Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD.
Diabetes Care. 2020 Oct;43(10):2607-2613. doi: 10.2337/dc20-1119. Epub 2020 Aug 14.
In African-born Blacks living in America, we determined by BMI category ) prevalence of abnormal glucose tolerance (Abnl-GT) and ) diagnostic value and reproducibility of hemoglobin A (HbA), fructosamine, and glycated albumin (GA).
Participants ( = 416; male, 66%; BMI 27.7 ± 4.5 kg/m [mean ± SD]) had an oral glucose tolerance test with HbA, GA, and fructosamine assayed. These glycemic markers were repeated 11 ± 7 days later. Abnl-GT diagnosis required 0 h ≥5.6 mmol/L (≥100 mg/dL) and/or 2 h ≥7.8 mmol/L (≥140 mg/dL). Thresholds for HbA, GA, and fructosamine were the values at the 75th percentile for the population (39 mmol/mol [5.7%], 14.2%, and 234 μmol/L, respectively).
Abnl-GT prevalence in the nonobese was 34% versus 42% in the obese ( = 0.124). Reproducibility was excellent for HbA and GA (both κ ≥ 0.8), but moderate for fructosamine (κ = 0.6). Focusing on HbA and GA in the nonobese, we found as single tests the sensitivities of HbA and GA were 36% versus 37% ( = 0.529). Combining HbA and GA, sensitivity increased to 58% because GA identified 37% of Africans with Abnl-GT not detected by HbA ( value for both tests vs. HbA alone was <0.001). For the obese, sensitivities for HbA, GA, and the combined tests were 60%, 27%, and 67%, respectively. Combined test sensitivity did not differ from HbA alone ( = 0.25) because GA detected only 10% of obese Africans with Abnl-GT not detected by HbA.
Adding GA to HbA improves detection of Abnl-GT in nonobese Africans.
在居住于美国的非裔美国人中，我们通过 BMI 类别来确定异常葡萄糖耐量（Abnl-GT）的患病率，以及血红蛋白 A（HbA）、果糖胺和糖化白蛋白（GA）的诊断价值和可重复性。
参与者（n=416；男性，66%；BMI 27.7±4.5kg/m²[均值±标准差]）进行口服葡萄糖耐量试验，同时检测 HbA、GA 和果糖胺。这些血糖标志物在 11±7 天后重复检测。Abnl-GT 的诊断需要 0 小时≥5.6mmol/L（≥100mg/dL）和/或 2 小时≥7.8mmol/L（≥140mg/dL）。HbA、GA 和果糖胺的阈值为人群第 75 百分位数的数值（39mmol/mol[5.7%]、14.2%和 234μmol/L）。
非肥胖人群中 Abnl-GT 的患病率为 34%，肥胖人群中为 42%（P=0.124）。HbA 和 GA 的重复性极好（两者κ≥0.8），但果糖胺的重复性中等（κ=0.6）。在非肥胖人群中，仅将 HbA 和 GA 作为单一检测，HbA 和 GA 的敏感性分别为 36%和 37%（P=0.529）。将 HbA 和 GA 联合使用，敏感性增加至 58%，因为 GA 发现了 37%的 HbA 无法检测到的 Abnl-GT（两种检测方法的 P 值均<0.001）。对于肥胖人群，HbA、GA 和联合检测的敏感性分别为 60%、27%和 67%。联合检测的敏感性与 HbA 单独检测没有差异（P=0.25），因为 GA 仅发现了 10%的 HbA 无法检测到的肥胖非洲裔美国人的 Abnl-GT。
在非肥胖的非洲裔美国人中，将 GA 添加到 HbA 中可提高 Abnl-GT 的检出率。
