HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study.
HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study.
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HbA1c%20Cutoff%20Point%20of%205.9%%20Better%20识别%20High%20Risk%20of%20进展%20to%20糖尿病%20among%20中国人%20成人：%20结果%20来自%20a%20回顾性%20队列%20研究
DOI：
10.1155/2018/7486493
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发表时间：
2018
影响因子：
4.3
通讯作者：
Chen L
中科院分区：
文献类型：
--
作者：
Liang K;Wang C;Yan F;Wang L;He T;Zhang X;Li C;Yang W;Ma Z;Ma A;Hou X;Chen L
本文进行了一项回顾性队列研究，以估计糖尿病的年发病率，并评估HbA 1c作为40岁或以上中国社区成人糖尿病进展预测因子的效用。 总共有2778名非糖尿病受试者（包括1901名女性）在基线和3年后进行了HbA 1c检测和口服葡萄糖耐量试验（OGTT）测量。糖尿病和前驱糖尿病的定义采用WHO标准。评估HbA 1c临界点以预测未来糖尿病风险。使用卡方检验计算相对风险（RR）。采用受试者工作特征（ROC）曲线下面积（AUC）评价空腹血糖（FPG）、餐后2小时血糖（2 hPG）和HbA 1c对糖尿病进展的预测效率。上级截止点定义为ROC曲线上具有较大Youden指数的点。 总体而言，7.5%（210/2778）的受试者进展为糖尿病，得出糖尿病年发病率为2.5%。此外，4.5%（100/2227）的糖耐量正常（NGT）受试者和19.6%（110/561）的前驱糖尿病受试者进展为糖尿病，前驱糖尿病受试者进展为糖尿病的相对风险是NGT受试者的5.188倍（p < 0.001）。与HbA 1c值≤ 5.6%的受试者相比，HbA 1c范围为5.7 - 5.8%、5.9 - 6.2%、6.3 - 6.4%和≥6.5%的受试者进展为糖尿病的RR分别为1.165、2.582、5.732和16.619。然而，HbA 1c范围为5.7 - 5.8%的受试者与HbA 1c ≤ 5.6%的受试者的RR无显著差异（p = 0.615）。通过FPG、2 hPG和HbA 1c预测3年后糖尿病的AUC分别为0.752（95%置信区间0.718-0.787）、0.710（95%置信区间0.671-0.748）和0.756（95%置信区间0.720-0.793）。HbA 1c临界点5.9%（敏感性0.771，特异性0.580）比5.7%（敏感性0.862，特异性0.371）更能识别糖尿病进展的高风险个体，因为前者的约登指数更大，为0.351，超过了FPG和2 hPG的指数。 使用HbA 1c值≥ 5.9%可以在评估进展为糖尿病的风险方面提供更高的准确性，并在中国成人中以更高的可靠性识别糖尿病前期个体。
This article performed a retrospective cohort study to estimate the annual incidence rates of diabetes and to assess the utility of HbA1c as a predictor for progression to diabetes in Chinese community adults aged 40 years or older. In all, 2778 nondiabetic subjects (including 1901 women) underwent HbA1c testing and oral glucose tolerance test (OGTT) measurements at baseline and after 3 years. Diabetes and prediabetes were defined using the WHO criteria. The HbA1c cutoff points were evaluated to predict the future risks of diabetes. Relative risk (RR) was calculated using the chi-square test. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficiency of fasting plasma glucose (FPG), 2 hr postprandial plasma glucose (2hPG), and HbA1c for progression to diabetes. A superior cutoff point was defined as the point on the ROC curve with a larger Youden index. Overall, 7.5% (210/2778) of the subjects progressed to diabetes, yielding an annual 2.5% diabetes incidence rate. Additionally, 4.5% (100/2227) of the subjects with normal glucose tolerance (NGT) and 19.6% (110/561) of the subjects with prediabetes progressed to diabetes, and the relative risk of progression to diabetes was 5.188 times higher in subjects with prediabetes than in subjects with NGT (p < 0.001). Compared to subjects with HbA1c values ≤ 5.6%, the RRs of progression to diabetes in subjects whose HbA1c ranged from 5.7 to 5.8%, 5.9 to 6.2%, 6.3 to 6.4%, and ≥6.5% were 1.165, 2.582, 5.732, and 16.619, respectively. However, the RRs for subjects with HbA1c ranging from 5.7 to 5.8% and those with HbA1c ≤ 5.6% did not differ significantly (p = 0.615). The AUCs for predicting diabetes after 3 years by FPG, 2hPG, and HbA1c were 0.752 (95% confidence interval 0.718–0.787), 0.710 (95% confidence interval 0.671–0.748), and 0.756 (95% confidence interval 0.720–0.793), respectively. The HbA1c cutoff point of 5.9% (sensitivity of 0.771 and specificity of 0.580) may better identify individuals at high risk of progression to diabetes than the 5.7% value (sensitivity of 0.862 and specificity of 0.371) due to the former's larger Youden index of 0.351, which exceeded the indices for FPG and 2hPG. The use of HbA1c values ≥ 5.9% may provide greater accuracy in evaluating the risk of progression to diabetes and identify individuals with prediabetes with greater reliability among Chinese adults.
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影响因子：
16.2
作者：
Bonora E;Kiechl S;Mayr A;Zoppini G;Targher G;Bonadonna RC;Willeit J
通讯作者：
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影响因子：
158.5
作者：
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影响因子：
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影响因子：
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作者：
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通讯作者：
Voelzke, Henry