A large proportion of prediabetes and diabetes goes undiagnosed when only fasting plasma glucose and/or HbA(1c) are measured in overweight or obese patients

作者：Cosson E; Hamo Tchatchouang E; Banu I; Nguyen M T; Chiheb S; Ba H; Valensi P^*

来源：Diabetes & Metabolism, 2010, 36(4): 312-318.

DOI：10.1016/j.diabet.2010.02.004

• Oral glucose tolerance test
• Prediabetes
• French National Agency of Accreditation and Evaluation in Health Care (ANAES)
• Overweight
• Obesity
• HbA(lc)

Aims. The purposes of the study were to determine the prevalence of unrecognized dysglycaemia in overweight (body mass index [BMI] 25-29.9 kg/m(2)) and obese (BMI >30 kg/m(2)) patients, to assess the extent to which measures of fasting plasma glucose (FPG) and/or HbA(1c), compared with oral glucose tolerance tests (OGTTs), misdiagnose dysglycaemia, and to determine the factors associated with an isolated abnormal post-OGTT glucose value.
Methods. OGTT was performed and HbA(1c) was measured in 1283 inpatients with BMI scores >= 25 kg/m(2) and no history of dysglycaemia.
Results. Prediabetes was found in 257 (20.0%) subjects (197 with impaired glucose tolerance, 29 with impaired fasting glucose, 31 with both) and diabetes in 77 (6.0%), including 22 with FPG >= 7 mmol/L (WHO definition). The sensitivity of FPG >6 mmol/L, FPG >5.5 mmol/L, HbA(1c), >= 6% and the recommendations of the French National Agency of Accreditation and Evaluation in Health Care (ANAES) to identify patients with abnormal OGTTs was 29.9, 41.3, 36.8 and 15.6%, respectively. The factors that were independently associated with diabetes in obese women with FPG <7 mmol/L were age (per 10 years: OR 1.54 [1.00-2.11]; P = 0.049) and FPG (OR 6.1 [1.4-30.0]; P=0.014), whereas age (OR 1.26 [1.09-1.44]; P<0.01) and waist circumference (per 10 cm: OR 1.17 [1.01-1.33]; P < 0.05) were independently associated with dysglycaemia in obese women with FPG <6.1 mmol/L.
Conclusion. In overweight and obese patients: dysglycaemia is commonly seen; FPG alone, compared with OGTT, failed to diagnose 70% of dysglycaemia cases; FPG>5.5 mmoUL and HbA(1c) >= 6.0% are not necessarily substitutes for OGTT; and older age and larger waist circumference should be used to select those obese women with normal FPG who might further benefit from OGTTs to diagnose dysglycaemia.

• 出版日期2010-9