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Identifying dysglycemic states in older adults: implications of the emerging use of hemoglobin A1c.
J Clin Endocrinol Metab. 2010 Dec; 95(12):5289-95.JC

Abstract

CONTEXT

Hemoglobin A1c (A1c) was recently added to the diagnostic criteria for diabetes and prediabetes.

OBJECTIVE

Our objective was to examine performance of A1c in comparison with fasting plasma glucose (FPG) in diagnosing dysglycemia in older adults.

DESIGN AND SETTING

We conducted a cross-sectional analysis of data from the Health, Aging, and Body Composition study at yr 4 (2000-2001) when FPG and standardized A1c measurements were available.

PARTICIPANTS

Of 3075 persons (aged 70-79 yr, 48% men, 42% Black) at study entry, 1865 participants without known diabetes who had appropriate measures were included.

MAIN OUTCOME MEASURES

Sensitivity and specificity of A1c-based diagnoses were compared with those based on FPG and the proportion of participants identified with dysglycemia by each measure.

RESULTS

Of all participants, 2.7 and 3.1% had undiagnosed diabetes by FPG≥126 mg/dl and A1c≥6.5%, respectively. Among the remaining participants, 21.1% had prediabetes by impaired fasting glucose (≥100 mg/dl) and 22.2% by A1c≥5.7%. Roughly one third of individuals with diabetes and prediabetes were identified by either FPG or A1c alone and by both tests simultaneously. Sensitivities and specificities of A1c compared with FPG were 56.9 and 98.4% for diabetes and 47.0 and 84.5% for prediabetes, respectively. Blacks and women were more likely to be identified with dysglycemia by A1c than FPG.

CONCLUSIONS

In this older population, we found considerable discordance between FPG- and A1c-based diagnosis of diabetes and prediabetes, with differences accentuated by race and gender. Broad implementation of A1c to diagnose dysglycemic states may substantially alter the epidemiology of these conditions in older Americans.

Authors+Show Affiliations

Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, P.O. Box 208088, 333 Cedar Street, SHM IE-61, New Haven, Connecticut 06520-8088, USA. kasia.lipska@yale.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20861123

Citation

Lipska, Kasia J., et al. "Identifying Dysglycemic States in Older Adults: Implications of the Emerging Use of Hemoglobin A1c." The Journal of Clinical Endocrinology and Metabolism, vol. 95, no. 12, 2010, pp. 5289-95.
Lipska KJ, De Rekeneire N, Van Ness PH, et al. Identifying dysglycemic states in older adults: implications of the emerging use of hemoglobin A1c. J Clin Endocrinol Metab. 2010;95(12):5289-95.
Lipska, K. J., De Rekeneire, N., Van Ness, P. H., Johnson, K. C., Kanaya, A., Koster, A., Strotmeyer, E. S., Goodpaster, B. H., Harris, T., Gill, T. M., & Inzucchi, S. E. (2010). Identifying dysglycemic states in older adults: implications of the emerging use of hemoglobin A1c. The Journal of Clinical Endocrinology and Metabolism, 95(12), 5289-95. https://doi.org/10.1210/jc.2010-1171
Lipska KJ, et al. Identifying Dysglycemic States in Older Adults: Implications of the Emerging Use of Hemoglobin A1c. J Clin Endocrinol Metab. 2010;95(12):5289-95. PubMed PMID: 20861123.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying dysglycemic states in older adults: implications of the emerging use of hemoglobin A1c. AU - Lipska,Kasia J, AU - De Rekeneire,Nathalie, AU - Van Ness,Peter H, AU - Johnson,Karen C, AU - Kanaya,Alka, AU - Koster,Annemarie, AU - Strotmeyer,Elsa S, AU - Goodpaster,Bret H, AU - Harris,Tamara, AU - Gill,Thomas M, AU - Inzucchi,Silvio E, Y1 - 2010/09/22/ PY - 2010/9/24/entrez PY - 2010/9/24/pubmed PY - 2011/1/15/medline SP - 5289 EP - 95 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 95 IS - 12 N2 - CONTEXT: Hemoglobin A1c (A1c) was recently added to the diagnostic criteria for diabetes and prediabetes. OBJECTIVE: Our objective was to examine performance of A1c in comparison with fasting plasma glucose (FPG) in diagnosing dysglycemia in older adults. DESIGN AND SETTING: We conducted a cross-sectional analysis of data from the Health, Aging, and Body Composition study at yr 4 (2000-2001) when FPG and standardized A1c measurements were available. PARTICIPANTS: Of 3075 persons (aged 70-79 yr, 48% men, 42% Black) at study entry, 1865 participants without known diabetes who had appropriate measures were included. MAIN OUTCOME MEASURES: Sensitivity and specificity of A1c-based diagnoses were compared with those based on FPG and the proportion of participants identified with dysglycemia by each measure. RESULTS: Of all participants, 2.7 and 3.1% had undiagnosed diabetes by FPG≥126 mg/dl and A1c≥6.5%, respectively. Among the remaining participants, 21.1% had prediabetes by impaired fasting glucose (≥100 mg/dl) and 22.2% by A1c≥5.7%. Roughly one third of individuals with diabetes and prediabetes were identified by either FPG or A1c alone and by both tests simultaneously. Sensitivities and specificities of A1c compared with FPG were 56.9 and 98.4% for diabetes and 47.0 and 84.5% for prediabetes, respectively. Blacks and women were more likely to be identified with dysglycemia by A1c than FPG. CONCLUSIONS: In this older population, we found considerable discordance between FPG- and A1c-based diagnosis of diabetes and prediabetes, with differences accentuated by race and gender. Broad implementation of A1c to diagnose dysglycemic states may substantially alter the epidemiology of these conditions in older Americans. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/20861123/Identifying_dysglycemic_states_in_older_adults:_implications_of_the_emerging_use_of_hemoglobin_A1c_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2010-1171 DB - PRIME DP - Unbound Medicine ER -