Tucker Larry A
College of Life Sciences, Brigham Young University, Provo, UT 84602, USA.
J Clin Med. 2020 Jul 13;9(7):2207. doi: 10.3390/jcm9072207.
This investigation was designed to determine the degree of concordance resulting from tests of fasting plasma glucose (FPG) and hemoglobin A1c (A1c) compared to the oral glucose tolerance test (OGTT) for detecting prediabetes and diabetes in undiagnosed adults. Another objective was to measure concordance within subsamples of women and men, and within three age groups. Lastly, the value of combining the FPG and A1c for detecting diabetes was compared to the OGTT. A total of 7412 randomly selected adults from the National Health and Nutrition Examination Survey (NHANES) were included. With outcomes classified as normal, prediabetes, or diabetes, according to standard guidelines, overall test agreements were low. With an OGTT diagnosis of diabetes, concordance was only 34% for the A1c assessment and 44% for the FPG assay. Delimited to older adults, agreement between the OGTT and A1c was only 25%, and between the OGTT and FPG, concordance was only 33.5%. Given the large percentage of discordant results associated with the FPG and A1c, clinicians should be cautious about employing these tests as lone assessments. Using both the FPG and A1c helped with accurately diagnosing diabetes and normal glycemia, but not prediabetes. The OGTT is a good choice to reduce misdiagnosis.
本研究旨在确定空腹血糖（FPG）和糖化血红蛋白（A1c）检测与口服葡萄糖耐量试验（OGTT）相比，在未确诊成年人中检测糖尿病前期和糖尿病时的一致性程度。另一个目标是测量女性和男性亚样本以及三个年龄组内的一致性。最后，将FPG和A1c联合检测糖尿病的价值与OGTT进行比较。纳入了来自美国国家健康与营养检查调查（NHANES）的7412名随机选择的成年人。根据标准指南，将结果分类为正常、糖尿病前期或糖尿病，总体检测一致性较低。在OGTT诊断为糖尿病的情况下，A1c评估的一致性仅为34%，FPG检测的一致性为44%。限定于老年人，OGTT与A1c之间的一致性仅为25%，OGTT与FPG之间的一致性仅为33.5%。鉴于FPG和A1c存在大量不一致的结果，临床医生在单独使用这些检测进行评估时应谨慎。同时使用FPG和A1c有助于准确诊断糖尿病和正常血糖，但对糖尿病前期的诊断没有帮助。OGTT是减少误诊的一个好选择。
