Screening for diabetes mellitus - a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications
Screening for diabetes mellitus - a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications
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DOI：
10.1046/j.1464-5491.2000.00382.x
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发表时间：
2000-11-01
影响因子：
3.5
通讯作者：
Tan, CE
中科院分区：
文献类型：
--
作者：
Tai, ES;Lim, SC;Tan, CE
目的比较美国糖尿病协会(ADA)新的空腹血糖(FPG)标准和1985年世界卫生组织(WHO)的空腹血糖(2hPG)标准在筛查无糖尿病病史者中的作用。评价空腹血糖与2hPG诊断糖尿病的一致性(Kappa)。结果空腹血糖诊断糖尿病患病率为7.3%，2hPG诊断糖尿病患病率为8.4%。空腹血糖受损的患病率为8.0%。空腹血糖和2hPG表现出中等一致性(kappa=0.646，95%可信区间0.584~0.708)。年龄、民族和肥胖对一致性程度没有影响。2hPG大于或等于11.1 mmol/L者中，40.8%的患者空腹血糖在非糖尿病范围内，而空腹血糖大于或等于7.0 mm ol/L者中，2hPG在非糖尿病范围内的占24.8%。空腹血糖大于或等于11.1 mm ol/L的最佳空腹血糖为6.1 mm o l/L。口服葡萄糖耐量试验结果显示，90.7%的有微血管并发症风险的个体被诊断为糖尿病。结论空腹血糖是一种简便的糖尿病筛查方法，与2hPG有较好的一致性。在空腹血糖受损的患者中，OGTT的两步策略改善了对高危个体的检测。然而，糖尿病不应该在一次测试中就被诊断出来。如果一个人的糖尿病检测呈阳性，应该在另一天重新进行测试。
Aims To compare the new American Diabetes Association (ADA) fasting plasma glucose (FPG) criteria to the 1985 World Health Organization (WHO) 2-h post glucose (2hPG) criteria when used for screening of those with no prior history of diabetes mellitus.Methods The study included 3407 subjects without a history of diabetes in whom both FPG and 2hPG were available from the 1992 Singapore National Health Survey. The agreement (kappa) between FPG and 2hPG for the diagnosis of DM was assessed. The optimal cut-off of FPG for the detection of individuals with 2hPG greater than or equal to 11.1 mmol/l was determined by receiver-operating characteristics analysis.Results The prevalence of diabetes diagnosed by FPG alone was 7.3% compared to 8.4% diagnosed by 2hPG. The prevalence of impaired fasting glucose was 8.0%. FPG and 2hPG showed moderate agreement(kappa = 0.646, 95% confidence interval 0.584-0.708). Age, ethnic group and obesity did not affect the degree of agreement. Of those with 2hPG greater than or equal to 11.1 mmol/l, 40.8% had FPG in the non-diabetic range while 24.8% of those with FG greater than or equal to 7.0 mmol/l had 2hPG in the non-diabetic range. The optimal FPG for the detection of 2hPG greater than or equal to 11.1 mmol/l was 6.1 mmol/l. Oral glucose tolerance tests (OGTT) in those with 6.0 mmol/ < FPG < 7.0 mmol/l resulted in the diagnosis of diabetes in 90.7% of individuals at risk of microvascular complications.Conclusions FPG provides a simple screening test for diabetes, which shows moderate agreement with the 2hPG. A two-step strategy of OGTT in those with impaired fasting glucose improves the detection of at-risk individuals. However, diabetes should not be diagnosed on a single test. The test should be repeated on another day if an individual tests positive for diabetes.