Duong Khanh N C, Tan Chia Jie, Rattanasiri Sasivimol, Thakkinstian Ammarin, Anothaisintawee Thunyarat, Chaiyakunapruk Nathorn
Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States.
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Front Med (Lausanne). 2023 Jan 24;10:1016381. doi: 10.3389/fmed.2023.1016381. eCollection 2023.
Fasting Plasma Glucose (FPG) and Hemoglobin A1c (HbA1c) are used as diagnostic tests for diagnosing diabetes mellitus, but it is unclear which test has the best diagnostic accuracy. This systematic review and network meta-analysis aimed to estimate the diagnostic accuracy of HbA1c ≥ 6.5%, FPG ≥ 126 mg/dl, and the combination of HbA1c ≥ 6.5% or FPG ≥ 126 mg/dl (HbA1c| FPG), compared with Oral Glucose Tolerance Test (OGTT) ≥ 200 mg/dl for diagnosis diabetes.
We performed a comprehensive search in PubMed, Embase, Cochrane Library, and Scopus from inception to September 24th, 2021. Inclusion criteria were any study design comparing HbA1c ≥ 6.5%, FPG ≥ 126 mg/dl, and HbA1c ≥ 6.5% or FPG ≥ 126 mg/dl with OGTT ≥ 200 mg/dl as the reference test. Data were independently extracted, risk of bias was assessed using QUADAS-2 by two reviewers. Network meta-analysis was done using a bivariate regression model using the Bayesian framework. The relative ranking of all tests was also assessed.
Out of 5,026 studies, 73 were included. The sensitivities of HbA1c, FPG, and HbA1c| FPG were 0.51 [95% Credible Interval (CrI): 0.43, 0.58], 0.49 (95% CrI: 0.43, 0.55), and 0.64 (95% CrI: 0.51, 0.75), while the specificities were 0.96 (95% CrI: 0.94, 0.97), 0.98 (95% CrI: 0.97, 0.98), and 0.95 (95% CrI: 0.88, 0.98), respectively. The corresponding positive likelihood ratios (LR) were 13.36 (95% CrI: 8.91, 20.72), 21.94 (95% CrI: 15.04, 31.88), and 11.78 (95% CrI: 5.48, 26.56). HbA1c| FPG is superior based on sensitivity, whereas FPG is ranked best based on specificity and positive LR.
Our findings suggest that FPG ≥ 126 mg/dl should be recommended as the best diagnostic test for diabetes.
https://www.crd.york.ac.uk/prospero/, identifier CRD42021282856.
空腹血糖（FPG）和糖化血红蛋白（HbA1c）被用作糖尿病的诊断检测指标，但尚不清楚哪种检测具有最佳诊断准确性。本系统评价和网状Meta分析旨在评估HbA1c≥6.5%、FPG≥126mg/dl以及HbA1c≥6.5%或FPG≥126mg/dl（HbA1c|FPG）与口服葡萄糖耐量试验（OGTT）≥200mg/dl相比用于诊断糖尿病的诊断准确性。
我们从数据库建库至2021年9月24日在PubMed、Embase、Cochrane图书馆和Scopus中进行了全面检索。纳入标准为任何将HbA1c≥6.5%、FPG≥126mg/dl以及HbA1c≥6.5%或FPG≥126mg/dl与OGTT≥200mg/dl作为参考检测进行比较的研究设计。数据由两名研究者独立提取，使用QUADAS-2评估偏倚风险。使用贝叶斯框架的双变量回归模型进行网状Meta分析。还评估了所有检测的相对排名。
在5026项研究中，纳入了73项。HbA1c、FPG和HbA1c|FPG的敏感性分别为0.51[95%可信区间（CrI）：0.43，0.58]、0.49（95%CrI：0.43，0.55）和0.64（95%CrI：0.51，0.75），而特异性分别为0.96（95%CrI：0.94，0.97）、0.98（95%CrI：0.97，0.98）和0.95（95%CrI：0.88，0.98）。相应的阳性似然比（LR）分别为13.36（95%CrI：8.91，20.72）、21.94（95%CrI：15.04，31.88）和11.78（95%CrI：5.48，26.56）。基于敏感性，HbA1c|FPG更优，而基于特异性和阳性LR，FPG排名最佳。
我们的研究结果表明，FPG≥126mg/dl应被推荐为糖尿病的最佳诊断检测指标。
