糖化血色素與糖尿病風險有關


  【24drs.com】根據一項歷史控制世代研究結果,糖化血色素(HbA1c)濃度大於等於5.0%,與糖尿病風險逐漸且顯著增加有關,HbA1c濃度大於等於6.0%到6.4%時的風險更高;第二項研究發現,HbA1c濃度是第二型糖尿病獨立危險因子。
  
  佛羅里達州坦帕退伍軍人事務醫學中心部門的Peiyao Cheng碩士與同事們在2月2日線上發表的糖尿病照護期刊上報告他們的發現。另一項研究由義大利維羅納大學內分泌與代謝科Enzo Bonoro醫師與同事們在2月9日線上發表於糖尿病照護期刊上。
  
  美國糖尿病醫學會指出,HbA1c濃度可以用來診斷糖尿病,但這個數值是否可以用於預測第二型糖尿病仍然未知。兩項研究針對HbA1c濃度是否可以預測糖尿病進行研究。Cheng與同事們的研究設計來決定HbA1c用於預測糖尿病診斷的發生率。另一項由Bonoro與同事們進行的研究評估高於正常值的HbA1c如何用於預測第二型糖尿病。
  
  Cheng與同事們的研究透過電子病歷找出了逾12,000位基礎HbA1c濃度6.5%且未罹患糖尿病的患者。這些患者接受為期8年的追蹤,看之後是否發生糖尿病。
  
  在平均追蹤4.4年後,26.9%患者發生糖尿病。當與對照組(HbA1c濃度低於4.5%)比較時,HbA1c濃度介於4.5%到4.9%的受試者,糖尿病發生率並未顯著增加。然而,糖尿病發生率隨著患者的HbA1c濃度大於等於5.0%後逐漸地且顯著地增加,當HbA1c濃度大於等於6.0%到6.4%時,風險增加更明顯(P=0.0001)。
  
  HbA1c濃度介於5.0%到5.4%、5.5%到5.9%、6.0%到6.4%患者們的個別多變項校正勝算比分別是1.70(95%信賴區間為1.21-2.36)、4.87(95%信賴區間為3.49-6.79)與16.06(95%信賴區間為11.40-22.65)。
  
  Cheng醫師與同事們的結論是,這些數據顯示當HbA1c濃度大於等於5.0%後,發生糖尿病的風險逐漸上升。研究人員發展出一個可以估計5年糖尿病風險,根據這些與其他臨床數據的風險計算器。
  
  第二項研究發現,超過正常值的HbA1c濃度是糖尿病的危險因子之一。Bonoro醫師與同事們表示,就我們所知,這是第一項檢驗基礎HbA1c濃度如何預測HbA1c濃度診斷糖尿病的研究。
  
  研究人員測量919位高加索受試者的HbA1c濃度,這些受試者的年齡介於40到79歲;在15年的後續追蹤期間記錄第二型糖尿病的新病例。
  
  受試者們根據基礎HbA1c濃度分類成:低於5.0%、5.0%到5.49%(對照組)、5.50%到5.99%、6.00%到6.49%。發生第二型糖尿病的年齡校正危險比值分別為1.11(95%信賴區間[CI]為0.30-4.41)、1.00(對照組)、3.79(95% CI為1.79-8.06)、與12.50(95% CI為5.51-28.34)。在校正許多共變項如身體質量指數後,並未改變結果。
  
  Bonoro醫師與同事們的結論是,目前這項研究發現確認了不同級距的HbA1c濃度以及第二型糖尿病風險逐漸上升之間的關係,且清楚地記錄高於正常值的HbA1c濃度是發生第二型糖尿病一個強烈的危險因子。
  
  根據研究者們表示,他們的發現支持了美國糖尿病醫學會使用HbA1c濃度用於風險分級,以及高於正常值患者應該接受預防性措施的建議。
  
  Cheng與同事們的研究接受VA健康服務、國家衛生研究院、Tosoh生科公司的贊助。Bonoro與同事們的研究接受維羅納大學與義大利教學、大學與研究署的經費。作者們表示沒有相關資金上的往來。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6466&x_classno=0&x_chkdelpoint=Y
  

Glycosylated Hemoglobin Associated With Diabetes Risk

By Emma Hitt, PhD
Medscape Medical News

February 23, 2011 — A glycosylated hemoglobin (HbA1c) level equal to or more than 5.0% is associated with a progressively and significantly increased risk for diabetes, with greatest risk for those with an HbA1c level of 6.0% to 6.4%, according to the findings of an historical cohort study. Levels of HbA1c were also found to be an independent risk factor for type 2 diabetes, according to the findings of a second study.

