Use of haemoglobin A1c to detect impaired fasting glucose or Type 2 diabetes in a United Kingdom community based population

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• 作者：B. Kumaravel^a ; M.O. Bachmann^a ; ^{m.bachmann@uea.ac.uk} ; N. Murray^b ; K. Dhatariya^b ; M. Fenech^b ; W.G. John^c ; T.J. Scarpello^d ; M.J. Sampson^b ; On behalf of the University of East Anglia Impaired Fasting Glucose (UEA-IFG) Study Group¹
• 关键词：HbA1c ; Impaired fasting glucose ; Pre-diabetes ; Diabetes ; Screening
• 刊名：Diabetes Research and Clinical Practice
• 出版年：2012
• 期刊代码：78_01688227
• 类别：med
• 出版时间：May, 2012
• 卷：96
• 期：2
• 页码：211-216
• 文件大小：256 K

摘要

Aims

To evaluate the diagnostic accuracy of haemoglobin A1c (HbA1c) in screening for impaired fasting glucose and Type 2 diabetes (T2DM).

Methods

We screened 3904 adults aged 45-70 (mean age 58.6 [standard deviation (SD) 6.9] years, mean body mass index (BMI) 29.9 [SD 4.7] kg/m²), with fasting plasma glucose (FPG) and HbA1c as part of a large diabetes prevention programme. We assessed the diagnostic accuracy of HbA1c for predicting impaired fasting glucose (IFG), (defined either as FPG 5.6-6.9 mmol/l, or 6.1-6.9 mmol/l), and T2DM (FPG 鈮?#xA0;7.0 mmol/l).

Results

The prevalences of IFG were 13.8%(FPG 5.6-6.9 mmol/l) and 4.5%(FPG 6.1-6.9 mmol/l) and of T2DM was 2.1%. Using FPG 5.6-6.9 mmol/l as the IFG reference standard, HbA1c of 39-47 mmol/mol (5.7-6.4%) was 63%sensitive and 81%specific, and HbA1c 43-47 mmol/mol (6.1-6.4%) was 21%sensitive and 98%specific, in diagnosing IFG. HbA1c 鈮?#xA0;48 mmol/mol (6.5%) was 61%sensitive and 99%specific in diagnosing T2DM. Having HbA1c 39-47 mmol/mol (5.7-6.4%), male sex, and body mass index >29.5 together increased the odds of IFG 6.5-fold (95%confidence interval (CI) 5.5-7.8) compared to the pre-test odds.

Conclusion

Defining 鈥榩re-diabetes鈥?at a lower HbA1c threshold of 39 mmol/mol (5.7%) instead of 47 mmol/mol (6.1%) increases its sensitivity in diagnosing IFG, but current American Diabetes Association definitions of 鈥榩re-diabetes鈥?based on HbA1c would fail to detect almost 40%of people currently classified as IFG. This has implications for current and future diabetes prevention programmes, for vascular risk management, and for clinical advice given to people with 鈥榩re-diabetes鈥?based on fasting glucose data.