AIM:This study assessed whether the poor correlation between HbA1c and oral glucose tolerance test (OGTT) for dysglycaemia diagnosis may be explained by haemoglobin glycation (HbG). METHODS:A total of 1033 consecutive overweight or obese patients with no known diabetes underwent OGTT and measurement of HbA1c to diagnose diabetes and dysglycaemia (American Diabetes Association criteria). For each OGTT result category, low, medium and high HbG was defined according to the mean HbA1c/fructosamine ratio and mean fructosamine. High HbG was defined as values greater than mean values in each OGTT category for both HbA1c/fructosamine ratio and fructosamine levels, and low HbG was defined as lower values of both. The remaining patients were considered medium HbG. RESULTS:Based on OGTT and HbA1c values, 267 (25.8%) and 443 (42.8%) patients had intermediate hyperglycaemia, and 66 (6.4%) and 95 (9.2%) patients had diabetes, respectively. The results were discordant for intermediate hyperglycaemia or diabetes diagnosis in 41.7% and for diabetes diagnosis in 10.0% of the patients. The proportion of patients with HbA1c≥6.5%, but without OGTT-diagnosed diabetes, was 0%, 3.8% and 32.8% in the low-HbG, medium-HbG and high-HbG groups, respectively. In contrast, the proportion of patients with HbA1c<5.7%, but with an abnormal OGTT, was 30.4%, 11.1% and 0%, respectively. The AUROC of HbA1c to detect OGTT-diagnosed diabetes was better in the medium-HbG group [0.874 (0.816-0.931)] than in those with low or high HbG [0.628 (0.489-0.768); P<0.01]. Only age was independently associated with high-HbG status [10-year OR: 1.3 (1.1-1.5); P<0.0001]. CONCLUSION:Haemoglobin glycation may explain many of the discordant results between HbA1c and OGTT when used for dysglycaemia diagnosis.

译文

目的:该研究评估了HbA1c与口服葡萄糖耐量试验(OGTT)诊断血糖异常之间的不良关联是否可以通过血红蛋白糖化(HbG)来解释。
方法:总共1033例不明糖尿病的连续超重或肥胖患者接受OGTT并测量HbA1c以诊断糖尿病和血糖异常(美国糖尿病协会标准)。对于每个OGTT结果类别,根据平均HbA1c /果糖胺比率和平均果糖胺定义低,中和高HbG。高HbG定义为HbA1c /果糖胺比率和果糖胺水平在每个OGTT类别中均大于平均值,而低HbG定义为两者均较低。其余患者被认为是中等HbG。
结果:基于OGTT和HbA1c值,分别有267(25.8%)和443(42.8%)患者患有中度高血糖症,分别有66(6.4%)和95(9.2%)患者患有糖尿病。结果与41.7%的中度高血糖或糖尿病诊断和10.0%的患者的糖尿病诊断不一致。低HbG,中HbG和高HbG组中HbA1c≥6.5%但无OGTT诊断的糖尿病的患者比例分别为0%,3.8%和32.8%。相反,HbA1c <5.7%但OGTT异常的患者比例分别为30.4%,11.1%和0%。在中等HbG组[0.874(0.816-0.931)]中,HbA1c的AUROC检测OGTT诊断的糖尿病要好于HbG较低或较高[0.628(0.489-0.768)]。 P <0.01]。只有年龄与高HbG状况独立相关[10年OR:1.3(1.1-1.5); P <0.0001]。
结论:血红蛋白糖基化可解释HbA1c和OGTT在诊断血糖异常中的许多不一致结果。

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