Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Faculty of Health Sciences, Universidade Zambeze, Beira, Mozambique.
Clin Chem Lab Med. 2022 Apr 27;60(7):961-974. doi: 10.1515/cclm-2022-0105. Print 2022 Jun 27.
Guidelines recommend the diagnosis of diabetes should be based on either plasma glucose or glycated hemoglobin (HbA) findings. However, lately studies have advocated glycated albumin (GA) as a useful alternative to HbA. We conducted a systematic review and meta-analysis to determine the overall diagnostic accuracy of GA for the diagnosis of diabetes.
We searched for articles of GA diabetes diagnostic accuracy that were published up to August 2021. Studies were selected if reported an oral glucose tolerance test as a reference test, measured GA levels by enzymatic methods, and had data necessary for 2 × 2 contingency tables. A bivariate model was used to calculate the pooled estimates.
This meta-analysis included nine studies, totaling 10,007 individuals. Of those, 3,106 had diabetes. The studies showed substantial heterogeneity caused by a non-threshold effect and reported different GA optimal cut-offs for diagnosing diabetes. The pooled diagnostic odds ratio (DOR) was 15.93 and the area under the curve (AUC) was 0.844, indicating a good level of overall accuracy for the diagnosis of diabetes. The effect of the GA threshold on diagnostic accuracy was reported at 15.0% and 17.1%. The optimal cut-off for diagnosing diabetes with GA was estimated as 17.1% with a pooled sensitivity of 55.1% (95% CI 36.7%-72.2%) and specificity of 94.4% (95% CI 85.3%-97.9%).
GA has good diabetes diagnostic accuracy. A GA threshold of 17.1% may be considered optimal for diagnosing diabetes in previously undiagnosed individuals.
指南建议糖尿病的诊断应基于血浆葡萄糖或糖化血红蛋白（HbA）的检测结果。然而，最近的研究提倡将糖化白蛋白（GA）作为 HbA 的有用替代指标。我们进行了一项系统评价和荟萃分析，以确定 GA 用于诊断糖尿病的总体诊断准确性。
我们检索了截至 2021 年 8 月发表的关于 GA 糖尿病诊断准确性的文章。如果研究报告了口服葡萄糖耐量试验作为参考试验、使用酶法测量 GA 水平且有 2×2 列联表所需的数据，则选择研究。使用双变量模型计算汇总估计值。
这项荟萃分析纳入了 9 项研究，共 10007 人。其中 3106 人患有糖尿病。研究显示存在显著的异质性，这是由非阈值效应引起的，并报告了用于诊断糖尿病的不同 GA 最佳截断值。汇总诊断比值比（DOR）为 15.93，曲线下面积（AUC）为 0.844，表明 GA 用于诊断糖尿病的整体准确性较好。GA 截断值对诊断准确性的影响为 15.0%和 17.1%。GA 诊断糖尿病的最佳截断值估计为 17.1%，其汇总敏感性为 55.1%（95%CI 36.7%-72.2%），特异性为 94.4%（95%CI 85.3%-97.9%）。
GA 具有良好的糖尿病诊断准确性。GA 截断值为 17.1%时，可能可用于诊断以前未确诊的个体中的糖尿病。
