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Applicability of a Combination of Hemoglobin A1c and Fasting Plasma Glucose in Population-based Prediabetes Screening.
MedLine Citation:
PMID:  22268513     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Purpose:  The purpose of this study is to determine (a) concordance between a combination of HbA1c and FPG (HbA1c+FPG) and a combination of FPG and 2hPG (FPG+2hPG), and (b) whether substituting FPG+2hPG with HbA1c+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 2007-2008 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 mg/dl, and 140-199 mg/dl of HbA1c, FPG and 2hPG, respectively. Concordances between HbA1c and FPG, HbA1c and 2hPG, HbA1c+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 HbA1c+FPG and FPG+2hPG in screening for prediabetes was high as indicated by sensitivity of 92.4% [95% CI=90.5-94.5]) and specificity of 84.1% [95% CI=81.2-87.0]. The application of HbA1c+FPG was associated with higher prevalence of prediabetes compared to FPG+2hPG. Compared with FPG+2hPG, screening with HbA1c+FPG was associated with 3.2%, 24.3% and 4.2%relative increased in identification of prediabetes in nondiabetic non-Hispanic Whites, non-Hispanic Blacks and Mexican-Americans, respectively. Conclusions:  The enhanced prevalence of prediabetes using HbA1c+FPG compared with FPG+2hPG calls for the need to redefine at a more basic and a more practical level how to apply HbA1c in screening for prediabetes. A redefined HbA1c that incorporates FPG, age, race/ethnicity and BMI may put forward a better way to use HbA1c in population-based and clinical settings.
Authors:
Ike S Okosun; Monique Davis-Smith; J Paul Seale; John Ngulefac
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-24
Journal Detail:
Title:  Journal of diabetes     Volume:  -     ISSN:  1753-0407     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101504326     Medline TA:  J Diabetes     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Ruijin Hospital and Blackwell Publishing Asia Pty Ltd.
Affiliation:
Institute of Public Health, Georgia State University, Atlanta, Georgia 30302 Department of Family Medicine, Mercer University School of Medicine, Macon, Georgia, 31210 Scimetrika Company. Atlanta, Georgia 30329.
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