Evaluation of ADA HbA1c criteria in the diagnosis of pre-diabetes and diabetes in a population of Chinese adolescents and young adults at high risk for diabetes: a cross-sectional study

被引：19

作者：

Li, Ge ^{[1
,2
,3
]}

Han, Lanwen ^{[4
]}

Wang, Yonghui ^{[4
]}

Zhao, Yanglu ^{[5
]}

Li, Yu ^{[1
,2
,3
]}

Fu, Junling ^{[1
,2
,3
]}

Li, Ming ^{[1
,2
,3
]}

Gao, Shan ^{[4
]}

Willi, Steven M. ^{[6
]}

机构：

[1] Chinese Acad Med Sci, Peking Union Med Coll Hosp, Natl Hlth & Family Planning Commiss, Dept Endocrinol,Key Lab Endocrinol, Beijing, Peoples R China

[2] CAMS, Peking Union Med Coll, Beijing, Peoples R China

[3] PUMC, Beijing, Peoples R China

[4] Capital Med Univ, Beijing Chaoyang Hosp, Dept Endocrinol, Beijing, Peoples R China

[5] Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Epidemiol, Los Angeles, CA USA

[6] Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Div Endocrinol, Philadelphia, PA 19104 USA

来源：

BMJ OPEN | 2018年 / 8卷 / 08期

基金：

北京市自然科学基金;

关键词：

HbA1c; diabetes; pre-diabetes; metabolic syndrome; adolescents; BETA-CELL FUNCTION; HOMEOSTASIS MODEL ASSESSMENT; FASTING PLASMA-GLUCOSE; INSULIN SENSITIVITY; HEMOGLOBIN A(1C); CHILDREN; A1C; PREVALENCE; RESISTANCE; CHILDHOOD;

D O I：

10.1136/bmjopen-2017-020665

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective We aimed to assess haemoglobin A1c (HbA1c) for the diagnosis of pre-diabetes and diabetes in a population of Chinese youths at risk of metabolic syndrome. Setting Beijing, China. Participants A total of 581 subjects aged 14-28 years underwent evaluation including an oral glucose tolerance test (OGTT). Insulin sensitivity, -cell function and a number of cardiovascular disease risk factors were evaluated. Receiver operating characteristic (ROC) curves were used to assess the screening efficacy of HbA1c. Results Using OGTT data as a standard, the majority (70.0%, 7/10) of subjects with diabetes would have been diagnosed with HbA1c 6.5%. In contrast, only 28.1% (16/57) of subjects with pre-diabetes possessed elevated HbA1cs, while the majority (68.4%) had normal HbA1cs. On the contrary, a total of 8.1% (39/479) of youths in the normal HbA1c category (<5.7%) and 21.3% in the pre-diabetes category had pre-diabetes. In the ROC analysis, the area under the curve (AUC) for HbA1c identifying pre-diabetes was 0.680(95% CI 0.640 to 0.719); the optimal threshold was 5.5%, with a sensitivity of 61.4% and specificity of 68.5%. For type 2 diabetes mellitus, the AUC for HbA1c was 0.970 (0.952 to 0.982), and the optimal threshold was 6.1%, with a sensitivity of 90.0% and a specificity of 98.7%. Applying these new cut-offs, pre-diabetic participants (HbA1c 5.5%-6.1%) had lower disposition index and higher risk of dyslipidaemia (OR=1.61,95% CI 1.10 to 2.37) and metabolic syndrome (OR=2.09, 1.27 to 3.45) than those with normal HbA1c (<5.5%). Conclusion The American Diabetes Association's established HbA1c criteria for pre-diabetes and diabetes (5.7% and 6.5%) may not be appropriately applied to adolescents and young adults in China. Our findings suggest that those with HbA1c of 5.5%-6.1%already exhibit impaired -cell function and increased cardiometabolic risk factors which may warrant intervention. Trial registration number NCT03421444.

引用

页数：9

共 32 条

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