상대특성곡선을 이용하여 당뇨병을 선별하기 위한 적절한 당화알부민의 수치를 분석하였을 때 18.8 %에서 민감도 65.7 %, 특이도 65.3 %를 보였다. 하지만 AUC (area under curve)는 0.707 으로 공복혈당(0.867), 당화혈색소(0.849)보다 떨어지는 것으로 나타났다(Figure 3).
당화알부민과 공복혈당, 당화혈색소를 당뇨병 진단에 같이 사용하였을 때의 민감도와 특이도를 알아보았다. 당화알부민이 18.8 % 이상이면서 공복혈당이 110 mg/dL 이상인 경우는 민감도 49.0 %, 특이도 98.2 %를 보였으며, 당화알부민이 18.8 % 이상이거나 공복혈당이 110 mg/dL 인 경우는 민감도 78.3 %, 특이도 63.9 %를 보였다(Table 4).
１４
Figure 3. ROC (Receiver Operating Characteristic) curve of (1) glycated albumin (AUC 0.707) (2) glycated hemoglobin A1c (AUC 0.849) (3) fasting plasma glucose (AUC 0.867)
１５
Table 4. Indices appropriate for screening of diabetes mellitus SEN, sensitivity; SPE, specificity; PPV, positive predictive value; NPV, negative predictive value; PLR, positive likelihood ratio; NLR, negative likelihood ratio; FPG, fasting plasma glucose; GA, glycated albumin; HbA1c, glycated hemoglobin A1c
１６
제4장 고찰
15.7 %까지라고 하였다. 그러나 이 연구들은 나이별로 정상치를 제시하고 있지는
수 있으며, 한국이 아닌 다른 나라의 연구라는 점에서 지역적인 차이가 있을 것으로
제5장 결론
이 연구는 우리나라 일부 지역사회의 당뇨병을 진단받지 않은 사람에서 당뇨병을 선별하기 위해 적절한 당화알부민의 수치를 알아보고자 한 연구이다. 당화알부민은 성별과 체질량지수에 영향을 받지 않는 지표로 공복혈당이나 당화혈색소와 같은 지표에 비교하여 단독으로는 다른 지표에 비해 민감도가 떨어진다. 다만, 당화알부민 18.8 % 이상 또는 공복혈당 110 mg/dL 이상의 기준을 병행 사용하는 경우에는, 당화알부민 기준 단독 또는 공복혈당 기준 단독으로 사용하는 경우에 비해 높은 민감도를 나타냈다. 따라서, 본 연구의 결과를 토대로 한국 장년층 성인에서 당화알부민 농도를 공복혈당 농도와 병행하여 사용하는 것은 당뇨병을 선별하는 지표로 활용할 수 있을 것으로 생각되나, 이를 위해서는 향후 추가적인 연구가 필요하겠다.
２０
참 고 문 헌
1. Genuth SM. 1995. “The case for blood glucose control”. Advanced in Internal Medicine, 40:573–623.
2. British Diabetic Association. 1993. “Population screening for diabetes mellitus”. Diabetic Medicine : a Journal of the British Diabetic Association, 10:777–781.
3. DECODE Study Group, the European Diabetes Epidemiology Group. 2001.
“Glucose tolerance and cardiovascular mortality: Comparison of fasting and 2-hour diagnostic criteria”. Archives of Internal Medicine, 161:397–405.
4. World Health Organization. 1989. Measuring Obesity – Classification and Description of Anthropometric Data. Report on a WHO consultation of
the epidemiology of obesity, Warsaw 21-23 October 1987. Copenhagen:
World Health Organization.
5. Albareda M, de Leiva A, Corcoy R. 2004. “Reproducibility of diabetes mellitus diagnosis (WHO 1999 criteria) in women”. Acta Diabetologica, 41:14–17.
6. International Expert Committee. 2009. “International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes”.
Diabetes Care, 32:1327–1334.
7. Sung C, Rhee EJ. 2007. “Glycated haemogloin as a predictor for metabolic syndrome in non-diabetic Korean adults”. Diabetic Medicine : a Journal of the British Diabetic Association, 24:848-854.
２１
8. American Diabetes association. 2010. “Diagnosis and classification of Diabetes mellitus”. Diabetes Care, 33:62-69.
9. Chujo K, Shima K, Tada H, Oohashi T, Minakuchi J, Kawashima S. 2006.
“Indicators for blood glucose control in diabetics with end-stage chronic renal disease: GHb vs. glycated albumin (GA)”. The Journal of Medical Jnvestigation, 53:223–228.
10. Takahashi S, Uchino H, Shimizu T et al. 2007. “Comparison of glycated albumin (GA) and glycated hemoglobin (HbA1c) in type 2 diabetic patients: Usefulness of GA for evaluation of short-term changes in glycemic control”. Endocrine Journal, 54:139–144.
11. Yamaguchi M, Kambe S, Eto T, Yamakoshi M, Kouzuma T, Suzuki N. 2005.
“Point of care testing system via enzymatic method for the rapid, efficient assay of glycated albumin”. Biosensors & Bioelectronics, 21:426–432.
12. Jin LH, Chang SJ, Ko SB, Kim KS, Lee TY, Ryu SY, Song JS, Park JK. 2011.
“Association between alcohol consumption and bone strength in Korean adults: the Korean Genomic Rural Cohort Study”. Metabolism Clinical and Experimental, 60:351-358.
13. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F; Chronic Kidney Disease Epidemiology Collaboration. 2008.
“Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate”. Annals of Internal Medicine, 145:247-254.
２２
14. National Kidney Foundation. 2002. “K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and
Stratification”. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 39:1-266.
15. 대한당뇨병학회 진료지침위원회. 2011. 당뇨병 진료지침 2011. 서울:
대한당뇨병학회.
16. Furusyo N, Koga T, Ai M, Otokozawa S, Kohzuma T, Ikezaki H, Schaefer EJ, Hayashi J. 2011. “Utility of glycated albumin for the diagnosis of diabetes mellitus in a Japanese population study: results from the Kyushu and Okinawa Population Study (KOPS)”. Diabetologia, 54:3028–
3036.
17. Schaefer EJ, Audelin MC, McNamara JR et al. 2001. “Comparison of fasting and postprandial plasma lipoproteins in subjects with and without coronary heart disease”. The American Journal of Cardiology, 88:1129–
1133.
18. Ma XJ, Pan JM, Bao YQ, Jian Z, Tang JL, Li Q, Xiang KS, Jia WP. 2010.
“Combined assessment of glycated albumin and fasting plasma glucose improves the detection of diabetes in Chinese subjects”. Clinical and Experimental Pharmacology & Physiology, 37:974–979.
19. Hiramatsu Y, Shimizu I, Omori Y, Nakabayashi M. 2012. “Determination of reference intervals of glycated albumin and hemoglobin A1c in healthy pregnant Japanese women and analysis of their time courses and
influencing factors during pregnancy”. Endocrine Journal, 59:145-151.
２３
20. Stephen P, Jurascheck, Michael WS, Elizabeth S. 2012. “Associations of alternative markers of glycemia with hemoglobin A1c and fasting glucose”. Clinical Chemistry, 58:1648-1655.
21. Lee EY, Lee BW, Lee YH, Moon JH, Chun SW, Cha BS, Lee HC. 2009. Comparison of glycated albumin and glycated hemoglobin in Korean type 2 diabetes patients [Abstract]. 제 35 차 대한당뇨병학회 추계학술대회
학술발표논문집, 163-164.
22. Koga M, Kasayama S. 2010. “Clinical impact of glycated albumin as another glycemic control marker”. Endocrine Journal, 57:751-762.
23. Rondeau P, Bourdon E. 2011. “The glycation of albumin: structural and functional impacts”. Biochimie, 93:645-658.
24. Lee EY, Lee BW, Kim D, Lee YH, Kim KJ, Kang ES, Cha BS, Lee EJ, Lee HC.
2011. “Glycated albumin is a useful glycation index for monitoring fluctuating and poorly controlled type 2 diabetic patients”. Acta Diabetologica, 48:167-172.
25. Roohk HV, Zaidi AR. 2008. “A review of glycated albumin as an intermediate glycation index for controlling diabetes”. Journal of Diabetes
Science and Technology, 2:1114-1121.
２４
Abstract
Role of glycated albumin in the screening of diabetes mellitus in Korean rural community
Kim Gun-Woo
Department of Medicine
The Graduate School, Yonsei University
(Directed by Professor Choon Hee Chung)
Background/Aims. The most effective method of managing diabetes mellitus is diagnosing the disease in its early stage and preventing the progression of related complications. Various methods, such as the measurement of fasting plasma glucose (FPG), postprandial plasma glucose, 75-g oral glucose tolerance test, or measurement of glycated hemoglobin (HbA1c) have been used to screen for diabetes mellitus. Glycated albumin (GA) is a novel parameter with several advantages compared to HbA1c-it can be measured at any point of time, and it can screen for diabetes mellitus with an onset of less than 3 months. Despite such benefits, however, few studies have focused on the use of GA in the screening or diagnosis of diabetes mellitus. Therefore, this study performed a cross-sectional analysis of a Korean rural community in order to investigate
２５
the characteristics of GA and to establish an appropriate cut-off point in the screening of diabetes mellitus.
Methods. Among 3,322 subjects participating in Korean Rural Genomic Cohort project, 2,621 subjects were enrolled after excluding those with medical history that may affect the diagnosis of diabetes and those with incomplete laboratory measurements. The changes in GA, HbA1c, and fasting plasma glucose associated with sex, age, and body mass index have been investigated, and the correlation between GA, HbA1c, fasting plasma glucose, and plasma glucose 2 hours after oral glucose tolerance test has been analyzed. A receiver operating characteristic (ROC) curve has been drawn to estimate the appropriate cut-off point of GA in screening for diabetes.
Results. The mean GA of all subjects was 18.8 ± 4.2 %. GA showed an increasing trend with age, and was not associated with sex or body mass index. GA was positively associated with HbA1c, fasting plasma glucose, and plasma glucose 2 hours after oral glucose tolerance test. Analysis of ROC curve revealed GA of 18.8 % as the cut-off point (sensitivity 65.7 %, specificity 65.1 %). When the criteria was expanded to include GA of 18.8% or above or fasting plasma glucose of 110 mg/dL or above, the sensitivity increased to 78.3 %, while specificity changed to 63.9 %.
Conclusion. The results of this study suggest that combining the criteria of GA 18.8 % or above with fasting plasma glucose 110 mg/dL or above may be used as a screening tool for diabetes mellitus among the adults of certain Korean rural community and it needs further studies in future.
２６
Key words: diabetes mellitus, screening, glycated albumin
２７