Document Detail


The potential impact and optimal cut-points of using glycated haemoglobin, HbA1c, to detect people with impaired glucose regulation in a UK multi-ethnic cohort.
MedLine Citation:
PMID:  20633944     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Recommended diagnostic cut-points to detect impaired glucose regulation (IGR, also termed prediabetes: impaired fasting glucose and/or impaired glucose tolerance based on WHO 1999 criteria) are HbA1c 6.0-6.4% and 5.7-6.4% from an International Expert Committee and American Diabetes Association, respectively. We investigated the impact on prevalence/phenotype from using these criteria compared to IGR detected on oral glucose tolerance testing (OGTT) and determined optimal HbA1c cut-points for IGR in a multi-ethnic cohort.
METHODS: Analysis of 8696 participants in the LEADER study of primary care individuals aged 40-75 years without diabetes, in Leicestershire (UK) who underwent OGTT and had HbA1c measured.
RESULTS: Use of OGTT detected less people with IGR (n=1407, 16.2%) compared to HbA1c 6.0-6.4% (n=1610, 18.5%) and HbA1c 5.7-6.4%(n=3904, 44.9%), a 1.1- and 2.8-fold increase in prevalence, respectively. There were 930 (10.7%) and 534 (6.1%) people with IGR on OGTT not detected using HbA1c 6.0-6.4% and 5.7-6.4%, respectively. From ROC curve analysis, the optimal cut-point for detecting IGR in white Europeans was HbA1c>or=5.8%, sensitivity/specificity 61.5%/67.9%, but in south Asians HbA1c>or=6.0%, sensitivity/specificity 63.8%/69.4%.
CONCLUSION: Recommended HbA1c cut-points to detect IGR significantly increase numbers detected, however introduce a change in people identified. Using HbA1c 6.0-6.4% lacks sensitivity in white Europeans, but is a reasonable option in south Asians.
Authors:
Samiul A Mostafa; Kamlesh Khunti; Balasubramanian Thiagarajan Srinivasan; David Webb; Laura J Gray; Melanie J Davies
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-07-14
Journal Detail:
Title:  Diabetes research and clinical practice     Volume:  90     ISSN:  1872-8227     ISO Abbreviation:  Diabetes Res. Clin. Pract.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-06     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8508335     Medline TA:  Diabetes Res Clin Pract     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  100-8     Citation Subset:  IM    
Affiliation:
Division of Diabetes and Endocrinology, Department of Cardiovascular Sciences, Leicester Royal Infirmary, Leicester, UK. samiul.mostafa@uhl-tr.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Asian Continental Ancestry Group
Blood Glucose / analysis
Cohort Studies
European Continental Ancestry Group
Female
Glucose Intolerance / blood*,  diagnosis*,  epidemiology,  ethnology
Glucose Tolerance Test
Great Britain / epidemiology
Hemoglobin A, Glycosylated / analysis*
Humans
Male
Mass Screening
Middle Aged
Phenotype
Practice Guidelines as Topic
Prediabetic State / blood*,  diagnosis*,  epidemiology,  ethnology
Sensitivity and Specificity
Grant Support
ID/Acronym/Agency:
//Department of Health
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Hemoglobin A, Glycosylated; 0/hemoglobin A1c protein, human

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