한국 성인에서 당뇨병 진단 기준으로서의 공복혈당과 당화혈색소 비교
Comparison of Fasting Glucose and Hemoglobin A1c for Diagnosing Diabetes in Korean Adults
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초록
연구배경: 본 연구는 한국인을 대상으로 당뇨병 진단 기준인 공복혈당 ≥126 mg/dl과 당화혈색소 ≥6.5%를 비교하여 당뇨병 진단기준으로서 당화혈색소의 적절성을 평가하고, 공복혈당과 당화혈색소를 기준으로 진단된 당뇨병 환자의 특성을 비교하였다. 방법: 1998년 국민건강영양조사에서 건강검진을 시행한 7,962명 중 공복당화혈색소 검사를 시행하고, 당뇨병 진단을 받은 적이 없으며, 빈혈이 없고, 혈중 크레아티닌 농도가 2 미만인 대상자 4,875명을 대상으로 분석을 시행하였다. 결과: 전체 대상자 4,875명 중 당화혈색소 ≥6.5%이면서 공복혈당 ≥126 mg/dl인 경우가 1.4%, 당화혈색소 ≥6.5% 이면서 공복혈당 <126 mg/dl인 경우가 0.4%, 당화혈색소 <6.5%이면서 공복혈당 ≥126 mg/dl인 경우가 5.6%였다. 당뇨병의 유병률은 공복혈당 기준 7.0%, 당화혈색소 기준으로는 1.8%였으며, 당화혈색소는 공복혈당에 비해 당뇨병의 유병률을 73% 과소평가하였다. 성, 연령, 흡연상태, 체질량지수를 보정한 후에도 공복혈당과 당화혈색소 기준이 당뇨병으로 일치했던 군은 두 기준이 서로 일치하지 않았던 군에 비해 당화혈색소와 혈당 및 허리둘레가 더 컸으며(P<0.05), 대사증후군의 오즈비도 2.6 (95% CI, 1.4-4.9, P<0.01)으로 더 컸다. 결론: 한국 성인에서 당화혈색소 6.5%는 공복혈당으로 정의한 당뇨병을 진단하는 데 민감하지 않았으며, 공복혈당과 당화혈색소 기준이 당뇨병으로 일치했던 군은 일치하지 않는 군에 비해 대사증후군의 위험이 더 컸다.
Abstract
Background: This study aimed to evaluate hemoglobin A1c (HbA1c) level of 6.5% as a diagnostic criterion for diabetes mellitus (diabetes) compared with fasting glucose level of 126 mg/dl, and to compare the characteristics of the individuals diagnosed with diabetes by each of HbA1c and fasting glucose. Methods: Data from the 1998 Korean National Health and Nutrition Examination Survey were used. Analyses were done for 4,875 adults (≥20 years) without a self-reported history of diabetes and anemia and had fasted for at least 8 hours and had the HbA1c level done. Results: Of the 4,875 adults, 1.4% had HbA1c ≥6.5% and fasting glucose ≥126 mg/dl, 0.4% had HbA1c ≥6.5%and fasting glucose <126 mg/dl, and 5.6% had HbA1c <6.5% and fasting glucose ≥126 mg/dl. The pre- valence of diabetes was 7.0% by fasting glucose and 1.8% by HbA1c, which underestimated the prevalence of diabetes compared with fasting glucose. After adjusting for age, sex, smoking status, and BMI, individuals with concordant diabetes by both fasting glucose and HbA1c had higher fasting glucose, HbA1c, and waist circumference (P<0.05), and higher odds ratio for metabolic syndrome (OR=2.6, 95% confidence interval, 1.4-4.9, P<0.01)compared with those with discordant diabetes. Conclusions: In Korean adults, HbA1c level of 6.5% as a diagnostic criterion was less sensitive in detecting newly diagnosed diabetes defined by fasting glucose. There was a significant difference in the odds ratio for metabolic syndrome between individuals with concordant and discordant diabetes defined by fasting glucose and HbA1c.
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