Endocrinology/Nephrology Axis, Centre de Recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada.
Endocrinology/Nephrology Axis, Centre de Recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada; Division of Endocrinology, Department of Medicine, Centre Hospitalier Universitaire de Quebec, Université Laval, Québec City, Québec, Canada.
Can J Diabetes. 2023 Oct;47(7):603-610. doi: 10.1016/j.jcjd.2023.06.002. Epub 2023 Jun 21.
Nonalcoholic fatty liver disease (NAFLD) is a risk factor for type 2 diabetes (T2D), but T2D screening tests are not well validated in this population. In this study, we assessed performance of glycated hemoglobin (A1C) and fasting plasma glucose (FPG) in glucose dysmetabolism screening and aimed to optimize detection thresholds for individuals with NAFLD.
We retrospectively included oral glucose tolerance tests (OGTTs) from consecutive patients undergoing a specialized clinic for NAFLD, if A1C and/or fasting glucose was available within 3 months of OGTT. We compared performances of A1C and fasting glucose with the "gold standard" of OGTT using thresholds from the 2018 Diabetes Canada guidelines. A1C and FPG thresholds were optimized for detection of glucose dysmetabolism using receiver operating characteristic curves.
We included 63 OGTTs from individuals with NAFLD (52% female, age 48 [interquartile range 35 to 63] years, body mass index 34 [interquartile range 29 to 40] kg/m). A1C had 16% (95% confidence interval [CI] 6% to 38%) sensitivity (Se) and 97% (95% CI 85% to 100%) specificity (Sp) for T2D detection, and 45% (95% CI 30% to 62%) Se and 100% (95% CI 83% to 100%) Sp for abnormal blood glucose detection. FPG had 67% (95% CI 45% to 83%) Se and 100% (95% CI 92% to 100%) Sp for T2D detection, and 74% (95% CI 59% to 85%) Se and 92% (95% CI 74% to 99%) Sp for abnormal blood glucose detection. Optimal A1C and FPG thresholds were 5.6% and 6.3 mmol/L for T2D detection, which are lower than current recommendations.
A1C is less sensitive than FPG and is suboptimal for T2D detection, suggesting that OGTT may be obtained if A1C is ≥5.6% or FPG is ≥6.3 mmol/L in individuals with NAFLD, to avoid underdiagnosis and treatment inertia.
非酒精性脂肪性肝病（NAFLD）是 2 型糖尿病（T2D）的一个危险因素，但 T2D 的筛查试验在该人群中尚未得到很好的验证。在本研究中，我们评估了糖化血红蛋白（A1C）和空腹血浆葡萄糖（FPG）在糖代谢紊乱筛查中的性能，并旨在优化 NAFLD 患者的检测阈值。
我们回顾性纳入了在专门的 NAFLD 诊所接受口服葡萄糖耐量试验（OGTT）的连续患者的 OGTT，如果在 OGTT 后 3 个月内有 A1C 和/或空腹血糖可用。我们使用 2018 年加拿大糖尿病指南的标准，比较了 A1C 和空腹血糖与 OGTT 的“金标准”之间的性能。使用受试者工作特征曲线优化 A1C 和 FPG 检测糖代谢紊乱的阈值。
我们纳入了 63 例来自 NAFLD 患者的 OGTT（52%为女性，年龄 48 [四分位间距 35 至 63] 岁，体重指数 34 [四分位间距 29 至 40] kg/m2）。A1C 对 T2D 的检测有 16%（95%置信区间 [CI] 6%至 38%）的灵敏度（Se）和 97%（95%CI 85%至 100%）的特异性（Sp），而对异常血糖的检测则有 45%（95%CI 30%至 62%）的 Se 和 100%（95%CI 83%至 100%）的 Sp。FPG 对 T2D 的检测有 67%（95%CI 45%至 83%）的 Se 和 100%（95%CI 92%至 100%）的 Sp，对异常血糖的检测有 74%（95%CI 59%至 85%）的 Se 和 92%（95%CI 74%至 99%）的 Sp。用于检测 T2D 的最佳 A1C 和 FPG 阈值分别为 5.6%和 6.3 mmol/L，这低于目前的建议。
A1C 的敏感性低于 FPG，对 T2D 的检测效果不理想，这表明在 NAFLD 患者中，如果 A1C≥5.6%或 FPG≥6.3 mmol/L，可能需要进行 OGTT，以避免漏诊和治疗惰性。
