The prevalence of hypertension and diabetes defined by fasting and 2-h plasma glucose criteria in urban Nepal.

AIMS: To determine the prevalence of diabetes, impaired fasting glucose and impaired glucose tolerance (IGT) in people aged >/= 40 years in urban communities of Nepal, comparing the fasting and 2-h plasma glucose (PG) criteria for diagnosis of diabetes and to relate the prevalence to age, gender and hypertension. METHODS: Field surveys of fasting and 2-h PG and blood pressure (BP) were done by cluster sampling in seven urban populations of Nepal. Of 1180 eligible individuals invited, 1012 (85.7%) aged >/= 40 years participated. RESULT: The age and sex standardized prevalence of diabetes (known and newly diagnosed), IGT and impaired fasting glycaemia (IFG) were 19.0%, 10.6% and 9.9%, respectively. Of the total population, 30.5% (37.8% of men and 25.3% of women) had some abnormality of glucose tolerance. Of all diabetic individuals, 54.4% (53.8% of men and 55.1% of women) were undiagnosed. The prevalence of diabetes increased with age until the age of 75 years. The prevalence of diabetes was higher in men than in women (P < 0.001). The sensitivity of the fasting plasma glucose (FPG) criterion compared with either FPG or 2-h PG or both criteria for the diagnosis of diabetes was 70.5%[95% confidence interval (CI) 60.7, 78.8] and the corresponding sensitivity of 2-h PG criterion was 79% (95% CI 69.8, 86.1). The age- and sex-standardized prevalence of hypertension (BP >/= 140/90 mmHg) was 22.7%. Hypertension was less common in subjects with normal plasma glucose than in those with diabetes (18.8% vs. 36.7%). Similarly, of all subjects with hypertension, 29.1% had diabetes (known or newly diagnosed) and 43.0% had glucose intolerance of some form. CONCLUSIONS: Our study shows that diabetes and hypertension are common and related problems in people aged >/= 40 years in urban Nepal. The overall sensitivity of the 2-h PG criteria was greater than that of the FPG criteria for diagnosing diabetes, except in subjects aged >/= 60 years.     

糖化血红蛋白用于筛查糖尿病的意义

目的比较并评价空腹血糖（FPG）和糖化血红蛋白（HbA1c）在筛查DM中的应用价值。方法上海地区研究对象2298名,为明确DM诊断而就诊者和DM高危人群接受DM筛查者,男956名,女1342名,年龄52±13岁,行OGTT并测定HbA1C;以其工作特征曲线（ROC）评价FPG和HbA。C在筛查DM中的敏感性和特异性。结果（1）按照1999年WHO的DM诊断标准,本研究人群糖耐量正常（NGT）、空腹血糖受损（IFG）、糖耐量受损（IGT）、IGT合并IFG和DM者分别为830、110、380、183、795例。其中DM患病率为34．6％。（2）依据ROC判断,与DM状态相关的FPG最佳临界点为6．1mmol／L,敏感性和特异性均为81．5％,曲线下面积为0．899（95％CI0．885～0．914）,阳性似然比4．18,阴性似然比0．23;与DM状态相关的HbA1c最佳临界点为6．1％,敏感性和特异性均为81．0％,曲线下面积为0．890（95％CI0．876-0．904）,阳性似然比4．26,阴性似然比0．23;如应用FPG≥6．1mmol／L或HbA1c≥6．1％筛查DM,敏感性和特异性分别为96．5％和65．2％,阳性似然比2．77,阴性似然比0．05。结论FPG和HbA1C在筛查DM中具有相似的价值,二者均有相似的特异性和敏感性以及阳性似然比和阴性似然比。为了最大限度的筛查出DM患者,建议对于6．1mmol／L≤FPG〈7．0mmol／L或HbA1c≥6．1％的患者行OGTT检查以明确有无DM。     

