Background: Although fasting plasma glucose (FPG) has been highly recommended as the sole test for diabetes screening, the efficacy of FPG alone for diabetes screening is potentially limited due to its low sensitivity. The aim of this study was to improve the efficacy of FPG for diabetes screening using urinary glucose (UG).
Methods: This study was initiated on November 12, 2015, and ended on June 28, 2016. A representative sample of individuals aged between 18 and 65 years, with no history of diabetes, from 6 cities in Jiangsu Province participated in this study. A 75-g oral glucose tolerance test was used to diagnose diabetes. All urine samples were collected within 2 h of oral glucose loading to measure UG. Partial correlation analyses were used to evaluate the associations between UG and other glycemic variables, including FPG, 2-h plasma glucose (2h-PG), and glycated hemoglobin A1c, after adjustment for age. The performance of UG was evaluated using a receiver operating characteristic (ROC) curve analysis.
Results: Of the 7485 individuals included, 8% were newly diagnosed with diabetes and 48.7% had prediabetes. The areas under the ROC curves for UG were 0.75 for estimation of 2h-PG ≥7.8 mmol/L and 0.90 for 2h-PG ≥11.1 mmol/L, respectively. The sensitivity and specificity of UG were 52.3% and 87.8%, respectively, for 2h-PG ≥7.8 mmol/L (cutoff point ≥130 mg), and 83.5% and 87.5%, respectively, for 2h-PG ≥11.1 mmol/L (cutoff point ≥178.5 mg). The combination of FPG and UG demonstrated a significantly higher sensitivity than that of FPG alone for the identification of diabetes ([483/597] 80.9% vs. [335/597] 56.1%, χ2 = 85.0, P < 0.001) and glucose abnormalities ([2643/4242] 62.3% vs. [2365/4242] 55.8%, χ2 = 37.7, P < 0.001).
Conclusions: The combination of UG and FPG substantially improves the efficacy of using FPG alone for diabetes screening; this combination might be a practical screening tool and is worth being recommended in the future.
空腹血糖联合尿糖在中国人群中的糖尿病筛查价值：一项多中心横断面研究摘要背景：空腹血糖（FPG）被推荐可单独使用进行糖尿病筛查，然而单独使用空腹血糖其灵敏度较低。本研究旨在利用尿糖（UG）提升FPG的糖尿病筛查效能。 方法：本研究起始于2015年11月12日，并于2016年6月28日结束。抽取江苏省6个城市，年龄20至65周岁既往从未诊断过糖尿病的城乡常住居民。所有的受试者均给予口服葡萄糖耐量试验。收集口服葡萄糖负荷2小时内所有尿液，定量检测UG。校正年龄后，偏相关分析评估UG与其他血糖变量包括FPG，2h血糖（2h-PG）和糖化血红蛋白（HbA1c）的相关性，受试者工作特征曲线（ROC）评价UG的筛查价值。 结果：最终纳入分析7485名受试者，新诊断糖尿病患病率8％，糖尿病前期患病率48.7％。鉴定2h-PG≥ 7.8 mmol/L，UG的ROC曲线下面积为0.75，鉴定2h-PG≥ 11.1 mmol/L，UG的ROC曲线下面积为0.90。UG筛查2h-PG≥ 7.8 mmol/L（最佳切点值≥ 130 mg）灵敏度和特异度分别为52.3％和87.8％，筛查2h-PG≥ 11.1 mmol/L（最佳切点值≥178.5mg）灵敏度和特异度分别为83.5％和87.5％。与单独使用FPG比较，FPG联合UG筛查糖尿病的灵敏度显著提升（[483/597] 80.9% vs [335/597], 56.1%, χ2 = 85.0, p < 0.001），筛查血糖异常的灵敏度仍然显著高于单独使用FPG（[2643/4242] 62.3% vs [2365/4242] 55.8%, χ2 = 37.7, p < 0.001）。 结论：UG联合FPG能显著提升单独使用FPG的糖尿病筛查效能，这可能是一种实用的筛查工具，值得在将来被推荐。.
Keywords: Diabetes Mellitus; Screening; Urinary glucose.