Relationship between glycated haemoglobin and microvascular complications: Is there a natural cut-off point for the diagnosis of diabetes?
Relationship between glycated haemoglobin and microvascular complications: Is there a natural cut-off point for the diagnosis of diabetes?
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DOI：
10.1007/s00125-009-1360-5
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发表时间：
2009-07-01
期刊：
影响因子：
8.2
通讯作者：
Wong, T. Y.
中科院分区：
文献类型：
--
作者：
Sabanayagam, C.;Liew, G.;Wong, T. Y.
本研究旨在确定糖化血红蛋白与糖尿病微血管并发症的关系是否显示出任何可用于诊断糖尿病的自然阈值。我们对新加坡3190名年龄在40-80岁的马来人进行了以人口为基础的抽样调查。关注的微血管结局是：(1)眼底照片定义的任何视网膜病变；(2)轻度视网膜病变，定义如(1)；(3)中度视网膜病变，定义如(1)；(4)慢性肾病，由肾小球滤过率确定；(5)微量或大量蛋白尿，由尿白蛋白与肌酐比值定义；(6)周围神经病变，由神经传感器或单丝感觉测试定义。升高的HbA（1c）与所有微血管并发症相关。检测轻中度视网膜病变的最佳截止点分别为6.6%（敏感性87.0%，特异度77.1%，ROC曲线下面积0.899）和7.0%（敏感性82.9%，特异度82.3%，ROC曲线下面积0.904）。轻度和中度视网膜病变的患病率低于最佳分界点1%。对于其他并发症，与HbA（1c）的关系是线性的，没有明显的阈值。虽然对其他并发症的ROC分析也提示最佳分界点在6.6%至7.0%之间，但这些分界点的敏感性明显低于轻度和中度视网膜病变的敏感性，分界点在31.8%至66.5%之间。较高的HbA（1c）水平与微血管并发症相关。我们的数据支持在诊断糖尿病时使用6.6 - 7.0%的HbA（1c）临界值。在这个范围内的分界点对于轻度和中度视网膜病变个体的鉴别是最好的。任何视网膜病变、慢性肾病、蛋白尿和周围神经病变在这些分界点上都不太容易被发现。
This study was designed to determine whether the relationship of glycated haemoglobin to diabetic microvascular complications shows any natural thresholds that could be useful in diagnosing diabetes.We examined a population-based sample of 3,190 Malay adults aged 40-80 years in Singapore. The microvascular outcomes of interest were: (1) any retinopathy, defined from fundus photographs; (2) mild retinopathy, defined as in (1); (3) moderate retinopathy, defined as in (1); (4) chronic kidney disease, defined from estimated glomerular filtration rate; (5) micro- or macroalbuminuria, defined from urinary albumin to creatinine ratio; and (6) peripheral neuropathy, defined from neurothesiometer or monofilament sensory testing.Increasing HbA(1c) was associated with all microvascular complications. The optimal cut-off points for detecting mild and moderate retinopathy were 6.6% (87.0% sensitivity, 77.1% specificity and area under the receiver operating characteristics [ROC] curve 0.899) and 7.0% (82.9% sensitivity, 82.3% specificity and area under ROC curve 0.904). The prevalences of mild and moderate retinopathy were < 1% below the optimal cut-off points. For other complications, the association with HbA(1c) was linear without evidence of a distinct threshold. Although ROC analysis for these other complications also suggested optimal cut-off points between 6.6% and 7.0%, the sensitivity at these cut-off points was considerably lower than for mild and moderate retinopathy, ranging from 31.8% to 66.5%.Higher levels of HbA(1c) were associated with microvascular complications. Our data support use of an HbA(1c) cut-off point of between 6.6 and 7.0% in diagnosing diabetes. Cut-off points in this range were best for the identification of individuals with mild and moderate retinopathy. Any retinopathy, chronic kidney disease, albuminuria and peripheral neuropathy are less well detected at these cut-off points.