Nitiyanant W, Ploybutr S, Sriussadaporn S, Yamwong P, Vannasaeng S
Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Diabetes Res Clin Pract. 1998 Sep;41(3):171-6. doi: 10.1016/s0168-8227(98)00082-5.
To determine whether a fasting plasma glucose (FPG) cutpoint of 7.0 mmol/l can be appropriately used for detection of diabetes mellitus (DM) in the Thai population, different FPG cutpoints were evaluated for their efficacy in the diagnosis of DM. A plasma glucose level of > or = 11.1 mmol/l at 2 h after a 75-g oral glucose tolerance test (OGTT) was used as the gold standard criterion for diagnosis of DM. OGTT was performed in 496 subjects who were at risk of developing diabetes. They were 120 males and 376 females, 14-76 years old (mean +/- S.D. = 45.0 +/- 12.2 years). Plasma glucose level was determined in NaF preserved plasma using the glucose oxidase method. Diagnosis of DM was made in 22.8% of cases by the gold standard criterion as compared to 4.2% by using FPG values of > or = 7.8 mmol/l. The sensitivity of the FPG cutpoint of 7.8 mmol/l was 18.6%. Diagnosis of DM using FPG > or = 7.0 mmol/l improved the sensitivity to 33.6% with a positive predictive value of 100% and highest Youden's index of 0.836. The receiver operating characteristic curve of FPG revealed the best cutpoint to lie between 5.6-6.0 mmol/l. A FPG cutpoint of < 6.0 mmol/l over-estimated the prevalence of diabetes. DM and impaired glucose tolerance were noted in 65.6 and 29.5% of the subjects who had FPG values between 6.0 and 6.9 mmol/l, respectively. We conclude that FPG cutpoint of 7.0 mmol/l is applicable to a high risk Thai population for detection of DM. OGTT is recommended for definitive determination of glucose tolerance status in those individuals with FPG values between 6.0 and 6.9 mmol/l.
为确定空腹血糖（FPG）切点7.0 mmol/l是否适用于泰国人群中糖尿病（DM）的检测，对不同的FPG切点在DM诊断中的效能进行了评估。口服75克葡萄糖耐量试验（OGTT）后2小时血浆葡萄糖水平≥11.1 mmol/l被用作DM诊断的金标准。对496名有糖尿病发病风险的受试者进行了OGTT。他们中有120名男性和376名女性，年龄在14 - 76岁（平均±标准差=45.0±12.2岁）。采用葡萄糖氧化酶法测定氟化钠保存血浆中的葡萄糖水平。根据金标准，22.8%的病例被诊断为DM，而使用FPG值≥7.8 mmol/l时这一比例为4.2%。FPG切点7.8 mmol/l的敏感性为18.6%。使用FPG≥7.0 mmol/l诊断DM可将敏感性提高到33.6%，阳性预测值为100%，尤登指数最高为0.836。FPG的受试者工作特征曲线显示最佳切点在5.6 - 6.0 mmol/l之间。FPG切点<6.0 mmol/l会高估糖尿病患病率。FPG值在6.0至6.9 mmol/l之间的受试者中，分别有65.6%和29.5%被诊断为DM和糖耐量受损。我们得出结论，FPG切点7.0 mmol/l适用于高危泰国人群DM的检测。对于FPG值在6.0至6.9 mmol/l之间的个体，建议进行OGTT以明确确定糖耐量状态。
