당뇨병 및 공복혈당장애 예측을 위한 당화혈색소 값
The Cutoff Value of HbA1c in Predicting Diabetes and Impaired Fasting Glucose
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초록
증가하고 있는 당뇨병을 예방하기 위한 연구와 함께 당뇨병의 진단 및 예측을 할 수 있는 방법에 대한 연구도 꾸준히 진행되고 있다. 가장 널리 알려져 있는 당화혈색소는 여러 선행 연구에서 그 타당성이 검증되었다. 본 연구에서는 당뇨군 및 공복혈당장애군에 대한 당화혈색소 분별점을 살펴보고, 당뇨군 및 공복혈당장애군 분별을 위한 적절한 임상 적용 기준에 대한 자료를제시하고 이에 대한 타당성 여부를 평가해 보고자 하였다. 2015 국민건강영양조사 데이터 중 측정치 누락자를 제외한 20세 이상 대상자 5,161명(남성 2,281명, 여성 2,880명)의 자료를 이용하였다. 대상자 전체의 공복혈당과 당화혈색소의 상관계수는 0.79로 나타나 강한 상관성이 입증되었다. 그러나 비당뇨군에서 공복혈당과 당화혈색소의 상관계수는 0.27, 공복혈당장애군에서는 0.39, 당뇨군에서는 0.66으로 나타나 당뇨군에서는 상관성이 높은 반면, 비당뇨군과 공복혈당장애군에서 상관계수는 상대적으로 낮았다. ROC curve를 이용하여 당뇨병을예측하기 위한 당화혈색소 cutoff값은 남녀 모두 6.05% (sensitivity 84.6%, specificity 92.0%)로 나타났으며, AUC는0.941 (남성의 경우 0.937, 여성의 경우 0.946)이었다. 반면에공복혈당장애를 예측하기 위한 당화혈색소 cutoff값은 5.55% (sensitivity 64.5%, specificity 70.0%), AUC는 0.733 (남성의경우 0.708, 여성의 경우 0.764)으로 나타났다. 이로써 민감도와 특이도 모두 70% 이하로 낮게 나온 공복혈당장애의 경우 진단 기준으로 적용하기에는 무리가 있다. 추후 공복혈당장애 예측을 위한 분별점의 연구에서는 공복혈당범위를 세분화하여 적용하면 좀 더 민감도와 특이도가 높은 분별점을 설정할 수 있을것으로 보인다.
Abstract
There have been many studies to develop methods for predicting diabetes and to prevent diabetes. The validity of glycated hemoglobin (HbA1c), one of the commonly known tools in predicting diabetes, has been verified by many previous studies. In this study, we examined the cutoff value of HbA1c for diabetes and impaired fasting glucose (IFG). Based on this study, we proposed a proper clinical guideline and evaluated the validation of the guideline. Excluding those without blood glucose and HbA1c data, we used the data of 5,161 subjects (2,281 men and 2,880 women) over the age of 20 years from the 2015 Korean National Health and Nutrition Examination Survey. The correlation efficient of fasting plasma glucose (FPG) and HbA1c was 0.79, indicating a strong relationship. Howeve, the correlation efficient of FPG and HbA1c was low, showing 0.27 in non-diabetes, 0.39 in IFG, and 0.66 in diabetes, showing a strong relationship. The cutoff value of HbA1c for predicting diabetes using ROC curve was 6.05% (sensitivity 84.6%, and specificity 92.0%), and AUC was 0.941 (0.937 in men, and 0.946 in women). The cutoff value of HbA1c for predicting IFG using ROC curve was 5.55% (sensitivity 64.5%, and specificity 70.0%), and AUC was 0.733 (0.708 in men, and 0.764 in women). Therefore, it may not be appropriate to apply the guidelines for diagnosing IFG since sensitivity and specificity were below 70%. For future studies retarding the cutoff value of HbA1c in predicting IFG, high sensitivity and specificity are expected if we segment the reference range of IFG.
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