Using point-of-care HbA1c to facilitate the identification of diabetes and abnormal glucose regulation in primary healthcare settings.
Using point-of-care HbA1c to facilitate the identification of diabetes and abnormal glucose regulation in primary healthcare settings.
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DOI：
10.3389/fpubh.2023.1078361
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发表时间：
2023
影响因子：
5.2
通讯作者：
Zhou, Zhiguang
中科院分区：
文献类型：
--
作者：
Pi, Linhua;Zheng, Ying;Shi, Xiajie;Wang, Zhen;Zhou, Zhiguang
糖化血红蛋白（HbA1c）是糖尿病诊断和血糖控制评价的重要指标。然而，在资源匮乏的中国农村地区，一种标准化的HbA1c测量方法是负担不起的。即时（POC） HbA1c检测方便且价格低廉，但其性能仍有待阐明。探讨POC HbA1c在资源有限的中国人群中识别糖尿病和血糖调节异常（AGR）的价值。研究对象来自湖南省6个乡镇卫生院。体检后取POC HbA1c、静脉HbA1c、空腹血糖、2 h-血糖。口服糖耐量试验作为诊断的金标准。评估POC HbA1c测量在预测未确诊糖尿病和AGR方面的诊断能力。在388名受试者中，经口服葡萄糖耐量试验（OGTT）鉴定血糖控制正常者274例（70.6%），糖尿病前期患者63例（16.2%），糖尿病患者51例（13.1%）。同时，在97名同时接受两种HbA1c检测方法的参与者中，POC HbA1c与标准化HbA1c呈正相关（r = 0.75, P < 0.001）。Bland-Altman图未观察到显著的系统差异。POC HbA1c临界值分别为5.95和5.25%，可有效识别糖尿病（AUC 0.92）和AGR （AUC 0.89）。替代POC HbA1c检测可有效区分AGR和糖尿病与正常血糖，特别是在初级卫生保健机构的中国人群中。
Glycated hemoglobin A1c (HbA1c) is a critical index for the diagnosis and glycemic control evaluation of diabetes. However, a standardized method for HbA1c measurement is unaffordable and unavailable among the Chinese population in low-resource rural settings. Point-of-care (POC) HbA1c testing is convenient and inexpensive, but its performance remains to be elucidated. To investigate the value of POC HbA1c for identifying diabetes and abnormal glucose regulation (AGR) in the resource-limited Chinese population. Participants were recruited from 6 Township Health Centers in Hunan Province. Samples for POC HbA1c, venous HbA1c, fasting plasma glucose, and 2 h-plasma glucose were obtained after physical examination. The oral glucose tolerance test was performed as the gold standard for diagnosis. The diagnostic capacities of the POC HbA1c measurement in predicting undiagnosed diabetes and AGR were evaluated. Among 388 participants, 274 (70.6%) normoglycemic controls, 63 (16.2%) prediabetes patients, and 51 (13.1%) diabetes patients were identified with oral glucose tolerance test (OGTT). Meanwhile, among 97 participants who underwent two HbA1c detection methods simultaneously, a positive correlation was found between POC HbA1c and standardized HbA1c (r = 0.75, P < 0.001). No notable systematic difference was observed from the Bland-Altman Plots. The POC HbA1c cutoff values were 5.95 and 5.25%, which efficiently identified diabetes (AUC 0.92) and AGR (AUC 0.89), respectively. The alternative POC HbA1c test efficiently discriminated AGR and diabetes from normoglycemia, especially among the Chinese population in primary healthcare settings.
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