a two-step screening, measurement of hba1c in association with fpg, may be useful in predicting diabetes一个两步检查,测量糖化血红蛋白与台塑协会,在预测糖尿病可能是有用的.pdfVIP

A Two-Step Screening, Measurement of HbA1c in Association with FPG, May Be Useful in Predicting Diabetes 1 2 3 Kyoko Nomura *, Kazuo Inoue , Kimihiko Akimoto 1Teikyo University School of Medicine, Department of Hygiene and Public Health, Tokyo, Japan, 2 Teikyo University School of Medicine, Department of Community Medicine, Tokyo, Japan, 3 Yuport, Medical Checkup Center, Tokyo, Japan Abstract Backgrounds: We compared the usefulness of fasting plasma glucose (FPG), or hemoglobin A1c (HbA1c), or both in predicting type 2 diabetes. Methods: This retrospective cohort study investigated 9,322 Japanese adults (4,786 men and 4,536 women), aged 19– 69 yrs, free of diabetes at baseline. Usefulness was assessed by predictive values (PV), sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) maximised under the best cut-off point. Results: During the average 6 years of follow-up, 221 men (4.6%) and 92 women (2%) developed diabetes. The best cut-off points for FPG (i.e., 5.67 mmol/l for men and 5.5 mmol/l for women) gave excellent AUROC, and the highest positive PV (13% for men and 9% for women) in predicting diabetes. In high risk subjects with FPG 6.1–6.9 mmol/l, 119 men (26.8%) and 39 women (28.3%) developed diabetes. Under the best cut-off points of FPG 6.39 mmol/l and A1c 5.8, AUROC and positive PV for FPG slightly decreased indicating FPG became less useful and were statistically indistinguishable from those for HbA1c in men. In fact, HbA1c was the most useful in women: HbA1c of 6.0% gave the highest positive likelihood ratio of 2.74 and larger AUROC than did FPG. Although AUROC for HbA1c was acceptable and indistinguishable from that for the combined use, HbA1c had higher specificity and positive LR than did the co