Peiyao Cheng, MS, with the Department of Veterans Affairs Medical Center, in Tampa, Florida, and colleagues reported their findings online February 2 in Diabetes Care. A second study by Enzo Bonoro, MD, with the Section of Endocrinology and Metabolism, at the University of Verona, in Verona, Italy, and colleagues was reported online February 9 in Diabetes Care.

The American Diabetes Association indicates that HbA1c level can be used to diagnose diabetes, but its value in the prediction of type 2 diabetes is poorly understood. Two studies investigated HbA1c as a predictor of diabetes. Cheng and colleagues' study was designed to determine the ability of HbA1c to predict the incidence of a diabetic diagnosis. The second study, by Bonoro and colleagues, evaluated how high-to-normal HbA1c levels predict type 2 diabetes.

Cheng and Colleagues

Cheng and colleagues identified more than 12,000 nondiabetic patients with a baseline HbA1c level of 6.5% using electronic medical record data. These patients were tracked for 8 years for a subsequent diagnosis of diabetes.

During an average follow-up of 4.4 years, diabetes developed in 26.9% of patients. When compared with the reference group (HbA1c level < 4.5%), participants with an HbA1c level of 4.5% to 4.9% were at no significant increased risk for incident diabetes. However, the incidence of diabetes progressively and significantly increased among patients with an HbA1c level above or equal to 5.0%, and a significantly increased risk was evident for those with an HbA1c level of 6.0% to 6.4% (P = .0001).

The respective multivariable-adjusted odds ratios for patients with HbA1c values from 5.0% to 5.4%, 5.5% to 5.9%, and 6.0% to 6.4% were 1.70 (95% CI, 1.21 - 2.36), 4.87 (95% CI, 3.49 - 6.79), and 16.06 (95% CI, 11.40 - 22.65).

"These data show a progressive risk for developing diabetes when HbA1c is ?5.0%, with nominal risk below that level," Dr. Cheng and colleagues conclude. The researchers developed a risk calculator to estimate the 5-year risk for diabetes based on these and other clinical data.

Bonoro and Colleagues

The second study also found that high-to-normal levels of HbA1c were a risk factor for diabetes. "To the best of our knowledge, this study is the first to examine how baseline HbA1c predicts HbA1c-diagnosed diabetes," Dr. Bonoro and colleagues note.

The researchers measured HbA1c level in 919 Caucasian participants, aged 40 to 79 years. New cases of type 2 diabetes were recorded during a 15-year follow-up period.

Participants were stratified according to baseline HbA1c values of less than 5.0%, 5.00% to 5.49% (reference), 5.50% to 5.99%, and 6.00% to 6.49%. Sex- and age-adjusted hazard ratios for type 2 diabetes were 1.11 (95% confidence interval [CI], 0.30 - 4.41), 1.00 (reference), 3.79 (95% CI, 1.79 - 8.06), and 12.50 (95% CI, 5.51 - 28.34), respectively. Results did not change after adjustment for several confounding factors such as body mass index.

"The findings of the current study confirm a progressively increased risk of type 2 diabetes across categories of HbA1c and clearly document that subjects with high-normal HbA1c have a strong risk of developing type 2 diabetes..., "Dr. Bonoro and colleagues conclude.

According to the researchers, their findings support the American Diabetes Association recommendations of using HbA1c level for diabetes risk stratification and targeting participants with high-normal levels with preventive strategies.

The study by Cheng and colleagues was funded by the VA Health services, the National Institutes of Health, and Tosoh Bioscience. The study by Borona and colleagues was supported by grants from the University of Verona and the Italian Ministry of Instruction, University, and Research. The authors of both studies have disclosed no relevant financial relationships.

Diabetes Care. Published online February 2, 2011.

Diabetes Care. Published online February 9, 2011.

    
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