Abstract: Background Currently，hospital physical examination centers or communities mainly use fasting plasma glucose and glycosylated hemoglobin as indicators to evaluate blood glucose levels. Previous studies explored the diagnostic value of detecting these two indicators separately or in combination，but these studies often only focus on the accuracy of the indicators and ignore their practical value. Based on the real situation，the study constructs a screening strategy for type 2 diabetes and prediabetes to detect and manage the population with abnormal glucose metabolism at an early stage. Objective Use fasting blood glucose and glycosylated hemoglobin indicators to form screening strategies and screening thresholds for type 2 diabetes and prediabetes in the physical examination population，so as to improve the detection rate of diabetes and prediabetes in the population. Methods 527 subjects who underwent physical examinations and two-hour postprandial blood glucose testing at a hospital in Shanghai from September to November 2023. The sensitivity，specificity，positive predictive value，negative predictive value，Youden index，screening cost，and cost-effectiveness of different screening thresholds in the two screening processes of fasting plasma glucose and fasting plasma glucose combined with glycosylated hemoglobin were compared. Results Among the 527 subjects，74 individuals（14.04%）were diagnosed with type 2 diabetes，141 individuals（26.76%）were identified as having prediabetes，and 312 individuals（59.2%）exhibited normal blood glucose levels. In the screening strategy using fasting plasma glucose alone，the maximum Youden index of 0.461 corresponded to a fasting plasma glucose screening threshold of 5.4 mmol/L，with a sensitivity of 54.42%，a specificity of 91.67%，and a cost-effectiveness of 233.97 yuan per person. The optimal screening threshold for fasting plasma glucose was 5.9 mmol/L，with a sensitivity of 33.02%，a specificity of 99.68%，a Youden index of 0.327，and a cost-effectiveness of 212.55 yuan per person. In the screening strategy combining fasting plasma glucose and glycosylated hemoglobin，the maximum Youden index of 0.433 corresponded to a glycosylated hemoglobin screening threshold of 6.1%，with a sensitivity of 51.63%，a specificity of 91.67%，and a cost-effectiveness of 480.23 yuan per person；the optimal screening threshold for glycosylated hemoglobin for abnormal glucose metabolism was 5.9%，with a sensitivity of 73.95，a specificity of 65.71，a Youden index of 0.370，and a cost-effectiveness of 475.62 yuan per person. Conclusion When using fasting plasma glucose as a single indicator to screen individuals with abnormal glucose metabolism，lowering the screening threshold for fasting plasma glucose has good screening effectiveness and cost-effectiveness. Glycosylated hemoglobin can serve as a good supplementary screening tool. Supplementing the use of glycosylated hemoglobin screening for individuals with normal fasting plasma glucose can significantly detect individuals with abnormal glucose metabolism status，thereby improving their compliance with glucose tolerance tests and providing more possibilities for optimizing screening strategies.

Key words: Blood glucose, Fasting plasma glucose, Glycated hemoglobin A, Prediabetic state, Glucose metabolism disorders, Screening

摘要： 背景 当前，医院体检中心或社区主要采用空腹血糖和糖化血红蛋白作为评估血糖水平的指标。已有研究探讨了这两种指标单独或联合检测的诊断价值，但这些研究仅关注指标的准确性，而忽略了其实践价值。本研究基于现实情景，构建2型糖尿病和糖尿病前期的筛查策略，以早期发现和管理糖代谢异常人群。目的 利用空腹血糖和糖化血红蛋白指标，形成针对2型糖尿病和糖尿病前期的筛查策略和筛查界值，以提高糖尿病和糖尿病前期人群的检出率。方法 纳入2023年9—11月在上海市某医院体检并接受餐后2h血糖检测的527名受检者，比较空腹血糖、空腹血糖结合糖化血红蛋白两种筛查流程中不同筛查界值的灵敏度、特异度、阳性预测值、阴性预测值、约登指数、筛查成本和成本效果。结果 527名受检者中2型糖尿病患者有74名（14.04%），糖尿病前期患者有141名（26.76%），正常血糖有312名（59.2%）。单独使用空腹血糖的筛查策略中，约登指数最大值0.461对应的空腹血糖筛查界值为5.4mmol/L，灵敏度为54.42%，特异度为91.67%，成本效果为233.97元/人；空腹血糖的最佳筛查界值为5.9mmol/L，灵敏度为33.02%，特异度为99.68%，约登指数为0.327，成本效果为212.55元/人。空腹血糖结合糖化血红蛋白筛查策略中，约登指数最大值0.433对应的糖化血红蛋白筛查界值为6.1%，灵敏度为51.63%，特异度为91.67%，成本效果为480.23元/人；糖代谢异常的糖化血红蛋白最佳筛查界值为5.9%，灵敏度为73.95，特异度为65.71，约登指数为0.370，成本效果为475.62元/人。结论 使用空腹血糖作为单一指标筛查糖代谢状态异常人群时，降低空腹血糖的筛查界值为5.9mmol/L时具有良好的筛查效果和经济性。糖化血红蛋白可以作为有效的补充筛查工具，补充应用糖化血红蛋白（界值为5.9%）筛查空腹血糖正常人群，能更多地发现实际糖代谢状态异常人群，从而提高他们进行糖耐量试验的依从性，为筛查策略的优化提供更多可能性。

关键词: 血糖, 空腹血糖, 糖基化血红蛋白 A, 糖尿病前期, 葡萄糖代谢障碍, 筛查