Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Endocrinology, The First Hospital of Jilin University, Changchun, China.
Front Endocrinol (Lausanne). 2022 Sep 8;13:943750. doi: 10.3389/fendo.2022.943750. eCollection 2022.
A tool was constructed to assess need of an oral glucose tolerance test (OGTT) in patients whose fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are normal. Data was collected from the longitudinal REACTION study conducted from June to November 2011 (14,686 subjects, aged ≥ 40 y). In people without a prior history of diabetes, isolated high 2-hour plasma glucose was defined as 2-hour plasma glucose ≥ 11.1 mmol/L, FPG < 7.0 mmol/L, and HbA1c < 6.5%. A predictive nomogram for high 2-hour plasma glucose was developed stepwise logistic regression. Discrimination and calibration of the nomogram were evaluated by the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow test; performance was externally validated in Northeast China. Parameters in the model included gender, age, drinking status, marriage status, history of hypertension and hyperlipidemia, waist-to-hip ratio, FPG, and HbA1c. All variables were noninvasive, except FPG and HbA1c. The AUC of the nomogram for isolated high 2-hour plasma glucose was 0.759 (0.727-0.791) in the development dataset. The AUCs of the internal and externally validation datasets were 0.781 (0.712-0.833) and 0.803 (0.778-0.829), respectively. Application of the nomogram during the validation study showed good calibration, and the decision curve analysis indicated that the nomogram was clinically useful. This practical nomogram model may be a reliable screening tool to detect isolated high 2-hour plasma glucose for individualized assessment in patients with normal FPG and HbA1c. It should simplify clinical practice, and help clinicians in decision-making.
构建了一个工具，用于评估空腹血糖（FPG）和糖化血红蛋白（HbA1c）正常的患者是否需要口服葡萄糖耐量试验（OGTT）。数据来自于 2011 年 6 月至 11 月进行的纵向 REACTION 研究（14686 例，年龄≥40 岁）。在无糖尿病既往史的人群中，孤立性高 2 小时血糖定义为 2 小时血糖≥11.1mmol/L，FPG＜7.0mmol/L，且 HbA1c＜6.5%。采用逐步逻辑回归方法建立了高 2 小时血糖的预测列线图。通过接受者操作特征曲线下面积（AUC）和 Hosmer-Lemeshow 检验评估列线图的区分度和校准度；采用中国东北地区的外部验证来评估其性能。模型中的参数包括性别、年龄、饮酒状况、婚姻状况、高血压和高脂血症史、腰臀比、FPG 和 HbA1c。除 FPG 和 HbA1c 外，所有变量均为非侵入性的。在开发数据集，孤立性高 2 小时血糖列线图的 AUC 为 0.759（0.727-0.791）。内部验证数据集和外部验证数据集的 AUC 分别为 0.781（0.712-0.833）和 0.803（0.778-0.829）。验证研究中列线图的应用显示出良好的校准度，决策曲线分析表明该列线图具有临床应用价值。该实用的列线图模型可能是一种可靠的筛查工具，可用于检测 FPG 和 HbA1c 正常患者的孤立性高 2 小时血糖，以进行个体化评估。它将简化临床实践，帮助临床医生做出决策。
