Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies
Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies
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DOI：
10.1016/s0140-6736(08)60343-8
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发表时间：
2008-03-01
期刊：
影响因子：
168.9
通讯作者：
Shaw, Jonathan
中科院分区：
文献类型：
--
作者：
Wong, Tien Y.;Liew, Gerald;Shaw, Jonathan
背景世界卫生组织和美国糖尿病协会的糖尿病诊断标准假定存在一个高灵敏度的血糖阈值来识别视网膜病变。然而，这一假设是基于之前三项研究的数据，这些研究在检测视网膜病变方面存在重要局限性。我们旨在为空腹血糖(FPG)与视网膜病变之间的关系提供最新数据，并评估当前FPG阈值在识别视网膜病变流行和事件方面的诊断准确性。方法我们检查了三个横断面成年人的数据：蓝山眼科研究(BMES，澳大利亚，n=3162)、澳大利亚糖尿病、肥胖和生活方式研究(澳大利亚，AusDiab，n=2182)和动脉粥样硬化多种族研究(MESA，n=6079)。根据每只眼睛的多张视网膜照片诊断视网膜病变，并根据改良的Airlie House分类系统进行分级。测定空腹静脉血的血糖浓度，发现BME患者视网膜病变的总患病率为11.5%(95%CI 10.4~12.6%)，AusDiab患者为9.6%(8.4~10.9)，MESA患者为15.8%(14.9~16.7)。然而，我们发现了不一致的证据，即普遍的和偶发的视网膜病变的血糖阈值是一致的，分析表明两者之间存在持续的关系。糖尿病患者广泛使用的空腹血糖界值为7。0 mmoL/L或以上的灵敏度<40%(14.8~39)。1)诊断视网膜病变，特异度为80.8%~95.8%。空腹血糖和视网膜病变的受试者工作特征曲线下面积较低，范围为0。56至0.61解释我们没有证据表明不同人群中视网膜病变的存在或发病率存在明确且一致的血糖阈值。目前的空腹血糖截止值为7。0 mmoL/L诊断糖尿病不能准确区分有无视网膜病变的人群。这些发现表明，诊断糖尿病的标准可能需要重新评估。
Background The WHO and American Diabetes Association criteria for diagnosing diabetes mellitus assume the presence of a glycaemic threshold with high sensitivity for identifying retinopathy. However, this assumption is based on data from three previous studies that had important limitations in detecting retinopathy. We aimed to provide updated data for the relation between fasting plasma glucose (FPG) and retinopathy, and to assess the diagnostic accuracy of current FPG thresholds in identifying both prevalent and incident retinopathy.Methods We examined the data from three cross-sectional adult populations: those in the Blue Mountains Eye Study (BMES, Australia, n=3162), the Australian Diabetes, Obesity and Lifestyle Study (AusDiab, Australia, n=2182), and the Multi-Ethnic Study of Atherosclerosis (MESA, USA, n=6079). Retinopathy was diagnosed from multiple retinal photographs of each eye, and graded according to the modified Airlie House Classification system. Plasma glucose concentrations were measured from fasting venous blood samples.Findings The overall prevalence of retinopathy was 11.5% in BMES (95% Cl 10.4-12.6%), 9.6% in AusDiab (8.4-10.9), and 15.8% in MESA (14.9-16.7). However, we found inconsistent evidence of a uniform glycaemic threshold for prevalent and incident retinopathy, with analyses suggesting a continuous relation. The widely used diabetes FPG cutoff of 7 . 0 mmol/L or higher had sensitivity less than 40% (range 14.8-39. 1) for detecting retinopathy, with specificity between 80.8% and 95.8%. The area under receiver operating characteristic curves for FPG and retinopathy was low and ranged from 0 . 56 to 0.61.Interpretation We saw no evidence of a clear and consistent glycaemic threshold for the presence or incidence of retinopathy across different populations. The current FPG cutoff of 7 . 0 mmol/L used to diagnose diabetes did not accurately identify people with and without retinopathy. These findings suggest that the criteria for diagnosing diabetes could need reassessment.