Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
Biostatistics Unit, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Diabetes Care. 2021 Apr;44(4):1062-1069. doi: 10.2337/dc20-1688.
One-hour plasma glucose (1-h PG) during the oral glucose tolerance test (OGTT) is an accurate predictor of type 2 diabetes. We performed a meta-analysis to determine the optimum cutoff of 1-h PG for detection of type 2 diabetes using 2-h PG as the gold standard.
We included 15 studies with 35,551 participants from multiple ethnic groups (53.8% Caucasian) and 2,705 newly detected cases of diabetes based on 2-h PG during OGTT. We excluded cases identified only by elevated fasting plasma glucose and/or HbA. We determined the optimal 1-h PG threshold and its accuracy at this cutoff for detection of diabetes (2-h PG ≥11.1 mmol/L) using a mixed linear effects regression model with different weights to sensitivity/specificity (2/3, 1/2, and 1/3).
Three cutoffs of 1-h PG, at 10.6 mmol/L, 11.6 mmol/L, and 12.5 mmol/L, had sensitivities of 0.95, 0.92, and 0.87 and specificities of 0.86, 0.91, and 0.94 at weights 2/3, 1/2, and 1/3, respectively. The cutoff of 11.6 mmol/L (95% CI 10.6, 12.6) had a sensitivity of 0.92 (0.87, 0.95), specificity of 0.91 (0.88, 0.93), area under the curve 0.939 (95% confidence region for sensitivity at a given specificity: 0.904, 0.946), and a positive predictive value of 45%.
The 1-h PG of ≥11.6 mmol/L during OGTT has a good sensitivity and specificity for detecting type 2 diabetes. Prescreening with a diabetes-specific risk calculator to identify high-risk individuals is suggested to decrease the proportion of false-positive cases. Studies including other ethnic groups and assessing complication risk are warranted.
口服葡萄糖耐量试验（OGTT）1 小时血糖（1-h PG）是 2 型糖尿病的准确预测指标。我们进行了一项荟萃分析，以确定使用 2 小时 PG 作为金标准检测 2 型糖尿病的最佳 1-h PG 截断值。
我们纳入了来自多个种族（53.8%为白种人）的 15 项研究，共 35551 名参与者，基于 OGTT 中的 2 小时 PG，有 2705 例新诊断的糖尿病病例。我们排除了仅通过空腹血糖升高和/或 HbA 升高确定的病例。我们使用混合线性效应回归模型，根据灵敏度/特异性（2/3、1/2 和 1/3），确定不同权重下最佳 1-h PG 截断值及其在此截断值下对糖尿病（2 小时 PG≥11.1mmol/L）的检测准确性。
1-h PG 的三个截断值为 10.6mmol/L、11.6mmol/L 和 12.5mmol/L，在权重为 2/3、1/2 和 1/3 时，灵敏度分别为 0.95、0.92 和 0.87，特异性分别为 0.86、0.91 和 0.94。11.6mmol/L（95%CI：10.6，12.6）的截断值具有 0.92（0.87，0.95）的灵敏度，0.91（0.88，0.93）的特异性，曲线下面积为 0.939（95%置信区间的特异性灵敏度：0.904，0.946），阳性预测值为 45%。
OGTT 中 1-h PG≥11.6mmol/L 对检测 2 型糖尿病具有良好的灵敏度和特异性。建议使用糖尿病特定风险计算器进行预筛查，以识别高危人群，从而减少假阳性病例的比例。需要进行包括其他种族并评估并发症风险的研究。