Incidence of diabetic nephropathy in Type 1 diabetic patients in Spain: 'Estudio Diamante'

To assess the use of fasting plasma glucose (FPG) alone for the screening of diabetes as defined by a 2-h plasma glucose (2-h PG) > or =11.1 mmol/l following a 75-g oral glucose tolerance test, we collated the results from 17512 subjects aged 30-89 years without a previous history of diabetes from 12 general population-based Asian studies. The performance of FPG corresponding to the 2-h PG > or =11.1 mmol/l was characterized. The prevalence of diabetes was 4.0% by the FPG criteria only and 6.0% by the 2-h PG criteria only. The FPG value of 7.0 mmol/l gave a sensitivity for diabetes as defined by a 2-h PG > or =11.1 mmol/l of 46% and specificity of 99%. The FPG associated with a 2-h PG > or =11.1 mmol/l with optimal sensitivity and specificity was 5.8 mmol/l (sensitivity 79%, specificity 85%). The optimal FPG cut-point was affected by gender, age, body mass index and the presence of hypertension, and the resulting sensitivity and specificity corresponding to each optimal cut-point changed. The FPG was a specific but insensitive screening test for diabetes defined by 2-h PG > or =11.1 mmol/l. There seems to be ethnic differences with respect to optimal FPG cut-point, and different screening strategies may be necessary in different parts of the world.     

Correlation among fasting plasma glucose, two-hour plasma glucose levels in OGTT and HbA1c

A study was made on the association among 2-h plasma glucose (PG) in oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) using correlation and regression equation. Subjects were 13 174 OGTT examinees tested between 1980 and 1998. Blood glucose was determined by the glucose oxidase method and glycated hemoglobin (HbA1c) by the HPLC method. As for correlation between 2-h PG and FPG, regression equation of the <60 year group was y=57.1+0.336x (r=0.866, P<0.0001) and that of the 60 year group was y=61.5+0.286x (r=0.814, P<0.0001). FPG was calculated at 124.3 in the <60 year group and 118.7 mg/dl in the 60 year group for 2-h PG of 200 mg/dl, 2-h PG were calculated at 199.5 and 210.7 mg/dl for FPG of 126 mg/dl, respectively. In the <60 year group, FPG were calculated at 121.7 and 124.4 mg/dl and 2-h PG at 193.2 and 199.3 mg/dl for HbA1c of 6.0 and 6.1%, respectively. As for associations between HbA1c and FPG or 2-h PG being high correlation, it is possible to estimate a prevalence of DM in a group using HbA1c6.1%. High correlations were demonstrated among all the three measures; FPG, 2-h PG, HbA1c. If 2-h PG is used in diagnosing diabetes mellitus, an FPG of 126 mg/dl proposed by ADA and World Health Organization (WHO) as a diagnostic level of FPG is an acceptable value for the Japanese.     

Hemoglobin A1c for the diagnosis of diabetes: To replace or to guide oral glucose tolerance tests?

Aims/Introduction: To evaluate if hemoglobin A1c (A1C) can replace the use of the oral glucose tolerance test (OGTT) to diagnose diabetes in Chinese patients. Materials and Methods: Subjects without pre‐existing diabetes were included in this community‐based study. Each participant received a 75‐g OGTT and A1C tests. Results: A total of 1362 subjects, 512 men and 850 women, aged 18–88 years, were enrolled. The prevalence of diabetes was 7.4 and 7.3% by OGTT and by A1C ≥ 6.5% criteria, respectively. The optimal A1C cut‐off for diabetes defined by OGTT was 6.1%. The performance of A1C ≥ 6.1% to find diabetes by OGTT was poor, with a kappa 0.50, sensitivity 80% and specificity 91%. Using current criteria of fasting plasma glucose (FPG) < 5.56 mmol/L to exclude and ≥7 mmol/L to diagnose diabetes (FPG criterion), the sensitivity, specificity and OGTT required were 77.2, 100 and 13.5%, respectively. Using A1C < 5.9% to exclude and ≥7.0% to diagnose diabetes (A1C criterion), the sensitivity, specificity and OGTT required were 89.1, 99.8 and 26.5%, respectively. However, using FPG < 5.56 mmol/L and A1C < 6.1% to exclude, and A1C ≥ 7.0% to diagnose diabetes (A1C plus FPG criterion), the sensitivity, specificity and OGTT required were 85.2, 100 and 18.9%, respectively. Conclusions: To screen for diabetes, the A1C criterion is more sensitive than the FPG criterion, with more OGTT needed. The A1C plus FPG criterion reduced the number of OGTT needed with acceptable sensitivity. A1C can guide, but cannot replace, OGTT to diagnose diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00181.x, 2011)     

