Tanaka Y, Atsumi Y, Asahina T, Hosokawa K, Matsuoka K, Kinoshita J, Onuma T, Kawamori R
Department of Medicine, Metabolism and Endocrinology, Juntendo University, Tokyo, Japan.
Diabetes Care. 1998 Jul;21(7):1133-7. doi: 10.2337/diacare.21.7.1133.
To examine the usefulness of the revised criterion for fasting plasma glucose (FPG) in the diagnosis of diabetes recommended by the American Diabetic Association (ADA) (126 mg/dl, 7 mmol/l), and to characterize insulin response during the 75-g oral glucose tolerance test (OGTT) in newly diagnosed Japanese diabetic subjects.
A series of 2,121 Japanese subjects underwent a 75-g OGTT (0-3 h) and were divided into three groups (normal glucose tolerance [NGT], impaired glucose tolerance [IGT], and diabetes mellitus [DM] according to the current World Health Organization criteria. After the cutoff values of FPG that distinguish NGT and IGT from diabetes were analyzed, the usefulness of the ADA criterion for FPG was examined by comparing diagnostic parameters (sensitivity, specificity, and accuracy) with those for the cutoff value of 140 mg/dl. To assess insulin response, both the insulinogenic index (IsIx), a marker of early secretion, and the area under the insulin response curve (AUCins), a marker of total secretion, were compared between the DM, NGT, and IGT groups.
First, the FPG cutoff value distinguishing NGT from diabetes was 109 mg/dl. An FPG of 126 mg/dl showed a higher sensitivity (0.52 vs. 0.31), the same specificity (1.00), and a higher accuracy (0.82 vs. 0.74) than an FPG of 140 mg/dl, and it had a higher specificity (1.00 vs. 0.86) with a slightly lower accuracy (0.82 vs. 0.85) than an FPG of 109 mg/dl. Second, the FPG cutoff value differentiating IGT from diabetes was 113 mg/dl. An FPG of 126 mg/dl showed a higher sensitivity (0.52 vs. 0.31) and accuracy (0.80 vs. 0.74) and a similar specificity (0.97 vs. 1.00) compared with an FPG of 140 mg/dl, and it had a higher specificity (0.97 vs. 0.82) with the same accuracy (0.80) as an FPG of 113 mg/dl. Third, the DM group showed the lowest IsIx among the three groups at all FPG values. The AUCIns in the DM group increased along with FPG, reached the maximum level at an FPG of 110 mg/dl, and declined thereafter. AUCIns was higher in the DM group than in the NGT group at FPG values > or = 100 mg/dl.
The revised ADA criterion for FPG of 126 mg/dl may improve diagnostic sensitivity without loss of specificity in Japanese diabetic subjects when compared with an FPG criterion of 140 mg/dl. Although early insulin secretion was impaired, total insulin secretion did not seem to be reduced in newly diagnosed Japanese diabetic subjects.
研究美国糖尿病协会（ADA）推荐的用于糖尿病诊断的空腹血糖（FPG）修订标准（126mg/dl，7mmol/L）的实用性，并对新诊断的日本糖尿病患者在75g口服葡萄糖耐量试验（OGTT）期间的胰岛素反应进行特征分析。
对2121名日本受试者进行75g OGTT（0 - 3小时），并根据世界卫生组织现行标准分为三组（正常糖耐量[NGT]、糖耐量受损[IGT]和糖尿病[DM]）。在分析区分NGT和IGT与糖尿病的FPG临界值后，通过将诊断参数（敏感性、特异性和准确性）与140mg/dl临界值的参数进行比较，检验ADA的FPG标准的实用性。为评估胰岛素反应，比较了DM、NGT和IGT组之间作为早期分泌标志物的胰岛素生成指数（IsIx）和作为总分泌标志物的胰岛素反应曲线下面积（AUCins）。
首先，区分NGT与糖尿病的FPG临界值为109mg/dl。与FPG为140mg/dl相比，FPG为126mg/dl时敏感性更高（0.52对0.31）、特异性相同（1.00）、准确性更高（0.82对0.74），且与FPG为109mg/dl相比，特异性更高（1.00对0.86），准确性略低（0.82对0.85）。其次，区分IGT与糖尿病的FPG临界值为113mg/dl。与FPG为140mg/dl相比，FPG为126mg/dl时敏感性更高（0.52对0.31）、准确性更高（0.80对0.74）、特异性相似（0.97对1.00），且与FPG为113mg/dl相比，特异性更高（0.97对0.82），准确性相同（0.80）。第三，在所有FPG值下，DM组的IsIx在三组中最低。DM组的AUCIns随FPG升高，在FPG为110mg/dl时达到最高水平，此后下降。在FPG值≥100mg/dl时，DM组的AUCIns高于NGT组。
与FPG标准为140mg/dl相比，ADA修订的FPG标准126mg/dl可能提高日本糖尿病患者诊断的敏感性且不损失特异性。尽管新诊断的日本糖尿病患者早期胰岛素分泌受损，但总胰岛素分泌似乎并未减少。
