Modan M, Halkin H, Karasik A, Lusky A
Am J Epidemiol. 1984 Mar;119(3):431-44. doi: 10.1093/oxfordjournals.aje.a113761.
Five shortcut methods of population screening for glucose intolerance (impaired glucose tolerance and non-insulin-dependent diabetes mellitus) were assessed for effectiveness: 1) glycosylated hemoglobin concentration (HbA1), 2) fasting plasma glucose level, 3) combinations of fasting plasma glucose and HbA1, 4) plasma glucose one hour post oral glucose load, and 5) plasma glucose two hour post oral glucose load. In a sample of the Israeli Jewish population aged 40-70 years, 2040 participants in the Israel Study of Glucose Intolerance, Obesity and Hypertension, who were not known to be diabetic, underwent an oral glucose tolerance test based on three blood samples (fasting, one hour, and two hour post oral glucose load). In 1058 of the subjects, HbA1 was also measured, and was found to increase significantly (P less than 0.001) with increasing glucose intolerance, but with extensive overlap of ranges, even between normals and newly found diabetics. Fasting plasma glucose was more effective than HbA1 in screening for both impaired glucose tolerance and diabetes by its higher specificity and predictive value of a positive test at comparable sensitivity levels. Combinations of HbA1 and fasting plasma glucose did not improve prediction over fasting plasma glucose alone. As observed in other studies, the screening effectiveness of fasting plasma glucose was also unsatisfactory, either post load glucose level being more effective. Plasma glucose level two hour post load was better for detection of diabetes alone. Plasma glucose level one hour post load was more effective at detecting the total group of glucose intolerance, but did not discriminate well between impaired tolerance and diabetes. A cost-risk-benefit evaluation suggests that a full three-sample oral glucose tolerance test is the best method in screening for both intolerance categories.
对葡萄糖耐量异常（糖耐量受损和非胰岛素依赖型糖尿病）人群筛查的五种快捷方法进行了有效性评估：1）糖化血红蛋白浓度（HbA1），2）空腹血糖水平，3）空腹血糖与HbA1的组合，4）口服葡萄糖负荷后1小时血糖，以及5）口服葡萄糖负荷后2小时血糖。在年龄为40 - 70岁的以色列犹太人群样本中，2040名参与以色列糖耐量异常、肥胖与高血压研究且此前未知患有糖尿病的参与者，基于三份血样（空腹、口服葡萄糖负荷后1小时和2小时）接受了口服葡萄糖耐量试验。在1058名受试者中还测量了HbA1，结果发现随着葡萄糖耐量异常程度增加，HbA1显著升高（P小于0.001），但范围存在广泛重叠，即使在正常人和新发现的糖尿病患者之间也是如此。在可比的敏感性水平下，空腹血糖在筛查糖耐量受损和糖尿病方面比HbA1更有效，因其具有更高的特异性和阳性检测预测值。HbA1与空腹血糖的组合在预测方面并不比单独使用空腹血糖有所改善。正如在其他研究中所观察到的，空腹血糖的筛查有效性也不令人满意，负荷后血糖水平更为有效。负荷后2小时血糖水平在单独检测糖尿病方面效果更好。负荷后1小时血糖水平在检测葡萄糖耐量异常总体人群方面更有效，但在区分糖耐量受损和糖尿病方面效果不佳。成本 - 风险 - 效益评估表明，完整的三份血样口服葡萄糖耐量试验是筛查这两种耐量异常类型的最佳方法。
