糖化血红蛋白与视网膜病变发生发展关系及其诊断糖尿病切点的队列研究

Diabetes and its complications are major public health problem in China. Current diagnostic criteria for diabetes are based on the concept that microvascular complications such as retinopathy occur above a threshold level of hyperglycemia that can be used to differentiate people with and without diabetes. But more recent population-based studies across different populations found no consistent fasting plasma glucose (FPG) threshold for retinopathy, with the data instead suggesting a continuous linear relationship and poor performance of the 7.0 mmol/l FPG cut-point in discriminating the presence of retinopathy. Such findings raise doubts about the underlying premise of a uniform glucose threshold for retinopathy. The American Diabetes Association and World Health Organization have recently adopted the glycated haemoglobin Alc (HbA1c) measurement as one method of diagnostic criteria for diabetes. The change in diagnostic criteria has important implications for diabetes treatment and prevention. But the use of HbA1c for diagnosis of type 2 diabetes is not currently recommended by the Chinese Diabetic Society as few epidemiological studies have examined the optimal cut-points for HbA1c that maximize sensitivity and specificity in Chinese population and the optimal cut-points could be the different according to the different ethnicities, age and gender distribution, and prevalence of diabetes. The performance of HbA1c in detecting diabetes in the Chinese population remains unknown. So we will conduct a population-based longitudinal study involving 4000 adults of Chinese ethnicity aged 35 years and older in rural China based on the Handan Eye Study Ⅱ(2012) to explore the association of FBG/HbAlc with the 3-years risk of developing diabetes, retinopathy, cardiocerebrovascular events and mortality, to evaluate the efficiency of HbA1c in diagnosing diabetes and to identify the optimal threshold in the adult Chinese population by using high performance liquid chromatography.

糖尿病(DM)已成为我国重要的公共卫生问题。DM诊断标准的产生及多次调整和变迁均是建立在以血糖与视网膜病变为主的微血管并发症的相关关系为依据的大量流行病学研究基础上。美国糖尿病协会和世界卫生组织最新指南分别正式确定和建议采用糖化血红蛋白(HbA1c)诊断DM。但鉴于HbA1c水平存在种族差异，HbA1c临床诊断切点尚未统一，我国缺乏大样本、前瞻性的以发生视网膜病变风险为判定标准的用以诊断DM 的HbA1c切点研究，因此我国指南暂不推荐采用HbA1c诊断DM。本研究将以邯郸眼病研究Ⅱ段约4000人为基础建立农村自然人群的研究队列，进行3年的前瞻性研究，阐明空腹血糖、HbA1c与糖尿病发生、糖尿病慢性并发症(视网膜病变、心血管事件、死亡)发生风险的关系，并评价其对糖尿病的诊断价值，评估HbA1c诊断糖尿病的适宜切点，从而积累中国人群血糖代谢特征的资料，为糖尿病标准的制定提供循证医学证据。