Re-examining the sensitivity of HbA1c to screen for diabetes mellitus
重新审视HbA1c用于筛查糖尿病的敏感性
Abstract
enBackground
One of the laboratory tests recommended by the American Diabetes Association (ADA) to screen for diabetes mellitus (DM) is HbA1c, and it is particularly suitable for segments of the population that cannot or are unwilling to fast for a screening test. The aim of this study was to determine whether HbA1c would be a useful tool to screen for DM in a real-world setting if ADA guidelines for repeat testing to confirm the diagnosis of DM are strictly adhered to.
Methods
A retrospective database study was performed by extracting demographic and laboratory data from a chronic disease registry that collects data on adults from three tertiary hospitals and nine large primary care clinics in Singapore. Data were extracted and analyzed for adults not previously known to have DM whose data was captured in the registry between 2005 and 2016 with HbA1c and at least two diagnostic tests for DM (fasting plasma glucose or 2-h plasma glucose) performed within 4 weeks after HbA1c determination.
Results
In all, 3928 adults were included in this study. The sensitivity, specificity, and area under the receiver operating characteristic curve for HbA1c at a threshold of 6.5% were 85.2%, 82.3%, and 0.914, respectively. A higher sensitivity was found in female adults, younger adults, and those of non-Chinese ethnicity.
Conclusions
The sensitivity of HbA1c as a screening test for DM in this study was significantly higher than that reported previously. This work provides additional evidence supporting the inclusion of HbA1c as one of the screening tests for DM.
Abstract
zh摘要
背景
美国糖尿病协会推荐的用于筛查糖尿病的实验室检测项目之一就是HbA1c, 并且它特别适合那些不能够或者不愿意进行空腹筛查试验的人群。这项研究的目的是在真实世界的环境中严格遵守美国糖尿病协会指南通过重复检测血糖确诊糖尿病来判定HbA1c能否是一个用于筛查糖尿病的有用工具。
方法
这是一项回顾性的数据库研究, 选取的人口统计学与实验室数据来自于慢性病登记表, 收集了新加坡3所三级医院以及9所大型初级保健诊所登记的成年人数据。从2005至2016年的登记表中提取出既往没有被诊断过糖尿病的成年人数据后再进行分析, 这些数据包括HbA1c以及测定HbA1c后4周内至少还有2个糖尿病的诊断测试数据(空腹血糖或者2小时血糖)。
结果
这项研究总共纳入了 3928 名成年人。切点为6.5%的HbA1c敏感性、特异性以及受试者工作特征曲线下面积分别为85.2%、82.3%与0.914。成年女性、年轻人以及非华裔的人群敏感性更高。
结论
在这项研究中HbA1c用于筛查糖尿病的敏感性要显著高于既往的报道。这项研究结果支持HbA1c可作为筛查糖尿病的测试选择之一。