Fasting plasma glucose diagnostic criterion, proposed by the American Diabetes Association, has low sensitivity for diagnoses of diabetes in Mexican population.

To determine the best cutoff value of fasting plasma glucose (FPG) for diagnosis of diabetes, using the 2-h postglucose load (2-h PG) as the gold standard, in Mexican population and compare it to the 7.0 mmol/l limit proposed by the American Diabetes Association (ADA). 712 apparently healthy Mexican individuals were included in a cross-sectional randomized population survey. Sensitivity of FPG criterion for diagnoses of type 2 diabetes was calculated from a fourfold table. Glycemia value 2-h PG of >or=11.1 mmol/l was the "gold standard" diagnostic test. The optimal FPG value for diagnoses of diabetes was established on a receiver operating characteristic (ROC) scatter plot. On the basis of the "gold standard" diagnostic test, diagnosis of type 2 diabetes was established in 65 (9.12%) subjects, whereas the ADA FPG diagnostic criterion only identified 39 (5.47%) subjects; that is a sensitivity of 60% (CI(95%) 47.1-72.0). The ROC scatter plot showed the best cutoff value of FPG for diagnoses of diabetes that corresponds to 6.1 mmol/l, which has the highest sensitivity (0.985). FPG diagnostic criterion proposed by the ADA Expert Committee for diagnosis of type 2 diabetes has low sensitivity in Mexican population. For epidemiological purposes, estimates of diabetes prevalence in Mexico based on a FPG value of >or=6.1 mmol/l will improve the success of the screening.     

Usefulness of HbA1c to diagnose diabetes among Japanese children detected by a urine glucose screening program in the Tokyo Metropolitan Area

We examined the correlation between plasma glucose (PG) and hemoglobin A1c (HbA1c) to evaluate the usefulness and limitations of applying the new diagnostic criteria for diabetes to Japanese pediatric patients. Data were collected from 298 school children who took an oral glucose tolerance test (OGTT) at a school-based urinary glucose screening program in the Tokyo Metropolitan Area between 1988 and 2009. Mean (SD) age of the children was 11.9 (2.5) years. Male-to-female ratio was 1:1.1. Children were diagnosed with renal glucosuria (n=146), diabetes mellitus (n=133), or the Japan Diabetes Society (JDS) "borderline type" (n=19). Median (range) values of fasting plasma glucose (FPG), 2-h plasma glucose in an OGTT (OGTT-2h), and HbA1c were 101 (76-378) mg/dL, 146.5 (57-563) mg/dL, and 6.05 (4.7-14.1) %. The correlation between PG and HbA1c was analyzed using least squares regression, and HbA1c was found to highly correlate with PG. From estimated regression equations, mean values of FPG and OGTT-2h corresponding to an HbA1c of 6.5% were calculated to be 111.4 mg/dL and 170.4 mg/dL. The mean values of HbA1c corresponding to an FPG of 126 mg/dL and OGTT-2h of 200 mg/dL were calculated to be 7.5% and 7.8%. The mean values of PG corresponding to HbA1c of 6.5% were lower than found in adults as analyzed by JDS. The mean values of HbA1c corresponding to diabetic type PG were higher than found in adults.     

