Utility of hemoglobin A1c in predicting diabetes risk
Utility of hemoglobin A1c in predicting diabetes risk
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DOI：
10.1111/j.1525-1497.2004.40178.x
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发表时间：
2004-12-01
影响因子：
5.7
通讯作者：
Oddone, EZ
中科院分区：
文献类型：
--
作者：
Edelman, D;Olsen, MK;Oddone, EZ
背景：围绕是否以及如何筛查成人 2 型糖尿病的问题存在争议。我们的目标是测量参加医疗保健系统的门诊患者中新发糖尿病的发病率，并确定糖化血红蛋白 (HbA1c) 值是否可以对患者在 3 年内患糖尿病的可能性进行风险分层。 方法：我们在退伍军人事务部医疗中心 (VAMC) 的一家大型三级医疗机构进行了一项前瞻性队列研究，并进行了 3 年随访。通过初始 HbA1c 测量，对 1,253 名年龄在 45 至 64 岁之间的无糖尿病门诊患者（按计划到 VAMC 就诊）进行了方便抽样，以筛查糖尿病。所有 HbA1c 大于或等于 6.0%（正常，4.0% 至 6.0%）的受试者均被邀请进行后续空腹血糖 (FPG)。然后，我们在三年内每年对患者进行一次调查，以确定医生对糖尿病的诊断间隔。初次筛选后 3 年重复基线筛选过程。基线筛查后，新发糖尿病病例定义为医生自我报告的糖尿病诊断，或 3 年随访时 HbA1c 大于或等于 7.0% 或 FPG 7.0 mmol/L。糖尿病发病率按每人每年随访的新发病例数计算。结果：最初筛查了 1253 名患者，发现 56 名患者（4.5%）在基线时患有普遍未被识别的糖尿病。 1,197 名基线时没有糖尿病的患者累计了 3,257 人年的随访。 3 年随访期间新增 73 例糖尿病病例，年发病率为 2.2%（95% 置信区间 [CI]，1.7% 至 2.7%）。在多变量逻辑回归模型中，基线 HbA1c 和基线体重指数 (BMI) 是新发糖尿病的唯一显着预测因子，其中 HbA1c 的影响大于 BMI。基线 HbA2c 小于或等于 5.5 的患者糖尿病的年发病率为 0.8%（CI，0.4% 至 1.2%）；对于 HbA1c 5.6 至 6.0，2.5%（Cl，1.6% 至 3.5%）；对于 HbA1c 6.1 至 6.9，7.8%（Cl，5.2% 至 10.4%）。 HbA1c 为 5.6 至 6.0 的肥胖患者的糖尿病年发病率为 4.1%（Cl，2.2% 至 6.0%）。 结论：HbA1c 检测有助于预测患者未来患糖尿病的可能性。 HbA1c 正常的患者糖尿病发病率较低，可能不需要 3 年内重新筛查。然而，HbA1c 升高但未患有糖尿病的患者可能需要更仔细的随访和积极的治疗，以降低患糖尿病的风险。 HbA1c 正常高值的患者可能需要 3 年以内的随访，特别是如果他们明显超重或肥胖。这一预测值表明 HbA1c 可能是定期糖尿病筛查的有用测试。
BACKGROUND: There is controversy surrounding the issue of whether, and how, to screen adults for type 2 diabetes. Our objective was to measure the incidence of new diabetes among outpatients enrolled in a health care system, and to determine whether hemoglobin A1c (HbA1c) values would allow risk stratification for patients' likelihood of developing diabetes over 3 years.METHODS: We conducted a prospective cohort study with 3-year follow-up at a single large, tertiary care, Department of Veterans Affairs Medical Center (VAMC). A convenience sample of 1,253 outpatients without diabetes, age 45 to 64, with a scheduled visit at the VAMC, were screened for diabetes using an initial HbA1c measurement. All subjects with HbA1c greater than or equal to 6.0% (normal, 4.0% to 6.0%) were invited for follow-up fasting plasma glucose (FPG). We then surveyed patients annually for 3 years to ascertain interval diagnosis of diabetes by a physician. The baseline screening process was repeated 3 years after initial screening. After the baseline screening, new cases of diabetes were defined as either the self-report of a physician's diagnosis of diabetes, or by HbA1c greater than or equal to 7.0% or FPG a 7.0 mmol/L at 3-year follow-up. The incidence of diabetes was calculated as the number of new cases per person-year of follow-up.RESULTS: One thousand two hundred fifty-three patients were screened initially, and 56 (4.5%) were found to have prevalent unrecognized diabetes at baseline. The 1,197 patients without diabetes at baseline accrued 3,257 person-years of follow-up. There were 73 new cases of diabetes over 3 years of follow-up, with an annual incidence of 2.2% (95% confidence interval [CI], 1.7% to 2.7%). In a multivariable logistic regression model, baseline HbA1c and baseline body mass index (BMI) were the only significant predictors of new onset diabetes, with HbA1c having a greater effect than BMI. The annual incidence of diabetes for patients with baseline HbA2c less than or equal to 5.5 was 0.8% (Cl, 0.4% to 1.2%); for HbA1c 5.6 to 6.0, 2.5% (Cl, 1.6% to 3.5%); and for HbA1c 6.1 to 6.9, 7.8% (Cl, 5.2% to 10.4%). Obese patients with HbA1c 5.6 to 6.0 had an annual incidence of diabetes of 4.1% (Cl, 2.2% to 6.0%).CONCLUSIONS: HbA1c testing helps predict the likelihood that patients will develop diabetes in the future. Patients with normal HbA1c have a low incidence of diabetes and may not require rescreening in 3 years. However, patients with elevated HbA1c who do not have diabetes may need more careful follow-up and possibly aggressive treatment to reduce the risk of diabetes. Patients with high-normal HbA1c may require follow-up sooner than 3 years, especially if they are significantly overweight or obese. This predictive value suggests that HbA1c may be a useful test for periodic diabetes screening.