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预测糖尿病新方法-日本科学家新近发现
作者:科学网  来源:本站整理  发表时间:2011/7/12 22:55:28

 

科学家提出预测糖尿病新方法 
 

    日本一个研究小组日前发表论文说,在血糖测试之外加做糖化血红蛋白(HbA1c)测试,综合两项测试结果能比单独进行其中一项测试更准确地预测糖尿病。

    来自日本筑波大学等机构的研究人员在新一期英国《柳叶刀》杂志网络版上刊登论文说,他们对6241人进行了为期5年的跟踪研究。研究对象包括4670名男性和1571名女性,他们的年龄介于24岁至82岁。所有研究对象接受研究之初都没有糖尿病既往史。

    结果显示,空腹血糖值偏高(指每100毫升血液葡萄糖含量100毫克-125毫克)的人群中有9%的人在5年内患上糖尿病,糖化血红蛋白检测值偏高(国际标准值5.7%-6.4%)的人群中有7%的人在5年内患糖尿病,而两项测试的数值都偏高的人群患糖尿病的比例达到38%。

    研究小组的负责人、筑波大学教授曾根博仁表示,与那些空腹血糖值和糖化血红蛋白检测值都较低的人相比,两项数值都偏高的人患糖尿病的风险是前者的32倍。曾根博仁认为,结合这两项测试的结果来筛查糖尿病,将有助于及时发现有必要进行早期介入的糖尿病发病高风险人士。

HbA1c 5·7—6·4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan (TOPICS 3): a longitudinal cohort study

Yoriko Heianza RD a b, Shigeko Hara MD b c, Yasuji Arase MD b c, Kazumi Saito MD a b, Kazuya Fujiwara MD a, Hiroshi Tsuji MD b c, Satoru Kodama MD a b, Shiun Dong Hsieh MD b c, Yasumichi Mori MD c, Prof Hitoshi Shimano MD a, Prof Nobuhiro Yamada MD a, Prof Kinori Kosaka MD b c, Prof Hirohito Sone MD

Summary
 

Background

The clinical relevance of the diagnostic criteria for prediabetes to prediction of progression to diabetes has been little studied. We aimed to compare the prevalence of prediabetes when assessed by the new glycated haemoglobin A1c (HbA1c) 5·7—6·4% criterion or by impaired fasting glucose, and assessed differences in progression rate to diabetes between these two criteria for prediabetes in a Japanese population.

Methods

Our longitudinal cohort study included 4670 men and 1571 women aged 24—82 years without diabetes at baseline (diabetes was defined as fasting plasma glucose ≥7·0 mmol/L, self-reported clinician-diagnosed diabetes, or HbA1c ≥6·5%) who attended Toranomon Hospital (Tokyo, Japan) for a routine health check between 1997 and 2003. Participants with a baseline diagnosis of prediabetes according to impaired fasting glucose (fasting plasma glucose 5·6—6·9 mmol/L) or HbA1c 5·7—6·4%, or both, were divided into four groups on the basis of baseline diagnosis of prediabetes. Rate of progression to diabetes was assessed annually.

Findings

Mean follow-up was 4·7 (SD 0·7) years. 412 (7%) of 6241 participants were diagnosed with prediabetes on the basis of the HbA1c 5·7—6·4% criterion. Screening by HbA1c alone missed 1270 (61%) of the 2092 prediabetic individuals diagnosed by a combination of impaired fasting glucose and HbA1c 5·7—6·4%. Overall cumulative probability of progression to diabetes did not differ significantly between participants with prediabetes discordantly diagnosed by either HbA1c or impaired fasting glucose alone (incidence was 7% for HbA1c alone [n=412 individuals and 30 incident cases] and 9% for impaired fasting glucose alone [n=1270, 108 cases]; log-rank test, p=0·3317). Multivariate-adjusted hazard ratios for incident diabetes were 6·16 (95% CI 4·33—8·77) for those diagnosed with prediabetes by impaired fasting glucose alone and 6·00 (3·76—9·56) for diagnosis by HbA1c alone, and were substantially increased to 31·9 (22·6—45·0) for diagnosis by both impaired fasting glucose and HbA1c compared with normoglycaemic individuals.

Interpretation

Diagnosis of prediabetes by both the new HbA1c criterion and impaired fasting glucose identified individuals with an increased risk of progression to diabetes. Although the new HbA1c criterion identified fewer individuals at high risk than did impaired fasting glucose, the predictive value for progression to diabetes assessed by HbA1c 5·7—6·4% was similar to that assessed by impaired fasting glucose alone. The two tests used together could efficiently target people who are most likely to develop diabetes and allow for early intervention.
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