Modan M, Harris M I
Department of Clinical Epidemiology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Diabetes Care. 1994 May;17(5):436-9. doi: 10.2337/diacare.17.5.436.
OBJECTIVE--To demonstrate the inadequacy of fasting plasma glucose for screening for NIDDM, even among groups at high risk for diabetes. RESEARCH DESIGN AND METHODS--Representative samples of adults 40-69 years of age in the U.S. (n = 2,035) and Israel (n = 2,316) were selected. Fasting plasma glucose (FPG) was measured and a 2-h oral glucose tolerance test (OGTT) was administered. Subjects with undiagnosed NIDDM were identified using internationally accepted diagnostic criteria (FPG > or = 7.8 mM or 2-h plasma glucose > or = 11.1 mM). RESULTS--Only 31-38% of subjects with undiagnosed NIDDM had fasting hyperglycemia (> or = 7.8 mM), and 36% in the U.S. and 19% in Israel had normoglycemia (< 6.1 mM). Postchallenge glucose, diagnostic of diabetes, was associated with all fasting values, including values < 5.0 mM. Based on sensitivity, specificity, and positive predictive value, no FPG level provided a satisfactory cutoff point to use in screening for undiagnosed NIDDM. Sensitivity at each FPG cutoff point varied little among groups classified by age, sex, race, blood pressure status, or body mass index (BMI) levels > 23, but sensitivity was lower among those with BMI levels < 23. CONCLUSIONS--In the clinical setting, FPG is commonly used in screening for NIDDM. However, fasting values < or = 7.8 mM are highly insensitive for detecting NIDDM. Lower FPG cutoff points tha achieve acceptable sensitivity are accompanied by inadequately low specificity, require a high percentage of patients to be retested, and result in a low yield of diabetes among those screened. Clinicians and researchers who seek detection of undiagnosed NIDDM should use the OGTT, because FPG lacks adequate sensitivity and specificity for this purpose.
目的——证明即使在糖尿病高危人群中，空腹血糖也不足以用于筛查非胰岛素依赖型糖尿病（NIDDM）。研究设计与方法——选取了美国40 - 69岁成年人的代表性样本（n = 2035）和以色列40 - 69岁成年人的代表性样本（n = 2316）。测量空腹血糖（FPG）并进行2小时口服葡萄糖耐量试验（OGTT）。使用国际公认的诊断标准（FPG≥7.8 mM或2小时血浆葡萄糖≥11.1 mM）来识别未确诊的NIDDM患者。结果——未确诊的NIDDM患者中只有31% - 38%存在空腹血糖过高（≥7.8 mM），在美国有36%的患者以及在以色列有19%的患者血糖正常（<6.1 mM）。挑战后诊断糖尿病的血糖水平与所有空腹血糖值相关，包括<5.0 mM的值。基于敏感性、特异性和阳性预测值，没有一个FPG水平能提供一个令人满意的切点用于筛查未确诊的NIDDM。在按年龄、性别、种族、血压状况或体重指数（BMI）水平>23分类的组中，每个FPG切点的敏感性变化不大，但在BMI水平<23的人群中敏感性较低。结论——在临床环境中，FPG常用于筛查NIDDM。然而，空腹血糖值≤7.8 mM对检测NIDDM的敏感性极低。能达到可接受敏感性的较低FPG切点伴随着特异性过低，需要对很高比例的患者进行重新检测，并且在筛查人群中糖尿病检出率低。寻求检测未确诊NIDDM的临床医生和研究人员应使用OGTT，因为FPG在此目的上缺乏足够的敏感性和特异性。
