Faruk KILINÇ, Zafer PEKKOLAY, Alpaslan Kemal TUZCU, Dilek GÜNEŞ, Coşkun BEYAZ

Diyabetes Mellitus Tanısında Hba1c Yanıltıcı, Glukoz Tolerans Testinde Doksan'ıncı Dakika Daha İyi Bir Belirteç Midir?

Amaç: Bu çalışmadaki amaç tip 2 diyabet tanısında HbA1c’nin yararlılığını araştırmak ve oral glukoz tolerans testine yeni bir bakış getirmektir. Yöntemler: Retrospektif kesitsel olan çalışmamızda yaş ortalaması 46.7±12.9 olan toplam 560 kişi (363 kadın, 197 erkek) çalışmaya dahil edildi. Bu kişilere standart 75 g oral glukoz tolerans testi (OGTT) yapıldı; ayrıca bunlar içerisinden kabul eden 232 kişide 0, 30, 60, 90 ve 120. dakikalarda plazma glukoz düzeyleri bakıldı ve Area Under Curve (AUC) değeri hesaplandı. Test ile eş zamanlı olarak HbA1c düzeyleri ölçüldü. OGTT yapılan bireylerde diyabet tanısında HbA1c’nin belirli kesim noktalarındaki sensitivite ve spesifitelerini belirlemek için Receiver Operating Characteristic (ROC) eğrisi kullanıldı. Şeker yüklemesinde hangi saatteki glukoz düzeyinin HbA1c ve AUC ile daha iyi korelasyon gösterdiği araştırıldı. Verilerin karşılaştırılmasında ki kare testi, ölçümler arasındaki ilişki için Pearson korelasyon testi kullanıldı. Bulgular: 560 kişiden 129 kişi, bunlar içerisinde sık aralıklı glukoz bakılan 232 kişiden 40 kişi diyabetti. Diyabet tanısında HbA1c %6,5 kesim noktası ile sensitivite %55,0, spesifite %80,9 bulundu. En yüksek korelasyon 90. dakikadaki plazma glukoz değeri ile AUC ve HbA1c arasında görüldü (sırasıyla r=0.971/P

Is HbA1c Misleading and 90-Minute Glucose Tolerance Test a Better Indicator in the Diagnosis of Diabetes Mellitus?

Objective: The present study aimed to investigate the efficacy of hemoglobin A1c (HbA1c) in diagnosing type 2 diabetesand to introduce a new approach to oral glucose tolerance test (OGTT).Methods: This retrospective cross-sectional study included 560 subjects (363 females, 197 males) with a mean age of46.7±12.9 years. These subjects underwent a standard 75-g OGTT, plasma glucose levels were assayed at 0, 30, 60, 90,and 120 minutes in 232 subjects who consented to these tests, and the area under the curve (AUC) was calculated. HbA1clevels were also measured simultaneously. The receiver operating characteristics (ROC) curve was used to determine thesensitivity and specificity of certain HbA1c cut-off values in diagnosing diabetes in subjects who underwent OGTT. Chisquare test was used for data comparisons, and Pearson’s correlation coefficient was used to evaluate the relationshipbetween the measurements.Results: Among the 560 subjects, 129 had diabetes and 40 of the 232 subjects who were frequently tested for glucoselevels had diabetes. The sensitivity and specificity of the HbA1c cut-off value of 6.5% in diagnosing diabetes were 55.0%and 80.9%, respectively. The highest correlation was observed between the glucose level at 90 minutes and AUC andHbA1c (r=0.971, P

