Royal College of Surgeons Ireland-Bahrain, Busaiteen, Bahrain.
Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar.
Diabetes Obes Metab. 2021 Sep;23(9):2109-2115. doi: 10.1111/dom.14449. Epub 2021 Jun 9.
To determine if an HbA1c diagnostic threshold of less than 6.5% (<48 mmol/mol) could be identified based on a urinary albumin-creatinine ratio (UACR) of 30 mg/g or higher in subjects not known to have diabetes.
A UACR was measured for 20 158 participants in the 2011-2018 nationally representative cross-sectional National Health and Nutrition Examination Surveys (NHANES; cycles 7-10 inclusive).
There was a significant trend for an increasing risk with a UACR of 30 mg/g or higher across increasing HbA1c categories (P < .0001). This trend was mainly attributable to the high prevalence of raised UACR in the 7.0% or higher HbA1c subgroup of subjects not previously diagnosed with diabetes. None of the odds ratios in the lower HbA1c subgroups versus the HbA1c subgroup of less than 5.0% reached significance. There were racial/ethnic differences in UACR risk (P < .0001), with White and Black subjects exhibiting little increased risk (vs. HbA1c <5.0%) until they reached an HbA1c of 7.0%, while Asian and Hispanic subjects showed some increased, but non-significant, risks at lower HbA1c levels. Maximizing the area under receiver operating characteristic curves from logistic regressions predicted an ideal HbA1c threshold of 5.8%, but there was little variation in area from 5.5% to 7.0%.
A clinically useful diagnostic threshold below 6.5% for HbA1c for elevated UACR risk was not identified, with an increased risk only obvious at an HbA1c of 7.0% or higher. Thus, the retinopathy-derived HbA1c threshold of 6.5% also captures the risk of diabetic nephropathy in NHANES.
确定对于无糖尿病病史人群，如果尿白蛋白肌酐比值（UACR）高于 30mg/g，是否可以将糖化血红蛋白（HbA1c）诊断阈值设定为低于 6.5%（<48mmol/mol）。
在 2011 年至 2018 年全国代表性横断面全国健康和营养检查调查（NHANES；包括周期 7-10）中，对 20158 名参与者进行了 UACR 测量。
随着 HbA1c 分类中 UACR 为 30mg/g 或更高，风险呈显著增加趋势（P<0.0001）。这种趋势主要归因于在先前未被诊断为糖尿病的 HbA1c 为 7.0%或更高亚组中，UACR 升高的高患病率。在 HbA1c 低于 5.0%的亚组与较低的 HbA1c 亚组之间，没有任何比值比达到显著水平。UACR 风险存在种族/民族差异（P<0.0001），白人及黑人受试者直至 HbA1c 达到 7.0%时，其 UACR 风险才会略有增加（与 HbA1c<5.0%相比），而亚裔和西班牙裔受试者在 HbA1c 较低水平时，风险虽有所增加，但不显著。通过逻辑回归最大化受试者工作特征曲线下的面积预测出理想的 HbA1c 阈值为 5.8%，但从 5.5%到 7.0%之间面积变化不大。
对于 UACR 风险升高的人群，未能确定低于 6.5%的 HbA1c 临床有用的诊断阈值，仅在 HbA1c 达到 7.0%或更高时才出现明显的风险增加。因此，NHANES 中的糖尿病视网膜病变衍生的 HbA1c 阈值 6.5%也可捕获糖尿病肾病的风险。
