (p<0.001).
CONCLUSION
We observed a high prevalence of DM and pre-DM, mainly triggered by increasing age and BMI, and provide evidence that HbA1c is suitable to assess DM also in populations of SSA with high proportions of anemia.
TRIAL REGISTRATION NUMBER
NCT03458338.
引言
撒哈拉以南非洲（SSA）地区关于糖尿病（DM）的流行病学数据匮乏，在贫血比例较高的非洲人群中，糖化血红蛋白（HbA1c）用于诊断糖尿病的效用尚不确定。
研究设计与方法
在一项横断面研究中，通过HbA1c对坦桑尼亚一个半农村非预约就诊人群（n = 992）前瞻性评估糖尿病和糖尿病前期的年龄调整患病率及预测因素。通过逻辑回归计算糖尿病的预测因素。HbA1c、血红蛋白和血糖水平之间的相关性通过Pearson相关性分析进行。
结果
总体而言，糖尿病和糖尿病前期的患病率分别为6.8%（95%CI 5.3至8.5）和25%（95%CI 22.8至28.3）。50 - 59岁患者（14.9%；95%CI 9.1至22.5）、≥60岁患者（18.5%；95%CI 12.2至26.2）以及超重患者（9.3%；95%CI 5.9至13.7）、肥胖患者（10.9%；95%CI 6.9至16）的糖尿病患病率相较于18 - 29岁患者（2.2%；95%CI 0.9至4.4）（p < 0.001）以及正常体重患者（3.6%；95%CI 2.1至5.6）（p < 0.01）均有所增加。年龄（OR 1.08，95%CI 1.05至1.12；p < 0.001）、体重指数（BMI）（OR 1.10，95%CI 1.04至1.16；p < 0.001）和急性感染（OR 3.46，95%CI 1.02至10.8；p = 0.038）是糖尿病的预测因素。比较BMI为20kg/m²和35kg/m²的患者，各年龄组中糖尿病的相对风险平均增加2.12倍（范围1.91 - 2.24）。比较20岁患者和70岁患者，各BMI组中糖尿病的相对风险平均增加9.7倍（范围8.9 - 10.4）。总体而言，333名患者（36%）患有贫血。HbA1c与血红蛋白之间的Pearson相关系数（r）为 - 0.009（p = 0.779），HbA1c与空腹血糖和随机血糖之间的相关系数分别为0.775和0.622（p < 0.001）。
结论
我们观察到糖尿病和糖尿病前期的患病率较高，主要由年龄增长和BMI增加引发，并提供了证据表明HbA1c也适用于评估贫血比例较高的SSA人群中的糖尿病。
试验注册号
NCT03458338。
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