How valid is fasting plasma glucose as a parameter of glycemic control in non-insulin-using patients with type 2 diabetes?
How valid is fasting plasma glucose as a parameter of glycemic control in non-insulin-using patients with type 2 diabetes?
复制标题
对于不使用胰岛素的 2 型糖尿病患者，空腹血糖作为血糖控制参数的有效性如何？
作者：
M. Bouma;J. Dekker;J. D. Sonnaville;F. E. E. V. D. Does;H. D. Vries;D. M. Kriegsman;P. Kostense;R. Heine;J. Eijk
目的
评估空腹血糖作为未使用胰岛素的2型糖尿病患者血糖控制参数的价值。
研究设计和方法
在1,020例接受饮食或口服降糖药（OHA）治疗的2型糖尿病患者中，测量空腹血糖（FPG）和HbA 1c。在617例患者中，3个月后可以重复测量。计算HbA 1c和FPG之间相关性的横截面相关系数。受试者工作特征（ROC）曲线分析用于检查FPG作为HbA 1c诊断检测的性能。纵向上，FPG的变化与HbA 1c的变化进行了比较，相关性测量和ROC曲线分析。
结果
HbA 1c与FPG、FPG变化与HbA 1c变化的相关系数分别为0.77和0.65。ROC曲线分析显示，HbA 1c很难从FPG值预测：66%的HbA 1c良好（< 7.0%）的患者通过FPG值< 7.8 mmol/l确定。作为HbA 1c变化的检测，FPG变化表现中等：在FPG变化值范围内，在临界点为0时达到灵敏度和特异性的最高组合值（分别为87.7%和57%）。
结论
FPG和HbA 1c值不一致在接受饮食或OHA治疗的2型糖尿病患者中并不罕见。HbA 1c很难从FPG值预测，更难的是从FPG变化预测HbA 1c的变化。
OBJECTIVE
To assess the value of fasting blood glucose as a parameter for glycemic control in type 2 diabetic patients not using insulin.
RESEARCH DESIGN AND METHODS
In 1,020 type 2 diabetic patients treated with diet or oral hypoglycemic agents (OHAs), measurements of fasting plasma glucose (FPG) and HbA1c were taken. In 617 patients, the measurement could be repeated after 3 months. Cross-sectional correlation coefficients were calculated for the association between HbA1c and FPG. Receiver-operating characteristic (ROC)-curve analyses were applied to examine the performance of FPG as a diagnostic test for HbA1c. Longitudinally, the change in FPG was compared with the change in HbA1c, with both correlation measures and ROC curve analyses.
RESULTS
Correlation coefficients between HbA1c and FPG and between FPG change and HbA1c change were 0.77 and 0.65, respectively. ROC curve analysis showed that HbA1c is difficult to predict from FPG values: 66% of the patients with good HbA1c (< 7.0%) were identified as such by FPG values < 7.8 mmol/l. As a test for HbA1c change, FPG change performed moderately: the highest combined values of sensitivity and specificity (87.7 and 57%, respectively) were reached at a cutoff point of zero in the range of FPG change values.
CONCLUSIONS
FPG and HbA1c values that do not correspond are not rare in type 2 diabetic patients on diet or OHA treatment. HbA1c is difficult to predict from FPG values, and even more difficult is the prediction of HbA1c changes from FPG changes.