Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA.
CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru.
Prim Care Diabetes. 2023 Oct;17(5):506-512. doi: 10.1016/j.pcd.2023.06.003. Epub 2023 Jun 13.
Establishing whether fasting plasma glucose (FPG), postprandial glucose (PPG), and HbA1c have the same diagnostic accuracy in NAFLD versus otherwise healthy people could inform T2DM screening recommendations for those with NAFLD.
Cross-sectional analysis of the Third National Health and Nutrition Examination Survey (NHANES III) 1989-1994. T2DM was defined as PPG ≥ 200 mg/dL, FPG ≥ 126 mg/dL, or HbA1c ≥ 6.5 %. We estimated sensitivity and specificity between the six pairwise combinations between the three T2DM definitions in people with and without NAFLD. With Poisson regressions, we investigated if people with NAFLD were more likely to have T2DM with two diagnostic criteria yet not with the third one.
There were 3652 people with mean age 55.6 years and 49.4 % were men; 673 (18.4 %) people had NAFLD. Compared to NAFLD-free individuals, those with NAFLD had lower specificity in all pairwise comparisons except when PPG was the reference vs HbA1c [98.28 % (95 % CI: 97.73 %-98.72 %) in people without NAFLD vs 96.15 % (95 % CI: 94.28 %-97.54 %)]. The sensitivity of FPG was slightly superior to PPG and HbA1c in people without NAFLD; for example, 64.62 % (95 % CI: 55.75 %-72.80 %) for FPG vs 56.58 % (95 % CI: 44.71 %-67.92 %) for HbA1c. People with NAFLD were more likely to be diagnosed with FPG and PPG yet not with HbA1c (PR=2.15; p = 0.020).
While these T2DM diagnostic criteria may capture different patients both in people with and without NAFLD, in the NAFLD population FPG appears to have the best sensitivity and there were no differences between PPG and HbA1c in terms of specificity.
确定空腹血糖（FPG）、餐后血糖（PPG）和糖化血红蛋白（HbA1c）在非酒精性脂肪性肝病（NAFLD）与健康人群中的诊断准确性是否相同，这将为 NAFLD 患者的 2 型糖尿病（T2DM）筛查提供依据。
对 1989-1994 年第三次全国健康和营养调查（NHANES III）进行横断面分析。T2DM 的定义为 PPG≥200mg/dL、FPG≥126mg/dL 或 HbA1c≥6.5%。我们在有无 NAFLD 的人群中，估算了这三种 T2DM 定义之间六种两两组合的敏感性和特异性。采用泊松回归，我们研究了具有两种诊断标准的 NAFLD 患者与仅具有第三种诊断标准的患者相比，患 T2DM 的可能性是否更大。
共纳入 3652 名平均年龄为 55.6 岁的患者，其中 49.4%为男性；673 名（18.4%）患者患有 NAFLD。与无 NAFLD 个体相比，除 PPG 与 HbA1c 比较时（无 NAFLD 个体中为 98.28%（95%CI：97.73%-98.72%），与 96.15%（95%CI：94.28%-97.54%））外，其余所有两两比较的特异性均较低。在无 NAFLD 个体中，FPG 的敏感性略高于 PPG 和 HbA1c；例如，FPG 为 64.62%（95%CI：55.75%-72.80%），而 HbA1c 为 56.58%（95%CI：44.71%-67.92%）。患有 NAFLD 的患者更可能被诊断为 FPG 和 PPG，但不能被诊断为 HbA1c（PR=2.15；p=0.020）。
尽管这些 T2DM 诊断标准在有或无 NAFLD 的患者中可能会捕获不同的患者，但在 NAFLD 患者中，FPG 的敏感性似乎最佳，而在特异性方面，PPG 和 HbA1c 之间没有差异。
