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
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.
Available from: Tadashi Iwao
- "However, the DECODA study suggests that FPG suggested by WHO would underestimate the prevalence of IGT and diabetes in Asian populations . Recent Japanese studies indicate on the basis of diabetes incidence that the optimal cut-off value of FPG was around 100 mg/dL    . 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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There are conflicting interpretations regarding the normal fasting plasma glucose level in Japanese subjects. We therefore aimed to define the upper limit of fasting plasma glucose level.
A total of 962 subjects who had a 75-g oral glucose tolerance test were examined. Subjects were divided into two groups - post-load normal glycemic group (2-h plasma glucose <140 mg/dL) and post-load hyperglycemic group (2-h plasma glucose≥140 mg/dL).
There were 434 subjects with post-load normal glycemia and 528 subjects with post-load hyperglycemia. Receiver operating characteristic curve (ROC) demonstrated that the optimal cut-off value for predicting post-load hyperglycemia was a fasting plasma glucose of 99 mg/dL (area under ROC curve=0.81), which had a sensitivity, specificity, and overall diagnostic accuracy of 68%, 81%, 74%, respectively.
These data suggest that for predicting post-load hyperglycemia, the optimal cut-off value of fasting plasma glucose was 99 mg/dL in Japanese subjects. Thus, the current cut-off value of fasting plasma glucose of 110 mg/dL in Japan might be lowered.
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ABSTRACT: To determine the optimal fasting plasma glucose (FPG) cut-off value which effectively identifies high risk subjects for type 2 diabetes in Japanese, we conducted a population-based prospective study on diabetes as part of the Japan Public Health Center-based Prospective Study and estimated the 5-year incidence of diabetes. The subjects of the analysis of this study were 2,207 Japanese aged 51-70 at baseline from whom a fasting blood sample was collected in both the baseline and the 5-year follow-up surveys and who completed the questionnaires at both times. Diabetes was defined as an FPG value > or = 126 mg/dL (7.0 mmol/L) and/or self-reported diabetes. A total of 125 subjects developed diabetes during the 5 years after the baseline survey, and the incidence rate for a baseline FPG value of 95-99, 100-104, 105-109, 110-114, 115- 119, and 120-125 mg/dL was 6.1, 11.5, 30.3, 52.6, 86.4, and 115.2 per 1,000 person-years, respectively. The results of receiver operating characteristic curve analysis suggested that an FPG value of 102 mg/dL (5.67 mmol/L) was optimal for predicting diabetes during the next 5-years. The cut-off value was similar in both genders and in the 51- to 60-year-old group and 61- to 70-year-old group. Use of hemoglobin A(1c) level > or = 6.1% for an additional diagnostic criterion resulted in a small increment in incidence, but the cut-off value for predicting diabetes was almost the same (101 mg/dL). The results of this study suggested that the cut-off FPG value should be lowered in terms of prediction of type 2 diabetes among Japanese populations.
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