Not performing an OGTT results in underdiagnosis, inadequate risk assessment and probable cost increases of (pre)diabetes in Han Chinese over 40 years: a population-based prospective cohort study
Not performing an OGTT results in underdiagnosis, inadequate risk assessment and probable cost increases of (pre)diabetes in Han Chinese over 40 years: a population-based prospective cohort study
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40 多年来，不进行 OGTT 会导致汉族糖尿病（前期）糖尿病的诊断不足、风险评估不充分以及可能的费用增加：一项基于人群的前瞻性队列研究
DOI：
10.1530/ec-18-0372
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发表时间：
2018-12-01
影响因子：
2.9
通讯作者：
Chen, Lu-Lu
中科院分区：
文献类型：
--
作者：
Hu, Xiang;Zhang, Qiao;Chen, Lu-Lu
目的：探讨40岁以上不进行口服葡萄糖耐量试验(OGTT)对汉族人群的影响。设计：6682名受试者进入前瞻性队列研究，并被跟踪3年。方法：采用世界卫生组织(WHO)或美国糖尿病协会(ADA)标准进行糖化血红蛋白(HbA1c)检测，糖尿病患病率为12.4%(95%可信区间：11.6-13.3)，糖化血红蛋白(HbA1c)符合世界卫生组织(WHO)或美国糖尿病协会(ADA)标准。根据WHO和ADA标准，糖尿病前期患病率分别为34.1%(95%CI：32.9-35.3)和56.5%(95%CI：55.2-57.8)。2H-PG检出的糖尿病个体多于空腹血糖和糖化血红蛋白。每例OGTT阳性病例的检测成本接近空腹血糖，低于2小时Pg或HbA1c。与OGTT相比，FPG、2h-PG和HbA1c策略会增加假阳性(FP)或假阴性(FN)结果并发症的成本。此外，基线OGTT确定为正常的最少个体发生糖尿病(前期)，而糖化血红蛋白(HbA1c)或空腹血糖(FPG)根据ADA标准确定的糖尿病前期最多的个体发生糖尿病。结论：在中国汉族人群中，单纯的糖耐量减低和单独的2小时负荷后糖尿病的患病率很高，大多数(前期)糖尿病患者未被发现。在中国汉族人群中，40年来不进行OGTT会导致诊断不足、发展风险评估不足和可能增加的(前期)糖尿病的费用增加，在检测这一人群(前期)糖尿病时应高度重视OGTT。进一步的基于人群的前瞻性队列研究较长期的影响是必要的，以调查(前期)糖尿病的风险评估和成本。
Objective: To explore the influence by not performing an oral glucose tolerance test (OGTT) in Han Chinese over 40 years.Design: Overall, 6682 participants were included in the prospective cohort study and were followed up for 3 years.Methods: Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2h-PG), FPG and 2h-PG (OGTT), and HbA1c testing using World Health Organization (WHO) or American Diabetes Association (ADA) criteria were employed for strategy analysis.Results: The prevalence of diabetes is 12.4% (95% CI: 11.6-13.3), while the prevalence of prediabetes is 34.1% (95% CI: 32.9-35.3) and 56.5% (95% CI: 55.2-57.8) using WHO and ADA criteria, respectively. 2h-PG determined more diabetes individuals than FPG and HbA1c. The testing cost per true positive case of OGTT is close to FPG and less than 2h-PG or HbA1c. FPG, 2h-PG and HbA1c strategies would increase costs from complications for false-positive (FP) or false-negative (FN) results compared with OGTT. Moreover, the least individuals identified as normal by OGTT at baseline developed (pre) diabetes, and the most prediabetes individuals identified by HbA1c or FPG using ADA criteria developed diabetes.Conclusions: The prevalence of isolated impaired glucose tolerance and isolated 2-h post-load diabetes were high, and the majority of individuals with (pre)diabetes were undetected in Chinese Han population. Not performing an OGTT results in underdiagnosis, inadequate developing risk assessment and probable cost increases of (pre)diabetes in Han Chinese over 40 years and great consideration should be given to OGTT in detecting (pre) diabetes in this population. Further population-based prospective cohort study of longer-term effects is necessary to investigate the risk assessment and cost of (pre)diabetes.