Risk of Macrovascular and Microvascular Disease in Diabetes Diagnosed Using Oral Glucose Tolerance Test With and Without Confirmation by Hemoglobin A1c: The Whitehall II Cohort Study.
Risk of Macrovascular and Microvascular Disease in Diabetes Diagnosed Using Oral Glucose Tolerance Test With and Without Confirmation by Hemoglobin A1c: The Whitehall II Cohort Study.
复制标题
使用口服葡萄糖耐受性检验诊断的糖尿病的大血管和微血管疾病的风险，并在没有血红蛋白A1C确认的情况下：Whitehall II队列研究。
DOI：
10.1161/circulationaha.122.059430
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发表时间：
2022-09-27
期刊：
影响因子：
37.8
通讯作者：
Kivimaki, Mika
中科院分区：
文献类型：
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作者：
Tabak, Adam G.;Brunner, Eric J.;Lindbohm, Joni, V;Singh-Manoux, Archana;Shipley, Martin J.;Sattar, Naveed;Kivimaki, Mika
关键词：
目前还不清楚是否取代口服葡萄糖耐量试验（OGTT）与HbA 1c测量诊断糖尿病是合理的。我们的目的是评估OGTT诊断的糖尿病病例中可以通过HbA 1c证实的比例，并检查OGTT诊断但非诊断性HbA 1c的个体是否具有更高的大血管和微血管疾病风险。参与者是来自英国白厅II前瞻性队列研究的5773名男性和女性。在2002-2004年和2007-2009年的临床检查中诊断的新OGTT糖尿病病例中，评估了2012-2013年和2015-2016年这些和后续临床检查中HbA 1c确认（≥6.5%）。所有参与者都通过与电子健康记录的链接跟踪主要心血管事件，直到2017年，以及慢性肾脏疾病事件（估计肾小球滤过率<60 ml/min/1.73 m2），直到最后一次临床检查。在血管疾病风险分析中，将新的OGTT糖尿病伴和不伴诊断性HbA 1c和既存糖尿病病例与无糖尿病的参与者进行比较。224/378（59.3%）例OGTT诊断为糖尿病的参与者在4.1（SD 4.1）年随访期间通过HbA 1c确认。我们在12.1年中记录了942例心血管事件。调整不可改变的风险因素后，与4997例无糖尿病的受试者相比，371例新确诊的HbA 1c糖尿病受试者和405例既存糖尿病受试者心血管疾病风险增加，风险比[HR]分别为1.53（95%CI 1.12 - 2.10）和1.85（95%CI 1.50 - 2.28）。在对新发慢性肾脏病（487例，随访6.6年）的分析中，282例新发HbA 1c确诊的糖尿病患者的相应HR为1.69（95%CI 1.09 - 2.62），276例既存糖尿病患者的相应HR为1.67（95%CI 1.22 - 2.28）。在这两项分析中，OGTT病例中的非诊断性HbA 1c（N=149和107）与无糖尿病人群的风险相似（HR 0.99-1.07）。超过40%的OGTT诊断的糖尿病病例在延长的随访期间未通过HbA 1c确认。然而，由于这些人有类似于无糖尿病人群的心血管疾病和慢性肾脏疾病的风险，因此以HbA 1c为基础的诊断取代OGTT似乎是合理的。
It is unclear whether replacing oral glucose tolerance test (OGTT) with HbA1c-measurement for diagnosing diabetes is justified. We aimed to assess the proportion of OGTT-diagnosed diabetes cases that can be confirmed by HbA1c and to examine whether individuals with OGTT-diagnosis, but non-diagnostic HbA1c are at higher risk of macro- and microvascular disease. Participants were 5773 men and women from the population-based Whitehall II prospective cohort study, UK. New OGTT-diabetes cases diagnosed in clinical examinations in 2002-2004 and 2007-2009 were assessed for HbA1c confirmation (≥6.5%) in these and subsequent clinical examinations in 2012-2013 and 2015-2016. All participants were followed for major cardiovascular events via linkage to electronic health records until 2017 and for incident chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m2) until the last clinical examination. In analysis of vascular disease risk, new OGTT-diabetes with and without diagnostic HbA1c and pre-existing diabetes cases were compared to diabetes-free participants. 224/378 (59.3%) participants with OGTT diagnosed diabetes were confirmed by HbA1c during 4.1 (SD 4.1) years of follow-up. We recorded 942 cardiovascular events over 12.1 years. After adjustment for non-modifiable risk factors and compared to the 4997 diabetes-free participants, 371 participants with new HbA1c-confirmed diabetes and 405 participants with pre-existing diabetes had increased risk of cardiovascular disease, hazard ratios [HR] 1.53 (95%CI 1.12 to 2.10) and 1.85 (95%CI 1.50 to 2.28), respectively. The corresponding HRs in the analysis of incident chronic kidney disease (487 cases, follow-up 6.6 years) were 1.69 (95%CI 1.09 to 2.62) for 282 participants with new HbA1c-confirmed diabetes and 1.67 (95%CI 1.22 to 2.28) for 276 participants with pre-existing diabetes. In both analyses, OGTT-cases with non-diagnostic HbA1c (N=149 and 107) had a similar risk (HRs 0.99-1.07) as the diabetes-free population. Over 40% of OGTT-diagnosed diabetes cases were not confirmed by HbA1c during an extended follow-up. However, as these people have a risk of cardiovascular disease and chronic kidney disease similar to the diabetes-free population, replacement of OGTT with HbA1c-based diagnosis appears justified.