Impact of A1C screening criterion on the diagnosis of pre-diabetes among U.S. adults.
Impact of A1C screening criterion on the diagnosis of pre-diabetes among U.S. adults.
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DOI：
10.2337/dc10-0752
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发表时间：
2010-10
期刊：
影响因子：
16.2
通讯作者：
Muntner P
中科院分区：
文献类型：
--
作者：
Mann DM;Carson AP;Shimbo D;Fonseca V;Fox CS;Muntner P
新的临床实践建议包括A1C作为空腹血糖的替代品，作为识别糖尿病前期的诊断试验。这些新建议对糖尿病前期诊断的影响尚不清楚。分析了1999-2006年国家健康和营养检查调查(n=7,029)的数据，以确定根据A1C升高(5.7-6.4%)和空腹血糖受损(空腹血糖100-125 mg/dl)标准分别归类为糖尿病前期的美国成年人的百分比和人数。以IFG为参考标准计算试验特征(敏感度、特异度、阳性预测值和阴性预测值)。根据A1C标准，美国成年人的糖尿病前期患病率为12.6%，以空腹血糖标准计算，为28.2%。根据这两种定义，只有7.7%的美国成年人有糖尿病前期，分别占A1C和空腹血糖糖尿病前期患者的61%和27%。仅使用A1C就会将3760万患有空腹血糖的美国人重新归类为没有糖尿病前期，将890万没有空腹血糖的美国人重新归类为糖尿病前期(4650万重新归类)。以IFG为参考标准，A1C标准预测糖尿病前期的敏感性为27%，特异性为93%，阳性预测值为61%，阴性预测值为77%。使用A1C作为糖尿病前期的标准将对近5000万美国人的糖尿病前期诊断进行重新分类。临床医生和卫生系统必须了解在诊断糖尿病前期时使用A1C或IFG的区别和相似之处。
New clinical practice recommendations include A1C as an alternative to fasting glucose as a diagnostic test for identifying pre-diabetes. The impact of these new recommendations on the diagnosis of pre-diabetes is unknown. Data from the National Health and Nutrition Examination Survey 1999–2006 (n = 7,029) were analyzed to determine the percentage and number of U.S. adults without diabetes classified as having pre-diabetes by the elevated A1C (5.7–6.4%) and by the impaired fasting glucose (IFG) (fasting glucose 100–125 mg/dl) criterion separately. Test characteristics (sensitivity, specificity, and positive and negative predictive values) using IFG as the reference standard were calculated. The prevalence of pre-diabetes among U.S. adults was 12.6% by the A1C criterion and 28.2% by the fasting glucose criterion. Only 7.7% of U.S. adults, reflecting 61 and 27% of those with pre-diabetes by A1C and fasting glucose, respectively, had pre-diabetes according to both definitions. A1C used alone would reclassify 37.6 million Americans with IFG to not having pre-diabetes and 8.9 million without IFG to having pre-diabetes (46.5 million reclassified). Using IFG as the reference standard, pre-diabetes by the A1C criterion has 27% sensitivity, 93% specificity, 61% positive predictive value, and 77% negative predictive value. Using A1C as the pre-diabetes criterion would reclassify the pre-diabetes diagnosis of nearly 50 million Americans. It is imperative that clinicians and health systems understand the differences and similarities in using A1C or IFG in diagnosis of pre-diabetes.