New diabetes diagnostic threshold of hemoglobin A(1c) and the 3-year incidence of retinopathy.
New diabetes diagnostic threshold of hemoglobin A(1c) and the 3-year incidence of retinopathy.
复制标题
血红蛋白 A(1c) 的新糖尿病诊断阈值和视网膜病变的 3 年发病率。
作者：
Tsugawa Y;Takahashi O;Meigs JB;Davis RB;Imamura F;Fukui T;Taylor WC;Wee CC
新的糖化血红蛋白诊断阈值是根据横断面研究的证据制定的，没有纵向研究支持其有效性。为了检验糖化血红蛋白 6.5% 或更高是否定义了发生视网膜病变风险升高的阈值，我们分析了 19,897 名日本成年人的纵向数据，这些成年人于 2006 年接受了健康检查，并在 3 年后进行了随访。我们使用逻辑回归模型和限制三次样条模型来检查基线糖化血红蛋白水平与视网膜病变患病率和 3 年发病率之间的关系。受限三次样条模型表明，糖化血红蛋白水平为 6.0-7.0% 时，发生视网膜病变的风险可能存在阈值。 Logistic 回归分析发现，与糖化血红蛋白水平为 5.0-5.4% 的个体相比，糖化血红蛋白水平为 6.5-6.9% 的个体在 3 年后发生视网膜病变的风险显着更高（调整后的比值比为 2.35 [95% CI 1.08-5.11]）。糖化血红蛋白水平在 5.5% 至 6.4% 之间的患者没有表现出风险升高的证据。我们在分析流行性视网膜病变时没有观察到阈值。我们的纵向结果支持新的糖化血红蛋白阈值 6.5% 或更高对于诊断糖尿病的有效性。
The new diagnostic threshold of hemoglobin A1c was made based on evidence from cross-sectional studies, and no longitudinal study supports its validity. To examine whether hemoglobin A1c of 6.5% or higher defines a threshold for elevated risk of incident retinopathy, we analyzed longitudinal data of 19,897 Japanese adults who underwent a health checkup in 2006 and were followed up 3 years later. We used logistic regression models and restricted cubic spline models to examine the relationship between baseline hemoglobin A1c levels and the prevalence and the 3-year incidence of retinopathy. The restricted cubic spline model indicated a possible threshold for the risk of incident retinopathy at hemoglobin A1c levels of 6.0–7.0%. Logistic regression analysis found that individuals with hemoglobin A1c levels of 6.5–6.9% were at significantly higher risk of developing retinopathy at 3 years compared with those with hemoglobin A1c levels of 5.0–5.4% (adjusted odds ratio, 2.35 [95% CI 1.08–5.11]). Those with hemoglobin A1c levels between 5.5 and 6.4% exhibited no evidence of elevated risk. We did not observe a threshold in the analysis of prevalent retinopathy. Our longitudinal results support the validity of the new hemoglobin A1c threshold of 6.5% or higher for diagnosing diabetes.
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