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Glycated Haemoglobin in Diagnosis of Diabetes Mellitus and Pre-diabetes among Middle-aged and Elderly Population:Shanghai Changfeng Study

查看全文 作　　者：MA [1]Hui;GAO [1]Xin;LIN Huan [1]Dong;HU [2]Yu;LI Xiao [1]Ming;GAO [3]Jian;ZHAO Nai [4]Qing 高影响力作者 机构地区：[1]Department of Endocrinology and Metabolism,Zhongshan Hospital,Fudan University;[2]Department of Geriatrics,Clinical Epidemiology Center,Zhongshan Hospital,Fudan University;[3]Department of Clinical Nutrition,Zhongshan Hospital,Fudan University;[4]Department of Biostatistics,College of Public Health,Fudan University高影响力机构 出　　处：《Biomedical and Environmental Sciences》索引2013年第26卷第3期,共8页高影响力期刊 基　　金：supported by grants from National Key Technologies R&D Program (Grant No. 2008 BAI52B03 to X. Gao);the National Key Technologies R&D Program (Grant No. 2009BAI80B01 to H. Lin);the Major Project of Subject Construction of Shanghai Bureau of Health (Grant No.08GWZX0203 to X. Gao) 摘　　要：Objective To investigate the optimal glycated haemoglobin (HbA1c) cut off points and evaluate the impact of HbA1c on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited from Shanghai Changfeng Study. A total of 1 973 community-based participants (age≥45) without known diabetes underwent oral glucose tolerance test (OGTT) by using a 75-g oral glucose load and HbA1c was measured by using high performance liquid chromatography (HPLC). Subjects were classified as normal glucose tolerance (NGT), pre-diabetes(impaired glucose regulation, IGR) and new diagnosed diabetes (NDD) per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve (ROC). Results Among 1973 subjects, 271 (13.7%) were diagnosed as NDD and 474 (24.0%) as IGR by using OGTT. HbA1c was 5.7%±0.7% in this population. Use of 6.5% as the HbA1C cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population (AUC 0.829, 95% CI 0.798-0.860, P<0.001) with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity (44.9%) and specificity (66.7%) with an AUC of 0.571 for HbA1c when 5.8% was used as the cutoff point. Participants detected with HbA1c≥6.0% were associated with nearly the same metabolic characteristics, including body mass index (BMI), blood pressure, lipid profile and urine albumin-creatinine ratio (uACR) compared with diabetic subjects detected by OGTT. Conclusion The optimum HbA1c cutoff point for diabetes in our study population was lower than ADA criteria, and HbA1c may not be used to identify IGR. 关 键 词：糖化血红蛋白 糖尿病 诊断 人口 前期 上海 老年 中年
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