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Implications of the Hemoglobin Glycation Index on the Diagnosis of Prediabetes and Diabetes.
J Clin Endocrinol Metab. 2020 03 01; 105(3)JC

Abstract

OBJECTIVE

Fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) from a 75-g oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) can lead to different results when diagnosing prediabetes and diabetes. The Hemoglobin Glycation Index (HGI) quantifies the interindividual variation in glycation resulting in discrepancies between FPG and HbA1c. We used data from the Vitamin D and Type 2 Diabetes (D2d) study to calculate HGI, to identify HGI-associated variables, and to determine how HGI affects prediabetes and diabetes diagnosis.

MEASUREMENTS

A linear regression equation [HbA1c (%) = 0.0164 × FPG (mg/dL) + 4.2] was derived using the screening cohort (n = 6829) and applied to calculate predicted HbA1c. This was subtracted from the observed HbA1c to determine HGI in the baseline cohort with 2hPG data (n = 3945). Baseline variables plus prediabetes and diabetes diagnosis by FPG, HbA1c, and 2hPG were compared among low, moderate, and high HGI subgroups.

RESULTS

The proportion of women and Black/African American individuals increased from low to high HGI subgroups. Mean FPG decreased and mean HbA1c increased from low to high HGI subgroups, consistent with the HGI calculation; however, mean 2hPG was not significantly different among HGI subgroups.

CONCLUSIONS

High HGI was associated with Black race and female sex as reported previously. The observation that 2hPG was not different across HGI subgroups suggests that variation in postprandial glucose is not a significant source of population variation in HGI. Exclusive use of HbA1c for diagnosis will classify more Black individuals and women as having prediabetes compared with using FPG or 2hPG.

Authors+Show Affiliations

Pennington Biomedical Research Center, Baton Rouge, Louisiana.University of Colorado, School of Medicine and VA Eastern Colorado Health Care System, Aurora, Colorado.Tufts Medical Center, Boston, Massachusetts.Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine.Keck School of Medicine of the University of Southern California, Los Angeles, California.Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont.Cleveland Clinic, Cleveland, Ohio.University of Tennessee Health Science Center, Memphis, Tennessee.Kaiser Permanente Center for Health Research NW, Portland, Oregon.Atlanta VA Medical Center, Decatur, Georgia and Emory University School of Medicine, Atlanta, Georgia.Louisiana State University Health Sciences Center, New Orleans, Louisiana.Omaha VA Medical Center, University of Nebraska Medical Center, Omaha, Nebraska.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

31965161

Citation

Hsia, Daniel S., et al. "Implications of the Hemoglobin Glycation Index On the Diagnosis of Prediabetes and Diabetes." The Journal of Clinical Endocrinology and Metabolism, vol. 105, no. 3, 2020.
Hsia DS, Rasouli N, Pittas AG, et al. Implications of the Hemoglobin Glycation Index on the Diagnosis of Prediabetes and Diabetes. J Clin Endocrinol Metab. 2020;105(3).
Hsia, D. S., Rasouli, N., Pittas, A. G., Lary, C. W., Peters, A., Lewis, M. R., Kashyap, S. R., Johnson, K. C., LeBlanc, E. S., Phillips, L. S., Hempe, J. M., & Desouza, C. V. (2020). Implications of the Hemoglobin Glycation Index on the Diagnosis of Prediabetes and Diabetes. The Journal of Clinical Endocrinology and Metabolism, 105(3). https://doi.org/10.1210/clinem/dgaa029
Hsia DS, et al. Implications of the Hemoglobin Glycation Index On the Diagnosis of Prediabetes and Diabetes. J Clin Endocrinol Metab. 2020 03 1;105(3) PubMed PMID: 31965161.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implications of the Hemoglobin Glycation Index on the Diagnosis of Prediabetes and Diabetes. AU - Hsia,Daniel S, AU - Rasouli,Neda, AU - Pittas,Anastassios G, AU - Lary,Christine W, AU - Peters,Anne, AU - Lewis,Michael R, AU - Kashyap,Sangeeta R, AU - Johnson,Karen C, AU - LeBlanc,Erin S, AU - Phillips,Lawrence S, AU - Hempe,James M, AU - Desouza,Cyrus V, AU - ,, PY - 2019/11/11/received PY - 2020/01/16/accepted PY - 2020/1/23/pubmed PY - 2020/11/25/medline PY - 2020/1/23/entrez KW - diagnosis KW - hemoglobin glycation KW - observational study KW - oral glucose tolerance test KW - prediabetes KW - type 2 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 105 IS - 3 N2 - OBJECTIVE: Fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) from a 75-g oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) can lead to different results when diagnosing prediabetes and diabetes. The Hemoglobin Glycation Index (HGI) quantifies the interindividual variation in glycation resulting in discrepancies between FPG and HbA1c. We used data from the Vitamin D and Type 2 Diabetes (D2d) study to calculate HGI, to identify HGI-associated variables, and to determine how HGI affects prediabetes and diabetes diagnosis. MEASUREMENTS: A linear regression equation [HbA1c (%) = 0.0164 × FPG (mg/dL) + 4.2] was derived using the screening cohort (n = 6829) and applied to calculate predicted HbA1c. This was subtracted from the observed HbA1c to determine HGI in the baseline cohort with 2hPG data (n = 3945). Baseline variables plus prediabetes and diabetes diagnosis by FPG, HbA1c, and 2hPG were compared among low, moderate, and high HGI subgroups. RESULTS: The proportion of women and Black/African American individuals increased from low to high HGI subgroups. Mean FPG decreased and mean HbA1c increased from low to high HGI subgroups, consistent with the HGI calculation; however, mean 2hPG was not significantly different among HGI subgroups. CONCLUSIONS: High HGI was associated with Black race and female sex as reported previously. The observation that 2hPG was not different across HGI subgroups suggests that variation in postprandial glucose is not a significant source of population variation in HGI. Exclusive use of HbA1c for diagnosis will classify more Black individuals and women as having prediabetes compared with using FPG or 2hPG. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/31965161/Implications_of_the_Hemoglobin_Glycation_Index_on_the_Diagnosis_of_Prediabetes_and_Diabetes_ DB - PRIME DP - Unbound Medicine ER -