NYU School of Medicine, NYU Diabetes Prevention Program, Endocrinology, Diabetes, Metabolism, VA New York Harbor Healthcare System, Manhattan Campus, 423 East 23rd Street, Room 16049C, NY, NY 10010, USA.
Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
Diabetes Res Clin Pract. 2020 Jul;165:108233. doi: 10.1016/j.diabres.2020.108233. Epub 2020 Jun 1.
Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity.
糖尿病前期(中间高血糖)由两种异常组成,即通过标准化的 75 克口服葡萄糖耐量试验(OGTT)检测到的空腹血糖受损(IFG)和葡萄糖耐量受损(IGT)。仅存在 IGT 或 IFG 和 IGT 合并的个体发生 2 型糖尿病(T2D)和心血管疾病(CVD)的风险增加。早期准确诊断糖尿病前期对于将高危个体转介进行强化生活方式改变至关重要。然而,目前基于美国糖尿病协会(ADA)和世界卫生组织(WHO)标准,尚无国际共识使用 HbA1c 或葡萄糖测量值诊断糖尿病前期,这些标准确定了不同人群发生糖尿病的风险。各种影响 HbA1c 解释准确性的注意事项,包括遗传因素,使情况更加复杂。这篇综述描述了基于葡萄糖和 HbA1c 参数检测葡萄糖紊乱的既定方法,以及包括 1 小时血浆葡萄糖(1-h PG)、葡萄糖挑战试验(GCT)、葡萄糖曲线形状、遗传学、连续血糖监测(CGM)、胰岛素分泌和敏感性测量、代谢组学以及果糖胺、糖化白蛋白(GA)、1,5-脱水葡萄糖醇(1,5-AG)等辅助工具在内的新方法。在考虑的方法中,如果通过包括健康经济学分析在内的其他数据得到证实,1-h PG 作为检测葡萄糖紊乱的生物标志物具有很大的潜力。1-h OGTT 是否优于遗传学和组学,为个体化治疗提供更高的精度,需要进一步研究。这些方法需要证明在检测葡萄糖紊乱方面具有明显优势,以证明其成本和复杂性是合理的。