Stedman Mike, Heald Adrian H, Holland David, Halsall Ian, Green Lewis, Wu Pensee, Patel Kashyap, Scargill Jonathan, Gibson Martin, Hanna Fahmy W F, Fryer Anthony A
Res Consortium, Andover, UK.
Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
Diabetes Ther. 2025 Feb;16(2):257-267. doi: 10.1007/s13300-024-01680-w. Epub 2024 Dec 20.
We previously reported sex differences in the distribution of glycated haemoglobin (HbA1c) for men/women aged < 50 years vs older individuals, with implications for delayed diabetes diagnosis. Here, we explored whether this pattern was also seen in matched fasting plasma glucose (FPG) levels.
We extracted data on same-day, paired HbA1c and FPG levels from clinical biochemistry laboratory databases from Mersey and West Lancashire Teaching Hospitals NHS Trust (n = 10,153) and Cambridge University Hospitals NHS Foundation Trust (n = 10,022) between Jan 2019 and Dec 2023. Only cases with a single, general-practice HbA1c test were utilised to minimise the risk of including non-diagnostic tests and tests from specialist care (e.g. endocrinology, antenatal services; final dataset: n = 17,271). We examined the links of HbA1c and FPG levels to age and sex.
Median HbA1c levels were 1 mmol/mol lower in women aged < 45 years compared to men aged < 45 years but not in those aged ≥ 45 years. This pattern was not seen with FPG, where median levels in women were 0.1-0.2 mmol/L lower across all ages. The HbA1c:FPG ratio was significantly higher in women than men in the 45-54 and ≥ 55 years age groups (p = 0.004, Z-score = 2.9 and p = < 0.001, Z-score = 8.9, respectively) but not in the < 45 years age group (p = 0.649, Z-score = 0.5). We confirmed our previous finding that median HbA1c levels in women aged ≥ 55 years and 45-55 years were the same as those in men (39 and 37 mmol/mol, respectively) and that for women aged < 45 years, the median HbA1c (34 mmol/mol) was 1 mol/mol lower than for men (35 mmol/mol). This is reflected in the Z-scores, which showed the largest deviation from zero in the < 45 years age group (- 9.1) and the smallest in the older age group (- 2.9).
We showed differences in HbA1c and FPG patterns with age between men and women, with implications for the diabetes diagnostic threshold for HbA1c in pre-menopausal women, the underdiagnosis of type 2 diabetes in younger women, and missed opportunities for intervention. We propose that a suggested change to HbA1c reference ranges in this group warrants serious consideration and detailed evaluation.
我们之前报告了糖化血红蛋白（HbA1c）在年龄小于50岁的男性/女性与年长者之间分布的性别差异，这对糖尿病的延迟诊断具有重要意义。在此，我们探讨了这种模式是否也存在于匹配的空腹血糖（FPG）水平中。
我们从默西和西兰开夏郡教学医院国民保健服务信托基金（n = 10153）以及剑桥大学医院国民保健服务基金会信托基金（n = 10022）的临床生物化学实验室数据库中提取了2019年1月至2023年12月期间同一天的配对HbA1c和FPG水平数据。仅使用具有单次全科医生HbA1c检测结果的病例，以尽量减少纳入非诊断性检测和专科护理检测（如内分泌科、产前服务；最终数据集：n = 17271）的风险。我们研究了HbA1c和FPG水平与年龄和性别的关系。
年龄小于45岁的女性的HbA1c中位数水平比年龄小于45岁的男性低1 mmol/mol，但45岁及以上的女性并非如此。FPG未出现这种模式，各年龄段女性的FPG中位数水平低0.1 - 0.2 mmol/L。在45 - 54岁和55岁及以上年龄组中，女性的HbA1c:FPG比值显著高于男性（分别为p = 0.004，Z值 = 2.9；p < 0.001，Z值 = 8.9），但在年龄小于45岁的组中并非如此（p = 0.649，Z值 = 0.5）。我们证实了之前的发现，即55岁及以上和45 - 55岁女性的HbA1c中位数水平与男性相同（分别为39和37 mmol/mol），而年龄小于45岁的女性，HbA1c中位数（34 mmol/mol）比男性（35 mmol/mol）低1 mmol/mol。这在Z值中得到体现，Z值在年龄小于45岁的组中偏离零的程度最大（-9.1），在年龄较大的组中最小（-2.9）。
我们发现男性和女性的HbA1c和FPG模式随年龄存在差异，这对绝经前女性HbA1c的糖尿病诊断阈值、年轻女性2型糖尿病的诊断不足以及干预机会的错失具有重要意义。我们建议对此组HbA1c参考范围的建议更改值得认真考虑和详细评估。
