Short-term variability in measures of glycemia and implications for the classification of diabetes
Short-term variability in measures of glycemia and implications for the classification of diabetes
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DOI：
10.1001/archinte.167.14.1545
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发表时间：
2007-07-23
影响因子：
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通讯作者：
Coresh, Josef
中科院分区：
文献类型：
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作者：
Selvin, Elizabeth;Crainiceanu, Ciprian M.;Coresh, Josef
背景：血糖测量的短期变异性对糖尿病的诊断和流行病学研究的进行和解释具有重要的意义。我们的目标是描述空腹血糖、2小时血糖和血红蛋白A(Lc)(HbA(Lc))水平的人内变异性，并评估重复测量用于糖尿病分类的影响。方法：我们分析了685名没有被诊断为糖尿病的空腹受试者的重复测量结果，这是1988年至1994年进行的一项子研究，在最初检查后大约2周进行重复检查。结果：2小时血糖水平的变异性明显更大(人内变异系数[CVW]，16.7%；与空腹血糖(CVW，5.7%；95%CI，5.3至6.1)或糖化血红蛋白(Lc)(CVW，3.6%；95%CI，3.2至4.0)水平进行比较。在第一次测试中，空腹血糖水平为126mgdL或更高(换算为每升毫米数，乘以0.0555)的人中，第二次血糖水平为126mgdL或更高的比例为70.4%(95%可信区间，49.8%对86.2%)。使用140 mg/dL或更高的2小时血糖截止点时，结果是相似的。使用单一空腹血糖水平为126 mg/dL或更高的未诊断糖尿病的患病率为3.7%。如果使用第二次空腹血糖水平为126 mg/dL或更高来确认诊断(美国糖尿病协会指南)，患病率降至2.8%(95%可信区间为1.5%至4.0%)，下降24.4%。结论：我们发现2小时血糖水平相对于空腹血糖水平具有较高的变异性，这两种水平都相对于HBA(Lc)水平具有较高的变异性。我们的发现表明，与只使用单一测量方法的研究相比，严格应用糖尿病诊断指南(两次血糖测量)的研究可能会得出截然不同的患病率估计。
Background: Short-term variability in measures of glycemia has important implications for the diagnosis of diabetes mellitus and the conduct and interpretation of epidemiologic studies. Our objectives were to characterize the within-person variability in fasting glucose, 2-hour glucose, and hemoglobin A(lc) (HbA(lc)) levels and to assess the impact of using repeated measurements for classification of diabetes.Methods: We analyzed repeated measurements from 685 fasting participants without diagnosed diabetes from the National Health and Nutrition Examination Survey III Second Examination, a substudy conducted from 1988 to 1994 in which repeated examinations were conducted approximately 2 weeks after the original examination.Results: Two-hour glucose levels had substantially more variability (within- person coefficient of variation [CVw], 16.7%; 95% confidence interval [CI], 15.0 to 18.3) compared with either fasting glucose (CVw, 5.7%; 95% CI, 5.3 to 6.1) or HbA(lc) (CVw, 3.6%; 95% CI, 3.2 to 4.0) levels. The proportion of persons with a fasting glucose level of 126 mg/dL or higher (to convert to millimoles per liter, multiply by 0.0555) on the first test who also had a second glucose level of 126 mg/dL or higher was 70.4% ( 95% CI, 49.8% to 86.2%). Results were similar using the 2-hour glucose cutoff point of 140 mg/dL or higher. The prevalence of undiagnosed diabetes using a single fasting glucose level of 126 mg/dL or higher was 3.7%. If a second fasting glucose level of 126 mg/dL or higher was used to confirm the diagnosis (American Diabetes Association guidelines), the prevalence decreased to 2.8% (95% CI, 1.5% to 4.0%), a 24.4% decrease.Conclusions: We found high variability in 2-hour glucose levels relative to fasting glucose levels and high variability in both of these relative to HbA(lc) levels. Our findings suggest that studies that strictly apply guidelines for the diagnosis of diabetes (2 glucose measurements) may arrive at substantially different prevalence estimates compared with studies that use only a single measurement.