한국인에서 미국 당뇨병 학회의 당뇨병 진단 기준인 당화혈색소의 적합성
Acceptability of HbA1c values as a diagnostic tool for diabetes mellitus in Korea
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목적: 2010년 미국당뇨병협회에서 당뇨병의 진단기준으로 당화혈색소 6.5% 이상을 채택하였다. 새롭게 채택된 당화혈색소 6.5% 이상이라는 기준이 한국 성인에서 당뇨병 진단에 적용 가능한지 알아보고자 했다. 방법: 2000년 1월부터 2010년 1월까지 건양대학교병원에 방문한 환자 중 75 g 경구당부하검사 및 당화혈색소를 시행한 1,862명 중 급성 질환을 앓고 있는 환자, 혈색소가 10 g/dL 이하인 환자, 크레아티닌 2 mg/dL 이상인 환자, 경구 혈당강하제나 인슐린을 처방 받았던 환자, 임신한 환자를 제외한 1,474명을 대상으로 조사하였다. 결과: 전체 1,474명의 환자에 대한 정보는 서양인에 비해 비만도가 낮은 한국인 당뇨병의 특성을 보였고, HOMA-IR을 통해 제2형 당뇨병의 특징을 보였다. 당뇨병 진단을 위한 당화혈색소의 값을 알아보고자 75 g 경구당부하검사의 결과를 통해 ROC curve를 구하였고, cutoff value로 6.25%라는 값을 얻었다. 또한 당뇨병성 망막병증에 대한 조사 결과를 통해 당뇨병을 진단하기 위한 값은 6.75%였다. 결론: 본 연구의 결과상 미국당뇨병협회에서 권고한 당뇨병 진단 기준으로서의 당화혈색소값과 차이를 보였다. 인종간 또는 문화 간의 차이 등으로 달라질 수 있는 당화혈색소의 특징을 고려하여 6.5% 이상이라는 기준보다는 한국인에게 적용하기 위한 적합한 값을 구하기 위해 당뇨병의 합병증에 관한 대규모 연구 등의 노력이 필요하겠다.
Abstract
Background/Aims: In 2010, the American Diabetes Association (ADA) adopted glycated hemoglobin (HbA1c) as a new diagnostic criterion for diabetes mellitus. However, HbA1c values may differ among races. We determined whether this criterion could be applied to Korean diabetics. Methods: Between January 2000 and January 2010, 1,862 patients among Konyang University Hospital visitors in which the 75 g oral glucose tolerance test (OGTT) and HbA1c were checked at the same time were enrolled. We excluded patients with acute disease, an Hb ≤ 10 g/dL, a Cr ≥ 2 mg/dL, those prescribed oral hypoglycemic agents or insulin, and those who were pregnant. Results: After applying the exclusion criteria, 1,474 Korean patients were enrolled. All had common features of Korean diabetics for body mass index and homeostatic model assessment of insulin resistance values. Using the 0 and 120 minute glucose levels of the OGTT from the receiver operating characteristic curve, the HbA1c cutoff value was 6.25%. The cutoff value to diagnose diabetes with the presence of diabetic retinopathy was 6.75%. Conclusions: Our study showed a difference between the HbA1c values for diagnosing diabetes and the new diagnostic criterion from the ADA. Considering that the HbA1c characteristics may be influenced by race or culture, larger studies on diabetes complications are needed to identify the appropriate HbA1c value for Korean diabetics.
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