HbA1c Alone Is a Poor Indicator of Cardiometabolic Risk in Middle-Aged Subjects with Pre-Diabetes but Is Suitable for Type 2 Diabetes Diagnosis: A Cross-Sectional Study
HbA1c Alone Is a Poor Indicator of Cardiometabolic Risk in Middle-Aged Subjects with Pre-Diabetes but Is Suitable for Type 2 Diabetes Diagnosis: A Cross-Sectional Study
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HbA1c 单独作为中年糖尿病前期受试者的心脏代谢风险指标很差，但适合 2 型糖尿病诊断：一项横断面研究
作者：
S. Millar;I. Perry;C. Phillips
目的糖化血红蛋白A1 c（HbA 1c）是糖尿病前期和2型糖尿病诊断的一种新方法。然而，有证据表明HbA 1c和FPG之间不一致。在这项研究中，我们检查了一系列代谢风险特征，促炎细胞因子，急性期反应蛋白，凝血因子和白色血细胞计数，以确定哪种检测方法更准确地识别心脏代谢风险增加的个体。材料与方法这是一项横断面研究，涉及2,047名年龄在46-73岁的男性和女性的随机样本。采用二项和多项logistic回归分析风险特征与糖尿病前期[HbA 1c水平5.7-6.4%（39-46 mmol/mol）或受损FPG水平5.6-6.9 mmol/l]和2型糖尿病[HbA 1c水平>6.5%（>48 mmol/mol）或FPG水平>7.0 mmol/l]的相关性。采用受试者工作特征曲线分析评价HbA 1c对糖尿病前期和FPG定义的糖尿病的区分能力。结果与HbA 1c检测结果相比，FPG检测结果与糖尿病相关表型的相关性更强。2型糖尿病患者表现出心脏代谢特征，根据两种检测方法的诊断结果大致相似。通过两种检测方法分类的糖尿病前期参与者显示出更多的促炎症、促动脉粥样硬化、高血压和胰岛素抵抗特征。与分别通过HbA 1c（OR：1.4，95% CI：1.2-1.8）或FPG（OR：3.0，95% CI：1.7-5.1）诊断的受试者相比，具有三个或更多代谢综合征特征的比值比也显著增加（OR：4.0，95% CI：2.8-5.8）。结论：在中年白种欧洲人中，单独HbA 1c是心脏代谢风险的不良指标，但适用于诊断糖尿病。HbA 1c和FPG的联合使用可能对检测2型糖尿病发生几率最高的个体有额外的益处。
Objectives Glycated haemoglobin A1c (HbA1c) measurement is recommended as an alternative to fasting plasma glucose (FPG) for the diagnosis of pre-diabetes and type 2 diabetes. However, evidence suggests discordance between HbA1c and FPG. In this study we examine a range of metabolic risk features, pro-inflammatory cytokines, acute-phase response proteins, coagulation factors and white blood cell counts to determine which assay more accurately identifies individuals at increased cardiometabolic risk. Materials and Methods This was a cross-sectional study involving a random sample of 2,047 men and women aged 46-73 years. Binary and multinomial logistic regression were employed to examine risk feature associations with pre-diabetes [either HbA1c levels 5.7-6.4% (39-46 mmol/mol) or impaired FPG levels 5.6-6.9 mmol/l] and type 2 diabetes [either HbA1c levels >6.5% (>48 mmol/mol) or FPG levels >7.0 mmol/l]. Receiver operating characteristic curve analysis was used to evaluate the ability of HbA1c to discriminate pre-diabetes and diabetes defined by FPG. Results Stronger associations with diabetes-related phenotypes were observed in pre-diabetic subjects diagnosed by FPG compared to those detected by HbA1c. Individuals with type 2 diabetes exhibited cardiometabolic profiles that were broadly similar according to diagnosis by either assay. Pre-diabetic participants classified by both assays displayed a more pro-inflammatory, pro-atherogenic, hypertensive and insulin resistant profile. Odds ratios of having three or more metabolic syndrome features were also noticeably increased (OR: 4.0, 95% CI: 2.8-5.8) when compared to subjects diagnosed by either HbA1c (OR: 1.4, 95% CI: 1.2-1.8) or FPG (OR: 3.0, 95% CI: 1.7-5.1) separately. Conclusions In middle-aged Caucasian-Europeans, HbA1c alone is a poor indicator of cardiometabolic risk but is suitable for diagnosing diabetes. Combined use of HbA1c and FPG may be of additional benefit for detecting individuals at highest odds of type 2 diabetes development.
影响因子：
16.2
作者：
Stern, MP;Williams, K;Haffner, SM
通讯作者：
Haffner, SM