Fasting Plasma Glucose in the Diagnosis of Diabetes Mellitus: A Study from Southern India

The usefulness of fasting plasma glucose (FPG) in the diagnosis of diabetes mellitus was assessed in Asian Indians in South India. Oral GTT values in 570 newly screened adults were studied. Taking the WHO criteria of 2 h plasma glucose (PG) of ≥ 11.1 mmol l^?1 for diagnosis of diabetes, the validity of a FPG of ≥ 7.8 mmol l^?1 cut off value for diabetes was assessed. Using the regression analysis, the correlations of the FPG to 2 h PG were examined. Among the 268 with 2 h PG value of ≥ 11.1 mmol l^?1, 205 (76.5 %) had FPG ≥ 7.8 mmol l^?1. Sensitivity of FPG was 76.5 % for diagnosis of diabetes and its specificity was 99 %. An exponential regression model gave the best fit for FPG vs 2 h PG and using the regression equation, the predicted FPG for a 2 h PG of 11.1 mmol l^?1 was 7.05 mmol l^?1. Sensitivity increased to 90.3 % with FPG of 7.05 mmol l^?1 while the specificity remained at 92 %. It is concluded that in the south Indian subjects, the sensitivity for diagnosis of diabetes with FPG of ≥ 7.8 mmol l^?1 was 76.5 %; and it increased to 90.3 % with FPG of ≥ 7.05 mmol l^?1.     

Prevalence of diabetes, obesity and hypertension in a Turkish population (Trabzon city).

OBJECTIVE: The objectives of this study were to determine the prevalence of diabetes mellitus in Trabzon city, Turkey, using standardized diagnostic criteria, and to evaluate associated factors. METHODS: A total of 3000 eligible study subjects were selected. Of those, 2646 subjects participated in the study. Individuals aged > or =20 years were selected from their family health cards and were invited to the health station. Anthropometric and demographic data were obtained for each subject. Plasma glucose was measured by an autoanalyser. People without previously diagnosed diabetes were categorized according to WHO diagnostic criteria as follows. Diabetes: a fasting plasma glucose (FPG)> or =140 mg/dl or 2-h plasma glucose > or =200 mg/dl after a 75-g oral glucose load. RESULTS: The overall prevalence of diabetes in those > or =20 years of age was 6.0% (n=160). Among diabetic subjects, 69 were newly diagnosed diabetes mellitus. Age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) and FPG were higher in diabetic subjects than in non-diabetic subjects. The prevalence of diabetes showed significant association with increased age (P<0.0001). The overall prevalence of obesity was 19.2%. The combined prevalence of both overweight and obesity was 60.6%. The prevalence of obesity was 27.4% among women and 10.7% among men (P<0.0001). Prevalence of diabetes increased with degree of obesity (P<0.0001). The rate of obesity in diabetic subjects was 35.6%. In the study population as a whole, the prevalence of obesity increased with age, being highest in the 50-59 years age group, but lower again in the 60+ age group. Prevalence of SBP> or =140 mmHg was 12.0% and of DBP> or =90 mmHg was 8.2%.     

Usefulness of hemoglobin A1c as a criterion of dysglycemia in the definition of metabolic syndrome in Koreans

