서울의 한 대학병원에서 당뇨병을 예측하는 당화혈색소 값의 분석 = The Cutoff Value of HbA1c in Predicting Diabetes in Korean Adults in a University Hospital in Seoul

국문 초록 (Abstract)

연구배경: HbA1c는 2~3개월 동안의 혈당 조절 상태를 반영하는 수치로 최근 진단적 기준으로서의 유용성에 대해서 많이 보고가 되고 있다. 이에 본 연구에서는 혈당이상이 의심되어 경구당부하검사를 시행한 1,482명의 대상자들에게서 당뇨병을 예측하는 HbA1c의 cutoff 값을 분석하였다. 방법: 이전에 당뇨병, 공복혈당장애, 내당능장애를 진단 받은 적이 없었던 1,482명의 연구 대상자들에게서 HbA1c, 공복혈당농도, 경구당부하 120분 후 혈장포도당 농도를 측정하였고 ROC curve를 이용하여 당뇨병을 예측하는 HbA1c의 cutoff 값을 분석하였다. 결과: ROC 분석을 이용하여 당뇨병을 예측하는 HbA1c를 분석하였을 때 cuttoff 값은 5.95% (sensitivity 60.8%, specificity 85.6%)였고 남자와 여자를 구분하여 분석하였을 때 HbA1c cutoff 값은 남자는 5.85%, 여자는 6.05%로 성별에 따라 달랐다. 결론: HbA1c 측정이 이전에 당뇨병을 진단받지 않은 비교적 건강한 한국인들에게서 당뇨병 발생을 예측하는데 유용할 것으로 생각된다. 그러나 다른 인종들을 대상으로 한 연구들과 비교하였을 때 당뇨병을 예측하는 HbA1c cutoff 값에 차이가 있었으며 이는 당뇨병을 예측하는 방법으로서 HbA1c를 이용하는 데에는 다양한 집단의 다양한 연령, 성별, 집단별 당뇨병 유병률 등이 고려되어야 함을 제시한다.

다국어 초록 (Multilingual Abstract)

Background: Glycated hemoglobin (HbA1c) levels represent a 2~3 month average of blood glucose concentration. The use of HbA1c as a diagnostic tool for diabetes is gaining interest. Therefore, we determined the cutoff point of HbA1c for predicting abnormal glucose tolerance status in non-diabetic Korean subjects. Methods: We analyzed the data from 1,482 subjects without diabetes mellitus in whom a 75-g oral glucose tolerance test (OGTT) was performed due to suspected abnormal glucose tolerance. We obtained an HbA1c cutoff point for predicting diabetes using Receiver Operating Characteristic (ROC) curve analysis. Results: A cut-off point of 5.95% HbA1c yielded sensitivity of 60.8% and specificity of 85.6%, respectively, for predicting diabetes. There was a difference in HbA1c cut-off value between men and women, 5.85% and 6.05%, respectively. Conclusion: To use the cut-off point of 5.95% HbA1c for predicting undiagnosed diabetes in Koreans may be reliable. However, studies of different ethnic groups have reported disparate HbA1c cut-off points. Thus, ethnicity, age, gender, and population prevalence of diabetes are important factors to consider in using elevated HbA1c value as a tool to diagnose diabetes. (Korean Diabetes J 33:503-510, 2009)

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