PDF

___

1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011; 34 (Suppl.1): 62-9.
2. American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes. Diabetes Care. 2018; 41 (Suppl.1): 55-64.
3. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes. Diabetes Care. 2018; 41(Suppl.1): 13-27 diabetes: Diabetes Care. 2009; 32: 1327-34.
4. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes: Diabetes Care. 2009; 32: 1327-34.
5. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2010; 33 (Suppl.1): 11-61.
6. Lages MV, Lauria MW, Goncalves Dias AP, et al. Can A1C replace oral glucose tolerance test in the evaluation of patients with impaired fasting glucose? EndocrinolMetabInt J. 2017; 4: 133‒9.
7. Ramachandran A, Snehalatha C, SamithShetty A, et al. Predictive value of HbA1c for incident diabetes among subjects with impaired glucose tolerance--analysis of the Indian Diabetes Prevention Programmes. Diabet Med. 2012; 29: 94-8.
8. d'Emden MC. Glycatedhaemoglobin for the diagnosis of diabetes. AustPrescr. 2014;37:98–100.
9. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2007; 30(Suppl.1): 4-41.
10. Kramer CK, Araneta MR, Barrett-Connor E. A1C and diabetes diagnosis: The Rancho Bernardo Study. Diabetes Care. 2010; 33(1): 101-3.
11. Yu EY, Wong CK, Ho SY, et al. Can HbA1c replace OGTT for the diagnosis of diabetes mellitus among Chinese patients with impaired fasting glucose? FamPract. 2015; 32: 631-8.
12. Xu N, Wu H, Li D, et al.Diagnostic accuracy of glycated hemoglobin compared with oral glucose tolerance test for diagnosing diabetes mellitus in Chinese adults: a meta-analysis. Diabetes Res ClinPract. 2014; 106: 11-8.
13. Meijnikman AS, De Block CEM, Dirinck E, et al. Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population. Int J Obes (Lond). 2017; 41: 1615-20.
14. Adamska E, Waszczeniuk M, Gościk J, et al. The usefulness of glycated hemoglobin A1c (HbA1c) for identifying dysglycemic states in individuals without previously diagnosed diabetes. Adv Med Sci. 2012; 57: 296-301.
15. Silverman RA, Thakker U, Ellman T, et al.Hemoglobin A1c as a screen for previously undiagnosed prediabetes and diabetes in an acute-care setting. Diabetes Care. 2011; 34: 1908-12.
17. Kim HJ, Choi EY, Park EW, et al. The Utility of HbA1c as a Diagnostic Criterion of Diabetes. Korean J Fam Med. 2011; 32: 383-9.
18. Manley S, Nightingale P, Stratton I, et al. Diagnosis of diabetes: HbA1c versus WHO criteria. Diabetes & Primary Care. 2010; 12: 87-96.
19. Kim SH, Park TS, Jin HY. Rethinking the accuracy of 75 g glucose used in the oral glucose tolerance test in the diagnosis and management of diabetes. Prim Care Diabetes. 2017; 11: 555-60.
16. Van 'tRiet E, Alssema M, Rijkelijkhuizen JM, et al. Relationship between A1C and glucose levels in the general Dutch population: the new Hoorn study. Diabetes Care. 2010; 33: 61-6.
20. Kjøllesdal MKR, Hjellset VT, Høstmark AT. Blood glucose measured at several time points and correlation with incremental area under the curve.J Nutr Food Sci. 2014; 4: 315.
21. Sakaguchi K, Takeda K, Maeda M, et al.Glucose area under the curve during oral glucose tolerance test as an index of glucose intolerance. Diabetol Int. 2015;7: 53-8.
22. Nielsen ML, Pareek M, Leósdóttir M, et al.Follow-up duration influences the relative importance of OGTT and optimal timing of glucose measurements for predicting future type 2 diabetes. Eur J Endocrinol. 2016; 174: 591-600.
23. Alyass A, Almgren P, Akerlund M, et al. Modelling of OGTT curve identifies 1 h plasma glucose level as a strong predictor of incident type 2 diabetes: results from two prospective cohorts. Diabetologia. 2015; 58: 87-97.
24. Abdul-Ghani MA, Williams K, DeFronzo RA, et al. What is the best predictor of future type 2 diabetes? Diabetes Care. 2007; 30: 1544-8.
28. Abdul-Ghani MA, Abdul-Ghani T, Stern MP, et al. Two-step approach for the prediction of future type 2 diabetes risk. Diabetes Care. 2011; 34: 2108-12.
29. Kuang L, Huang Z, Hong Z, et al. Predictability of 1-h postload plasma glucose concentration: A 10-year retrospective cohort study. J Diabetes Investig. 2015; 6: 647-54.
25. Abdul-Ghani MA, Lyssenko V, Tuomi T, et al. Fasting versus postload plasma glucose concentration and the risk for future type 2 diabetes: results from the Botnia Study. Diabetes Care. 2009; 32: 281-6. metabolic syndrome identify subjects at high risk for future type 2 diabetes. Diabetes Care. 2008; 31: 1650-5.
26. Abdul-Ghani MA, Abdul-Ghani T, Ali N, et al. One-hour plasma glucose concentration and the metabolic syndrome identify subjects at high risk for future type 2 diabetes. Diabetes Care. 2008; 31: 1650-5.
27. Abdul-Ghani MA, Stern MP, Lyssenko V, et al.Minimal contribution of fasting hyperglycemia to the incidence of type 2 diabetes in subjects with normal 2-h plasma glucose. Diabetes Care. 2010; 33: 557-61.
30. Peddinti G, Bergman M, Tuomi T, et al. 1- Hour Post-OGTT Glucose Improves the Early Prediction of Type 2 Diabetes by Clinical and Metabolic Markers. J Clin Endocrinol Metab. 2019; 104: 1131-40.