Peer Nasheeta, George Jaya, Lombard Carl, Levitt Naomi, Kengne Andre-Pascal
Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa.
Department of Chemical Pathology, University of the Witwatersrand, and National Health Laboratory Services, Johannesburg, South Africa.
Clin Chim Acta. 2021 Aug;519:291-297. doi: 10.1016/j.cca.2021.05.014. Epub 2021 May 19.
The associations of glycated albumin (GA) and fructosamine (FA) as alternate tests for diabetes screening in South Africans were examined to overcome shortcomings with oral glucose tolerance tests (OGTTs).
Based on OGTTs, glycaemic status included 1) normal glucose, 2) dysglycaemia (impaired fasting glucose, impaired glucose tolerance, newly diagnosed diabetes), and 3) known diabetes.
Among 1092 participants, >21 years, mean GA (16.9%) and FA (230.2 μmol/l) increased significantly by age and worsening glycaemic status and were significantly higher in women vs. men and BMI (kg/m) ≥ 30 vs. <30. For dysglycaemia, correlations of GA and FA with fasting and 2-hour glucose levels were higher in obese (0.576 to 0.688) vs. non-obese (-0.010 to 0.522). Optimal GA threshold to identify dysglycaemia was 15.35% and comparable, but with lower sensitivity (0.54) and specificity (0.55), to Asian studies. For FA, the optimal cut-point of 227.0 μmol/l approximated that described in the literature. Dysglycaemia and known diabetes were associated with GA, while only known diabetes was related to FA, in models adjusted for age, gender and obesity.
Potential exists for GA and/or FA as alternative measures of dysglycaemia in clinical practice in Africans, but longitudinal studies are required to clearly elucidate their utility.
为克服口服葡萄糖耐量试验（OGTT）的缺点，研究了糖化白蛋白（GA）和果糖胺（FA）作为南非人糖尿病筛查替代检测方法的相关性。
基于OGTT，血糖状态包括1）血糖正常，2）血糖异常（空腹血糖受损、糖耐量受损、新诊断糖尿病），以及3）已知糖尿病。
在1092名年龄大于21岁的参与者中，平均GA（16.9%）和FA（230.2μmol/l）随年龄增长和血糖状态恶化而显著升高，且女性高于男性，体重指数（kg/m）≥30者高于<30者。对于血糖异常，肥胖者（0.576至0.688）中GA和FA与空腹及2小时血糖水平的相关性高于非肥胖者（-0.010至0.522）。识别血糖异常的最佳GA阈值为15.35%，与亚洲研究结果相当，但敏感性（0.54）和特异性（0.55）较低。对于FA，最佳切点为227.0μmol/l，与文献中描述的相近。在根据年龄、性别和肥胖进行调整的模型中，血糖异常和已知糖尿病与GA相关，而只有已知糖尿病与FA相关。
在非洲人的临床实践中，GA和/或FA作为血糖异常替代指标具有潜力，但需要纵向研究来明确其效用。
