Ko G T, Chan J C, Yeung V T, Chow C C, Tsang L W, Li J K, So W Y, Wai H P, Cockram C S
Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong, China.
Diabetes Care. 1998 Aug;21(8):1221-5. doi: 10.2337/diacare.21.8.1221.
To assess the validity of using fasting plasma glucose (FPG) concentrations in conjunction with HbA1c or fructosamine for the screening of diabetes in high-risk individuals.
In this study 2,877 Hong Kong Chinese (565 [19.6%] men; 2,312 [80.4%] women) with various risk factors for glucose intolerance underwent a 75-g oral glucose tolerance test (OGTT) for screening of diabetes. The risk factors included a family history positive for diabetes, a history of gestational diabetes or impaired glucose tolerance, and obesity.
Using World Health Organization (WHO) criteria, 1,593 (55.4%) had normal glucose tolerance, 657 (22.8%) had impaired glucose tolerance, and 627 (21.8%) had diabetes. When the 1997 American Diabetes Association (ADA) criteria were applied, 394 (13.7%) had diabetes with an FPG > or = 7.0 mmol/l. Using multiple receiver operating characteristic curve analysis, the paired values of an FPG of 5.6 mmol/l and a HbA1c of 5.5% gave an optimal sensitivity of 83.8% and specificity of 83.6% to predict a 2-h plasma glucose (PG) > or = 11.1 mmol/l. Likewise, the paired values of an FPG of 5.4 mmol/l and a fructosamine level of 235 mumol/l (n = 2,408) gave an optimal sensitivity of 81.5% and specificity of 83.2%. An FPG > or = 5.6 mmol/l and an HbA1c > or = 5.5% was 5.4-fold more likely to occur in diabetic subjects (based on the WHO criteria) compared with nondiabetic subjects. For paired parameters less than these values, the likelihood ratio of this occurring in diabetic subjects was only 0.11. Similarly, an FPG > or = 5.4 mmol/l and a fructosamine > or = 235 mumol/l was fivefold more likely to occur in diabetic subjects than in nondiabetic subjects, with both parameters less than these values having a likelihood ratio of 0.04. Using these paired values as initial screening tests, only subjects who had an FPG > or = 5.6 mmol/l and < 7.8 mmol/l and an HbA1c > or = 5.5% (n = 642) required an OGTT to confirm diabetes, thereby saving 77.7% [(2,877-642)/2,877] of the OGTTs performed. Similarly, only subjects who had an FPG > or = 5.4 mmol/l and < 7.8 mmol/l and a fructosamine > or = 235 mumol/l (n = 526) required OGTT to confirm diabetes, meaning that 78.2% [(2,408-526)/2,408] of the OGTTs could have been saved. Based on the 1997 ADA criterion of an FPG cutoff value of 7.0 mmol/l, the corresponding numbers of OGTTs to be saved were 82.6% and 85.5%, respectively.
The paired values of FPG and HbA1c or FPG and fructosamine helped to identify potentially diabetic subjects, the diagnosis of which could be further confirmed by the 75-g OGTT. Using this approach approximately 80% of OGTTs could have been saved, depending on the diagnostic cutoff value of FPG.
评估空腹血糖（FPG）浓度联合糖化血红蛋白（HbA1c）或果糖胺用于高危个体糖尿病筛查的有效性。
本研究中，2877名有糖耐量异常各种危险因素的中国香港人（565名[19.6%]男性；2312名[80.4%]女性）接受了75克口服葡萄糖耐量试验（OGTT）以筛查糖尿病。危险因素包括糖尿病家族史阳性、妊娠期糖尿病或糖耐量受损史以及肥胖。
根据世界卫生组织（WHO）标准评估，1593名（55.4%）糖耐量正常，657名（22.8%）糖耐量受损，627名（21.8%）患有糖尿病。采用1997年美国糖尿病协会（ADA）标准时，394名（13.7%）FPG≥7.0 mmol/l的患者患有糖尿病。采用多受试者工作特征曲线分析，FPG为5.6 mmol/l与HbA1c为5.5%的配对值预测2小时血浆葡萄糖（PG）≥11.1 mmol/l时，敏感性最佳为83.8%，特异性为83.6%。同样，FPG为5.4 mmol/l与果糖胺水平为235 μmol/l（n = 2408）的配对值，敏感性最佳为81.5%，特异性为83.2%。与非糖尿病受试者相比，糖尿病受试者（基于WHO标准）发生FPG≥5.6 mmol/l且HbA1c≥5.5%的可能性高5.4倍。对于低于这些值的配对参数，在糖尿病受试者中出现这种情况的似然比仅为0.11。同样，糖尿病受试者发生FPG≥5.4 mmol/l且果糖胺≥235 μmol/l的可能性比非糖尿病受试者高5倍，两个参数均低于这些值时似然比为0.04。将这些配对值用作初始筛查试验时，只有FPG≥5.6 mmol/l且<7.8 mmol/l以及HbA1c≥5.5%（n = 642）的受试者需要进行OGTT以确诊糖尿病，从而节省了77.7%[（2877 - 642）/2877]的OGTT检测。同样，只有FPG≥5.4 mmol/l且<7.8 mmol/l以及果糖胺≥235 μmol/l（n = 526）的受试者需要进行OGTT以确诊糖尿病，这意味着可以节省78.2%[（2408 - 526）/2408]的OGTT检测。基于1997年ADA标准FPG临界值为7.0 mmol/l，相应可节省的OGTT检测数量分别为82.6%和85.5%。
FPG与HbA1c或FPG与果糖胺的配对值有助于识别潜在糖尿病患者，其诊断可通过75克OGTT进一步确认。采用这种方法，根据FPG的诊断临界值，大约80%的OGTT检测可以节省。
