Erythrocytosis and Performance of HbA1c in Detecting Diabetes on an Oxygen-Deficient Plateau: A Population-based Study

作者：Qian Ren, Xuemei Lv, Lihui Yang, Jun Yue, Yingying Luo, Lingli Zhou, Shuyou Meng, Senlin Yang, Basang Puchi, Xianghai Zhou, Linong Ji · 发表于：The Journal of Clinical Endocrinology & Metabolism · 年份：2020 · DOI：10.1210/clinem/dgaa001 · 被引用次数：12 · 研究领域：High Altitude and Hypoxia、Diabetes, Cardiovascular Risks, and Lipoproteins、Adipokines, Inflammation, and Metabolic Diseases

CONTEXT: The hemoglobin A1c (HbA1c) test is a standard test for diabetes screening and diagnosis. OBJECTIVE: To evaluate A1c performance for diabetes screening in high-altitude polycythemia compared to a population with a high proportion of people living in an oxygen-deficient environment. DESIGN: A population-based epidemiological survey was conducted. SETTING: The cities Lhasa and Shigatse were selected. Volunteers were recruited through educational advertisements about diabetes. PARTICIPANTS: A total of 1401 Tibetan adults without known diabetes. INTERVENTIONS: Oral glucose tolerance test (OGTT), HbA1c, and complete blood cell count were performed. Hemoglobin A1c was evaluated using high-performance liquid chromatography, and serum glucose level, using the hexokinase method. MAIN OUTCOME MEASURES: World Health Organization criteria were used to define diabetes and prediabetes. Hemoglobin A1c test performance was evaluated using receiver operating characteristic analysis. RESULTS: The participants' mean age was 44.3 ± 15.0 years; 33.3% of the participants were men and 38.6% lived in urban areas. The prediabetes and diabetes prevalence rates were 7.5% and 3.6%, respectively. The optimal HbA1c cutoff for detecting diabetes was 46 mmol/mol (6.4%), with a sensitivity and specificity of 60.8% and 93.6%, respectively. The cutoff for detecting diabetes was 6.7% (50 mmol/mol) in subjects with high-altitude polycythemia (HAPC). The relationship between red blood cell (RBC) counts an...