To explore the utility of the HbA1c criterion in the definition of metabolic syndrome (MS) in Koreans, we cross-sectionally analyzed clinical and laboratory data on 11,293 non-diabetic Korean adults (aged 20-89 years, 34% women) collected during regular health checkups. Dysglycemia was defined as either fasting plasma glucose (FPG) ≥ 5.6 mmol/l or HbA1c ≥ 5.7%. The prevalence of MS as judged by the HbA1c criterion alone (17.8%) was significantly less than that determined by FPG level alone (24.5%). Use of a combination of both criteria slightly increased the prevalence of MS (26.0%). Among the 2953 subjects categorized as having MS using the combined criteria, 929 (31%) were diagnosed by the FPG criterion alone, 177 (6%) by the HbA1c criterion alone, and 1847 (63%) using both criteria. The group diagnosed using FPG values alone had significantly higher BMI, waist circumference, blood pressure, fasting plasma insulin levels, and insulin resistance index compared with those in the group diagnosed using HbA1c levels alone. In men, the brachial-ankle pulse wave velocity was significantly higher and the HDL-cholesterol level was lower in the HbA1c-alone group. Therefore, employment of the HbA1c criterion may be useful to define MS in subjects at increased risk for atherosclerosis.     

Screening for gestational diabetes mellitus and its prevalence in Bangladesh

Background

The prevalence of gestational diabetes mellitus (GDM) has important health complications for both mother and child and is increasing all over the world. Although prevalence estimates for GDM are not new in developed and many developing countries, data are lacking for many low-income countries like Bangladesh.

Objective

To evaluate the prevalence of GDM in Bangladesh.

Research design and methods

This cross-sectional study included 3447 women who consecutively visited the antenatal clinics with an average gestation age of 26 weeks. GDM was defined according to WHO criteria (fasting plasma glucose [FPG] ≥7.0 mmol/L or 2-h ≥7.8 mmol/L) and the new ADA criteria (FPG ≥5.3 mmol/L or 2-h ≥8.6 mmol/L OGTT). We also calculated overt diabetes as FPG ≥7.0 mmol/L.

Results

Prevalence of GDM was 9.7% according to the WHO criteria and 12.9% according to the ADA criteria in this study population. Prevalence of overt diabetes was 1.8%. Women with GDM were older, higher educated, had higher household income, higher parity, parental history of diabetes, and more hypertensive, compared with non-GDM women.

Conclusion

This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help to formulate new policies to prevent and manage diabetes.     

Comparison of A1C, fasting and 2-h post-load plasma glucose criteria to diagnose diabetes in Italian Caucasians

Background and aimsThe American Diabetes Association (ADA) has revised criteria for diagnosis of type 2 diabetes recommending an A1C cut point of ≥6.5% in addition to criteria based on glucose levels. We compared A1C, fasting plasma glucose (FPG) or 2-h post-challenge glucose (2-hPG) criteria for the diagnosis of diabetes in a cohort of Italian Caucasians.Methods and resultsA total of 1019 individuals without known diabetes completed an oral glucose tolerance test (OGTT) and had A1C measured. Moderate agreement existed for A1C and FPG criteria for diagnosis of type 2 diabetes (κ coefficient = 0.522), with 85.5% of individuals classified as not having diabetes by both A1C and FPG criteria, and 5.8% classified as having diabetes by both A1C and FPG criteria. Discordant classifications occurred for 5.5% of individuals who had an A1C ≥ 6.5% and FPG <126 mg dl^?1, and for 3.2% who had an A1C <6.5% and FPG ≥126 mg dl^?1. Modest agreement existed for A1C and 2-hPG criteria for diagnosis of type 2 diabetes (κ coefficient = 0.427), with 81.8% of individuals classified as not having diabetes by both A1C and 2-hPG criteria, and 6.0% classified as having diabetes by both A1C and 2-hPG criteria. The area under the receiver operating characteristic curve of A1C for identifying subjects with diabetes according to FPG or 2-hPG criteria was 0.856 and 0.794, respectively. Modest agreement existed for A1C and FPG and/or 2-hPG criteria for diagnosis of type 2 diabetes (κ coefficient = 0.446).ConclusionsA1C ≥ 6.5% demonstrates a moderate agreement with fasting glucose and 2-hPG for diagnosing diabetes among adult Italian Caucasians subjects.     

