Abstract: Background　The prevalence of diabetes remains high in China. What's more，there may be a large number of people who may have undiagnosed prediabetes or diabetes. Stable and reliable screening methods will help to identify diabetes and prediabetes patients more quickly and effectively. Objective　To evaluate the effect of fasting fingerstick glucose（FFG） in the screening for diabetes and prediabetes in high-risk populations. Methods　A stratified sampling survey was conducted in 10 communities of Shanghai's Putuo District according to the population distribution of the district in 2017. A questionnaire developed based on the 2017 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes was used for screening residents at high risk for diabetes，which named Diabetes Risk Assessment for Shanghai Community Residents. Then these high risk people underwent laboratory tests to measure FFG and fasting venous blood glucose （FVBG），and received oral glucose tolerance test to determine whether they had prediabetes or diabetes. ROC analysis and performance table of screening test were used to determine the optimal cut-off value of FFG for screening diabetes and prediabetes，and evaluate its effect. Results　A total of 13 057 individuals at high risk for diabetes were identified，among whom 108 cases without FVBG were excluded，and the other 12 949 cases were finally included，including 3 182 （24.57%） diagnosed with diabetes and prediabetes〔1 380 （10.66%） with diabetes，and 1 802 （13.92%） with prediabetes〕. There was a strong correlation between FFG and FVBG（rs=0.722，P<0.001）. The ROC analysis showed that the AUC of FFG to predict diabetes and prediabetes was 0.923 8. When 5.7 mmol/L was taken as the cut-off value of the FVBG test，the Youden Index reached the largest value （0.70），and the sensitivity，specificity，positive predictive value，negative predictive value and Kappa value were 88.62%，81.10%，60.44%，95.63% and 0.83，respectively. The cut-off value of FFG in diagnosing diabetes and prediabetes was 5.7 mmol/L either in men or women，and that ranged 5.6-5.8 mmol/L in different age groups，all were similar to that for the overall population. Conclusion　FFG measurement is a rapid，accurate，reliable and stable test and has high potential to be used as a pre-screening for diabetes and prediabetes. The recommended cut-off value of FFG for screening for diabetes and prediabetes is 5.7 mmol/L，but it could be adjusted within a certain range according to needs of screening.

Key words: Diabetes mellitus, Prediabetic state, Fasting fingerstick glucose, Screening

摘要： 背景　近年来我国糖尿病患病率居高不下，且有大量未诊断的糖尿病及糖尿病前期患者亟待发现。确定稳定、可靠的筛查方法有助于更加快速、有效地发现糖尿病及糖尿病前期患者。目的　评价空腹手指末梢血糖（FFG）在糖尿病高危人群筛查中对糖尿病及糖尿病前期的筛检效果。方法　2017年，根据上海市普陀区人口分布状况，在10个社区进行分层整群抽样调查。依据《中国2型糖尿病防治指南（2017年版）》中的标准制定《上海市社区居民风险评估表》，筛选糖尿病高危人群。糖尿病高危人群进一步行实验室检查，检测FFG、空腹静脉血糖（FVBG）并行口服葡萄糖耐量试验（OGTT）以筛检糖尿病及糖尿病前期人群。通过受试者工作特征（ROC）曲线、筛检试验效能表确定FFG筛检糖尿病及糖尿病前期人群的最佳截断值，并评价其应用效果。结果　共筛选糖尿病高危人群13 057例，剔除108例未做FVBG检测者，最终纳入12 949例，其中糖尿病及糖尿病前期3 182例（24.57%）：糖尿病1 380例（10.66%），糖尿病前期1 802例（13.92%）。相关性分析结果显示，FFG与FVBG具有良好的相关性（rs=0.722，P<0.001）。FFG预测糖尿病及糖尿病前期的ROC曲线下面积为0.923 8。当FFG以5.7 mmol/L为筛检试验截断值时，约登指数最大（0.70），筛检试验的灵敏度、特异度、阳性预测值、阴性预测值和Kappa值分别为88.62%、81.10%、60.44%、95.63%和0.83。男、女性分析结果与整体分析结果一致，FFG截断值均为5.7 mmol/L。不同年龄组分析结果与整体分析结果相近，FFG截断值为5.6~5.8 mmol/L。结论　FFG快速、准确、可靠、稳定，可以作为糖尿病筛查中的预检手段。推荐FFG筛检糖尿病及糖尿病前期的截断值为5.7 mmol/L，但可以根据筛检需求在一定范围内进行调节。

关键词: 糖尿病, 糖尿病前期, 空腹手指末梢血糖, 筛查