糖尿病

[ADA2015]ADA指南的HbA1c诊断标准不适用于中国青少年人群

作者:医脉通 来源:医脉通 日期:2015-06-12
导读

         2015年第75届美国糖尿病协会(ADA)科学年会正在美国波士顿召开。北京朝阳医院内分泌科高珊教授的一项研究在ADA2015年会普通壁报专场(GeneralPosterSession)上发布。该研究指出,ADA指南推荐的HbA1c诊断标准不适合诊断我国青少年人群糖尿病。

        2015年第75届美国糖尿病协会(ADA)科学年会正在美国波士顿召开。北京朝阳医院内分泌科高珊教授的一项研究在ADA2015年会普通壁报专场(GeneralPosterSession)上发布。该研究指出,ADA指南推荐的HbA1c诊断标准不适合诊断我国青少年人群糖尿病。以下是研究摘要译文。

        背景:2010年ADA指南推荐将 HbA1c 5.7%-6.4% 定义为糖尿病前期,而 HbA1c 6.5% 是糖尿病的诊断切点。关于HbA1c诊断糖尿病前期和糖尿病标准的大型研究主要集中于成年人,青少年群体(尤其是中国青少年人群)是否适用尚属未知。本研究旨在评估HbA1c诊断糖尿病前期和糖尿病的标准能否应用于具有糖尿病高危风险的中国青少年和年轻成人。

        方法:从中国儿童及青少年代谢综合征(BCAMS)研究中招募 559 例基线时未诊断糖尿病的个体,随访10年。所有人均接受口服葡萄糖耐量试验(OGTT)和 HbA1c检测,采用受试者特征曲线(ROC)评估HbA1c诊断标准的有效性。

        结果:根据HBA1c水平对受试者进行分类:糖耐量正常者 (HBA1c<5.7%) 占85.5%,糖尿病危险者(HbA1c 5.7%-6.4%)占13.3%,糖尿病患者(HbA1c>6.5%)占1.2%。在糖尿病危险者中,有28.9%经OGTT诊断为糖尿病前期或糖尿病,而糖尿病患者中有80%为2型糖尿病患者。

        2型糖尿病患者组的HbA1c诊断曲线下面积(AUC)为0.968,最佳HbA1c诊断阈值为6.1%,特异性和灵敏度分别为99.1%和88.9%。而糖尿病前期患者组的HbA1c诊断AUC为0.683,最佳HbA1c诊断阈值为5.5%,特异性和灵敏度分别为67.4%和61.9%。

        结论:ADA指南推荐的HbA1c诊断切点5.7%和6.5%不适用于诊断儿童及青少年人群的糖尿病前期和糖尿病,尤其是中国青少年人群。

        【研究摘要

Abstract Number: 1393-P
Title: ADA HbA1c Diagnostic Criteria Fail to Identify Prediabetes and Diabetes in a Population of Chinese Adolescents and Young Adults at High Risk for Diabetes
Authors: SHAN GAO, MING LI, XIAOXUE QU, YONGHUI WANG, XIUJUAN ZHANG, XIUJUAN ZHANG, BCAMS, STEVEN M. WILLI, Beijing, China, Philadelphia, PA
Abstract:

     

      Introduction: In2010, the American Diabetes Association(ADA) recommended HbA1c value of 5.7-6.4% was defined as pre-diabetes and HbA1c value of 6.5% was selected as the diagnostic cut off for diabetes.Current researches for identifying pre-diabetes and diabetes has been largely studied in adult populations, we have to think whether the criteria used for adults best serve us to make the diagnosis of diabetes or pre-diabetes in adolescents and the youths, especially in Chinese population.

      OBJECTIVE: The aim of this study was to assess HbA1c for the diagnosis of pre-diabetes and diabetes in a population of Chinese adolescents and young adults at a high risk of diabetes.

      RESEARCH DESIGN AND METHODS: The study cohort consisted of 559 individuals, recruited from the cohort of Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study, without a diagnosis of diabetes at baseline, with a follow-up time of 10 years. All subjects underwent an oral glucose tolerance test (OGTT) and HbA1c measurement. ROC curve analysis was performed for evaluating HbA1c screening efficacy.

      Results: Subjects were stratified according to HBA1c categories: 85.5% with normal glucose tolerance (HBA1c<5.7%), 13.3% at risk for diabetes (HBA1c 5.7-6.4%), and 1.2% with diabetes (HBA1c>6.5%). In the at risk for diabetes category, 28.9% were classified with prediabetes or diabetes, and in the diabetes category, 80 % were classified with type 2 diabetes by the OGTT. In the type 2 diabetes category, the AUC for HbA1c to diagnosed was 0.968. The optimal threshold of HbA1c was 6.1% in identifying type 2 diabetes, with a specificity of 99.1% and sensitivity of 88.9%. For pre-diabetes, the AUC for HBA1c was 0.683.The optimal threshold was 5.5%, with a specificity of 67.4% and sensitivity of 61.9%.

      The ADA suggested that an HbA1c of 5.7% and 6.5% may not serve us to make the diagnosis of diabetes or pre-diabetes in adolescents and the youths, especially in Chinese population.

 

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