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首页> 外文期刊>Journal of Clinical & Translational Endocrinology >Role of HbA1c in post-partum screening of women with gestational diabetes mellitus
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Role of HbA1c in post-partum screening of women with gestational diabetes mellitus

机译：HbA1c在妊娠糖尿病妇女产后筛查中的作用

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AimTo compare the performance of HbA1c with established glucose criteria during an oral glucose tolerance test (OGTT) and to assess HbA1c as a screening test for undiagnosed diabetes and pre-diabetes after gestational diabetes mellitus (GDM).MethodsGlucose homeostasis was re-evaluated 1–5 years after delivery in 140 women with previous GDM, by means of OGTT and simultaneous HbA1c measurement. Glucose tolerance was defined according to World Health Organisation criteria. HbA1c ≥6.5% (≥48?mmol/mol) was used for diabetes diagnosis and HbA1c ≥5.7% (≥39?mmol/mol) to define abnormal glucose homeostasis.ResultsHbA1c had low sensitivity (14.3%) and high specificity (99.1%) in diabetes diagnosis. Sensitivity and specificity of HbA1c to detect abnormal glucose tolerance were 29.5% and 95.2%, respectively. The consistency in classifying abnormal glucose tolerance between HbA1c and OGTT criteria was 59% (κ?=?0.227) and the area under the receiver operating characteristic curve was 0.708. The combined use of HbA1c and fasting glucose criteria showed similar performance to that of fasting glucose criteria alone. The latter identified 63% of the women with pre-diabetes or diabetes in the study cohort. However, by lowering the cut-point of HbA1c to ≥5.0% (≥31?mmol/mol), an additional proportion (27%) with isolated post-glucose load hyperglycaemia was identified.ConclusionProposed thresholds of HbA1c had low diagnostic sensitivity. Combined with a fasting glucose test, the performance was no better than with using a fasting glucose test alone. Combining a fasting glucose test with a lower HbA1c cut-point may be an alternative approach for selection of women for an OGTT.
机译：目的：比较口服糖耐量测试（OGTT）中HbA1c的性能与既定的葡萄糖标准，并评估HbA1c作为妊娠糖尿病（GDM）后未诊断的糖尿病和糖尿病前期的筛查测试。方法重新评估了葡萄糖稳态。分娩后5年，通过OGTT和同时进行的HbA1c测量，对140名先前患有GDM的妇女分​​娩。葡萄糖耐量是根据世界卫生组织的标准定义的。 HbA1c≥6.5％（≥48？mmol / mol）用于糖尿病诊断，HbA1c≥5.7％（≥39？mmol / mol）用于定义葡萄糖稳态异常。结果HbA1c灵敏度低（14.3％），特异性高（99.1％） ）在糖尿病诊断中。 HbA1c检测异常葡萄糖耐量的敏感性和特异性分别为29.5％和95.2％。 HbA1c和OGTT标准之间分类异常葡萄糖耐量的一致性为59％（κ？=？0.227），接受者工作特征曲线下的面积为0.708。 HbA1c和空腹血糖标准的联合使用显示出与仅空腹血糖标准相似的性能。在研究队列中，后者确定了63％患有糖尿病前期或糖尿病的妇女。但是，通过将HbA1c的下限降低到≥5.0％（≥31？mmol / mol），可以确定额外的比例（27％）与孤立的葡萄糖负荷后高血糖有关。与空腹血糖测试相结合，其性能并不比单独使用空腹血糖测试更好。将空腹血糖测试与较低的HbA1c切点结合起来可能是选择女性进行OGTT的另一种方法。

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