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Use of high-normal levels of haemoglobin A(1C) and fasting plasma glucose for diabetes screening and for prediction: a meta-analysis.
Diabetes Metab Res Rev. 2013 Nov; 29(8):680-92.DM

Abstract

BACKGROUND

Using high-normal levels of haemoglobin A1C (Abnormal-A1C) or fasting plasma glucose (FPG) (Abnormal-FPG) for diabetes screening are expected to improve the ability to detect persons with or at high risk of diabetes. We assessed the diagnostic and predictive capacity for diabetes of Abnormal-A1C and Abnormal-FPG. We compared these to the combined use of the two measures to the single use of either measurement.

METHODS

We analysed 31 eligible cross-sectional or cohort studies that assessed diagnostic or predictive ability, respectively, by using lower A1C and FPG cutoff values than recommended by current diabetes criteria. Positive and negative likelihood ratios (LR+ and LR-) were calculated to assess the ability to confirm or exclude diabetes, respectively, on the basis of a bivariate random-effects model.

RESULTS

With both Abnormal-A1C and Abnormal-FPG, the pooled LR+ was above 4 for diagnosing diabetes and above 3 for predicting diabetes. However, the pooled LR- for predicting diabetes was higher with Abnormal-A1C (0.48) and Abnormal-FPG (0.49) in comparison with that for diagnosing diabetes (0.27, Abnormal-A1C ; 0.28, Abnormal-FPG). In eight studies that assessed the predictive ability of the combination of A1C and FPG, using either Abnormal-A1C or Abnormal-FPG could lower LR- to 0.17 from 0.43 for only Abnormal-A1C and from 0.38 for only Abnormal-FPG. Accordingly, LR+ was also lowered to 2.37 from 3.36 for only Abnormal-A1C and from 3.84 for only-Abnormal-FPG.

CONCLUSION

The use of the two blood glucose tests had insufficient capacity to identify subjects at high risk for diabetes but had considerable capacity to identify undiagnosed diabetes.

Authors+Show Affiliations

Department of Health Management Center, Mito Kyodo General Hospital, Ibaraki, Japan; Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.No 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 availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23963843

Citation

Kodama, Satoru, et al. "Use of High-normal Levels of Haemoglobin A(1C) and Fasting Plasma Glucose for Diabetes Screening and for Prediction: a Meta-analysis." Diabetes/metabolism Research and Reviews, vol. 29, no. 8, 2013, pp. 680-92.
Kodama S, Horikawa C, Fujihara K, et al. Use of high-normal levels of haemoglobin A(1C) and fasting plasma glucose for diabetes screening and for prediction: a meta-analysis. Diabetes Metab Res Rev. 2013;29(8):680-92.
Kodama, S., Horikawa, C., Fujihara, K., Hirasawa, R., Yachi, Y., Yoshizawa, S., Tanaka, S., Sone, Y., Shimano, H., Iida, K. T., Saito, K., & Sone, H. (2013). Use of high-normal levels of haemoglobin A(1C) and fasting plasma glucose for diabetes screening and for prediction: a meta-analysis. Diabetes/metabolism Research and Reviews, 29(8), 680-92. https://doi.org/10.1002/dmrr.2445
Kodama S, et al. Use of High-normal Levels of Haemoglobin A(1C) and Fasting Plasma Glucose for Diabetes Screening and for Prediction: a Meta-analysis. Diabetes Metab Res Rev. 2013;29(8):680-92. PubMed PMID: 23963843.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of high-normal levels of haemoglobin A(1C) and fasting plasma glucose for diabetes screening and for prediction: a meta-analysis. AU - Kodama,Satoru, AU - Horikawa,Chika, AU - Fujihara,Kazuya, AU - Hirasawa,Reiko, AU - Yachi,Yoko, AU - Yoshizawa,Sakiko, AU - Tanaka,Shiro, AU - Sone,Yasuko, AU - Shimano,Hitoshi, AU - Iida,Kaoruko Tada, AU - Saito,Kazumi, AU - Sone,Hirohito, PY - 2012/10/15/received PY - 2013/06/13/revised PY - 2013/08/07/accepted PY - 2013/8/22/entrez PY - 2013/8/22/pubmed PY - 2014/6/12/medline KW - blood glucose KW - diagnosis KW - haemoglobin A, glycosylated KW - hyperglycemia KW - mass screening KW - meta-analysis SP - 680 EP - 92 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab Res Rev VL - 29 IS - 8 N2 - BACKGROUND: Using high-normal levels of haemoglobin A1C (Abnormal-A1C) or fasting plasma glucose (FPG) (Abnormal-FPG) for diabetes screening are expected to improve the ability to detect persons with or at high risk of diabetes. We assessed the diagnostic and predictive capacity for diabetes of Abnormal-A1C and Abnormal-FPG. We compared these to the combined use of the two measures to the single use of either measurement. METHODS: We analysed 31 eligible cross-sectional or cohort studies that assessed diagnostic or predictive ability, respectively, by using lower A1C and FPG cutoff values than recommended by current diabetes criteria. Positive and negative likelihood ratios (LR+ and LR-) were calculated to assess the ability to confirm or exclude diabetes, respectively, on the basis of a bivariate random-effects model. RESULTS: With both Abnormal-A1C and Abnormal-FPG, the pooled LR+ was above 4 for diagnosing diabetes and above 3 for predicting diabetes. However, the pooled LR- for predicting diabetes was higher with Abnormal-A1C (0.48) and Abnormal-FPG (0.49) in comparison with that for diagnosing diabetes (0.27, Abnormal-A1C ; 0.28, Abnormal-FPG). In eight studies that assessed the predictive ability of the combination of A1C and FPG, using either Abnormal-A1C or Abnormal-FPG could lower LR- to 0.17 from 0.43 for only Abnormal-A1C and from 0.38 for only Abnormal-FPG. Accordingly, LR+ was also lowered to 2.37 from 3.36 for only Abnormal-A1C and from 3.84 for only-Abnormal-FPG. CONCLUSION: The use of the two blood glucose tests had insufficient capacity to identify subjects at high risk for diabetes but had considerable capacity to identify undiagnosed diabetes. SN - 1520-7560 UR - https://www.unboundmedicine.com/medline/citation/23963843/Use_of_high_normal_levels_of_haemoglobin_A_1C__and_fasting_plasma_glucose_for_diabetes_screening_and_for_prediction:_a_meta_analysis_ L2 - https://doi.org/10.1002/dmrr.2445 DB - PRIME DP - Unbound Medicine ER -