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Applicability of a combination of hemoglobin A(1c) and fasting plasma glucose in population-based prediabetes screening.
J Diabetes. 2012 Dec; 4(4):407-16.JD

Abstract

BACKGROUND

The purpose of this study is to determine: (i) the concordance between a combination of hemoglobin A(1c) (Hb(A1c)) and fasting plasma glucose (FPG) (Hb(A1c) + FPG) and a combination of FPG and 2-h plasma glucose (2hPG) (FPG + 2hPG); and (ii) whether substituting FPG + 2hPG with Hb(A1c) + FPG can enhance the detection of prediabetes in diabetes-free non-Hispanic Whites, non-Hispanic Blacks, and Mexican-Americans adults.

METHODS

Data (n = 1376) from the 2007 to 2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Prediabetes cut points were determined using 5.7-6.4%, 100-125, and 140-199 mg/dL for Hb(A1c), FPG, and 2hPG, respectively. Concordances between Hb(A1c) and FPG, Hb(A1c) and 2hPG, Hb(A1c) + FPG and FPG + 2hPG in screening for undiagnosed prediabetes were determined using sensitivity, specificity, and positive and negative likelihood ratios.

RESULTS

The overall concordance between Hb(A1c) + FPG and FPG + 2hPG in screening for prediabetes was high, as indicated by a sensitivity of 92.4% (95% CI = 90.5-94.5) and specificity of 84.1% (81.2-87.0). The application of Hb(A1c) + FPG was associated with a higher prevalence of prediabetes compared to FPG + 2hPG. Compared with FPG + 2hPG, screening with Hb(A1c) + FPG was associated with 3.2%, 24.3%, and 4.2% relative increases in the identification of prediabetes in nondiabetic non-Hispanic Whites, non-Hispanic Blacks and Mexican-Americans, respectively.

CONCLUSIONS

The enhanced prevalence of prediabetes using Hb(A1c) + FPG compared with FPG + 2hPG calls for the need to redefine at a more basic and practical level how to apply Hb(A1c) in screening for prediabetes. A redefined Hb(A1c) that incorporates FPG, age, race/ethnicity, and body mass index may be a better way to use Hb(A1c) in population-based and clinical settings.

Authors+Show Affiliations

Institute of Public Health, Georgia State University, Atlanta, Georgia 30303, USA. iokosun@gsu.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22268513

Citation

Okosun, Ike S., et al. "Applicability of a Combination of Hemoglobin A(1c) and Fasting Plasma Glucose in Population-based Prediabetes Screening." Journal of Diabetes, vol. 4, no. 4, 2012, pp. 407-16.
Okosun IS, Davis-Smith M, Paul Seale J, et al. Applicability of a combination of hemoglobin A(1c) and fasting plasma glucose in population-based prediabetes screening. J Diabetes. 2012;4(4):407-16.
Okosun, I. S., Davis-Smith, M., Paul Seale, J., & Ngulefac, J. (2012). Applicability of a combination of hemoglobin A(1c) and fasting plasma glucose in population-based prediabetes screening. Journal of Diabetes, 4(4), 407-16. https://doi.org/10.1111/j.1753-0407.2012.00188.x
Okosun IS, et al. Applicability of a Combination of Hemoglobin A(1c) and Fasting Plasma Glucose in Population-based Prediabetes Screening. J Diabetes. 2012;4(4):407-16. PubMed PMID: 22268513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Applicability of a combination of hemoglobin A(1c) and fasting plasma glucose in population-based prediabetes screening. AU - Okosun,Ike S, AU - Davis-Smith,Monique, AU - Paul Seale,J, AU - Ngulefac,John, PY - 2012/1/25/entrez PY - 2012/1/25/pubmed PY - 2013/7/17/medline SP - 407 EP - 16 JF - Journal of diabetes JO - J Diabetes VL - 4 IS - 4 N2 - BACKGROUND: The purpose of this study is to determine: (i) the concordance between a combination of hemoglobin A(1c) (Hb(A1c)) and fasting plasma glucose (FPG) (Hb(A1c) + FPG) and a combination of FPG and 2-h plasma glucose (2hPG) (FPG + 2hPG); and (ii) whether substituting FPG + 2hPG with Hb(A1c) + FPG can enhance the detection of prediabetes in diabetes-free non-Hispanic Whites, non-Hispanic Blacks, and Mexican-Americans adults. METHODS: Data (n = 1376) from the 2007 to 2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Prediabetes cut points were determined using 5.7-6.4%, 100-125, and 140-199 mg/dL for Hb(A1c), FPG, and 2hPG, respectively. Concordances between Hb(A1c) and FPG, Hb(A1c) and 2hPG, Hb(A1c) + FPG and FPG + 2hPG in screening for undiagnosed prediabetes were determined using sensitivity, specificity, and positive and negative likelihood ratios. RESULTS: The overall concordance between Hb(A1c) + FPG and FPG + 2hPG in screening for prediabetes was high, as indicated by a sensitivity of 92.4% (95% CI = 90.5-94.5) and specificity of 84.1% (81.2-87.0). The application of Hb(A1c) + FPG was associated with a higher prevalence of prediabetes compared to FPG + 2hPG. Compared with FPG + 2hPG, screening with Hb(A1c) + FPG was associated with 3.2%, 24.3%, and 4.2% relative increases in the identification of prediabetes in nondiabetic non-Hispanic Whites, non-Hispanic Blacks and Mexican-Americans, respectively. CONCLUSIONS: The enhanced prevalence of prediabetes using Hb(A1c) + FPG compared with FPG + 2hPG calls for the need to redefine at a more basic and practical level how to apply Hb(A1c) in screening for prediabetes. A redefined Hb(A1c) that incorporates FPG, age, race/ethnicity, and body mass index may be a better way to use Hb(A1c) in population-based and clinical settings. SN - 1753-0407 UR - https://www.unboundmedicine.com/medline/citation/22268513/Applicability_of_a_combination_of_hemoglobin_A_1c__and_fasting_plasma_glucose_in_population_based_prediabetes_screening_ L2 - https://doi.org/10.1111/j.1753-0407.2012.00188.x DB - PRIME DP - Unbound Medicine ER -