不同空腹血糖切点对健康危害和糖尿病筛检效果的评价

Health Damage and Diabetes Screening Effectiveness Evaluation of Different Fasting Plasma Glucose Cut-points

目的从不同空腹血糖(FPG)切点对健康危害和糖尿病(DM)筛检成本效果评价下调空腹血糖受损(IFC)切点是否适宜。方法采用多阶段分层随机抽样方法,在山东省农村共词查16 341名居民,测量身高、体重、腰围、血压和空腹血糖;对2个县空腹血糖值在5.6～7.0 mmol/L间,6个县空腹血糖值在6.1～7.0 mmol/L者复做口服葡萄糖耐量试验(OGTT)。做不同空腹血糖值对健康的影响分析及比较不同IFG切点筛检糖耐量受损(IGT)和DM的成本效果。结果肥胖、中心性肥胖及高血压患病率及人体测量参数均随血糖值升高而升高,特别是血糖值在5.1 mmol/L以上,患病率及均数升高更加明显。采用美国糖尿病学会(ADA)标准,单纯性IFG(I- IFG)和IFG合并IGT(IFG/IGT)的患病率增加了1.80倍和1.09倍,DM患病率仅增加6.34%。OCTT结果显示,FPG在5.6～6.1 mmol/L的调查对象,其IGT、DM患病率仅是FPG在6.1～7.0 mmol/L间的50%和67%,前者筛检的成本效果比仅是后者1/2和2/3。结论从不同方面考虑,ADA和世界卫生组织(WHO)提出的IFC切点均有其合理性,应根据不同的研究目的选择不同的切点。

Objective To perform evaluations on health impact and cost -effectiveness of diabetes mellitus （DM） screening for different fasting plasma glucose （FPG） cut - points and further determine the rationality of lowering the cut - point of impaired fasting glucose （IFG）. Methods A sample of 16 341 rural residents was selected and investigated in Shandong province of China. All participants were physically examined on height, weight, waist circumference, blood pressure and FPG. Oral glucose tolerance test （OGTT） was performed for subjects with FPG valued from 5.6 to 7.0 mmol/L in two counties and 6. 1 to 7.0 mmol/L in other six counties. Then the health effects at the different FPG cut - points were analyzed and the cost - effectiveness of impaired glucose tolerance （IGT） and DM screening with different cut - points of IFG were compared . Results Both the prevalence of obesity, central obesity, hypertension and the mean of anthropometric indexes increased with the increasing of FPG, especially FPG was 5. 1 mmol/L and above. The prevalence of isolated IFG （I -IFG） , impaired fasting glucose with impaired glucose tolerance （IFG/IGT） increased by 1.80 and 1.09 times, but the prevalence of DM increased by 6.34% only as the standards of ADA was adopted. The result of OGTT shows that the prevalence of IGT and DM in subjects with FPG valued from 5.6 to 6. 1 mmol/L lowers half and one third than the subjects with FPG valued from 6.1 to 7.0 mmol/L. The cost - effectiveness of screening in former is a half and two third of that in the latter respectively. Conclusion Both cut - point of IFG developed by ADA and WHO are rational if we consider it from different aspects. Different cut - off point should be chosen according to the different purpose of study.