【进展】糖尿病危险个体识别：糖化血红蛋白检测并无优势
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Hemoglobin A1c between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: The Insulin Resistance Atherosclerosis Study (IRAS)
Published online before print June 23, 2010, doi: 10.2337/dc10-0679
Abstract
Objective: Hemoglobin A1c (A1C) is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose (2-h PG) for detecting at-risk individuals is not well-known.
Methods: A two-hour glucose tolerance test, frequently sampled intravenous glucose tolerance test, and A1C were obtained in the follow-up examination in 855 participants in the Insulin Resistance Atherosclerosis Study. For this report, 385 were at increased risk of diabetes as defined by A1C between 5.7 and 6.4%, (A1C5.7–6.4%), impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG).
Results: IFG and IGT identified 69.1% and 59.5% of all individuals at increased risk of diabetes, respectively. A1C5.7–6.4% detected 23.6% of all at-risk individuals, although more African Americans (31.4%) and Hispanics (35.2%) than non-Hispanic whites (9.9%). Relative to A1C, FPG was more strongly related to fasting insulin (r = 0.38 vs. 0.26, p <0.01), AIR (r = − 0.20 vs. − 0.09, p <0.01), and waist circumference (r = 0.43 vs. 0.25, p <0.001) by the Spearman's correlation test. Similarly, 2-h PG was more strongly related to SI (r = − 0.40 vs. − 0.27, p <0.01) and triglycerides (r = 0.30 vs. 0.08, p <0.001).
Conclusions: A1C5.7–6.4% is less sensitive for detecting at-risk individuals than IFG and IGT, particularly among non-Hispanic whites. Single determinations of FPG and 2-h PG appear more precise correlates of insulin resistance and secretion than A1C and in general better for other metabolic disorders.
最近发表在《糖尿病护理》上的一项研究显示，与空腹血糖受损（IFG）和糖耐量受损（IGT）相比，糖化血红蛋白HbA1c水平5.7–6.4%在检出糖尿病危险个体方面的敏感性较差，尤其是在非西班牙裔白人中。单独检测FPG和2-h PG与普通个体胰岛素抵抗和分泌的相关性均优于HbA1c。
HbA1c水平检测是诊断糖尿病及检出糖尿病高危患者的一种可选方法。然而在糖尿病危险个体筛查方面，HbA1c与空腹（FPG）以及餐后2小时血浆血糖（2-h PG）相比是否有优势还未可知。
研究者在IRAS研究（胰岛素抵抗动脉粥样硬化研究）855例受试者的随访中进行了一次餐后2小时糖耐量检验、多次采样的静脉糖耐量检验和HbA1c结果的检测。共385名受试者具有糖尿病危险增高的风险，增高定义为HbA1c水平在5.7和6.4%之间、IGT和/或IFG。
IFG 和 IGT在所有个体中分别检出69.1%和59.5%的个体糖尿病危险增高，这一结果在HbA1c水平5.7-6.4%检测下仅为23.6%；非裔美国人（31.4%）和西班牙裔（35.2%）高于非西班牙裔白人（9.9%）。根据Spearman相关性检验，相对于HbA1c，FPG与空腹胰岛素（r = 0.38对0.26, p <0.01）、AIR（r = − 0.20 对 − 0.09, p <0.01）和腰围（r = 0.43对0.25, p <0.001）的相关性更强。与此类似，2-h PG与SI （r = − 0.40对 − 0.27, p <0.01）和甘油三酯（r = 0.30 对0.08, p <0.001）的相关性更强。
Published online before print June 23, 2010, doi: 10.2337/dc10-0679
Abstract
Objective: Hemoglobin A1c (A1C) is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose (2-h PG) for detecting at-risk individuals is not well-known.
Methods: A two-hour glucose tolerance test, frequently sampled intravenous glucose tolerance test, and A1C were obtained in the follow-up examination in 855 participants in the Insulin Resistance Atherosclerosis Study. For this report, 385 were at increased risk of diabetes as defined by A1C between 5.7 and 6.4%, (A1C5.7–6.4%), impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG).
Results: IFG and IGT identified 69.1% and 59.5% of all individuals at increased risk of diabetes, respectively. A1C5.7–6.4% detected 23.6% of all at-risk individuals, although more African Americans (31.4%) and Hispanics (35.2%) than non-Hispanic whites (9.9%). Relative to A1C, FPG was more strongly related to fasting insulin (r = 0.38 vs. 0.26, p <0.01), AIR (r = − 0.20 vs. − 0.09, p <0.01), and waist circumference (r = 0.43 vs. 0.25, p <0.001) by the Spearman's correlation test. Similarly, 2-h PG was more strongly related to SI (r = − 0.40 vs. − 0.27, p <0.01) and triglycerides (r = 0.30 vs. 0.08, p <0.001).
Conclusions: A1C5.7–6.4% is less sensitive for detecting at-risk individuals than IFG and IGT, particularly among non-Hispanic whites. Single determinations of FPG and 2-h PG appear more precise correlates of insulin resistance and secretion than A1C and in general better for other metabolic disorders.
最近发表在《糖尿病护理》上的一项研究显示，与空腹血糖受损（IFG）和糖耐量受损（IGT）相比，糖化血红蛋白HbA1c水平5.7–6.4%在检出糖尿病危险个体方面的敏感性较差，尤其是在非西班牙裔白人中。单独检测FPG和2-h PG与普通个体胰岛素抵抗和分泌的相关性均优于HbA1c。
HbA1c水平检测是诊断糖尿病及检出糖尿病高危患者的一种可选方法。然而在糖尿病危险个体筛查方面，HbA1c与空腹（FPG）以及餐后2小时血浆血糖（2-h PG）相比是否有优势还未可知。
研究者在IRAS研究（胰岛素抵抗动脉粥样硬化研究）855例受试者的随访中进行了一次餐后2小时糖耐量检验、多次采样的静脉糖耐量检验和HbA1c结果的检测。共385名受试者具有糖尿病危险增高的风险，增高定义为HbA1c水平在5.7和6.4%之间、IGT和/或IFG。
IFG 和 IGT在所有个体中分别检出69.1%和59.5%的个体糖尿病危险增高，这一结果在HbA1c水平5.7-6.4%检测下仅为23.6%；非裔美国人（31.4%）和西班牙裔（35.2%）高于非西班牙裔白人（9.9%）。根据Spearman相关性检验，相对于HbA1c，FPG与空腹胰岛素（r = 0.38对0.26, p <0.01）、AIR（r = − 0.20 对 − 0.09, p <0.01）和腰围（r = 0.43对0.25, p <0.001）的相关性更强。与此类似，2-h PG与SI （r = − 0.40对 − 0.27, p <0.01）和甘油三酯（r = 0.30 对0.08, p <0.001）的相关性更强。
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