指尖血联合中国糖尿病风险评分表法筛查糖尿病及糖尿病前期的效率分析

Efficiency of fingertip blood glucose combined with Chinese Diabetes Risk Score in screening diabetes mellitus and pre-diabetes

目的探索指尖血糖(CBG)联合中国糖尿病风险评分法(CDRS)在2型糖尿病(T2DM)及糖尿病前期[空腹血糖受损(IFG)、糖耐量减低(IGT)]初筛中的价值。方法2018年7~8月以"糖尿病危险因素早期识别、早期诊断技术与切点研究(SENSIBLE研究)"江苏分中心的3798例社区居民为研究对象,分别检测空腹指尖血糖(FCBG)及糖负荷后2 h指尖血糖(2h-CBG)。以口服葡萄糖耐量试验(OGTT)为"金标准"诊断T2DM或糖尿病前期,并以受试者工作特征(ROC)曲线评价CBG单独或联合CDRS≥25分时的切点和筛查效能。结果(1)根据世界卫生组织(WHO)1999年糖尿病诊断标准,FCBG筛查T2DM的最优切点为6.7 mmol/L,与CDRS≥25分联合则为6.2 mmol/L。FCBG、CDRS≥25分、FCBG+CDRS≥25分的灵敏度(特异度)分别为79.48%(91.20%)、91.17%(27.56%)、78.96%(78.22%)。(2)FCBG筛查IFG的最优切点为6.0 mmol/L,与CDRS≥25分联合则为6.1 mmol/L。FCBG、CDRS≥25分、FCBG+CDRS≥25分的灵敏度(特异度)分别为82.31%(68.94%)、89.93%(27.53%)、75.18%(74.11%)。与CDRS≥25分相比,FCBG+CDRS≥25分筛查T2DM和IFG的ROC曲线下面积分别增加32.3%和27.1%。(3)2 h-CBG筛查IGT的最优切点为8.2 mmol/L,与CDRS≥25分联合则为8.5 mmol/L。2 h-CBG、CDRS≥25分、2 h-CBG+CDRS≥25分的灵敏度(特异度)分别为88.66%(76.04%)、84.85%(28.58%)、80.67%(77.87%)。与CDRS≥25分相比,2 h-CBG+CDRS≥25分筛查IGT的ROC曲线下面积增加43.6%。结论CBG和CDRS均为有效的T2DM和糖尿病前期初筛工具,两者联合能进一步提高初筛效能。

Objective To explore the value of fingertip capillary whole blood glucose(CBG)combined with Chinese Diabetes Risk Score(CDRS)in screening for type 2 diabetes mellitus(T2DM)and pre-diabetes[impaired fasting glucose(IFG)and impaired glucose tolerance(IGT)].Methods From July to August 2018,3798 community residents from Jiangsu branch center of the study on evaluation of innovated screening tools and determination of optimal diagnostic cut-off points for type 2 diabetes in Chinese multi-ethnic(SENSIBLE study)were included.The fingertip fasting CBG(FCBG)and 2-hour CBG after glucose load(2 h-CBG)were measured.Oral glucose tolerance test(OGTT)was used as the"gold standard"for the diagnosis of T2DM or pre-diabetes.Receiver operating characteristic curve(ROC)was used to evaluate the cut-off point and the screening efficacy of CBG alone and combined CDRS.Results(1)According to the World Health Organization(WHO)diagnostic criteria in 1999,the optimal cut-off point for screening T2DM by FCBG was 6.7 mmol/L,and 6.2 mmol/L when combined with CDRS(≥25).The sensitivity(specificity)of FCBG,CDRS(≥25)and FCBG+CDRS(≥25)were 79.48%(91.20%),91.17%(27.56%)and 78.96%(78.22%),respectively.(2)The optimal cut-off point for screening IFG by FCBG was 6.0 mmol/L,and 6.1 mmol/L when combined with CDRS(≥25).The sensitivity(specificity)of the three methods were 82.31%(68.94%),89.93%(27.53%)and 75.18%(74.11%),respectively.Compared with CDRS(≥25),the AUC of FCBG+CDRS(≥25)in screening for T2DM and IFG were increased by 32.3%and 27.1%,respectively.(3)The optimal cut-off point for IGT screening by 2 h-CBG was 8.2 mmol/L,and 8.5 mmol/L in combination with CDRS(≥25).The sensitivity(specificity)of 2 h-CBG,CDRS(≥25)and 2 h-CBG+CDRS(≥25)were 88.66%(76.04%),84.85%(28.58%)and 80.67%(77.87%),respectively.Compared with CDRS(≥25),the AUC of 2 h-CBG+CDRS(≥25)in screening IGT was increased by 43.6%.Conclusions CBG and CDRS are both effective tools for screening T2DM and pre-diabetes,and their combination can further improve the screening efficiency.