A report on the diagnosis of intermediate hyperglycemia in Korea: A pooled analysis of four community-based cohort studies

Many studies show poor agreement between fasting plasma glucose (FPG)-based and 2-h postchallenge glucose (2-h PG)-based criteria to assess glucose metabolism. We examined the rate of agreement between FPG- and 2-h PG-based criteria in the diagnosis of intermediate hyperglycemia in four representative cohort studies in South Korea and compared the clinical characteristics and biochemical parameters in subjects with impaired fasting glucose (IFG) according to their FPG values.

Of 6234 subjects from four population-based studies performed from 1993 to 2000, 4610 individuals with data from a 75 g oral glucose tolerance test (OGTT) and no previous history of diabetes were selected. We examined the concordance rate between the FPG and 2-h PG-based criteria. We also investigated the differences in the clinical characteristics and biochemical parameters between individuals with IFG according to their FPG values.

The fasting and 2-h PG criteria had large discordance rates in the diagnosis of diabetes and impaired glucose tolerance (IGT) in Korean adults. When individuals with IFG were classified into stage 1 [5.6–6.1 mmol/L (100–109 mg/dL)] and stage 2 [6.1–7.0 mmol/L (110–125 mg/dL)] IFG, individuals with stage 2 IFG are more obese and had higher blood pressure and total cholesterol and triglycerides concentrations compared with those with stage 1 IFG. In addition, more individuals with stage 2 IFG were with diabetes as determined by a 2-h PG ≥ 11.1 mmol/L (14.1% vs. 1.9%) (P < 0.05).

Considering the poorer metabolic profile and higher percentage of people with diabetes by OGTT, these data indicate that, in the Korean population, individuals with stage 2 IFG should be treated differently from those with stage 1 IFG. To detect more cases of diabetes, the OGTT is recommended for all individuals with stage 2 IFG and cases with stage 1 IFG with some additional risk factors for diabetes.     

Impact of hemoglobin A1c‐based criterion on diagnosis of prediabetes: The Korea National Health and Nutrition Examination Survey 2011

To examine the impact of hemoglobin A1c (HbA1c) criterion on the diagnosis of prediabetes in Koreans, we analyzed nationally representative cross‐sectional data of 5,845 Korean adults aged ≥20 years from the Fifth Korea National Health and Nutrition Examination Survey 2011. Standardized prevalence rates of prediabetes in Korean adults by fasting plasma glucose (FPG; 5.6–6.9 mmol/L), HbA1c (5.7–6.4% [39–46 mmol/mol]), and combined criteria were 16.9, 28.4 and 33.8%, respectively. Among the subjects with prediabetes, 16% met FPG criteria only, 55% met HbA1c criteria only and 29% met both criteria. Prediabetic subjects who met HbA1c criteria only were significantly older, more likely to be women, and had lower hemoglobin and serum iron concentrations, whereas those who met FPG criteria only had higher body mass index, waist circumference, systolic and diastolic blood pressure. In conclusion, introduction of HbA1c criterion markedly increased the prevalence of prediabetes in Koreans, and the two criteria identified people with different characteristics.     

HbA1C和空腹血糖在糖尿病筛查中的应用价值

目的探索HbA1c及FPG筛查糖尿病（DM）的应用价值。方法南京地区参加体检的未诊断糖尿病1330例,测定FPG和HbA1c,予标准化早餐后测定餐后2小时血糖（2hPG）,用受试者工作特征曲线（ROC）评价FPG和HbA1C筛查糖尿病的效果。结果按1999年WHO的糖尿病诊断标准,本研究人群DM患病率为6．8％。采用ROC曲线判断,与DM状态相关的FPG临界点为6．1mmol／L,敏感性和特异性分别为81．3％和96．3％;HbA1c临界点为6．1％,敏感性和特异性分别为83,5％和88．8％。当采用FPG≥6．1mmol／L或HhA1c≥6．1％作为标准时,敏感性达到92．3％,同时有较好的特异性81．2％。结论单独使用FPG较HbA1c在筛查DM中具有稍高的价值,为了最大限度的筛查DM患者,建议对6．1mmol／L≤FPG≤7．0mmol／L或HbA1c≥6．1％的患者行OGTT以明确有无糖尿病。     

