Pitfalls in the use of HbA1c as a diagnostic test: the ethnic conundrum

被引：107

作者：

Dagogo-Jack, Samuel ^{[1
]}

机构：

[1] Univ Tennessee, Hlth Sci Ctr, Div Endocrinol Diabet & Metab, Memphis, TN 38163 USA

来源：

NATURE REVIEWS ENDOCRINOLOGY | 2010年 / 6卷 / 10期

关键词：

GLYCOSYLATION GAP; HEMOGLOBIN A(1C); GLUCOSE; A1C; HETEROGENEITY; PREVALENCE; ADULTS;

D O I：

10.1038/nrendo.2010.126

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The purpose of a diagnostic test is to identify individuals who have a disorder and reassure those who do not. An HbA(1c)-based diagnosis of diabetes mellitus or prediabetes fails to meet that purpose. Diabetes mellitus is a disorder of glucose, not HbA(1c), metabolism. Microvascular complications in diabetes mellitus are driven by chronic hyperglycemia. The correlation of these complications with HbA(1c) levels is convenient; however, unlike the direct information provided by glucose, HbA(1c) values reflect glycemic and nonglycemic factors. The latter include modulators of glucose transport across the erythrocyte membrane, intracellular protein glycation and deglycation, erythrocyte turnover, systemic illness and hematological and medical disorders, among others. Genetic rather than glycemic factors explain most of the variance in HbA(1c) levels. Finally, HbA(1c) values are misleading as a measure of average blood glucose among persons of African, Asian, Hispanic and other non-European ancestry. Given the numerous pitfalls, the use of HbA(1c) levels for diagnosing diabetes mellitus or prediabetes is ill-advised.

引用

页码：589 / 593

页数：5

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