A Two-Step Screening, Measurement of HbA1c in Association with FPG, May Be Useful in Predicting Diabetes 英文参考文献.docVIP

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A Two-Step Screening, Measurement of HbA1c in Association with FPG, May Be Useful in Predicting Diabetes 英文参考文献.doc

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A Two-Step Screening, Measurement of HbA1c in Association with FPG, May Be Useful in Predicting Diabetes 英文参考文献

ATwo-StepScreening,MeasurementofHbA1cin AssociationwithFPG,MayBeUsefulinPredicting Diabetes KyokoNomura1*,KazuoInoue2,KimihikoAkimoto3 1Teikyo University School of Medicine, Department of Hygiene and Public Health, Tokyo, Japan, 2Teikyo University School of Medicine, Department of Community Medicine,Tokyo,Japan,3Yuport,MedicalCheckupCenter,Tokyo,Japan Abstract Backgrounds: We compared the usefulness of fasting plasma glucose (FPG), or hemoglobin A1c (HbA1c), or both in predictingtype2diabetes. Methods: This retrospective cohort study investigated 9,322 Japanese adults (4,786 men and 4,536 women), aged 19– 69yrs,freeofdiabetesatbaseline.Usefulnesswasassessedbypredictivevalues(PV),sensitivity,specificity,andthearea underthereceiveroperatingcharacteristiccurve(AUROC)maximisedunderthebestcut-offpoint. Results:Duringtheaverage6yearsoffollow-up,221men(4.6%)and92women(2%)developeddiabetes.Thebestcut-off pointsforFPG(i.e.,5.67mmol/lformenand5.5mmol/lforwomen)gaveexcellentAUROC,andthehighestpositivePV (13%formenand9%forwomen)inpredictingdiabetes.InhighrisksubjectswithFPG6.1–6.9mmol/l,119men(26.8%) and 39 women (28.3%) developed diabetes. Under the best cut-off points of FPG 6.39mmol/l and A1c 5.8, AUROC and positivePVforFPGslightlydecreasedindicatingFPGbecamelessusefulandwerestatisticallyindistinguishablefromthose forHbA1cinmen.Infact,HbA1cwasthemostusefulinwomen:HbA1cof6.0%gavethehighestpositivelikelihoodratioof 2.74andlargerAUROCthandidFPG.AlthoughAUROCforHbA1cwasacceptableandindistinguishablefromthatforthe combineduse,HbA1chadhigherspecificityandpositiveLRthandidthecombineduse. Conclusions: This study demonstrated that FPG was the most useful to predict diabetes in the general population. However, in subjects with FPG 6.1–6.9mmol/l, FPG became less useful and diagnostic performance of FPG was indistinguishablefromthatofHbA1cinmenwhereasHbA1cwasthemostusefulinwomen.Thus,atwo-stepscreening, measurementofHbA1cinassociationwithFPG,maybeusefulinpredictingdiabetes. Citation: