中国全科医学2025，Vol.28Issue(32)：4055-4061,7.DOI:10.12114/j.issn.1007-9572.2024.0704
空腹血糖与糖化血红蛋白对2型糖尿病与糖尿病前期的筛查效果及筛查策略研究
Research on the Screening Effect and Strategy of Fasting Plasma Glucose and Glycosylated Hemoglobin for Type 2 Diabetes and Prediabetes Mellitus
摘要
Abstract
Background Currently,hospital physical examination centers or communities mainly use fasting plasma glucose and glycosylated hemoglobin as indicators to evaluate blood glucose levels.Previous studies explored the diagnostic value of detecting these two indicators separately or in combination,but these studies often only focus on the accuracy of the indicators and ignore their practical value.Based on the real situation,the study constructs a screening strategy for type 2 diabetes and prediabetes mellitus to detect and manage the population with abnormal glucose metabolism at an early stage.Objective Use fasting blood glucose and glycosylated hemoglobin indicators to form screening strategies and screening thresholds for type 2 diabetes and prediabetes mellitus in the physical examination population,so as to improve the detection rate of diabetes and prediabetes in the population.Methods 527 subjects who underwent physical examinations and two-hour postprandial blood glucose testing at Wusong Central Hospital of Baoshan District of Shanghai from September to November 2023.The sensitivity,specificity,positive predictive value,negative predictive value,Youden index,screening cost,and cost-effectiveness of different screening thresholds in the two screening processes of fasting plasma glucose and fasting plasma glucose combined with glycosylated hemoglobin were compared.Results Among the 527 subjects,74 individuals(14.0%)were diagnosed with type 2 diabetes mellitus,141 individuals(26.8%)were identified as having prediabetes mellitus,and 312 individuals(59.2%)exhibited normal blood glucose levels.In the screening strategy using fasting plasma glucose alone,the maximum Youden index of 0.461 corresponded to a fasting plasma glucose screening threshold of 5.4 mmol/L,with a sensitivity of 54.42%,a specificity of 91.67%,and a cost-effectiveness of 233.97 yuan per person.When the screening threshold for fasting plasma glucose was 5.9 mmol/L,the sensitivity was 33.02%,the specificity wasi 99.68%,Youden index was 0.327,and the cost-effectiveness was 212.55 yuan per person.In the screening strategy combining fasting plasma glucose and glycosylated hemoglobin,the maximum Youden index of 0.433 corresponded to a glycosylated hemoglobin screening threshold of 6.1%,with a sensitivity of 51.63%,a specificity of 91.67%,and a cost-effectiveness of 480.23 yuan per person;When the screening threshold for glycosylated hemoglobin for abnormal glucose metabolism was 5.9%,the sensitivity was 73.95%,the specificity was 65.71%,the Youden index was 0.370,and the cost-effectiveness was 475.62 yuan per person.Conclusion When using fasting plasma glucose as a single indicator to screen individuals with abnormal glucose metabolism,lowering the screening threshold for fasting plasma glucose has good screening effectiveness and cost-effectiveness.Glycosylated hemoglobin can serve as a good supplementary screening tool.Supplementing the use of glycosylated hemoglobin screening for individuals with normal fasting plasma glucose can significantly detect individuals with abnormal glucose metabolism status,thereby improving their compliance with glucose tolerance tests and providing more possibilities for optimizing screening strategies.关键词
血糖/空腹血糖/糖基化血红蛋白A/糖尿病/糖尿病前期/筛查Key words
Blood glucose/Fasting plasma glucose/Glycated hemoglobin A/Diabetes mellitus/Prediabetic state/Screening分类
医药卫生引用本文复制引用
张磊,张环宇,陈凯悦,励晓红,郭莺..空腹血糖与糖化血红蛋白对2型糖尿病与糖尿病前期的筛查效果及筛查策略研究[J].中国全科医学,2025,28(32):4055-4061,7.基金项目
国家自然科学基金资助项目(72274036) （72274036）