Confirming Glycemic Status in the Diabetes Prevention Program: Implications for Diagnosing Diabetes in High Risk Adults

AimsTo examine the ability of fasting plasma glucose (FPG) and/or 2-h glucose to confirm diabetes and to determine the proportion of participants with HbA1c ≥ 6.5%.MethodsDiabetes confirmation rates were calculated after a single elevated FPG and/or 2-h glucose on an oral glucose tolerance test (OGTT) using a confirmatory OGTT performed within 6 weeks.Results772 (24%) participants had elevated FPG or 2-h glucose on an OGTT that triggered a confirmation visit. There were 101 triggers on FPG alone, 574 on 2-h glucose alone, and 97 on both. Only 47% of participants who triggered had confirmed diabetes. While the confirmation rate for FPG was higher than that for 2-h glucose, the larger number of 2-h glucose triggers resulted in 87% of confirmed cases triggering on 2-h glucose. Confirmation rates increased to 75% among persons with FPG ≥ 126 mg/dl and HbA1c ≥ 6.5%.ConclusionsOnly half of the persons with elevated FPG and IGT were subsequently confirmed to have diabetes. At current diagnostic levels, more persons trigger on 2-h glucose than on FPG, but fewer of these persons have their diagnoses confirmed. In individuals with FPG ≥ 126 mg/dl and HbA1c ≥ 6.5%, the confirmation rate was increased.     

WHO与美国糖尿病学会糖尿病诊断标准异同的探讨

目的　探讨WHO与美国糖尿病学会 (ADA)糖尿病 (DM )诊断标准的异同及可能的原因。方法　对大庆地区 9832人糖尿病普查中做口服葡萄糖耐量试验 (OGTT)的 10 6 9人 ,分别以WHO与ADA诊断标准划分不同的血糖水平人群。分析人群分布的异同 ,并以Pearson相关分析探讨两种诊断标准的血糖异常人群不相符的原因。结果　WHO与ADA标准检出糖尿病患者分别为2 0 2例及 2 5 3例 ,与WHO标准比较 ,ADA标准诊断的DM符合率为 78.7% ,血糖正常人群符合率为 72 .3 % ,WHO检出的糖耐量低减 (IGT)人群中仅有 41.6 %被ADA判定为空腹血糖升高 (IFG) ,在空腹血浆葡萄糖 (FPG) <5 .83mmol/L的IGT及DM人群中 ,FPG均与 2小时血糖 (PG2h)不相关 ;在FPG≥ 5 .83mmol/L的人群中 ,FPG与PG2h相关。结论　ADA糖尿病诊断标准并非WHO诊断标准的替代物。WHO之IGT与ADA之IFG人群差异很大 ,以空腹血糖为标准找出与IGT完全相同的人群是不可能的     

A combination of HbA1c, fasting glucose and BMI is effective in screening for individuals at risk of future type 2 diabetes: OGTT is not needed

