Association of characteristics of people with type 2 diabetes mellitus with discordant values of fasting glucose and HbA1c
空腹血糖与糖化血红蛋白值之间的不一致现象与2型糖尿病患者特征之间的关系
Abstract
enBackground
Primary care physicians frequently encounter people with type 2 diabetes mellitus (T2DM) with discordant values for fasting glucose and HbA1c. The aim of this study was to identify the prevalence and characteristics of people in whom blood glucose and HbA1c did not match.
Methods
Overall, 64 553 people with T2DM from 939 general or internal medicine practices (Disease Analyzer database, Germany; January 2013–December 2015) were analyzed. Multivariable logistic regression models were used to identify associations between baseline clinical characteristics, comorbidity, and glucose-lowering treatment and discordance of fasting glucose and HbA1c values measured at the same visit.
Results
Overall, 8582 (13%) patients had fasting glucose ≥140 mg/dL and HbA1c <7% (<53 mmol/mol), and 6508 (10%) had HbA1c ≥7% (≥53 mmol/mol) and fasting glucose <140 mg/dL. Using patients with both fasting glucose <140 mg/dL and HbA1c <7% as the reference (n = 31 834; 49%), solitary high fasting glucose values (and HbA1c <7%) were positively associated with higher age, male sex, longer diabetes duration, obesity, liver disease, low estimated glomerular filtration rate (eGFR), and glucose-lowering treatment. High HbA1c (and fasting glucose <140 mg/dL) was positively related to longer diabetes duration, obesity, neuropathy, retinopathy, low eGFR, and insulin treatment. There were lower odds of having solitary increased HbA1c ≥7% (fasting glucose <140 mg/dL) with higher age, hypertension, depression, and the number of diabetes patients (>200) per practice.
Conclusions
A considerable number of people with T2DM in primary care practices have discordant fasting blood glucose and HbA1c values. People who have discordant glycemic values have different characteristics.
Abstract
zh摘要
背景
基层保健医生经常会遇到2型糖尿病(T2DM)患者出现空腹血糖与HbA1c值不一致的现象。这项研究的目的是确定血糖与HbA1c不匹配人群的患病率以及特征。
方法
共分析了64553名来自939个全科或者内科诊所的T2DM患者(德国疾病分析数据库;2013年1月-2015年12月)。使用多元logistic回归模型来确定基线时的临床特征: 存在的疾病、降糖治疗和空腹血糖与HbA1c值不一致现象之间的关系在同一次访视时测量。
结果
总的来说, 有8582名(13%)空腹血糖≥ 140 mg/dL的患者HbA1c < 7%(< 53 mmol/mol), 有6508名(10%)HbA1c ≥ 7%(≥ 53mmol/mol)的患者空腹血糖< 140 mg/dL。采用空腹血糖低于140 mg/dL并且HbA1c < 7%的患者(n=31834;49%)作为参照, 单纯高空腹血糖值(并且HbA1c < 7%)与高龄、男性性别、更长的糖尿病病程、肥胖、肝脏疾病、估算的肾小球滤过率(eGFR)较低以及降糖治疗之间呈正相关。高HbA1c(并且空腹血糖< 140mg/dL)与更长的糖尿病病程、肥胖、神经病变、视网膜病变、eGFR较低以及胰岛素治疗之间呈正相关。单纯HbA1c升高≥ 7%(空腹血糖 < 140mg/dL)合并高龄、高血压、抑郁症、每次临床实践中糖尿病患者数量(> 200)的发生率都较低。
结论
在基层保健实践中有相当数量的T2DM患者会出现空腹血糖与HbA1c值不一致的现象。血糖值不一致的患者具有不同的临床特征。
