Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study.
Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study.
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DOI：
10.1016/s2213-8587(16)30321-7
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发表时间：
2017-01
影响因子：
44.5
通讯作者：
Selvin, Elizabeth
中科院分区：
文献类型：
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作者：
Warren, Bethany;Pankow, James S.;Matsushita, Kunihiro;Punjabi, Naresh M.;Daya, Natalie R.;Grams, Morgan;Woodward, Mark;Selvin, Elizabeth
国际组织对糖尿病前期的定义缺乏共识。与并发症的关联可以告知不同糖尿病前期定义的比较价值。我们进行了一项前瞻性队列研究，共有10，844名社区动脉粥样硬化风险（ARIC）研究参与者参加了第2次访视（1990-92），其中没有诊断为糖尿病，7，194名参加了第4次访视（1996-98）。在访视2时测量空腹血糖和HbA 1c，在访视4时测量空腹血糖和2小时血糖。我们比较了基于空腹血糖（美国糖尿病协会[ADA] 5.6-6.9 mmol/L和世界卫生组织[WHO] 6.1-6.9 mmol/L）、HbA 1c（ADA 39-46 mmol/mol和国际专家委员会[IEC] 42-46 mmol/mol）和2小时血糖（ADA/WHO 7.8-11.0 mmol/L）的糖尿病前期定义。ADA空腹血糖定义的糖尿病前期（患病率37.9%）对主要临床结局最敏感，而ADA和IEC HbA 1c和WHO空腹血糖定义（患病率分别为18.7%、9.0%、11.2%）更特异。在人口统计学调整后，基于HbA 1c的糖尿病前期定义与空腹血糖相比，具有更高的风险比，并表现出对慢性肾脏疾病、心血管疾病、外周动脉疾病和全因死亡率的更好的风险区分（适度较大的C统计量，所有p<0.05）。例如，ADA空腹血糖类别和ADA HbA 1c临床类别的慢性肾脏疾病事件的C统计量分别为0.636和0.640（差异-0.005，95%CI-0.008，-0.001）。此外，与基于葡萄糖的定义相比，ADA HbA 1c定义的前驱糖尿病还显示出心血管结局和死亡的净重新分类指数的显著总体改善。比较ADA和WHO空腹血糖和ADA/WHO 2小时血糖，未发现慢性肾脏疾病、心血管疾病或死亡结局的风险区分存在统计学显著差异。我们的研究结果表明，HbA 1c定义的糖尿病前期定义更具体，并提供了适度的改善临床并发症的风险区分。总体而言，ADA空腹血糖是一个更敏感的定义。
There is a lack of consensus across international organizations regarding definitions of prediabetes. Associations with complications can inform the comparative value of different prediabetes definitions. We conducted a prospective cohort study of 10,844 Atherosclerosis Risk in Communities (ARIC) study participants without diagnosed diabetes who attended visit 2 (1990–92) and 7,194 who attended visit 4 (1996–98). Fasting glucose and HbA1c were measured at visit 2 and fasting glucose and 2-hour glucose were measured at visit 4. We compared prediabetes definitions based on fasting glucose (American Diabetes Association [ADA] 5.6–6.9 mmol/L and World Health Organization [WHO] 6.1–6.9 mmol/L), HbA1c (ADA 39–46 mmol/mol and International Expert Committee [IEC] 42–46 mmol/mol), and 2-hour glucose (ADA/WHO 7.8–11.0 mmol/L). ADA fasting glucose-defined prediabetes (prevalence 37.9%) was the most sensitive for major clinical outcomes, while ADA and IEC HbA1c and WHO fasting glucose-based definitions (prevalence 18.7%, 9.0%, 11.2%, respectively) were more specific. After demographic adjustment, HbA1c-based definitions of prediabetes had higher hazard ratios and demonstrated better risk discrimination for chronic kidney disease, cardiovascular disease, peripheral arterial disease, and all-cause mortality compared to fasting glucose (modestly larger C-statistics, all p<0.05). For example, the C-statistic for incident chronic kidney disease was 0.636 for ADA fasting glucose categories and 0.640 for ADA HbA1c clinical categories (difference −0.005, 95%CI −0.008, −0.001). Additionally, ADA HbA1c-defined prediabetes also demonstrated significant overall improvement in the net reclassification index for cardiovascular outcomes and death compared to glucose-based definitions. Comparing ADA and WHO fasting glucose and ADA/WHO 2-hour did not reveal statistically significant differences in risk discrimination for chronic kidney disease, cardiovascular, or mortality outcomes. Our results suggest that HbA1c-defined prediabetes definitions were more specific and provided modest improvements in risk discrimination for clinical complications. ADA fasting glucose was a more sensitive definition overall.