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2000年的研究利用GHB（糖化血紅蛋白，又稱HbA1c）來篩查美國人口中未診斷的糖尿病。結果顯示，使用GHB高靈敏度（83.4%）和特異性（84.4%）篩查未診斷糖尿病。此研究證實，GHB是一種與空腹血糖測量相比的便捷而有效的篩查方法，特別是在高風險人群中。
Use of GHB (HBA1C) in screening for undiagnosed diabetes in the U.S. population
在美國人口中使用糖化血紅蛋白 (HbA1c) 篩查未診斷的糖尿病
Rohlfing CL, Little RR, Wiedmeyer HM, et al. Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population [published correction appears in Diabetes Care 2000 Jun;23(6):876]. Diabetes Care. 2000;23(2):187-191. doi:10.2337/diacare.23.2.187
Abstract
To evaluate the use of GHb as a screening test for undiagnosed diabetes (fasting plasma glucose > or =7.0 mmol/l) in a representative sample of the U.S. population. The Third National Health and Nutrition Examination Survey included national samples of non-Hispanic whites, non-Hispanic blacks, and Mexican Americans aged > or =20 years. Of these subjects, 7,832 participated in a morning examination session, of which 1,273 were excluded because of a previous diagnosis of diabetes, missing data, or fasting time of <8 h before examination. Venous blood was obtained to measure fasting plasma glucose and GHb in the remaining 6,559 subjects. Receiver operating characteristic curve analysis was used to examine the sensitivity and specificity of GHb for detecting diabetes at increasing GHb cutoff levels. GHb demonstrated high sensitivity (83.4%) and specificity (84.4%) for detecting undiagnosed diabetes at a GHb cutoff of 1 SD above the normal mean. Moderate sensitivity (63.2%) and very high specificity (97.4%) were evident at a GHb cutoff of 2 SD above the normal mean. Sensitivity at this level ranged from 58.6% in the non-Hispanic white population to 83.6% in the Mexican-American population; specificity ranged from 93.0% in the nonHispanic black population to 98.3% in the non-Hispanic white population. GHb is a highly specific and convenient alternative to fasting plasma glucose for diabetes screening. A GHb value of 2 SD above the normal mean could identify a high proportion of individuals with undiagnosed diabetes who are at risk for developing diabetes complications.
摘要
為評估在美國人口中使用糖化血紅蛋白 (GHb) 作為篩查未診斷糖尿病（空腹血漿葡萄糖 ≥ 7.0 mmol/l）的方法，第三次全國健康與營養調查包括年齡 ≥ 20 歲的非西班牙裔白人、非西班牙裔黑人和墨西哥裔美國人的全國樣本。在這些受試者中，7,832 人參加了上午的檢查，其中 1,273 人因之前被診斷為糖尿病、數據缺失或檢查前空腹時間少於 8 小時而被排除。剩餘 6,559 名受試者的靜脈血被用來測量空腹血漿葡萄糖和 GHb。使用受試者操作特徵曲線分析來檢查不同 GHb 截止水平下 GHb 檢測糖尿病的敏感性和特異性。在 GHb 截止值為正常平均值高於 1 個標準差時，GHb 檢測未診斷糖尿病顯示出高敏感性（83.4%）和高特異性（84.4%）。在 GHb 截止值為正常平均值高於 2 個標準差時，顯示出中等敏感性（63.2%）和非常高的特異性（97.4%）。在這一水平上的敏感性從非西班牙裔白人群體的 58.6% 到墨西哥裔美國人群體的 83.6% 不等；特異性從非西班牙裔黑人群體的 93.0% 到非西班牙裔白人群體的 98.3% 不等。GHb 是一種高度特異且方便的糖尿病篩查替代方法。GHb 值高於正常平均值 2 個標準差可以識別出大量未診斷糖尿病且有發展糖尿病併發症風險的個體。
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