Hemoglobin A1c in predicting progression to diabetes

Diabetes Centre, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Diabetes research and clinical practice (Impact Factor: 2.54). 11/2009; 87(1):126-31. DOI: 10.1016/j.diabres.2009.11.001
Source: PubMed


The predictive value of hemoglobin A1c (HbA1c) in comparison to fasting plasma glucose (FPG) is evaluated for 5-year incident diabetes (DM), as HbA1c may be more practical than FPG in the screening for DM in the future. Of 1189 non-DM subjects aged 35-89 years old from the Funagata Study, 57 subjects (4.8%) had developed DM on the WHO criteria at 5-year follow-up. The odds ratio (95% confidence interval: CI) for a one standard deviation increase in FPG/HbA1c was 3.40 (2.44-4.74)/3.49 (2.42-5.02). The area under the receiver operating characteristic curve for FPG/HbA1c was 0.786 (95% CI: 0.719-0.853)/0.785 (0.714-0.855). The HbA1c corresponding to FPG 5.56 mmol/l was HbA1c 5.3%. There was no statistical difference in sensitivity between FPG 5.56 mmol/l and HbA1c 5.3% (61.4% vs. 56.1%), while specificity was higher in HbA1c 5.3% than FPG 5.56 mmol/l (87.8% vs. 82.5%, p-value<0.001). The fraction of incident case from those with baseline IGT was similar between the groups, however the fraction of people above the cut-off was significantly lower in HbA1c 5.3% than FPG 5.56 mmol/l (14.3% vs. 19.6%, p-value<0.001). HbA1c is similar to FPG to evaluate DM risk, and HbA1c could be practical and efficient to select subjects for intervention.

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    • "However, the DECODA study suggests that FPG suggested by WHO would underestimate the prevalence of IGT and diabetes in Asian populations [8]. Recent Japanese studies indicate on the basis of diabetes incidence that the optimal cut-off value of FPG was around 100 mg/dL [9] [10] [11] [12]. Thus, these studies suggest that the cut-off FPG value should be lowered in terms of prediction of diabetes in Japanese subjects. "
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