比较HbA^(1c)与血糖诊断糖尿病的一致性

Comparison of HbA^(1c) and glucose criteria in detecting Diabetes

目的:在糖尿病高危人群中比较采用糖化血红蛋白(HbA1c)和空腹血糖(FPG)或HbA1c和口服葡萄糖耐量试验(OGTT)分别诊断糖尿病时的一致性。方法:入选2009年5月至2011年9月为明确糖尿病诊断到本院行75g口服葡萄糖耐量试验(OGTT)的1398例就诊者。结果:采用HbA1c与FPG来分别诊断糖尿病时,二者具有较高的一致性(κ=0.70,95%CI 0.66~0.73),84.8%的受试者能获得一致的结果。而采用HbA1c与OGTT来分别诊断糖尿病时,二者具有中度的一致性(κ=0.62,95%CI 0.57~0.66),80.7%的受试者能获得一致的结果。结论:采用HbA1c与血糖分别诊断糖尿病时,二者间存在中高度的一致性;其中HbA1c与FPG分别诊断糖尿病时的一致性较高。

Objective] To examine the concordance between hemoglobin A1c （HbA1c ） and glucose criteria in identifying indi-viduals with diabetes among Chinese high risk subjects.[Method]We studied 1398 consecutive subjects with at least one risk factor for diabetes who were referred to the diabetes outpatient clinics for screening diabetes between May 2009 and September 2011.An oral glucose tolerance test （OGTT） was performed and HbA1c was tested for each individual. [Result]Concordant classifications occurred for 84.8% of 1398participants when HbA1c≥6.5% and FPG≥7.0 mmol/L were used separately to de-fine diabetes .There was a high agreement for diabetes diagnosis between the method of FPG ≥7.0 mmol/L and HbA1c ≥6.5% （κ〗= 0.70 , 95% CI 0.66~0.73 ） . Similarly , concordant classifications occurred for 80.7% of participants when HbA1c≥6.5% and OGTT criteria were used separately to define diabetes .However ,the agreement for diabetes diagnosis was moderate between the method of OGTT and HbA1c≥6.5% （κ = 0.62 ,95% CI 0.57~0.66）. [Conclusions] Moderate or high degree of overlap and reasonable agreement were noted between the glucose and HbA1c criteria for diabetes diagnosis .The degree of agreement for diabetes diagnosis was higher between the method of FPG and HbA1c .