Objective. To identify a screening model that predicts high risk of future type 2 diabetes and is useful in clinical practice. Design and methods. Incident case‐referent study nested within a population‐based health survey. We compared screening models with three risk criteria and calculated sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and attributable proportion. We used fasting plasma glucose (FPG) alone or with an oral glucose tolerance test (OGTT), glycosylated haemoglobin A (HbA1c) (normal range 3.6–5.3%), body mass index (BMI), triglycerides and family history of diabetes (FHD). Setting. Participants in a health survey at all primary care centres (n = 33 336) and subjects with diagnosed type 2 diabetes in primary and hospital care (n = 6088) in Umeå during 1989–2001. Subjects. Each of the 164 subjects who developed clinically diagnosed type 2 diabetes (median time to diagnosis of 5.4 years) and 304 sex‐ and age‐matched referents without diabetes diagnosis. Results. Screening models with at least one criterion present had sensitivities of 0.90–0.96, specificities of 0.43–0.57 and PPVs of 8–9%. Combinations of the criteria, FPG ≥ 6.1 mmol L^?1 (capillary plasma), HbA1c ≥ 4.7% and BMI ≥ 27 in men and BMI ≥ 30 in women, had sensitivities, specificities and PPVs of 0.66%, 0.93% and 32%, and 0.52%, 0.97% and 46% respectively. Using FHD as one of three risk criteria showed comparable results. Addition of triglycerides or OGTT did not improve the prediction. Conclusions. The combination of HbA1c, FPG and BMI are effective in screening for individuals at risk of future clinical diagnosis of type 2 diabetes. OGTT or FHD is not necessary.     

Epidemiological ramifications of diagnosing diabetes with HbA1c levels

AimsTo compare the prevalence of diabetes by history and using the fasting plasma glucose (FPG) criterion alone, the HbA1c criterion alone or either one in those not known to have diabetes.MethodsAnalysis of NHANES population ≥ 20 years old from 1999 through 2010.ResultsIn those diagnosed by laboratory tests, 86% met the FPG criterion and 53% met the HbA1c criterion. The prevalence of diabetes (history or laboratory test) was significantly increased when the FPG criterion was used compared with the HbA1c criterion in the entire (11.5% vs 10.5%, P = 0.018) and Caucasian (10.6% vs 9.2%, P = 0.022) populations. In contrast, there were no significant differences in the prevalence when only the FPG criterion was used compared with only the HbA1c criterion in Hispanics (12.9% vs 12.1% P = 0.386) and African Americans (14.5 vs 14.3%, P = 0.960). Using history and either criterion in those not known to have it, diabetes increased by 61% in this 12 year period in adults ≥ 20 years old.ConclusionsUsing the FPG rather than the HbA1c criterion to diagnose diabetes in those without a history significantly increased the total prevalence of diabetes in Caucasians but not in African Americans or Hispanics.     

空腹血糖、餐后2h血糖及糖化血红蛋白对糖尿病的诊断价值

目的探讨空腹血糖(FPG)、餐后2 h血糖(2 hPG)及糖化血红蛋白(HbA1c)的检测对糖尿病诊断的参考价值。方法选取2018年5月—2020年4月期间于该院接受检查的62例2型糖尿病患者、57例空腹血糖受损患者及60名健康体检人员作为研究对象,分为A组、B组和C组,通过对FPG、2 hPG以及HbA1c的检测,分析各组的检测结果。结果A组患者的FPG、2 hPG以及HbA1c检测结果分别为(7.81±1.93)mmol/L、(13.76±2.04)mmol/L和(8.16±1.05)%,显著高于B组(t=3.945、21.621、10.953)和C组(t=9.942、40.440、16.331),差异有统计学意义(P<0.05),B组、C组患者在FPG、HbA1c检测结果上差异有统计学意义(P<0.05)。在A组确诊为2型糖尿病的患者中,以FPG≥7.0 mmol/L、2 hPG≥11.1 mmol/L、HbA1c≥6.5%为诊断标准,对糖尿病的确诊率分别为53.23%、85.48%和87.10%。而在FPG、2 hPG以及HbA1c的联合检测中,检测结果糖尿病的确诊率为98.39%,与其他3项诊断标准对比,差异有统计学意义(χ²=34.474、6.961、4.313,P<0.05)。结论在糖尿病的临床诊断中,通过对受检者FPG、2 hPG以及HbA1c等指标的检测,可以根据检测结果,对糖尿病的发生做出判断。采取联合检测的方式,对检测结果进行综合分析,可以有效提高糖尿病诊断的准确性,其对糖尿病的防治有着重要的参考价值。