Gatete Jean de Dieu, Worthy Charlita C, Jagannathan Ram, DuBose Christopher W, Sacks David B, Sumner Anne E
Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
Institute of Global Health Equity, University of Global Health Equity, Kigali, Rwanda.
Diabetes Metab Syndr Obes. 2023 Sep 5;16:2689-2693. doi: 10.2147/DMSO.S426406. eCollection 2023.
To improve detection of abnormal glucose tolerance (Abnl-GT), attention has moved beyond the oral glucose tolerance test (OGTT), to non-fasting markers of glycemia, specifically, HbA1c, fructosamine (FA) and glycated albumin (GA). Emerging data suggest that in African descent populations, the combination of HbA1c and GA is superior to the combination of HbA1c and FA. However, the diagnosis of Abnl-GT is usually based on tests which are performed only once. As reproducibility of Abnl-GT diagnosis by HbA1c, fructosamine (FA) and glycated albumin (GA) is unknown, reproducibility of Abnl-GT diagnosis by HbA1c, FA and GA were assessed in 209 African-born Blacks living in America.
At Visits 1 and 2 (9 ± 4 days apart), samples were obtained for HbA1c, FA and GA levels. Glucose tolerance status was determined at Visit 1 by OGTT. Reproducibility was based on the К-statistic and paired t-tests. Thresholds for the diagnosis of Abnl-GT by FA and GA which corresponded to an HbA1c of 5.7% were 235umol/L and 14.6%, respectively.
Abnl-GT occurred in 38% (80/209). Diagnostic reproducibility was excellent for HbA1c (К≥0.86) and GA (К≥0.89), but only moderate for FA (К=0.59). Neither HbA1c nor GA levels varied between visits (both ≥0.3). In contrast, FA was significantly lower at Visit 2 than Visit 1(<0.01).
As HbA1c and GA provided similar diagnostic results on different days and FA did not, HbA1C and GA are superior to FA in both clinical care settings and epidemiologic studies.
为了提高对异常糖耐量（Abnl-GT）的检测，关注点已从口服葡萄糖耐量试验（OGTT）扩展到非空腹血糖标志物，特别是糖化血红蛋白（HbA1c）、果糖胺（FA）和糖化白蛋白（GA）。新出现的数据表明，在非洲裔人群中，HbA1c与GA的组合优于HbA1c与FA的组合。然而，Abnl-GT的诊断通常基于仅进行一次的检测。由于HbA1c、果糖胺（FA）和糖化白蛋白（GA）对Abnl-GT诊断的可重复性未知，因此在209名生活在美国的非洲出生的黑人中评估了HbA1c、FA和GA对Abnl-GT诊断的可重复性。
在第1次和第2次就诊时（间隔9±4天），采集样本检测HbA1c、FA和GA水平。在第1次就诊时通过OGTT确定糖耐量状态。可重复性基于K统计量和配对t检验。与HbA1c为5.7%相对应的FA和GA诊断Abnl-GT的阈值分别为235μmol/L和14.6%。
Abnl-GT发生率为38%（80/209）。HbA1c（K≥0.86）和GA（K≥0.89）的诊断可重复性极佳，但FA的可重复性一般（K=0.59）。就诊期间HbA1c和GA水平均无变化（均≥0.3）。相比之下，第2次就诊时FA显著低于第1次就诊时（<0.01）。
由于HbA1c和GA在不同日期提供相似的诊断结果，而FA并非如此，因此在临床护理环境和流行病学研究中，HbA1c和GA均优于FA。
